increasing response rates to mail questionnaires: a review of inducement strategies

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Increasing Response Rates to Mail Questionnaires: AReview of Inducement StrategiesKeith A. King PhD, CHES a , Lisa N. Pealer PhD a & Amy L. Bernard PhD, CHES aa Health Promotion in the Health Promotion and Education Program , University ofCincinnati , ML 0002, 526 TC, Cincinnati , OH , 45221-0002 , USAPublished online: 24 Feb 2013.

To cite this article: Keith A. King PhD, CHES , Lisa N. Pealer PhD & Amy L. Bernard PhD, CHES (2001) Increasing ResponseRates to Mail Questionnaires: A Review of Inducement Strategies, American Journal of Health Education, 32:1, 4-15, DOI:10.1080/19325037.2001.10609392

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Increasing Response Rates to Mail Questionnaires: A Review of Inducement Strategies

Keith A. King, Lisa N. Pealer, and Amy L. Bernard

AeSTRACT

Health education researchers frequently use mail questionnaires to collect data. One major limitation to mail survey research is nonresponse bias. W h e n the nonresponse rate is high, external validity is compromised. A number of studies have examined the efect of inducement strategies on response rate. Such studies have resulted in muck discrepancy and uncertainty as to the strategies that consistently increase response rate. This article provides survey researchers with efective inducement strategies based on a comprehensive review of the professional literature. Five areas of consideration regarding mail survey research are examined: (1) envelopes and postage, (2) cover letter, ( 3 ) incentives, (4) questionnaire characteristics, and (5) participant contact. The use of this information should strengthen mail survey research and minimize nonresponse bias.

Health surveys are a valuable source of information and a common method of research and evaluation in public health and health education. Mail survey research provides information for health care policy makers, health education and public health officials, and health consumers interested in planning, implementing, and evaluating health promotion programs, policies, and services. Mail surveys are generally an inexpensive survey technique, and if well designed can be simple, clear, and reach a large population (Aday, 1996; McDermott & Sarvela, 1999; Torabi, 1991). However, it is nearly impossible to receive a response from all participants in a sample, and nonresponse bias is a critical limitation to mail survey research. Nonetheless, error due to nonresponse in mail survey research can be offset by techniques designed to

increase participation (Fowler, 1984; Isaac & Michael, 1995; Rossi, Wright, & Anderson, 1983).

Nonresponse bias is the potential difference between those who respond to a specific survey and those who do not respond (Clausen & Ford 1947; Filion, 1975; Mangione, 1995; Worthen & Valcarce, 1985). External validity of research findings (the extent to which similar research findings can be expected in different populations) is compromised when the nonresponse rate of a study is high (Dodd & Markwiese, 1988). Research has shown that rejecting study results with response rates lower than 50% may be justifiable (Dolsen & Machlis, 1991). Therefore, researchers have examined various elements critical to maximizing response rates. Unfortunately, however, the professional

literature and the common press report inconsistent findings regarding inducement strategies, which creates confusion as to what truly works for health education survey researchers.

In general, when conducting mail survey research consideration should be given to the following five areas: (1) envelopes and postage, ( 2 ) cover letter, (3) incentives, (4) questionnaire characteristics, and (5) participant contact. The purpose of this article is to provide survey researchers with effective inducement strategies based

Keith A. King, PhD, CHES; Lisa N. Pealer, PhD; and Amy L. Bernard, PhD, CHES are assistant professors of health promotion in the Health Promotion and Education Program, University of Cincinnati, M L 0002, 526 TC, Cincinnati, OH 45221 -0002; E-mail: [email protected].

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on a comprehensive review of the professional literature. It is hoped that such information will strengthen mail survey research by minimizing nonresponse bias, thus increasing the statistical power and external validity of studies. Recom- mendations for further research are also offered.

Envelopes and Postage An issue often overlooked in survey

research is that the targeted individual must first be motivated to open the envelope containing the cover letter and questionnaire.

with making decisions on the appearance of outgoing envelopes and postage, as well as whether to include a self-addressed, stamped, return envelope (Table I).

Outgoing Envelope and Postage Studies have found that personalization

of outgoing envelopes is important in increasing response rates (Kahle & Sales, 1978). One strategy used to personalize the outgoing envelope is to print the individual’s name on the envelope as opposed to using a blind respondent label (e.g., “respondent,” “occupant”). Dignan,

(1994) determined that outgoing envelopes using a person’s name and address yielded a significantly higher response rate than outgoing envelopes using“resident” or “occupant.” Similarly, Nederhof ( 1983a) found that using follow-up envelopes with personalized handwritten address labels led to a 6.5% greater response rate than using follow-up envelopes with personalized computer-printed labels. Regarding outgoing postage, certified mail, though more costly, has been shown to increase response rate by 16% over first-class postage (Del Valle, Morgenstern, Rogstad, Albright, & -

Survey researchers are therefore presented Michielutte, Jones-Lighty, and Bahnson Vichy , 1997).

T m 1. Envelope and Postage Inducement Strategies that Increase Response Rates

inducement Strategy

Comparison Group

Study % Increase of Response Rate

Outgoing Envelope Personalized typed Preprinted address labels Kahle & Sales ( 1 978) name and addresses “Resident” addressed labels Dignan et al. ( 1994)

1 o.oa -1-a

Outgoing Postage First-class postage

Certified mail First class postage

2nd, 3rd or bulk rate postage Metered postage

Fox et al. ( 1 988)a Fox et al. ( 1 988lb Del Valle et al. ( 1 997)

1.8 No difference

1 6.5a

Return Postage First-class postage No postage

Business reply postage

Business reply postage No postage Metered postage No postage Commemorative stamps No postage

Outgoing stamp different from return stamp

Regular paper stamps Outgoing stamp same as the return stamp

Choi et al. ( 1 990) Armstrong & Lusk ( 1 987ld Armstrong & Lusk ( 1 987)‘ Fox et al. ( 1 988)‘ Harris & Guffey ( 1 978) Choi et al. ( 1 990) Choi et al. ( 1 990) Choi et al. ( 1 990) Choi et at. ( 1 990) Hensley ( I 974)

1 3.8a 3.0 9.2a 6.2a 6.Ia 7.0a

1 1 .3a 1 7.3a 3.5 10.0”

Race-specific stamps Use of general stamps Price et al. ( 1996) , ?o difference

Follow-Up Envelopes Personalized Personalized computer labels Nederhoff 1 1 983a) handwritten addresses

6.5”

’p I .05 bResults based on meta-analysis of 5 studies ‘Results based on meta-analysis of 4 studies dResults based on meta-analysis of 6 studies ‘Results based on meta-analysis of 16 studies fResults based on meta-analysis of 9 studies 4- = Percentage increase not provided

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Return Envelope and Postage Inclusion of a self-addressed, postage-

paid return envelope has been observed to increase response rates (Harris & Guffey, 1978; Yammarino, Skinner, & Childers, 1991). Stamped mail tends to yield higher response rates than metered or business reply mail (Fox, Crask, & Kim, 1988). The use of first-class postage on the return envelope has been found to yield a 9% greater increase in return rate than business reply postage (Armstrong & Lusk, 1987). Choi, Pak, and Purdham (1990) compared different types of stamps on return envelopes (i.e., no stamp, business-reply stamp, metered stamp, small regular stamp, and large commemorative stamp) and found that the use of paper stamps, especially large commemorative stamps, on return envelopes increased return rate and reduced response time. This finding tends to highlight the importance of envelope appearance. Respondents may perceive commemorative stamps to be indicators of increased time and consideration spent by researchers in developing the study. Thus, through the use of commemorative stamps, a more positive impression of the researcher may be gained, resulting in an increased response rate. Price, Easton, Kandakai, and Oden (1996) found that race-specific stamps on return envelopes did not increase the response rate of Afri- can-American women. Since some women may have immediately discarded the surveys prior to seeing the race-specific stamp, placement of such a stamp on the outgoing envelope may have increased response rate. Regardless of specific stamp type, research indicates that there is a greater response rate when the stamp on the outgoing envelope and the stamp on the return envelope are the same (Hensley, 1974). However, the pairing of a commemorative stamp on the outgoing envelope and meter postage on the return envelope yields a higher response rate than all other types of pairings.

Cover Letter Following the envelope, the survey cover

letter is often the next contact with poten-

tial participants and therefore is responsible for convincing participants to respond. The cover letter has been identified as an effective strategy to elicit high response rates (Alreck & Settle, 1995; Dodd & Markwiese, 1986; Duncan, 1979; Forsgren, 1989; Foxet al., 1988; Gendall, Hoek, & Esslemont, 1995; Henley, 1976; Linsky, 1975; O’Rourke & O’Rourke, 1983; Wagner & O’Toole, 1985). Elements of the cover letter that continue to receive much attention and debate regarding their effect on response rate include sponsorship; personalization; type of appeal; notification of deadline; as surances of anonymity and/or confidentiality; signature; and postscript (Table 11). Sponsorship

Respondents are more likely to respond to questionnaires that they consider presti- gious (Brunner & Carroll, 1969; Houston & Nevin, 1977; Fox et al., 1988; Jones & Lang, 1980; Jones & Linda, 1978). The effect of survey sponsorship on response rates has been widely examined. Among those sponsors studied (university, governmental, or commercial/private industry), university sponsorship has been found to yield the greatest increase in response rates, followed in order by governmental agency and commercial/private industry (Jones & Linda, 1978). Recognition of university or government sponsorship may increase respondents’ perceived importance of the study and abate feelings of marketing ploys.

Personalization A cover letter is considered personalized

when name and address individually iden- tify each participant and the salutation greets the person by name (Alreck & Settle, 1995; Carpenter, 1974; Forsgren, 1989). Research on the effect of personalization on response rates has been inconsistent and therefore somewhat disconcerting because a considerable investment might be required to personalize cover letters. Most reports find that a personal salutation does not significantly increase response rates when compared with an impersonal greeting (Forsgren, 1989; Kanuk & Berenson, 1975; Worthen &Valcarce, 1985).

However, typed salutations have been found to produce greater response rates than handwritten salutations (Moss & Worthen, 1991; Simon, 1967).

On the other hand, overpersonalization of the cover letter, such as inclusion of a picture of the researcher, has been shown to decrease response rate, because increased personalization may threaten anonymity or assurances of confidentiality (Rucker, Hughes, Thompson, Harrison, & Vanderlip, 1984). Linksy (1975) suggests considering the basis for a personal relation- ship with participants, and if questionnaire content requires maximum anonymity personalization might be contraindicated.

Type of Appeal Cover letter appeal, or message, has

been manipulated to determine influence on response rate. The types of appeals studied include the egoistic appeal and the altruistic appeal. The egoistic appeal emphasizes the importance of the participant’s opinions by including statements such as “your opinions are important to us” and “you can expect to be better served as a result” in the cover letter. Gendall et al. (1995) suggest the egoistic appeal poses the survey as an opportunity for participants to express their opinions. Altruistic appeals ask participants for their help (help-the-researcher or help-the-sponsor) and include statements such as “we need your help” in the cover letter. Altruistic appeals might also empha- size the benefits of the research to the participants’ population (social utility) in the cover letter by including statements such as “The information you provide will contrib- ute to understanding more about ...” (Champion & Sear, 1969; Forsgren, 1989; Gendall et al., 1995; Jones & Linda, 1978). An altruistic appeal has not proven effective in increasing response rate, yet the egoistic cover letter is likely to produce a higher response rate (Champion & Sear, 1969; Forsgren, 1989; Jones & Linda, 1978; O’Rourke & O’Rourke, 1983).

Researchers carefully note that “the effectiveness of any given appeal may be

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situation specific” and that effectiveness often is related to survey sponsorship (Duncan, 1979, p. 45; Gendall et al., 1995; Houston & Nevin, 1977; Jones & Linda, 1978).

Notification of Deadline No consistent evidence exists to confirm

that the inclusion of a deadline in the cover letter will increase response rate in mail

surveys (Duncan, 1979; Foxet al., 1988; Henley, 1976; O’Rourke & O’Rourke, 1983). However, compared with cover letters with no inclusion of a deadline, those with a deadline will likely yield a higher response rate in early responses (Duncan, 1979; Ferriss, 1951; Henley, 1976; O’Rourke & O’Rourke, 1983; Roberts, Mcrory, &

Forthofer, 1978). After the deadline has passed, fewer questionnaires will be returned. If no deadline is provided, researchers can anticipate a slower return rate, but will continue to receive questionnaires for a longer time period, eventually equal to the response rate of a questionnaire that included a deadline in the cover letter

Inducement Strategy Comparison Study % increase of Group Response Rate

Sponsorship University Private agency Brunner & Carroll ( 1 969) 26 4”

10 0 6 3

Jones & Linda ( 1 978) Jones & Lang ( 1 980)

Government agency Jones & Linda [ 1978) 5 7 Government Private agency Jones & Linda ( I 978) 4 3

’ Typed Salutatfon Handwritten Moss & Worthen (1991) I2 0” Personalb Less personal type face Carpenter ( 1 974) 7 0”

Personalization

Personalb Impersonal form lettef Kanuk & Berenson [ 1975)” 7 0 Longworth ( 1 953) 5 0

Handwritten signature Facsimile Dodd & Markwiese [ 1986) 8 0 Kanuk & Berenson / 1 975ja

Personalized/hand signature Impersonal/facsimile signature Worthen & Valcarce ( 1 985) 4 8 Clausen & Ford ( I 947)

No details available

No difference

Type of Appeal Altruistic appeal Egoistic

Egoistic appeal Altruistic

Jones & Lang ( 1 980) Jones & Linda ( I 978) Gendall et al. [I 995) Champion & Sear ( I 969)

4.0 No difference

No details available” 3.6”

Notification of Deadline Deadline Expired deadline Ferriss / 1 95 1 ) 18.1 Dead I i ne No deadline given Roberts et al. ( 1 978) 24.0”

Henley ( 1 976) 7.6“

Confidentiality Anonymity Groves et al. ( 1 997) 4.4

Mason et al. / 196 I ) No difference Rosen ( 1 960) No difference

Maheux et al. ( 1 989) Kanuk & Berenson ( 1 9751”

*p 5.05 aResults based on a meta analysis of 4 experimental studies examining handwritten postscript versus no postscript. hPersonalized cover letters address participants by name, “Dear Mr. Smith” “mpersonal form letters address participants in a generic format, “Dear Ohioan.”

Handwritten postscript No postscript 8.8*

No details available

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(Ferris, 1951; O’Rourke & O’Rourke, 1983; Roberts et al., 1978).

Anonymity and Confidentiality Research has examined whether anony-

mous or confidential surveys yield higher response rates. Groves, Price, Olsson, and King (1997) reported no significant difference in return rates between the two groups, a finding supported in the literature (Mason, Dressel, & Bain, 1961; Rosen, 1960). Singer, von Thurn, and Miller (1995) found that to improve response rates for questionnaires containing sensitive items, a strong assurance of confidentiality was needed. However, if the questionnaire items are not sensitive, strong assurances of confidentiality may encourage skepticism and mistrustfulness in participants (Forsgren, 1989; Singer, Hippler, & Schwartz, 1992). Additional research conducted by Singer, Mathiowetz, and Couper (1995) identified participant “trust in the integrity of the data-collection agency” as being fundamental to the confidentiality debate rather than the “nature of the assurance given to the respondent” (p. 479). At times research requires anonymity to gain access to a sample, in which case double responses of mail surveys are a concern. Summers and Price (1997), however, found the rate of double responses to be low, less than 1%. Signature

Researchers have explored the effects of a handwritten signature versus a photo- copied or other facsimile signature. A personalized signature has not been shown conclusively to increase the response rate of mail surveys (Dodd & Markwiese, 1986; Kanuk & Berenson, 1975). McDermott and Sarvela (1999) recommend, however, that a personal signature using a colored ballpoint pen as evidence of a real signature demonstrates to potential participants the researcher’s level of commitment to the questionnaire, a sugges- tion supported throughout the literature (Dillman, 1972). Postscript

Early survey research reported that handwritten notes (postscripts) requesting

participation increased response rates due to the effect of personalization (Fox et al., 1988; Longworth, 1958; Kanuk & Berenson, 1975). However, the effect of postscripts on response rate have been inconsistent, and moderately significant increases in response rate have been achieved (Andreasen, 1970; Forsgren, 1989; Fox et al., 1988). Incentives

The use of an incentive is the second most commonly addressed issue in studies examining mail survey response rates (Fox et al., 1988). It is clear from the literature that the use of an incentive does increase response rate (Brennan, Hoek, & Astridge, 1991; Church, 1993; Everett, Price, Bedell, & Telljohann, 1997; Fox et al., 1988; Goyder, 1982; Hare, Price, Flynn, & King, 1998; Heberlein & Baumgartner, 1978; Kanuk & Berenson, 1975; Linsky, 1975; Yammarino et al., 1991). Nevertheless, a number of issues should be adequately addressed when preparing to use incentives in a mail survey (Table 111). Amount of Incentive

The inclusion of a $.25, $.50, $1.00, or $2.00 incentive in the mailing has resulted in response rates that are 8.5, 8.9, 18.6, or 23.4% greater than controls, respectively (James & Bolstein, 1990). Similarly, Oden and Price (1999) found that a $1 .OO incentive resulted in an 81% response rate whereas no incentive resulted in a 66% response rate. Generally, the larger the incentive, the greater the response rate (Hopkins & Gullickson, 1992). However, Mizes, Fleece, and Roos (1984) found no significant difference on response rate between $1 and $5 incentives (each showed a 21% improvement over no incentive). Cost-fffectiveness of lncentives

Although incentives as low as $0.25 have been found to be effective at increasing response rates (Fox et al., 1988; James & Bolstein, 1990; Kanuk & Berenson, 1975), a $1.00 incentive is the most consistently effective incentive and has the highest codbenefit ratio (Easton, Price, Telljohann, & Boehm, 1997; Fox et al., 1988; James & Bolstein, 1990, 1992). In

fact, Everett and colleagues (1997) found that a $1.00 incentive for a questionnaire sent to physicians was more cost-effective than a third postcard reminder mailing. Although some research has shown a positive correlation between the amount of the incentive and response rate (Church, 1993; James & Bolstein, 1992; Linsky, 1975), others have demonstrated a point of diminishing returns. This point of diminishing returns is generally the point at which the amount of money is no longer considered a “thank you” (i.e., $ l ) , but instead a payment for services (i.e., $5) (Everett et al., 1997; Kanuk & Berenson, 1975; Mangione, 1995). Monetary Versus Nonmonetary lncen tives

The research shows that monetary incentives tend to have a greater impact on response rates than nonmonetary incentives (e.g., coffee packets; books; pens; key rings; golf balls; tie clips; donations to charity; and feedback on survey responses) (Church, 1993; Everett et al., 1997; James & Bolstein, 1990, 1992; Kanuk & Berenson, 1975; Linsky, 1975; Mangione, 1995; Yammarino et al., 1991). For instance, Easton et al. (1997) found that the inclusion of a $1.00 incentive led to a 15% higher response rate than the inclusion of an informational booklet incentive. Timing of Incentive Delivery

Regardless of amount of the monetary incentive, the research clearly shows that incentives provided in the initial mailing are much more effective at increasing response rate than promised rewards (Berry & Kanouse, 1987; Church, 1993; James & Bolstein, 1992; Linsky, 1975; O’Rourke, 1999). Hopkins and Gullickson (1992) employed a meta-analysis to show that the average response rate increased 19% when a gratuity was enclosed (prepaid) and only 7% when a gratuity was promised (contin- gent on the return of the questionnaire). A significant increase in response rate appears to be true regardless of whether the prepaid incentive is monetary or nonmonetary (Church, 1993).

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Inducement Strategy Comparison Group


Prepaid monetary incentives ( $ ) 40.00 No incentive 20.00 No incentive 10.00 No incentive 10.00 5 1 .oo

James & Bolstein ( 1992) 33.3" James & Bolstein 1992) 33.3*

23 .3* No difference

James & Bolstein ( 1 992) James & Bolstein ( 1 992)

5.00

5.00

No incentive Mizes et al. ( 1 984) 21.1* James & Bolstein ( 1 992) 5 1 .oo Mizes et al. ( 1 984) No difference

18.0"

I 2.00 No incentive James & Bolstein ( 1 990) 23.4'

1 .oo to 5 1.99 No incentive Hopkins & Gullickson 1 992Ia 25.1

1 .oo

1 .oo

No incentive Mizes et al. ( I 984) James & Bolstein ( 1 992) Brennan et al. ( I 99 1 ) James & Bolstein ( 1 990) Everett et al. ( I 997) Oden & Price ( I 999) Hare et al. ( 1 998) Hopkins et al. ( 1 988) Easton et al. ( 1 997) Informational booklet

21.1* 20 .0* 17.6" 18.6* 18.0* 15.0" 12.0* 1 o.o* 15.0"

.50 to .99 No incentive Hopkins & Gullickson ( 1 992Jb 20.0*

.50 No incentive Brennan et al. ( 1 99 I ) James & Bolstein ( 1 990)

21 .3* 8.9"

.50 or less No incentive Yammarino et al. ( 199 1 Ib 18.4" 7 .3* Hopkins & Gullickson ( 1 992Ic

.25 No incentive James & Bolstein ( 1 990) 8.5"

Timing of incentive Prepaid monetary incentive Incentive promised Berry & Kanouse ( 1 987) 12 o*

Hopkins & Gullickson ( 1992)( 1 1 9* $50 check promised James & Bolstein ( I 992) No difference No incentive Church ( 1 993)' 19 I *

Nonmonetary incentives Nonmonetary incentive No incentive Enclosed ballpoint pen No incentive

Church ( 1 993)' 7.9" Nederhof ( 1 98313) No difference

*p 5.05 'Results based on meta-analysis of 62 studies bResults based on meta-analysis of 115 studies 'Results based on meta-analysis of 38 studies

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Questionnaire Characteristics Although incentives, cover letters, and

envelopes and postage are important issues to address when attempting to increase response rates, the questionnaire should not be overlooked. A questionnaire that is tedious, difficult to understand, and lacking in aesthetic appeal is less likely to be completed and returned (Dillman, Sinclair, & Clark, 1993; Fox et al., 1988). Therefore, questionnaire characteristics also must be examined prior to mailings (Table IV). Questionnaire Color

The color of the questionnaire has been shown to affect response rates (Pressley & Tullar, 1977; Pucel, Nelson, & Wheeler, 1971). Questionnaires that are a color other than white are less apt to be lost o r misplaced because they stand out on a respondents’desk (Mangione, 1995). Some evidence does exist to suggest that the use of a green questionnaire may yield higher response rates than the use of a white questionnaire (Fox et al., 1988; Gullahorn & Gullahorn, 1963). The effects

of other colors on response rates have not been widely reported in the literature. Questionnaire Length

Burchell and Marsh (1992) estimated that the response rate decreases by 0.4% for each additional page of a questionnaire. Therefore, these researchers recommended questionnaires be limited to 10 pages and 100 items. An experimental study of alternatives to the current U.S. decennial census questionnaire showed that shortening the questionnaire improved response (Dillman et al., 1993). Interest- ingly, Adams and Gale (1982) found that the response rate to a 3-page questionnaire was higher than that to a l-page or 5-page questionnaire. Perhaps participants may feel that a 3-page questionnaire is more important than a l-page questionnaire and less burdensome than a 5-page questionnaire. However, researchers have suggested that length of questionnaire not be considered as the lone determin- ing factor of response rates (Burchell & Marsh, 1992; Mangione, 1995). Specific efforts should also be made to maintain

respondent motivation (Herzog & Bachman, 1981). Strategies to maintain high levels of motivation include ensuring respondents that their information is crucial to the suc- cess of the study, developing questionnaires examining interesting content, and format- ting questionnaires in an attractive and user- friendly manner. Ease and Interest in Completing the Survey

The research indicates that questionnaire length is much less important to increasing response rates than ease and interest in completing the survey (O’Rourke & O’Rourke, 1983). Questionnaires that address the most salient topics at the beginning tend to have higher response rates (Mullner, Levy, Byre, & Matthews, 1982). Quickly engaging a respondent’s interest and then maintaining that interest level is crucial (Mangione, 1995). Dillman et al. (1993) termed questionnaires that are easy to complete and avoid confusing items, “respondent -friendly.” Respondent-friendly questionnaires were found to increase response rates whereas questionnaires

Inducement Strategy Comparison Group


Length 4 pages or less 3 pages 5 pages

4 pages or more

3 pages 1 Page 3 pages 1 Page 1 Page 5 pages 1 page [both sides) 8 pages

Yammarino et al. [ 199 1 J” 7.8* Adams & Gale ( 1 982) 25.1 *

5.9* Rudd & Maxwell ( 1 980) No difference Adams & Gale 1982) 19.2* Dillman et al. ( 1 993) 4.6*

Adams & Gale ( 1 982)

Color Green White Fox et al. ( 1 988)b 2.0

Gullahorn & Gullahorn [ I 9631 2 .o

At end of questionnaire At beginning of questionnaire Roberson & Sundstrom [ 1990) 8.0* Jensen ( 1 995) No difference

Demographic items present No demographic items present Giles & Feild ( 1 978) No difference

Location of Demographics

*p I .05 ‘Results based on meta-analysis of 115 experimental studies

bResults based on meta-analysis of 3 experimental studies

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asking potentially difficult or objectionable questions (i.e., social security number) low- ered response rates (Dillman et al., 1993). Interestingly, the combined effect of a questionnaire that was both respondent-friendly and short increased response rates by 8 to 10 percentage points. Location of Demographic Items

After reading a description of the questionnaire in the cover letter, individuals who are perhaps looking forward to responding may be unpleasantly surprised that the first question(s) are about age, gender, race, or education. Such questions, in respondents’ minds, often are viewed as not directly pertaining to the health issue (Dillman, 2000). The most salient topics should be placed at the beginning to increase response rates (Mullner et al., 1982). For these reasons, Dillman (2000) recommends that questionnaires should seldom begin with demographic items. Roberson and Sundstrom (1990) found that placing demographic items at the end of the instrument increased response rate by 8%. Nevertheless, some recommend that “simple” and “easy-to-complete’’ items such as demographic items should be placed at the beginning of the questionnaire as a means to increase respondent confidence in completing the survey (Alreck & Settle, 1995). Jensen (1995) found no significant difference in response rate between questionnaires with demographic items placed in the beginning and questionnaires with demographic items placed at the end. Giles and Feild (1978) found no difference in response rate between questionnaires with demographic items and questionnaires without demographic items. Thus, item placement should be considered in context with questionnaire content and target audience.

Participant Contact Participant contact can take two forms:

prenotification and follow-up (Table V). Prenotification is intended to alert participants that the questionnaire will be arriv- ing and to establish the legitimacy of the

questionnaire. Follow-up contacts serve to positively reinforce participants who have returned the questionnaire and to remind those who have not to do so (Fox et al., 1988). Although all methods of contact have a positive impact on response rate, participant contact via telephone or registered mail has been found to yield significantly higher rates than that via regular mail (Eckland, 1965; Champion & Sear, 1969; Gullahorn & Gullahorn, 1959; Heberlein & Baumgartner, 1978; Kanuk & Berenson, 1975; Linsky, 1975; Phillips, 1951; Slocum, 1956). The research clearly indicates that the number of participant contacts (either prenotification or follow-up) has a significant positive correlation with response rate (Heberlein & Baumgartner, 1978; Yammarino et al., 1991;Yu &Cooper, 1983). In a linear regression analysis, Heberlein and Baumgartner found that each contact increases the predicted response rate by 12%. However, most researchers agree that follow-up participant contacts are a better investment of resources than prenotification contacts (Kanuk & Berenson, 1975; Linsky, 1975; Mangione, 1995; O’Rourke, 1999). Yammarino et al. found that although preliminary notification increased response rate by 28.5%, follow-up contacts increased response rates by over 30.6%. Dillman (1978) recommends three follow- ups after the initial mailing of the questionnaire. He suggests first and third follow-ups should be postcard reminders and the second follow-up should include another copy of the questionnaire. Postcards have been shown to be equally effective as letters in follow-ups (Kanuk & Berenson, 1975; Linsky, 1975).

Conclusion Many of the inducement strategies

presented here are interdependent and interrelated in the execution of mail survey research. Decisions on each compo- nent of the mail survey process cannot be made independently of the others. There- fore, it may be impossible to establish a defined and rigid protocol for mail

survey research. It is imperative researchers understand their potential respondents and tailor the cover letter and questionnaire to meet their unique interests and appeals.

Nevertheless, this review of the survey research literature suggests that mail survey researchers can increase response rates if (1) outgoing envelopes are personalized; (2) self-addressed stamped envelopes are provided; (3) university sponsorship is evident; (4) research benefits are empha- sized; ( 5 ) confidentiality is assured when asking sensitive questions; (6) up-front monetary incentives are provided (if funding allows); (7) colored, easy-to- complete questionnaires are employed; and (8) participants are contacted multiple times (Figure 1). Based on the findings of this review, the following recommenda- tions are offered to help direct future research in this area.

(1) Research studies in health education should be conducted that solely examine individuals’ beliefs of effective inducement strategies (as opposed to studies that examine inducement strategies within the context of a larger, and topically different study).

(2) Research studies should seek to iden- tify nonrespondents to a particular survey and then examine their perceived barriers to responding (e.g., topic, format).

(3) Research studies should examine whether inducement strategies vary based on demographic characteristics of respondents (e.g., gender, education level, race/ ethnicity, age, socioeconomic status).

(4) Research studies should continue to examine the combined effects of inducement strategies on response rates as opposed to the individual effects of a lone inducement strategy.

(5) Attention should be given to the professional marketing literature as a means of identifying effective marketing concepts and integrating such concepts in health education survey research.

(6) Health education journals and conferences should continue to devote attention to maximizing mail survey response rates.

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613-639.

Call for Papers on Mental Health

The American Journal of Health Education announces a call for original manuscripts or Teaching Ideas for a special insert or issue on mental health. We invite ethicists, policy makers, practitioners, and researchers from health education or related disciplines to submit manuscripts that describe and/or analyze mental health issues of interest to health educators. Topics of interest would include but are not limited to the following:

Reducing violence in adolescents and/or adults Mental health promotion for at-risk groups Costs of mental illness to society and the role of health education Mental health provisions in public schools Suicide prevention for youths or other high-risk groups Stress; death and dying; eating disorders; etc.

Authors should follow the Guidelines for Authors found in issues of the

Manuscript submission deadline: March 30,200 1 American Journal of Health Education.

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increasing response rates to mail questionnaires: a review of inducement strategies

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