How do local political elites respond to a survey? Evidence from a large-scale councilors survey in Poland

Cost-efficient methods are essential for successful participant recruitment in clinical trials. Patient portal messages are an emerging means of recruiting potentially eligible patients into trials. We assessed the response rate and complaint rate from direct-to-patient, targeted recruitment through patient portals of an electronic medical record for a clinical trial, and compared response rates by differences in message content. The Study to Understand Fall Reduction and Vitamin D in You (STURDY) trial is a National Institutes of Health-sponsored, community-based study of vitamin D supplementation for fall prevention in older adults conducted at Johns Hopkins. Potential participants were identified using the Epic electronic medical record at the Johns Hopkins Health System based on age (≥70 years), ZIP code (30-mile radius of study site), and prior activation of a patient portal account. We prepared a shorter message and a longer message. Both had basic information about study participation, but the longer message also contained information about the significance of the study and a personal invitation from the STURDY principal investigator. The Hopkins Institutional Review Board did not require prior consent from the patient or their providers. We calculated the response rate and tracked the number of complaints and requests for removal from future messages. We also determined response rate according to message content. Of the 5.5 million individuals receiving care at the Johns Hopkins Health System, a sample of 6896 met our inclusion criteria and were sent one patient portal recruitment message between 6 April 2017 and 3 August 2017. Assessment of enrollment by this method ended on 1 December 2017. There were 116 patients who expressed interest in the study (response rate: 1.7%). Twelve (0.2%) recipients were randomized. There were two complaints (0.03%) and one request to unsubscribe from future recruitment messages (0.01%). Response rate was higher with the longer message than the shorter message (2.1% vs 1.2%; p = 0.005). Patient portal messages inviting seniors to participate in a randomized controlled trial resulted in a response rate similar to commercial email marketing and resulted in very few complaints or opt-out requests. Furthermore, a longer message with more content enhanced response rate. Recruitment through patient portals might be an effective strategy to enroll trial participants.

Abstract. A meta-analysis was performed to determine whether response rates to online psychology surveys have decreased over time and the effect of specific design characteristics (contact mode, burden of participation, and incentives) on response rates. The meta-analysis is restricted to samples of adults with depression or general anxiety disorder. Time and study design effects are tested using mixed-effects meta-regressions as implemented in the metafor package in R. The mean response rate of the 20 studies fulfilling our meta-analytic inclusion criteria is approximately 43%. Response rates are lower in more recently conducted surveys and in surveys employing longer questionnaires. Furthermore, we found that personal invitations, for example, via telephone or face-to-face contacts, yielded higher response rates compared to e-mail invitations. As predicted by sensitivity reinforcement theory, no effect of incentives on survey participation in this specific group (scoring high on neuroticism) could be observed.

Achieving a high participation rate is a common challenge in healthcare research based on web-based surveys. A study on local anesthetic systemic toxicity awareness and usage among medical practitioners at two Swiss university hospitals encountered resistance in obtaining personal email addresses from Heads of Departments. Participants were therefore divided into two groups: those who were directly invited via email (personal invitation group) and those who received a generic link through intermediaries (generic link group). The latter group was eventually excluded from survey data analysis. To determine whether one method of survey administration was more effective than another, we carried out a retrospective analysis of response rates and the proportion of new questionnaires completed after initial invitation and subsequent reminders. The results showed significantly higher response rates in the personal invitation group (40.2%, 313/779) compared to the generic link group (25.3%, 22/87), emphasizing the effectiveness of personal invitations on response rate (+14.9%, p = 0.007). The personal invitation group consistently yielded a higher number of completed questionnaires following the initial invitation and each reminder. The method of survey administration can greatly influence response rates and should be acknowledged as a quality criterion when conducting web-based surveys.

Patient experience surveys are vital to evaluating healthcare provider performance. However, declining response rates over time and questions about whether responses reflect the perspectives of all patients under care have raised concerns. One proposed approach to address these concerns is web-based survey administration, a mode that has not been studied in the hospice setting. We tested a sequential web–mail mode for administering a care experience survey in this unique setting, where family caregivers respond after the patient dies. Sampled caregivers of 15,515 patients who died March–August 2021 while receiving care from 56 hospices across the US were randomized to one of four survey modes: mail-only, telephone-only, mail–telephone (mail with telephone follow-up), or web–mail (email invitation to a web survey with mail follow-up). Email addresses were available for 31.3 percent of sampled eligible caregivers. Relative to mail-only (estimated response rate = 35.1 percent), response rates were significantly higher for web–mail (39.7 percent) and mail–telephone (45.3 percent) and significantly lower for telephone-only (31.5 percent). The web–mail response rate was similar to the mail-only response rate among caregivers without email addresses (35.2 versus 34.3 percent), but substantially higher among caregivers with email addresses (49.6 versus 36.7 percent). Web–mail and mail-only respondents reported similar experiences for 26 of 27 evaluative items. Among eligible sampled caregivers, several patient/caregiver characteristics differed by caregivers’ email address availability, but web–mail and mail-only respondents did not differ on any characteristic. A web–mail mode is feasible for surveying bereaved caregivers about care experiences, producing substantially higher response rates than single-mode approaches, with increasing benefits for hospices with higher proportions of caregivers with email addresses. Findings may be applicable to surveys of other sensitive topics and to populations that prefer asynchronous survey modes.

ABSTRACTThis study sheds light on the relationship between local and national elites during political transitions. Examining local councils in post-revolutionary Tunisia (2011–2013), it examines why and when the composition of councils changed in the absence of local elections. The study yields two important lessons. First, changes in councils resulted from a power struggle between national and local elites. Councils were more likely to remain in place when local parties and unions helped council members resist pressures from above. The interplay of local and national actors, and not the council’s competencies, explains when changes took place. Second, all councils became politicized in the process. Far from being caretaker councils impartially addressing local needs, the councils were institutions playing important roles in the struggles between local and national political elites. Councils were arenas in which political power, and notions of legitimate representation, were contested in the absence of elections. The argument is supported by quantitative analyses of original data and four comparative case studies based on qualitative fieldwork. The findings highlight the importance of local councils in transition processes and provide a basis for further work exploring local-national engagement in democratization.

This article analyzes why it is that China, an authoritarian political system, has managed to generate more popular support for the reform process than India, a democracy. The authors argue that when local politicians and bureaucrats are more supportive of the reform process, there is likely to be greater popular support for economic reform. Local political elite may be more supportive of reform in an authoritarian than in a democratic system because the level of local elite support for the reform process is influenced by the incentives faced by local elite. In China, institutional reform changed the incentives faced by local elite, whereas in India, reforms have not been accompanied by institutional changes that would encourage local elite to support reform to the same extent as in China. The argument is based on local elite and mass surveys conducted in China and India in 1990 and 1996, respectively. A logit model, controlling for a variety of alternative explanations, provides evidence that local elite support is critical for explaining whether reforms are popular.

Background.High participation rates are an essential component of an effective screening programme and many approaches were introduced as being successful for enhancing compliance to screening guidelines. The aim of this study was to evaluate to which extent a personal invitation by mail increases the rate of attendance in a cervical cancer screening programme in a primary health care centre.Materials and methods.The study was carried out as a pilot project to gain insight into feasibility of applying a well-known compliance increasing measure in Lithuanian population. The study included a sample of women registered at the primary health care centre in Panevėžys who had not participated in the cervical cancer screening programme for six and more years. Personal registered invitation letters to attend the primary health care centre for a Pap smear were sent out to 1789 women by mail.Results.In total, 2195 women were tested during 2011 at the primary health care centre. 487 (22.2%) of them attended the screening programme after receiving a personal invitation letter. Response rate for attending screening after receiving a personal invitation letter was 27.3%.Conclusions.Our study demonstrated that personal invitation letters addressed to long-term non-attendees could markedly increase participation in cervical cancer screening in Lithuania.

The response rate to the invitation to the fracture liaison service and reasons for non-response were evaluated in 2,207 fragility fracture patients. Fifty-one percent responded; non-responders were most often not interested (38 %) or were hip fracture patients. After 1 year of treatment, 88 % was still persistent and 2 % had a new fracture. To increase the percentage of elderly fracture patients undergoing a dual energy x-ray absorptiometry (DXA) measurement, and to investigate why some patients did not respond to invitation to our fracture liaison service (FLS). In four Dutch hospitals, fracture patients ≥ 50 years were invited through a written or personal invitation at the surgical outpatient department, for a DXA measurement and visit to our FLS. Patients who did not respond were contacted by telephone. In patients diagnosed with osteoporosis, treatment was started. Patients were contacted every 3 months during 1 year to assess drug persistence and the occurrence of subsequent fractures. Of the 2,207 patients who were invited, 50.6 % responded. Most frequent reasons for not responding included: not interested (38 %), already screened/under treatment for osteoporosis (15.7 %), physically unable to attend the clinic (11.5 %), and death (5.2 %). Hip fracture patients responded less frequently (29 %) while patients with a wrist (60 %) or ankle fracture (65.2 %) were more likely to visit the clinic. In 337 responding patients, osteoporosis was diagnosed and treatment was initiated. After 12 months of follow-up, 88 % of the patients were still persistent with anti-osteoporosis therapy and only 2 % suffered a subsequent clinical fracture. In elderly fracture patients, the use of a FLS leads to an increased response rate, a high persistence to drug treatment, and a low rate of subsequent clinical fractures. Additional programs for hip fracture patients are required, as these patients have a low response rate.

First Report of <i>Squash leaf curl China virus</i> Associated with Mosaic and Mild Leaf Curl Disease of Pumpkin in Bangladesh

The objective of this study was to compare response rates, respondents' characteristics, and substantive results for CAHPS surveys administered using web and mail protocols. Patients who had one or more primary care visits in the preceding 6months. Patients for whom primary care practices had email addresses were randomized to one of four survey administration protocols: web via a portal invitation; web via an email invitation; combination of web and mail; and mail only. Another sample of patients without known email addresses was surveyed by mail. Samples of nonrespondents to the Internet and mail protocols were surveyed by telephone. Response rates to surveys administered using the Internet protocols were lower than for the surveys administered by mail (20 percent vs over 40 percent). However, characteristics of respondents and survey answers were very similar across protocols. Respondents without email addresses were older, less educated, and more likely to be male than those with email addresses, and there were a few differences in their responses. There was little evidence of nonresponse bias in either the mail or web protocols. In this well-educated patient population, web protocols had lower response rates, but substantive results very similar to those from mail protocols.

E-mail is a common invitation mode for Web surveys. However, collecting e-mail addresses in another mode may raise privacy concerns among respondents. In our previous study, fewer than half the respondents provided an e-mail address. In this paper we report on an experiment to test the efficacy of asking for e-mail addresses. Respondents to the 2012 German General Social Survey (ALLBUS) who reported having Internet access at home were randomized to two groups, with one group not being asked for their e-mail address, while the other being asked. Using a mailed invitation to a follow-up Web survey, we explore the effect of this request on the subsequent response rate. We also followed up all cases (including those who reported not having Internet access at home) with a mail survey to explore the effect of adding mail in a sequential mixed-mode design. We find that asking for e-mail address does not appear to have negative effects on subsequent response. We also find that a mixed-mode design substantially increases response rates and brings the follow-up sample more in line with the ALLBUS in terms of selected demographic and attitudinal variables.

BackgroundNonresponse to questionnaires can affect the validity of surveys and introduce bias. Offering financial incentives can increase response rates to postal questionnaires, but the effect of financial incentives on response rates to online surveys is less clear.ObjectiveAs part of a survey, we aimed to test whether knowledge of a financial incentive would increase the response rate to an online questionnaire.MethodsA randomized controlled trial of 485 UK-based principal investigators of publicly funded health services and population health research. Participants were contacted by email and invited to complete an online questionnaire via an embedded URL. Participants were randomly allocated to groups with either “knowledge of” or “no knowledge of” a financial incentive (£10 Amazon gift voucher) to be provided on completion of the survey. At the end of the study, gift vouchers were given to all participants who completed the questionnaire regardless of initial randomization status. Four reminder emails (sent from the same email address as the initial invitation) were sent out to nonrespondents at one, two, three, and four weeks; a fifth postal reminder was also undertaken. The primary outcome measure for the trial was the response rate one week after the second reminder. Response rate was also measured at the end of weeks one, two, three, four, and five, and after a postal reminder was sent.ResultsIn total, 243 (50%) questionnaires were returned (232 completed, 11 in which participation was declined). One week after the second reminder, the response rate in the “knowledge” group was 27% (66/244) versus 20% (49/241) in the “no knowledge” group (χ21 = 3.0, P = .08). The odds ratio for responding among those with knowledge of an incentive was 1.45 (95% confidence interval [CI] 0.95 - 2.21). At the third reminder, participants in the “no knowledge” group were informed about the incentive, ending the randomized element of the study. However we continued to follow up all participants, and from reminder three onwards, no significant differences were observed in the response rates of the two groups.ConclusionsKnowledge of a financial incentive did not significantly increase the response rate to an online questionnaire. Future surveys should consider including a randomized element to further test the utility of offering incentives of other types and amounts to participate in online questionnaires.Trial RegistrationISRCTN59912797; http://www.controlled-trials.com/ISRCTN59912797 (Archived by WebCite at http://www.webcitation.org/5iPPLbT7s)

Background: Healthcare communication often relies on complex digital infrastructures, yet clinicians increasingly adopt general-purpose Instant Messaging Apps (IMAs) such as WhatsApp® to meet unmet needs. DonnaRosa, an Italian community of breast cancer specialists founded in 2017, is a Community of Practice (CoP), where experts exchange second opinions, guidelines, and trial opportunities. This paper examines its origins, practices, and implications. Methods: A mixed-methods design was applied: (1) qualitative analysis of chat logs to identify interaction patterns and rules; (2) a 2024 online survey of 54 members (92.5% response rate) exploring demographics, usage, and perceived value; (3) ongoing semi-structured interviews with founders and participants to reconstruct history, recruitment, and professional impact. Results: The group has grown through personal invitations, creating a friendly network of oncologists. Communication is concise, colloquial, and collegial. Activities focus on case discussions, reassurance, interpretation of guidelines, and exchange of research opportunities. This article presents data from an online survey conducted in 2024, showing that the group is widely used for second opinions, often consulted even on weekends and holidays, and perceived as a source of professional support and learning. Members report that participation frequently changes or refines their clinical judgement, especially when guidelines are incomplete or ambiguous. The community also promotes resilience, reduces professional isolation, supports informal collaboration in research projects, and encourages interaction on organisational and healthcare management issues. Conclusions:DonnaRosa illustrates how informal IMAs can evolve into robust infrastructures of care and professional solidarity, complementing formal systems. In the era of artificial intelligence, CoPs like DonnaRosa may become even more relevant: AI tools, especially large language models, can accelerate literature retrieval and data synthesis, while the CoP provides the critical, experience-based interpretation needed for safe and meaningful application. Such a dual infrastructure-technological and human-offers a promising path for oncology, where complexity requires both computational breadth and the depth of expert clinical judgement. Taken together, these findings and the evolving role of AI in clinical communication underscore the need for oncology societies to develop governance frameworks that ensure the safe, accountable, and clinically appropriate use of instant-messaging tools in professional practice.

Mobile breast screening: Factors affecting uptake, efforts to increase response and acceptability

Publication of a manuscript does not end an author's responsibilities. Reasons to contact an author after publication include clarification, access to raw data, and collaboration. However, legitimate questions have been raised regarding whether these responsibilities generally are being met by corresponding authors of biomedical publications. This study aims to establish (1) what proportion of corresponding authors accept the responsibility of correspondence; (2) identify characteristics of responders; and (3) assess email address decay with time. We hypothesize that the response rate is unrelated to journal impact factor. We contacted 450 corresponding authors throughout various fields of biomedical research regarding the availability of additional data from their study, under the pretense of needing these data for a related review article. Authors were randomly selected from 45 journals whose impact factors ranged from 52 to 0; the source articles were published between May 2003 and May 2013. The proportion of corresponding authors who replied, along with author characteristics were recorded, as was the proportion of emails that were returned for inactive addresses; 446 authors were available for final analysis. Fifty-three percent (190/357) of the authors with working email addresses responded to our request. Clinical researchers were more likely to reply than basic/translational scientists (51% [114/225] versus 34% [76/221]; p<0.001). Impact factor and other author characteristics did not differ. Logistic regression analysis showed that the odds of replying decreased by 15% per year (odds ratio [OR], 0.85; 95% CI, 0.79-0.91; p<0.001), and showed a positive relationship between clinical research and response (OR, 2.0; 95% CI, 1.3-2.9; p=0.001). In 2013 all email addresses (45/45) were reachable, but within 10 years, 49% (21/43) had become invalid. Our results suggest that contacting corresponding authors is problematic throughout the field of biomedical research. Defining the responsibilities of corresponding authors by journals more explicitly-particularly after publication of their manuscript-may increase the response rate on data requests. Possible other ways to improve communication after research publication are: (1) listing more than one email address per corresponding author, eg, an institutional and personal address; (2) specifying all authors' email addresses; (3) when an author leaves an institution, send an automated reply offering alternative ways to get in touch; and (4) linking published manuscripts to research platforms.