Conducting surveys with multidisciplinary health care providers: Current challenges and creative approaches to sampling, recruitment, and data collection

A Cross-Sectional Survey of Fixed-Dose Combination Antihypertensive Medicine Prescribing in Twenty-Four Countries, Including Qualitative Insights

Background

Treatment inertia, non-adherence and non-persistence to medical treatment contribute to poor blood pressure (BP) control worldwide. Fixed dose combination (FDC) antihypertensive medicines simplify prescribing patterns and improve adherence. The aim of this study was to identify factors associated with prescribing FDC antihypertensive medicines and to understand if these factors differ among doctors worldwide.

Methods

A cross-sectional survey was conducted online from June 2023 to January 2024 to recruit doctors. We collaborated with an international network of researchers and clinicians identified through institutional connections. A passive snowballing recruitment strategy was employed, where network members forwarded the survey link to their clinical colleagues. The survey instrument, developed through a literature review, interviews with academic and clinical researchers, and pilot testing, assessed participants perspectives on prescribing FDC antihypertensive medicines for hypertension. Participants rated their level of agreement (5-point Likert scale) with statements representing six barriers and four facilitators to FDC use.

Findings

Data from 191 surveys were available for analysis. 25% (n = 47) of participants worked in high-income countries, 38% (n = 73) in upper-middle income, 25% (n = 48) in lower-middle income, 6% (n = 10) in low-income countries. Forty percent (n = 70) of participants were between 36-45 years of age; two thirds were male. Cost was reported as a barrier to prescribing FDC antihypertensive medicines [51% (n = 87) agreeing or strongly agreeing], followed by doctors' confidence in BP measured in clinic [40%, (n = 70)], access [37%, (n = 67)], appointment duration [35%, (n = 61)], concerns about side-effects [(21%, n = 37)], and non-adherence [12%, (n = 21)]. Facilitators to FDC antihypertensive polypills prescribing were clinician facing, such as access to educational supports [79%, (n = 143)], more BP measurement data [67%, (n = 120)], a clinical nudge in health records [61%, (n = 109)] and patient-facing including improved patient health literacy [49%, (n = 88)]. The levels of agreement and strong agreement across all barriers and facilitators were similar for participants working in higher or lower income countries. Across all countries, participants rated FDC antihypertensive medications highly valuable for managing patients with non-adherence, (82% reported high or very high value), for patients with high pill burden (80%).

Interpretation

Cost and access were the most common barriers to prescribing FDCs across high- and low-income countries. While greater educational support for clinicians was perceived as the leading potential facilitator of FDC use, this seems unlikely to be effective without addressing access.

Evaluating strategies to recruit health researchers to participate in online survey research

BACKGROUND

Engaging researchers as research subjects is key to informing the development of effective and relevant research practices. It is important to understand how best to engage researchers as research subjects.

METHODS

A 24 factorial experiment, as part of a Multiphase Optimization Strategy, was performed to evaluate effects of four recruitment strategy components on participant opening of an emailed survey link and survey completion. Participants were members of three US-based national health research consortia. A stratified simple random sample was used to assign potential survey participants to one of 16 recruitment scenarios. Recruitment strategy components were intended to address both intrinsic and extrinsic sources of motivation, including: $50 gift, $1,000 raffle, altruistic messaging, and egoistic messaging. Multivariable generalized linear regression analyses adjusting for consortium estimated component effects on outcomes. Potential interactions among components were tested. Results are reported as adjusted odds ratios (aOR) with 95% confidence intervals (95% CI).

RESULTS

Surveys were collected from June to December 2023. A total of 418 participants were included from the consortia, with final analytical sample of 400 eligible participants. Out of the final sample, 82% (341) opened the survey link and 35% (147) completed the survey. Altruistic messaging increased the odds of opening the survey (aOR 2.02, 95% CI: 1.35-2.69, p = 0.033), while egoistic messaging significantly reduced the odds of opening the survey (aOR 0.56, 95%CI 0.38-0.75, p = 0.08). The receipt of egoistic messaging increased the odds of completing the survey once opened (aOR 1.81, 95%CI: 1.39-2.23, p < 0.05). There was a significant negative interaction effect between the altruistic appeal and egoistic messaging strategies for survey completion outcome. Monetary incentives did not a have a significant impact on survey completion.

CONCLUSION

Intrinsic motivation is likely to be a greater driver of health researcher participation in survey research than extrinsic motivation. Altruistic and egoistic messaging may differentially impact initial interest and survey completion and when combined may lead to improved rates of recruitment, but not survey completion. Further research is needed to determine how to best optimize message content and whether the effects observed are modified by survey burden.

Recruitment, data collection, participation rate, and representativeness of the international cross-sectional PRICOV-19 study across 38 countries

BACKGROUND

Recruitment for surveys has been a great challenge, especially in general practice.

METHODS

Here, we reported recruitment strategies, data collection, participation rates (PR) and representativeness of the PRICOV-19 study, an international comparative, cross-sectional, online survey among general practices (GP practices) in 37 European countries and Israel.

RESULTS

Nine (24%) countries reported a published invitation; 19 (50%) had direct contact with all GPs/GP practices; 19 (50%) contacted a sample of GPs /GP practices; and 7 (18%) used another invitation strategy. The median participation rate was 22% (IQR = 10%, 28%). Multiple invitation strategies (P-value 0.93) and multiple strategies to increase PR (P-value 0.64) were not correlated with the PR. GP practices in (semi-) rural areas, GP practices serving more than 10,000 patients, and group practices were over-represented (P-value < 0.001). There was no significant correlation between the PR and strength of the primary care (PC) system [Spearman's r 0.13, 95% CI (-0.24, 0.46); P-value 0.49]; the COVID-19 morbidity [Spearman's r 0.19, 95% CI (-0.14, 0.49); P-value 0.24], or COVID-19 mortality [Spearman's r 0.19, 95% CI (-0.02, 0.58); P-value 0.06] during the three months before country-specific study commencement.

CONCLUSION

Our main contribution here was to describe the survey recruitment and representativeness of PRICOV-19, an important and novel study.

The Challenge of Surveying New Graduate Nurses

Random samples are the gold standard when surveying a nationwide population, such as new graduate nurses. The goal of this article is to detail the challenges experienced when sampling and surveying newly licensed RNs who entered the health care environment during the coronavirus disease (COVID-19) pandemic. To create a random sample of this population, all 51 U.S. state boards of nursing were contacted. State boards of nursing are the best resource for this information, but obtaining contact information, soliciting a response, and dealing with privacy laws as well as the cost of the lists reduced the survey frame. Of the 51 state boards, eight provided usable lists of participants. Obtaining a sampling frame was challenging. Once created, other issues arose. Finding ways to obtain random sampling lists of RNs and encouraging nurses to participate in research are key elements of addressing issues in health care today. [J Contin Educ Nurs. 2024;55(3):145-148.].

Clinic-based perspectives on the integration of patient-reported outcomes (PROs) in a tertiary cancer center

PURPOSE

This study examines providers' and clinic staff's perspectives on patient-reported outcomes (PROs) implementation at an academic medical center.

METHODS

An anonymous and voluntary survey was administered to Henry Ford Cancer providers and clinic staff 18 months after PROs program implementation in September 2020, to obtain their feedback on perceived barriers, impact on workflows, and PROs administration frequency in routine cancer care.

RESULTS

A total of 180 providers and 40 clinic staff were invited to complete the survey; 31% and 63% completed the survey, respectively. Approximately 68% of providers reported that electronically integrated PROs scores were either beneficial or somewhat beneficial to their patients, while only 28% of the clinic staff reported that PROs were beneficial or somewhat beneficial to patients. According to the clinic staff, the most common barriers to PROs completion included lack of patients' awareness of the utility of the program with respect to their care, patients' health status at check-in, and PROs being offered too frequently.

CONCLUSION

There is favorable acceptance of the PROs program by providers, but clinic staff found it less favorable. Interventions to address barriers and improve program engagement are needed to ensure broad adoption of PROs in oncology practice.

Laryngeal Mask Use in the Neonatal Population: A Survey of Practice Providers at a Regional Tertiary Care Center in the United States

OBJECTIVE

The aim of this study was to evaluate the level of training, awareness, experience, and confidence of neonatal practice providers in the use of laryngeal mask (LM), and to identify the barriers in its implementation in the neonatal population.

STUDY DESIGN

Descriptive observational study utilizing an anonymous online questionnaire among healthcare providers at the Oklahoma Children's Hospital who routinely respond to newborn deliveries and have been trained in the Neonatal Resuscitation Program (NRP). Participants included physicians, trainees, nurse practitioners, nurses, and respiratory therapists.

RESULTS

Ninety-five participants completed the survey (27.5% response rate). The sample consisted of 77 NRP providers (81%), 11 instructors (12%), and 7 instructor mentors (7%). Among 72 respondents who had undergone LM training, 51 (54%) had hands-on manikin practice, 4 (4%) watched the American Academy of Pediatrics (AAP) NRP educational video, and 17 (18%) did both. Nurses (39 out of 46) were more likely to have completed LM training than were physicians (31 out of 47). With only 11 (12%) participants having ever placed a LM in a newly born infant, the median confidence for LM placement during neonatal resuscitation was 37 on a 0 to 100 scale. Frequently reported barriers for LM use in neonates were limited experience (81%), insufficient training (59%), preference for endotracheal tube (57%), and lack of awareness (56%).

CONCLUSION

While the majority of the neonatal practice providers were trained in LM placement, only a few had ever placed one in a live newborn, with a low degree of confidence overall. Future practice improvement should incorporate ongoing interdisciplinary LM education, availability of LM in the labor and delivery units, and promotion of awareness of LM as an alternative airway.

KEY POINTS

· LM is underutilized as an alternative airway.. · Insufficient experience and training limit LM use.. · Providers confidence with LM placement is low..

A web-based survey of UK pharmacists to assess the effectiveness of Viagra Connect® additional risk minimisation measures

Background To support reclassification in the UK of sildenafil citrate (50 mg) from prescription-only medicine to a pharmacy medicine (P status) under the brand name “Viagra Connect^®”, additional risk minimisation measures were implemented that included training materials and an optional checklist to assist community pharmacists in the safe supply of Viagra Connect^® to suitable patients. Objective To evaluate the effectiveness of Viagra Connect^® additional risk minimisation measures by assessing community pharmacists’ participation in training, their knowledge of key risk messages, and utilisation of the checklist. Setting A post-authorisation safety study implemented as a web-based survey, conducted in a representative population of UK community pharmacists. Method A random sample of community pharmacists who received at least 1 request to supply Viagra Connect^® within the past 6 months completed an online questionnaire of 33 closed-ended questions/statements with multiple-choice responses. Data were summarised using descriptive statistics. Main outcome measure Knowledge of key risk messages and dispensing practices communicated in the additional risk minimisation measures. Results The survey was completed by 345 community pharmacists. Respondents displayed a high level of knowledge of key risk messages, with ≥80 % selecting correct answers for 43/51 items. Nearly all respondents (90.1 %) reported that the training materials were useful/very useful, and reported using the checklist at the point of supply (91.9 %). Counselling of patients who requested Viagra Connect^® was generally considered a positive exercise. Conclusions The Viagra Connect^® additional risk minimisation measures were effective for education of community pharmacists and to ensure safe supply of Viagra Connect^® behind-the-counter to patients.

Impact of Two Different Recruitment Procedures (Random vs. Volunteer Selection) on the Results of Seroepidemiological Study (SARS-CoV-2)

The proper recruitment of subjects for population-based epidemiological studies is critical to the external validity of the studies and, above all, to the sound and correct interpretation of the findings. Since 2020, the novel coronavirus SARS-CoV-2 pandemic has been a new factor that has been, additionally, hindering studies. Therefore, the aim of our study is to compare demographic, socio-economic, health-related characteristics and the frequency of SARS-CoV-2 infection occurrence among the randomly selected group and the group composed of volunteers. We compare two groups of participants from the cross-sectional study assessing the seroprevalence of SARS-CoV-2 coronavirus, which was conducted in autumn 2020, in three cities of the Silesian Voivodeship in Poland. The first group consisted of a randomly selected, nationally representative, age-stratified sample of subjects (1167 participants, “RG” group) and was recruited using personal invitation letters and postal addresses obtained from a national registry. The second group (4321 volunteers, “VG” group) included those who expressed their willingness to participate in response to an advertisement published in the media. Compared with RG subjects, volunteers were more often females, younger and professionally active, more often had a history of contact with a COVID-19 patient, post-contact nasopharyngeal swab, fewer comorbidities, as well as declared the occurrence of symptoms that might suggest infection with SARS-CoV-2. Additionally, in the VG group the percentage of positive IgG results and tuberculosis vaccination were higher. The findings of the study confirm that surveys limited to volunteers are biased. The presence of the bias may seriously affect and distort inference and make the generalizability of the results more than questionable. Although effective control over selection bias in surveys, including volunteers, is virtually impossible, its impact on the survey results is impossible to predict. However, whenever possible, such surveys could include a small component of a random sample to assess the presence and potential effects of selection bias.

A Multi-Center Structural Equation Modeling Approach to Investigate Interpersonal Violence Screening for Public Health Promotion

Background: Interpersonal violence is a significant public health issue. Routine health screening is a cost-effective strategy that may reduce harmful physical and mental consequences. However, existing research finds consistently low rates of violence screening offered by healthcare providers, e.g., nurses, nurse practitioners, physicians. There is a critical need for research that helps understand how providers' screening behaviors are impacted by individual-level and organizational-level factors to promote the uptake of routine screening for interpersonal violence. Two recent studies, i.e., The Health Care Providers study and Nurse Practitioners Violence Screening study, involved quantitative data collected to measure providers' screening behavior and multi-level factors impacting violence screening. Methods: The current analysis includes a combination of multi-center data collected from The Health Care Providers and Nurse Practitioners Violence Screening studies, respectively. The total sample is 389 providers across the United States. The proposed research develops a system-level multi-center structural equation model framework to rigorously integrate data from the two studies and examine providers' screening behavior for interpersonal violence based upon Theory of Planned Behavior from a quantitative perspective. Results & Conclusions: We successfully examine the efficacy of the Theory of Planned Behavior proposed by Ajzen to predict healthcare providers' screening behavior for interpersonal violence. Organizational factors, e.g., availability of policy for interpersonal violence screening, organizational priority given to violence screening relative to other priorities, and if providers within the health center are interested in improving care quality, were significantly associated with providers' screening behavior. The knowledge and insights generated from our study may facilitate the design and optimization of health professional training and practice environment, and lead to improved women's health and quality of care.

Work environment of hospital nurses during the COVID-19 pandemic in Brazil

AIM

To investigate the nurses' work environment in university hospitals during the COVID-19 pandemic in Brazil.

BACKGROUND

The COVID-19 pandemic brought challenging times for nurses worldwide. In Brazil, as well as in several countries, nurses are working hard in hospital settings caring for patients infected with the virus, sometimes with unfavourable work environment conditions.

METHODS

This study was a convergent embedded mixed methods research. The sample comprised 104 nurses from three Brazilian university hospitals. Data were collected in April-June 2020 from an online questionnaire with a self-reporting Likert scale survey designed to measure the nurses' perceptions of their work environment. Qualitative data in the form of written comments were also collected through an open question. Data were analysed using descriptive statistics and content analysis.

RESULTS

The quantitative results showed that the responses to 'I received training on the correct use of personal protective equipment' and 'I am afraid of being infected' items had the best and worst evaluations, respectively. The qualitative findings revealed five themes: feeling of insecurity, lack of personal protective equipment, lack of diagnostic tests, changes in the care flow and fear of the unknown.

CONCLUSION

The study has highlighted the challenges faced by hospital nurses while caring for patients with COVID-19.

IMPLICATIONS FOR NURSING AND NURSING POLICY

The gaps identified will assist the policymakers and hospital managers in developing policies to enhance the support offered to nurses and improve the care provided to patients with COVID-19 in university hospitals. The results also indicate the need for attention to the mental health of the professionals due to the increasing workload and treatment of an illness hitherto unknown.