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Strategies to Achieve Strong Response Rates to Surveys Kim Carter, PhD, RN, NEA-BC, Senior Director, Nursing Research, EBP & Excellence Nurse researchers often use surveys as a cost-effective strategy to measure knowledge, attitudes, and perceptions about topics that affect nursing practice and patient care 1,2. Although survey findings inform health policy and care delivery, low response rates to surveys are a consistent challenge for survey researchers in healthcare2. Technological advances in business have introduced the opportunity for administration of surveys using computer and web-based strategies3. However, regardless of the methodology implemented to administer the survey, use of random sampling and strong response rates decreases nonresponse bias (the threat that those who do not response are different from those who do respond) and increases confidence in the results being a reflection of the population2-4. Nurses and other healthcare workers are bombarded with requests to complete surveys, so it is important to incorporate a solid plan for achieving a strong sample size into the study design to ensure that the study achieves meaningful and generalizable data. In a meta-analysis of strategies to improve response rates by health care professionals, Cho and colleagues noted that monetary incentives improve participation 2. While a $1.00 incentive may be enough to encourage response, higher incentive amounts over $30.00 were needed to achieve a 60% response rate2. This cost must be factored into the overall cost of the study, and the amount will be considered by the IRB to ensure that coercion is not a threat and that potential risks of study participation are not overshadowed by the amount of the incentive 2. Other studies have similarly found that small monetary incentives improve nurse response rates, but nonmonetary tokens, like pencils and pens, are less effective for nurses and physicians 1. Consideration of how the survey is delivered and follow-up strategies will also enhance survey response rates1,2. In a 2013 meta-analysis2, Cho noted that higher response rates were achieved with postal surveys. The literature incorporated into their review would now be over a decade old; therefore, it is possible that the preference for mailed paper surveys has changed. Cho suggests that a mixed approach using multiple survey completion alternatives (mailed and electronic) offers the most flexibility to allow completion at the respondent’s convenience 2. Hoddinott & Bass propose that the Dillman Total Design Survey Method is an effective approach to achieve strong survey response rates5. Bogue and Carter used a modified version of the Dillman approach for survey research (manuscript under development) at Carilion, achieving a strong sample size. The Dillman method consists of multiple steps in the survey methodology, including prenotification by a key organizational leader, specific instructions, a means for removal of identifiers and ensuring anonymity, how the questions are presented, color of ink/font, and a precise pattern for follow-up at one, three, and seven weeks5. Personalized prenotification and sponsorship is useful3, especially when surveys are sent through programs such as REDCap, to assure the participant that the survey email and link are legitimate. Reminders and prompts are effective1. Very specific details should be thoughtfully attended to when planning survey studies. For example, VanGeest & Johnson’s systematic review of how to improve response rates illustrates the impact of type of mailing, noting that first class postage did not result in improved response rates, but certified mail yielded better response. Careful attention to the wording of the reminder is important, and the reminder is most effective if the survey tool or link is again included with the reminder, rather than expecting the recipient to track down the previous invitation and survey1.
