Abstract
BackgroundCompliance is a critical issue for parental questionnaires in school based epidemiological surveys and high compliance is difficult to achieve. The objective of this study was to determine trends and factors associated with parental questionnaire compliance during respiratory health surveys of school children in Merseyside between 1991 and 2006.MethodsFour cross-sectional respiratory health surveys employing a core questionnaire and methodology were conducted in 1991, 1993, 1998 and 2006 among 5-11 year old children in the same 10 schools in Bootle and 5 schools in Wallasey, Merseyside. Parental compliance fell sequentially in consecutive surveys. This analysis aimed to determine the association of questionnaire compliance with variation in response rates to specific questions across surveys, and the demographic profiles for parents of children attending participant schools.ResultsParental questionnaire compliance was 92% (1872/2035) in 1991, 87.4% (3746/4288) in 1993, 78.1% (1964/2514) in 1998 and 30.3% (1074/3540) in 2006. The trend to lower compliance in later surveys was consistent across all surveyed schools. Townsend score estimations of socio-economic status did not differ between schools with high or low questionnaire compliance and were comparable across the four surveys with only small differences between responders and non-responders to specific core questions. Respiratory symptom questions were mostly well answered with fewer than 15% of non-responders across all surveys. There were significant differences between mean child age, maternal and paternal smoking prevalence, and maternal employment between the four surveys (all p<0.01). Out-migration did not differ between surveys (p=0.256) with three quarters of parents resident for at least 3 years in the survey areas.ConclusionMethodological differences or changes in socio-economic status of respondents between surveys were unlikely to explain compliance differences. Changes in maternal employment patterns may have been contributory. This analysis demonstrates a major shift in community parental questionnaire compliance over a 15 year period to 2006. Parental questionnaire compliance must be factored into survey designs and methodologies.
Highlights
Compliance is a critical issue for parental questionnaires in school based epidemiological surveys and high compliance is difficult to achieve
Parental compliance fell sequentially in the consecutive Merseyside surveys over the fifteen year period, and the present analysis aimed to describe how response rates to specific questions varied over time and how they related to socioeconomic status and demographic characteristics of parents of children attending these primary schools
There was a substantial variation in questionnaire compliance between individual schools, the trend to lower compliance in later surveys was consistent across all schools
Summary
Compliance is a critical issue for parental questionnaires in school based epidemiological surveys and high compliance is difficult to achieve. The first Respiratory Health Survey was completed in 1991, amongst school children aged 5-11 years and achieved a parental compliance for questionnaire completion of 92% Analysis of this data showed a spatial association of childhood asthma symptoms which was associated with the concentrations of airborne dust pollution on contour maps [1,2]. As a consequence a total of three further cross-sectional surveys were undertaken in the same primary schools in 1993, 1998, and 2006, using essentially the same parental questionnaire and survey methodology [3] These studies had focussed on childhood health outcomes in relation to pregnancy smoking, residential location, socio-economic status and factors related to asthma, obesity and Attention Deficit Hyperactivity Disorder (ADHD) [4,5,6,7,8,9,10,11,12,13,14]
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