The Danish health and morbidity surveys: study design and participant characteristics

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Abstract

Background

Reliable data from health surveys are essential to describe the status and trends in health indicators by means of information not available from official registers. In Denmark, nationally representative health surveys (the Danish Health and Morbidity Surveys) have been carried out among adults during the past three decades by the Danish National Institute of Public Health, University of Southern Denmark. The aim of the present study is to describe the study design of the three most recent surveys in 2010, 2013, and 2017, including the survey mode and response rates.

Methods

In 2010, 2013, and 2017, the samples ( n = 25,000 each) were based on random sampling of individuals aged 16 years or older with a permanent residence in Denmark. A subsample of previously invited respondents was also re-invited in subsequent survey waves. Data were collected through self-administered questionnaires, yet with a concurrent mixed-mode approach, allowing for the invited individuals to complete either a web questionnaire or an identical paper questionnaire. In 2010 and 2013, survey invitations were sent by regular postal mail, whereas a secure electronical mail service, Digital Post, was used to invite the majority (90.1%) of the sample in 2017.

Results

The overall response rate decreased from 60.7% in 2010 to 57.1% in 2013 and 56.1% in 2017. Between 2010 and 2017 the response mode distribution for the web questionnaire increased markedly from 31.7 to 73.8%. The largest increase in the proportion which completed the web questionnaire was found in the oldest age group.

Conclusions

Data from the Danish Health and Morbidity Surveys reveal an increasing proportion of the respondents to complete web questionnaires instead of paper questionnaires. Even though the response rate remained relatively stable in 2017, declining response rates is a major concern in health surveys. As the generalizability to the Danish population may be compromised by a low response rate, efforts to increase the response rate or keep it stable are crucial in future surveys. Thus, efforts should be made to ensure convenience and feasibility in relation to access to and the completion of survey (web) questionnaires.

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Comparison of response rates and cost-effectiveness for a community-based survey: postal, internet and telephone modes with generic or personalised recruitment approaches

Martha Sinclair, Joanne O'Toole, Manori Malawaraarachchi … (2012)

Background Epidemiological research often requires collection of data from a representative sample of the community or recruitment of specific groups through broad community approaches. The population coverage of traditional survey methods such as mail-outs to residential addresses, and telephone contact via public directories or random-digit-dialing is declining and survey response rates are falling. There is a need to explore new sampling frames and consider multiple response modes including those offered by changes in telecommunications and internet technology. Methods We evaluated response rates and cost-effectiveness for three modes of survey administration (postal invitation/postal survey, postal invitation/internet survey and postal invitation/telephone survey) and two styles of contact approach (personalised and generic) in a community survey of greywater use. Potential respondents were contacted only once, with no follow up of non-responders. Results The telephone survey produced the highest adjusted response rate (30.2%), followed by the personalised postal survey (10.5%), generic postal survey (7.5%) and then the internet survey (4.7% for the personalised approach and 2.2% for the generic approach). There were some differences in household characteristics and greywater use rates between respondents to different survey modes, and between respondents to personalised and generic approaches. These may be attributable to the differing levels of motivations needed for a response, and varying levels of interest in the survey topic among greywater users and non-users. The generic postal survey had the lowest costs per valid survey received (Australian $22.93), followed by the personalised postal survey ($24.75). Conclusions Our findings suggest that postal surveys currently remain the most economic option for population-based studies, with similar costs for personalised and generic approaches. Internet surveys may be effective for specialised groups where email lists are available for initial contact, but barriers other than household internet access still exist for community-based surveys. Given the increasing recruitment challenges facing community-based studies, there is an imperative to gather contemporary comparative data on different survey modes and recruitment approaches in order to determine their strengths, limitations and costs. Researchers also need to document and report on the potential biases in the target and respondent populations and how this may affect the data collected.

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Maximising response to postal questionnaires – A systematic review of randomised trials in health research

Rachel A Nakash, Jane Hutton, Ellen C Jørstad-Stein … (2006)

Background Postal self-completion questionnaires offer one of the least expensive modes of collecting patient based outcomes in health care research. The purpose of this review is to assess the efficacy of methods of increasing response to postal questionnaires in health care studies on patient populations. Methods The following databases were searched: Medline, Embase, CENTRAL, CDSR, PsycINFO, NRR and ZETOC. Reference lists of relevant reviews and relevant journals were hand searched. Inclusion criteria were randomised trials of strategies to improve questionnaire response in health care research on patient populations. Response rate was defined as the percentage of questionnaires returned after all follow-up efforts. Study quality was assessed by two independent reviewers. The Mantel-Haenszel method was used to calculate the pooled odds ratios. Results Thirteen studies reporting fifteen trials were included. Implementation of reminder letters and telephone contact had the most significant effect on response rates (odds ratio 3.7, 95% confidence interval 2.30 to 5.97 p = <0.00001). Shorter questionnaires also improved response rates to a lesser degree (odds ratio 1.4, 95% confidence interval 1.19 to 1.54). No evidence was found that incentives, re-ordering of questions or including an information brochure with the questionnaire confer any additional advantage. Conclusion Implementing repeat mailing strategies and/or telephone reminders may improve response to postal questionnaires in health care research. Making the questionnaire shorter may also improve response rates. There is a lack of evidence to suggest that incentives are useful. In the context of health care research all strategies to improve response to postal questionnaires require further evaluation.

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25-year trends and socio-demographic differences in response rates: Finnish adult health behaviour survey.

Hanna Tolonen, Satu Helakorpi, Kirsi M Talala … (2006)

When estimating population level changes in health indicators, the declining response rate, especially if also the characteristics of non-respondents are changing may bias the outcome. There is evidence that survey response rates are declining in many countries. It is also known that respondents and non-respondents differ in their socio-economic and demographic status as well as in their health and health behaviours. There is no information about the changes in the differences between respondents and non-respondents over time. Our purpose was to investigate the changes over time in the differences between respondents and non-respondents in respect to their sex, age, marital status and educational level. The data from the Finnish Adult Health Behaviour Survey (1978-2002) was used. The response rate declined over the past 25 years for both men and women in all age groups. The decline was faster among men than women, and also faster in younger age groups than older age groups. There is a marked difference in the response rate between married and non-married persons but it did not change over time. Also the response rate between different educational levels differed for both men and women, and this difference increased over the years. The declining response rate and at the same time occurring change in the non-respondent characteristics will decrease the representativeness of the results, limit the comparability of the results with other surveys, increase the bias of the trend estimates and limit the comparability of the results between population groups.

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Author and article information

Contributors

Heidi Amalie Rosendahl Jensen:

ORCID: http://orcid.org/0000-0001-7171-7429

harj@niph.dk

Ola Ekholm: oek@niph.dk

Michael Davidsen: md@niph.dk

Anne Illemann Christensen: ach@niph.dk

Journal

Journal ID (nlm-ta): BMC Med Res Methodol

Journal ID (iso-abbrev): BMC Med Res Methodol

Title: BMC Medical Research Methodology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2288

Publication date (Electronic): 3 May 2019

Publication date PMC-release: 3 May 2019

Publication date Collection: 2019

Volume: 19

Electronic Location Identifier: 91

Affiliations

ISNI 0000 0001 0728 0170, GRID grid.10825.3e, National Institute of Public Health, , University of Southern Denmark, ; Copenhagen, Denmark

Author information

Heidi Amalie Rosendahl Jensen http://orcid.org/0000-0001-7171-7429

Article

Publisher ID: 733

DOI: 10.1186/s12874-019-0733-9

PMC ID: 6499958

PubMed ID: 31053088

SO-VID: 0a5faf46-0dd9-4a9c-9f83-97a856b252ab

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 7 August 2018

Date accepted : 12 April 2019

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ScienceOpen disciplines: Medicine

Keywords: cross-sectional studies,study design,data collection,follow-up studies,health surveys,health surveillance

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ScienceOpen disciplines: Medicine

Keywords: cross-sectional studies, study design, data collection, follow-up studies, health surveys, health surveillance

The Danish health and morbidity surveys: study design and participant characteristics

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Most cited references 20

Comparison of response rates and cost-effectiveness for a community-based survey: postal, internet and telephone modes with generic or personalised recruitment approaches

Maximising response to postal questionnaires – A systematic review of randomised trials in health research

25-year trends and socio-demographic differences in response rates: Finnish adult health behaviour survey.

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