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A study of response and non-response to postal questionnaire follow-up in clinical trials

By Rachel Anne Nakash


Postal questionnaires offer one of the least expensive modes of collecting patient based outcomes in health care research. Many methods of increasing response to questionnaires used in educational and market research surveys have been tested. Behavioural theories have also been applied to survey research to understand response decisions. Little attention, however, has focussed specifically on response issues to postal questionnaires used to collect data in clinical trials. This is the subject of this thesis.\ud A systematic review of methods of improving response to postal questionnaire follow-up in health care studies was conducted. A method of improving response was then devised and its effectiveness was tested within an existing clinical trial (the Collaborative Ankle Support Trial - CAST). This method was a 'Trial Calendar'which was a prompting and reminder tool to encourage response. Qualitative data were gathered from clinical trial participants to ascertain factors influencing their response decisions. Finally, the socio-demographic characteristics of CAST participants were examined.\ud The systematic review demonstrated that follow-up reminder systems had the most significant effect on response rates (RR 1.82, Cl 95% 1.11 to 2.99). Incorporating such reminders into a tool such as the 'Trial Calendar', however, had no effect on improving response in CAST. The qualitative study revealed aspects of behavioural theories which could be incorporated into trial information and appeals for response. Analysis of the sociodemographic characteristics of CAST participants revealed that the\ud youngest age group (16-24 years) was less likely to respond at every followup point.\ud It is concluded that rather than anticipating low response rates and striving to devise methods of converting non-responders into responders, efforts should be directed at preventing participants becoming non-responders in the first place. This thesis argues for the area of follow-up to postal questionnaires in clinical trials to become a theoretical research issue in its own right

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