Review and special article
Physician response to surveys: A review of the literature1

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Abstract

Objective: Physician-specific surveys are a frequently used tool in health services research, but attempts at ensuring adequate response rates are rarely reported. We reviewed literature of survey methodology specific to physician surveys and report those found to be most effective.

Data Sources: Studies were identified by searching MEDLINE and PSYCHInfo from 1967 through February 1999. We included all English-language studies that randomized physician survey respondents to an experimental or control group. The authors independently extracted data from 24 studies examining survey methodology of physician-specific surveys. We included Mantel–Haenszel chi-squares comparing treatment groups, if present. If not, these were calculated from study data.

Results: Pre-notification of survey recipients, personalizing the survey mailout package, and nonmonetary incentives were not associated with increased response rates. Monetary incentives, the use of stamps on both outgoing and return envelopes, and short questionnaires did increase response rates. Few differences were reported in response rates of phone surveys compared with mail surveys and between the demographics and practice characteristics of early survey respondents and late respondents.

Conclusions: We report some simple approaches that may significantly increase response rates of mail surveys. Surprisingly, the response rates of mail surveys of physicians compared favorably with those from telephone and personal interview surveys. Nonresponse bias may be of less concern in physician surveys than in surveys of the general public. Future research steps include specifically testing the more compelling results to allow for better control of confounders.

Introduction

Physicians play a key role in the rapidly changing health care and public health system, and it is essential to study their attitudes, beliefs, behaviors, and concerns. One of the most effective ways of doing this is through the use of surveys. Surveys of physicians are widely used for eliciting opinions on issues affecting practice,1 the delivery of clinical preventive services,2 implementation of public health interventions,3 the changing environment of medicine in the era of managed care,4 ethics,5 prevention efforts,6, 7 and other topics.

Epidemiologists, health administrators, and other public health professionals rely on mailed questionnaires to obtain data from physicians.8 However, low response rates to physician surveys are common, which could seriously impair the validity and generalizability of results.9, 10, 11, 12, 13 For example, one study examining response rates among 321 mail surveys published in medical journals over a one-year period showed that nonphysician surveys had a mean response rate of 68% compared to 54% in physician surveys.14 These circumstances have motivated investigators to consider the differences between the general public and physicians regarding survey response, and to specifically examine the best ways to survey physicians so as to maximize response rates and minimize nonresponse bias.

Mail surveys of highly educated, professional persons (e.g., physicians) should theoretically elicit higher response rates than those of less educated respondents. Overall, such persons (1) can read the survey and (2) are more likely to have considered issues that are to be covered in the survey and to have formulated their opinions in advance.11 Alternatively, some professionals may resist surveys or questions that (1) stereotype or generalize issues, (2) are restrictive (i.e., multiple choice questions), (3) do not make sense to them, and (4) take too much time out of an already overburdened schedule.5

Although abundant research exists regarding the way in which the general population responds to surveys,10, 16, 17, 18, 19, 20, 21, 22 there are relatively few studies examining how and why physicians respond. In addition, 6 of the 24 studies reviewed in this paper were not available on Medline (i.e., they were found on PsychINFO) and thus may not be readily available to researchers planning physician surveys. To assess techniques purported to increase the response rates of physicians, we reviewed peer-reviewed literature and examined methods used to increase response rates to physician-specific surveys. While the limited number of studies and comparison difficulties across studies preclude universal conclusions, methodologic issues raised in this review can be considered by researchers who are in the business of conducting surveys of physicians.

Section snippets

Methods

We searched Medline and PsychINFO databases from 1967 through February 1999 to identify published research on survey methodology specific to physicians. The references of all retrieved articles were screened for further citations. The search was limited to articles in English. Medline/PsychINFO index terms searched included “questionnaire,” “survey,” and “physician.” “Methodology” and “questionnaire” were also searched using the text word option in Medline.

Only randomized, controlled studies

Results

We found 24 published studies that examined methods to increase physicians’ response rates to mail, telephone, or personal interview surveys. These studies evaluated techniques to improve response rates, compared the efficacy of mail versus telephone and mail versus personal interview surveys and examined the effect of nonresponse bias in physician surveys.

Five papers examined general attempts to increase response rates to the first mailing of a survey (Table 1). Pre-notification of survey

Discussion

We reviewed available published literature and found several simple interventions that may increase response rates to physician surveys. Although the number of studies dealing directly with strategies to improve physician survey response is small compared to survey methods of the general population, the studies we reviewed are of high quality and similarities to findings from survey methods research of the general population support our findings.

The strategies we found effective in these

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