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Utilizing the Total Design Method in medicine: maximizing response rates in long, non-incentivized, personal questionnaire postal surveys

Authors Kazzazi F, Haggie R, Forouhi P, Kazzazi N, Malata CM

Received 5 November 2017

Accepted for publication 21 February 2018

Published 6 June 2018 Volume 2018:9 Pages 169—172


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Robert Howland

Fawz Kazzazi,1 Rebecca Haggie,1 Parto Forouhi,2 Nazar Kazzazi,3 Charles M Malata2,4,5

1Clinical School, University of Cambridge, Cambridge, UK; 2Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s University Hospital, Cambridge, UK; 3Jasmine Breast Centre, Doncaster Royal Infirmary, Doncaster, UK; 4Department of Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s University Hospital, Cambridge, UK; 5Postgraduate Medical Institute, Faculty of Medical Sciences, Anglia Ruskin University School of Medicine, Cambridge, UK

Maximizing response rates in questionnaires can improve their validity and quality by reducing non-response bias. A comprehensive analysis is essential for producing reasonable conclusions in patient-reported outcome research particularly for topics of a sensitive nature. This often makes long (≥7 pages) questionnaires necessary but these have been shown to reduce response rates in mail surveys. Our work adapted the “Total Design Method,” initially produced for commercial markets, to raise response rates in a long (total: 11 pages, 116 questions), non-incentivized, very personal postal survey sent to almost 350 women.
Patients and methods: A total of 346 women who had undergone mastectomy and immediate breast reconstruction from 2008–2014 (inclusive) at Addenbrooke’s University Hospital were sent our study pack (Breast-Q satisfaction questionnaire and support documents) using our modified “Total Design Method.” Participants were sent packs and reminders according to our designed schedule.
Results: Of the 346 participants, we received 258 responses, an overall response rate of 74.5% with a useable response rate of 72.3%. One hundred and six responses were received before the week 1 reminder (30.6%), 120 before week 3 (34.6%), 225 before the week 7 reminder (64.6%) and the remainder within 3 weeks of the final pack being sent. The median age of patients that the survey was sent to, and the median age of the respondents, was 54 years.
Conclusion: In this study, we have demonstrated the successful implementation of a novel approach to postal surveys. Despite the length of the questionnaire (nine pages, 116 questions) and limitations of expenses to mail a survey to ~350 women, we were able to attain a response rate of 74.6%.

Keywords: breast, surgery, postal survey, oncology, cancer, breast reconstruction, immediate postmastectomy breast reconstruction, patient satisfaction, PROMs

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