Original articlesThe Effects of Lottery Incentive and Length of Questionnaire on Health Survey Response Rates: A Randomized Study
Introduction
Self-administered questionnaires are an important means of acquiring health information. They allow respondents to answer questions about sensitive subjects in their own environment with adequate time to reflect on their responses, and are economical compared with telephone surveys or personal interviews [1]. Traditionally, a major disadvantage of mail surveys has been a low response rate, which potentially impairs study validity [2]. High response rates are necessary to minimize non-responder bias [3], although even with response rates above 70% bias may still be present 4, 5.
A number of techniques have been applied in order to maximize the response rate. A meta-analysis indicated that repeated contacts, appeals, inclusion of a return envelope, paid return postage, shorter survey forms, and monetary incentives were effective in increasing survey response rates [6]. Survey topic may also be important, as sensitive topics can elicit poorer response rates [7].
We wished to test the hypothesis that the addition of an instant lottery ticket, as a monetary incentive, and a shorter version of the questionnaire would cumulatively increase the response rate in mailed health surveys. Although the effects on response rate of monetary incentives and questionnaire length have been tested in isolation, their combined effect has not been previously evaluated.
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Methods
This study was approved by the Wentworth Area Health Services Ethics Committee. The sample was drawn randomly from the electoral rolls of Lindsay, a suburb in Western Sydney, Australia. Since voting is compulsory and universal for all citizens 18 years and older in Australia, the Electoral Commission in each state routinely registers and updates the lists of citizens in respective areas.
The survey consisted of a self-administered questionnaire sent out to 440 residents between April 1997 and
Results
Of the initial 440 questionnaires sent out, 17 questionnaires were returned as “not known at this address” at different stages of the mailing and were replaced. In total, seven surveys were not returned (address changed, language barrier discovered during the telephone follow-up), giving an effective sample of 433 residents. Overall, 311 completed questionnaires were returned for an eventual response rate of 71.8%.
At the telephone follow-up stage, 144 names were sought in the White pages on
Discussion
There have been many attempts to devise optimal strategies to increase response rates of mailed surveys. High response rates reduce non-response bias considerably but may not completely eliminate it [4]. Quantitative reviews of individual studies, using meta-analytic techniques suggested by Glass [9] have attempted to address the limitations of a diverse range of previous studies by examining the effects of factors hypothesized to affect response rates and by assessing these across a number of
Acknowledgements
We are indebted to Mr. Stuart Howell for his assistance with the statistical analyses. This work was supported by the National Health and Medical Research Council (NH&MRC), Australia.
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