Health surveys via the Internet: quick and dirty or rapid and robust?

The Moderating Role of Psychological Safety in the Relationship between Job Embeddedness, Organizational Commitment, and Retention Intention among Home Care Attendants in Taiwan

As Taiwan's population ages, the need for long-term care, such as home care, is increasing due to improved medical services and longer life expectancy; however, the current coverage rate for home care services is only 50%, highlighting the importance of retaining home care workers. This study applies job embeddedness, organizational commitment, and psychological safety as variables to explore the retention intention of Taiwan's home care workers. A questionnaire survey was distributed among home care workers using convenience sampling, resulting in 547 collected questionnaires, of which 458 were valid. Data analysis was conducted with SPSS 22.0 and AMOS 22.0, and a structural equation model (SEM) was used to test the hypotheses. Our findings suggest that job embeddedness has a positive impact on organizational commitment (γ = 0.649, γ = 0.607, and γ = 0.628; p < 0.001) and retention intention (γ = 0.253, γ = 0.242, γ = 0.271; p < 0.001), similar to organizational commitment (γ = 0.721, p < 0.001). Additionally, organizational commitment mediates job embeddedness and retention intention, while psychological safety moderated organizational commitment and retention intention (β = 0.639; p < 0.001). This study aims to provide information for the development of more effective human resource policies and contribute to practical advancements in the home care service environment and management structure of home care organizations. By analyzing and exploring the main factors contributing to home care workers' retention intention, we hope to enhance the overall benefits of home service organizations and the industry.

Healthcare workers' perception of gender and work roles during the COVID-19 pandemic: a mixed-methods study

OBJECTIVES

A high functioning healthcare workforce is a key priority during the COVID-19 pandemic. We sought to determine how work and mental health for healthcare workers changed during the COVID-19 pandemic in a universal healthcare system, stratified by gender factors.

DESIGN

A mixed-methods study was employed. Phase 1 was an anonymous, internet-based survey (7 May-15 July 2020). Phase 2 was semistructured interviews offered to all respondents upon survey completion to describe how experiences may have differed by gender identity, roles and relations.

SETTING

National universal healthcare system (Canada).

PARTICIPANTS

2058 Canadian healthcare worker survey respondents (87% women, 11% men, 1% transgender or Two-Spirit), including 783 health professionals, 673 allied health professionals, 557 health support staff. Of the 63 unique healthcare worker types reported, registered nurses (11.5%), physicians (9.9%) and pharmacists (4.5%) were most common. Forty-six healthcare workers were interviewed.

MAIN OUTCOME MEASURES

Reported pandemic-induced changes to occupational leadership roles and responsibilities, household and caregiving responsibilities, and anxiety levels by gender identity.

RESULTS

Men (19.8%) were more likely to hold pandemic leadership roles compared with women (13.4%). Women (57.5%) were more likely to report increased domestic responsibilities than men (45%). Women and those with dependents under the age of 10 years reported the greatest levels of anxiety during the pandemic. Interviews with healthcare workers further revealed a perceived imbalance in leadership opportunities based on gender identity, a lack of workplace supports disproportionately affecting women and an increase in domestic responsibilities influenced by gender roles.

CONCLUSIONS

The COVID-19 pandemic response has important gendered effects on the healthcare workforce. Healthcare workers are central to effective pandemic control, highlighting an urgent need for a gender-transformative pandemic response strategy.

Increasing access to erectile dysfunction treatment via pharmacies to improve healthcare provider visits and quality of life: Results from a prospective real-world observational study in the United Kingdom

OBJECTIVES

The Medicines and Healthcare Products Regulatory Agency in the United Kingdom (UK) formally reclassified sildenafil citrate 50 mg tablets as a pharmacy medicine (sildenafil-P) in 2017 for adult men with erectile dysfunction (ED). A 1-year prospective real-world observational study was conducted to track men's health behaviour, particularly their healthcare resource utilisation (HCRU) and quality of life (QoL) before and after the availability of sildenafil-P.

METHODS

Adult men with ED aged ≥18 years provided data at baseline (prior to launch of sildenafil-P) and every 3 months after the launch. Demographics, health characteristics, treatments at baseline and HCRU, including number of pharmacist and physician/nurse practitioner visits over time are reported. QoL-related outcomes were assessed via the Self-Esteem and Relationship Questionnaire (SEAR), 2-Item Patient Health Questionnaire and ratings of sexual satisfaction. Generalised linear models were used to assess the association of sildenafil-P use with total physician/nurse practitioner and pharmacist visits and QoL-related outcomes at 12 months.

RESULTS

Overall, 1162 men completed the survey at all 5 time points. The mean ± SD age was 59.02 ± 12.06 years; 55.42% reported having a moderate-to-severe ED. Hypertension (37.52%) and hypercholesterolaemia (31.50%) were the most common risk factors for ED. At baseline, 62.99% were not using any ED treatment. After adjusting for baseline visits/other covariates, mean physician/nurse practitioner (3.68 vs 2.87; P = .003) and pharmacist visits for any reason (2.10 vs 1.34; P < .001) at 12 months were significantly higher among sildenafil-P users than those who never used sildenafil-P. Sildenafil-P users also had significantly higher SEAR total and domain (sexual relationship and self-esteem) scores at 12 months.

CONCLUSION

Following the reclassification to a pharmacy medicine in the UK, sildenafil-P was associated with a higher number of physician/nurse practitioner and pharmacist visits for any reason. Sildenafil-P use was also associated with better QoL, although group differences were small in magnitude.

A guide to evaluating survey research methodology in pediatric urology

Surveys are one of the most common study designs in healthcare research. They are easy to undertake, have minimal cost and aim to obtain reliable and unbiased information from a population of interest. Surveys in pediatric surgery/urology are an effective tool for gathering information on clinical practices for rare and complex conditions that highlight information on their behavior, institutional disparities, and healthcare paradigms. This education article consists of using a published survey by one of the authors as an example to demonstrate both positive and negative aspects, including limitations, of survey design studies with the purpose of helping pediatric urologists develop a framework to create and critically appraise survey methodology. Using this approach, readers should be able to reliably discern the methodological quality of published surveys.

Real-World Assessment of the Impact of Erectile Dysfunction on Sexual Planning Behavior and Health- and Treatment-Related Outcomes Among Men in 8 Countries

INTRODUCTION

The effect of erectile dysfunction (ED) on sexual planning behaviors and outcomes in men taking phosphodiesterase type 5 inhibitors (PDE5Is) is not well studied.

AIMS

To assess sexual habits, behaviors, and treatment-related outcomes of PDE5I-treated men with ED.

METHODS

This cross-sectional observational study recruited men aged 30 to 70 years with mild-to-severe ED from 8 diverse countries (the United States, the United Kingdom, Italy, Russia, Turkey, Israel, China, and Japan) to complete an approximately 15-minute survey. Differences were evaluated using bivariate analyses, and data were summarized using descriptive statistics.

MAIN OUTCOME MEASURES

Self-reported data were collected for demographics, health characteristics, treatment, sexual habits, ED severity, ED-specific quality of life, and treatment satisfaction.

RESULTS

The survey was completed by 1,575 men. Mean frequency of sexual intercourse was 5.7 times/month. Overall, 87.1% of men always, often, or sometimes planned for sexual activity. Of those planning in advance, 32.8% and 40.6% agreed or strongly agreed that they plan for specific days of the week and times of day, respectively. Sexual planning habits were similar for patients taking short-acting vs long-acting PDE5Is. The most commonly cited reasons for planning sexual activity were needing time to take medication (48.4%), needing to make sure medication has taken effect (43.4%), convenient time for sexual activity (34.9%), and needing the partner's agreement (33.4%). Mean Self-Esteem and Relationship Questionnaire total score was 56.4.

CONCLUSIONS

The differences in ED burden and sexual planning behavior observed across countries were not influenced by the type of PDE5I being taken, suggesting that cultural differences are an important factor when considering types of ED treatment. These findings provide a better understanding of burden, sexual habits, planning behaviors, quality of life, and treatment-related outcomes among PDE5I-treated men with ED in 8 Western and non-Western countries and may aid healthcare providers in selecting optimal treatments. Goldstein I, Giraldi A, Maculaitis MC, Real-World Assessment of the Impact of Erectile Dysfunction on Sexual Planning Behavior and Health- and Treatment-Related Outcomes Among Men in 8 Countries. J Sex Med 2020;8:338-349.

Global Consensus From Clinicians Regarding Low Back Pain Outcome Indicators for Older Adults: Pairwise Wiki Survey Using Crowdsourcing

BACKGROUND

Low back pain (LBP) is one of the most debilitating conditions among older adults. Unfortunately, existing LBP outcome questionnaires are not adapted for specific circumstances related to old age, which may make these measures less than ideal for evaluating LBP in older adults.

OBJECTIVE

To explore the necessity of developing age-specific outcome measures, crowdsourcing was conducted to solicit opinions from clinicians globally.

METHODS

Clinicians around the world voted and/or prioritized various LBP outcome indicators for older adults on a pairwise wiki survey website. Seven seed outcome indicators were posted for voting while respondents were encouraged to suggest new indicators for others to vote/prioritize. The website was promoted on the social media of various health care professional organizations. An established algorithm calculated the mean scores of all ideas. A score >50 points means that the idea has >50% probability of beating another randomly presented indicator.

RESULTS

Within 42 days, 128 respondents from 6 continents cast 2466 votes and proposed 14 ideas. Indicators pertinent to improvements of physical functioning and age-related social functioning scored >50 while self-perceived reduction of LBP scored 32.

CONCLUSIONS

This is the first crowdsourcing study to address LBP outcome indicators for older adults. The study noted that age-specific outcome indicators should be integrated into future LBP outcome measures for older adults. Future research should solicit opinions from older patients with LBP to develop age-specific back pain outcome measures that suit clinicians and patients alike.

Electronic Questionnaires Design and Implementation

BACKGROUND

Nursing and health care research are increasingly using e-questionnaires and e-forms for data collection and survey conduction. The main reason lies in costs, time and data-entry errors containment, increased flexibility, functionality and usability. In spite of this growing usage, no specifc and comprehensive guidelines for designing and submitting e-questionnaires have been produced so far.

OBJECTIVE

The aim of this review is to collect information on the current best practices, taking them from various fields of application. An evaluation of the efficacy of the single indication is provided.

METHOD

A literature review of guidelines currently available on WebSM (Web Survey Methodology) about electronic questionnaire has been performed. Four search strings were used: "Electronic Questionnaire Design", "Electronic Questionnaire", "Online Questionnaire" and "Online survey". Articles' inclusion criteria were English language, relevant topic in relation to the aim of the research and the publication date from January 1998 to July 2014.

RESULTS

The review process led to identify 48 studies. The greater part of guidelines is reported for Web, and e-mail questionnaire, while a lack of indications emerges especially for app and e-questionnaires.

CONCLUSION

Lack of guidelines on e-questionnaires has been found, especially in health care research, increasing the risk of use of ineffective and expensive instruments; more research in this field is needed.

Leakage after Surgery for Rectum Cancer: Inconsistency in Reporting to the Danish Colorectal Cancer Group

Purpose. Anastomotic leakage accounts for up to 1/3 of all fatalities after rectal cancer surgery. Evidence suggests that anastomotic leakage has a negative prognostic impact on local cancer recurrence and long-term cancer specific survival. The reported leakage rate in 2011 in Denmark varied from 7 to 45 percent. The objective was to clarify if the reporting of anastomotic leakage to the Danish Colorectal Cancer Group was rigorous and unequivocal. Methods. An Internet-based questionnaire was e-mailed to all Danish surgical departments, who reported to Danish Colorectal Cancer Group (DCCG) in 2011. There were 23 questions. Four core questions were whether pelvic collection, fecal appearance in a pelvic drain, rectovaginal fistula, and "watchfull" waiting patients were reported as anastomotic leakage. Results. Fourteen out of 17 departments, who in 2011 according to DDCG performed rectal cancer surgery, answered the questionnaire. This gave a response rate of 82%. In three of four core questions there was disagreement in what should be reported as anastomotic leakage. Conclusion. The reporting of anastomotic leakage to the Danish Colorectal Cancer Group was not rigorous and unequivocal. The reported anastomotic leakage rate in Danish Colorectal Cancer Group should be interpreted with caution.

Internet-Based Birth-Cohort Studies: Is This the Future for Epidemiology?

Background

International collaborative cohorts the NINFEA and the ELF studies are mother-child cohorts that use the internet for recruitment and follow-up of their members. The cohorts investigated the association of early life exposures and a wide range of non-communicable diseases.

Objective

The objective is to report the research methodology, with emphasis on the advantages and limitations offered by an Internet-based design. These studies were conducted in Turin, Italy and Wellington, New Zealand.

Methods

The cohorts utilized various online/offline methods to recruit participants. Pregnant women who became aware volunteered, completed an online questionnaire, thus obtaining baseline information.

Results

The NINFEA study has recruited 7003 pregnant women, while the ELF study has recruited 2197 women. The cohorts targeted the whole country, utilizing a range of support processes to reduce the attrition rate of the participants. For the NINFEA and ELF cohorts, online participants were predominantly older (35% and 28.9%, respectively), highly educated (55.6% and 84.9%, respectively), and were in their final trimester of pregnancy (48.5% and 53.6%, respectively).

Conclusions

Internet-based cohort epidemiological studies are feasible, however, it is clear that participants are self-selective samples, as is the case for many birth cohorts. Internet-based cohort studies are potentially cost-effective and novel methodology for conducting long-term epidemiology research. However, from our experience, participants tend to be self-selective. In marked time, if the cohorts are to form part of a larger research program they require further use and exploration to address biases and overcome limitations.

An online survey of horse-owners in Great Britain

BACKGROUND

Contingency planning for potential equine infectious disease outbreaks relies on accurate information on horse location and movements to estimate the risk of dissemination of disease(s). An online questionnaire was used to obtain unique information linking owner and horse location to characteristics of horse movements within and outwith Great Britain (GB).

RESULTS

This online survey yielded a strong response, providing more than four times the target number of respondents (1000 target respondents) living in all parts of GB. Key demographic findings of this study indicated that horses which were kept on livery yards and riding schools were likely to be found in urban environments, some distance away from the owner's home and vaccinated against influenza and herpes virus. Survey respondents were likely to travel greater than 10 miles to attend activities such as eventing or endurance but were also likely to travel and return home within a single day (58.6%, 2063/3522). This may affect the geographical extent and speed of disease spread, if large numbers of people from disparate parts of the country are attending the same event and the disease agent is highly infectious or virulent. The greatest risk for disease introduction and spread may be represented by a small proportion of people who import or travel internationally with their horses. These respondents were likely to have foreign horse passports, which were not necessarily recorded in the National Equine Database (NED), making the location of these horses untraceable.

CONCLUSIONS

These results illustrate the difficulties which exist with national GB horse traceability despite the existence of the NED and the horse passport system. This study also demonstrates that an online approach could be adopted to obtain important demographic data on GB horse owners on a more routine and frequent basis to inform decisions or policy pertaining to equine disease control. This represents a reasonable alternative to collection of GB horse location and movement data given that the NED no longer exists and there is no immediate plan to replace it.

Use of electronic communication by physician breastfeeding experts for support of the breastfeeding mother

BACKGROUND

Breastfeeding initiation and duration increase because of physician encouragement. However, many physicians have not received education on breastfeeding, and some may not have a supportive attitude or commitment to breastfeeding. Patients identify dissatisfaction with their current provider as a motivating factor in seeking health information on the Internet. This survey was performed to determine how many physicians with an interest and expertise in breastfeeding are being contacted for breastfeeding information over the Internet and to examine physicians' attitudes to these requests.

SUBJECTS AND METHODS

An e-mail describing the survey, inviting participation, and containing a link to the online questionnaire was posted on the Web site of the Academy of Breastfeeding Medicine and as well as on the Listserv of the American Academy of Pediatrics-Section on Breastfeeding. Information collected included physician training, successes and challenges related to providing breastfeeding medicine support by e-mail, and current level of e-mail communication with patients regarding breastfeeding issues.

RESULTS

One-fourth of physicians in our survey receive e-mails with questions about breastfeeding issues from patients with whom they have no preexisting relationships. More receive e-mail from known patients. This suggests that breastfeeding mothers seek expert information on the Internet. Over half of the physicians replied to e-mails individually and without any financial reimbursement.

CONCLUSIONS

Many breastfeeding mothers reach out to breastfeeding experts over the Internet. Our findings suggest that physicians who provide care to breastfeeding mothers need further education on breastfeeding to provide adequate support to their own patients.

What do surgical trainees think about patient safety culture, and is this different from their consultants?

Introduction

Little is known about the patient safety culture within surgical departments in UK hospitals. What has been done to date is to survey only permanent senior staff opinion of the safety culture in their institution. This study surveyed both consultant and trainee views on perceived patient safety and compared the results between these two groups.

Material and methods

The previously validated Team Work and Safety Climate Questionnaire was configured in Survey Monkey format and sent to all surgical trainees and consultant surgeons in the South West Strategic Health Authority. Two reminders were sent to achieve as high a return rate as possible.

Results

Two hundred and ninety-six replies were received. Forty-four percent of trainees and 30% of consultants responded to the survey. Consultants consistently rated a higher safety culture than surgical trainees. Only 2.9% of trainees believe their patient safety concerns would be acted upon by hospital management. There is notable variation in perceived patient safety culture between hospitals.

Conclusion

This study has suggested that the patient safety culture in hospitals, within a Strategic Health Authority, is variable and sub-optimal when viewed by surgical trainees and their consultants. This study also provides some evidence that the perception of patient safety in an organization varies according to clinical experience. As trainees deliver a great deal of clinical care, surveys of safety culture should include this group. As perceived patient safety culture is correlated to clinical outcomes, validated safety surveys might form part of the assessment of a hospital's performance, along with outcome and patient satisfaction.

Continuing education for advanced manual and manipulative physiotherapists in Canada: a survey of perceived needs

PURPOSE

Our purpose was to determine advanced manual and manipulative physiotherapists' (AMPTs') current use and awareness of continuing education (CE) opportunities; to establish their perceived CE needs by identifying facilitators and barriers to participation; and to explore the association of demographics with CE needs.

METHODS

A questionnaire was e-mailed to 456 registered members of the Canadian Academy of Manipulative Physiotherapy. Data analyses using frequencies and percentages of total responses and t-tests for group comparisons were performed.

RESULTS

One hundred thirty-three (29.2%) participants responded. Most lived in an urban region and worked predominantly in direct patient care. More respondents reported engaging in informal CE than in formal CE. Hands-on or practical workshops were the preferred CE format. Common barriers to CE included professional commitments and cost and time of travel; facilitators included interest in the topic and increasing knowledge and competency. AMPTs with less physical therapy experience found cost to be a greater barrier and were more interested in mentorship programs and CE as a means to obtain credentials.

CONCLUSIONS

AMPTs' preferred CE formats are inconsistent with the CE opportunities in which they participate. CE initiatives for AMPTs should include hands-on training and should account for time and cost to make CE opportunities more readily available to them.

Attitudes of a group of Brazilian orthodontists towards the diagnosis and management of primary headache (migraine): an electronic-based survey

Objectives

The aim of this study was to investigate the knowledge and attitudes of orthodontists in the diagnosis and management of migraine without aura.

Material and Methods

Participants were dentists, recruited among members of the Brazilian Association of Orthodontics and Facial Orthopedics (ABOR). An e-mail was sent to all ABOR members, with a link to a website, especially prepared for this research. Dentists were presented to a report of a fictional patient fulfilling diagnostic criteria for a primary headache disorder, known as migraine without aura. Participants were asked to describe how they would relieve the patient's pain. Professional procedures were classified as "adequate" or "inadequate" according to the answers given.

Results

161 valid answers were received (18.8% response rate). Of them, 36% of the actions were considered to be "adequate" procedures, while 64% were "inadequate". The results yielded 12 main procedures, based on common characteristics. Eighty-two orthodontists suggested orthodontic treatment with or without orthognathic surgery, and some suggested using stabilization appliances prior to the orthodontic treatment.

Conclusions

The majority of participants proposed inadequate therapies, and 51% suggested orthodontic correction of occlusion, including orthognathic surgery. Educational activities on migraine should also target orthodontists.

Use of a web-based questionnaire to explore cat owners' attitudes towards vaccination in cats

This study aimed to develop a better understanding of factors involved in cat owners' decisions related to vaccination and to explore their views and knowledge of vaccination. Data were collected using a web-based 'Cat Health Questionnaire'. A total of 3204 respondents participated in the survey, each answering questions with only one cat in mind. Forty-one questionnaires were not included; of the remaining 3163 cats, 69 per cent were reported to have been vaccinated in the last 12 months. Vaccination as a kitten was the strongest predictor of up-to-date vaccination status, followed by the intention to take the cat to a cattery or cat show in the next year. The owners' perception of the importance of stress on the cat, the age of the cat or the cost of vaccination was associated with the cat's current vaccination status. Owners who perceived the severity of infectious diseases or veterinary advice as very important were more likely to vaccinate their cats than owners who perceived these factors as less important. The owners' perceptions of the risk and their previous experiences of side effects in a cat were not associated with a decreased likelihood of vaccination.

Premonition of Death in Trauma: A Survey of Healthcare Providers

Prognostication in western medicine has traditionally been based on objective scientific criteria, yet providers often rely on a feeling or “sense” based on experience to provide prognoses. In trauma, some providers believe that patients who express a feeling of death are more likely to die. We randomly surveyed 302 members of the Eastern Association for the Surgery of Trauma regarding patient's premonitions of death (POD). Ninety-five per cent of respondents reported encountering patients who expressed POD. Fifty per cent agreed patients expressing POD had a higher mortality rate. Fifty-seven per cent believe patient willpower affects outcome. Forty-four per cent agreed patients have an innate ability to sense their ultimate outcome after injury; 85 per cent believe patient's POD do not cause deviations from protocols. Most trauma providers have encountered patients expressing POD. Whereas most believe that a patient's willpower affects outcome, they do not believe that expressing a desire to live decreases mortality with seemingly fatal injuries. Providers who have witnessed negative POD believe these patients are more likely to die, however, they do not deviate from treatment protocols. This survey represents the first attempt to understand the magnitude of premonition of death in trauma and the need for future research.

Veiled communication: is uncovering necessary for psychiatric assessment?

Facial expressions are significant to decipher information during a dialogue and more so in a clinical consultation. Veils (Niqab) worn by Muslim women may pose a clinical dilemma for the psychiatric assessment especially if clinicians are not aware of their religious significance. To investigate whether clinical judgment is affected if full facial expressions are not accessible, we conducted an email survey of psychiatrists and psychologists across the world who frequently work in these situations. Of 25 colleagues contacted 16 responded and 11 of them agreed for their comments to be included in the study. Nine out of 11 believed clinical assessment may be compromised, although respondents were aware of cultural sensitivity around the issue. Two out of 11 however, felt fully able to assess the mental state of a veiled woman. Some professionals reported that they feel unable to assess or treat if the request to take the veil off is declined. This small survey demonstrates the diverse opinions on whether unveiling is necessary for psychiatric assessment. Further qualitative examination of this area is needed to develop wider consensus and guidance to mental health care professionals who may be dealing with these groups.

Online consumer surveys as a methodology for assessing the quality of the United States health care system

BACKGROUND

Interest in monitoring the quality of health care in the United States has increased in recent years. However, the policy objectives associated with collecting this information are constrained by the limited availability of timely and relevant data at a reasonable cost. Online data-collection technologies hold the promise of gathering data directly and inexpensively from large, representative samples of patients and consumers. These new information technologies also permit efficient, real-time assessment in such areas as health status, access to care, and other aspects of the care experience that impact health outcomes.

OBJECTIVE

This study investigates the feasibility, validity, and generalizability of consumer online surveys to measure key aspects of health care quality in the United States.

METHODS

Surveys about the health and health care experiences of a general adult population and of adults with diabetes were administered online and by telephone. The online survey drew from a sample frame of nearly 1 million consumers and used a single e-mail notification. The random-digit-dial methodology included 6 follow-up calls. Results from the online sample were compared to the telephone sample and to national benchmark data.

RESULTS

Survey responses about quality of care collected using online and telephone methods were commensurate once they were weighted to represent the demographic distribution of the 2000 United States Census. Expected variations in health and health care quality across demographic and socioeconomic groups were largely observed, as were hypothesized associations among quality indicators and other variables. Fewer individuals were required to be contacted to achieve target sample sizes using online versus telephone methods. Neither method yielded representative cohorts of nonwhite individuals.

CONCLUSIONS

Conclusions about the level and variations in health care quality in the United States are similar using data collected in this study compared to data collected using other telephone-based survey methods. As is typical for national telephone surveys conducted by the National Center for Health Statistics, stratified sampling and weighting of survey responses is necessary for results to be generalizable. Online methods are more appropriate for understanding health care quality than for conducting epidemiologic assessments of health in the United States.

Using the Internet to conduct surveys of health professionals: a valid alternative?

OBJECTIVE

The purpose of this study was to examine whether Internet-based surveys of health professionals can provide a valid alternative to traditional survey methods.

METHODS

(i) Systematic review of published Internet-based surveys of health professionals focusing on criteria of external validity, specifically sample representativeness and response bias. (ii) Internet-based survey of GPs, exploring attitudes about using an Internet-based decision support system for the management of familial cancer.

RESULTS

The systematic review identified 17 Internet-based surveys of health professionals. Whilst most studies sampled from professional e-directories, some studies drew on unknown denominator populations by placing survey questionnaires on open web sites or electronic discussion groups. Twelve studies reported response rates, which ranged from nine to 94%. Sending follow-up reminders resulted in a substantial increase in response rates. In our own survey of GPs, a total of 268 GPs participated (adjusted response rate = 52.4%) after five e-mail reminders. A further 72 GPs responded to a brief telephone survey of non-respondents. Respondents to the Internet survey were more likely to be male and had significantly greater intentions to use Internet-based decision support than non-respondents.

CONCLUSIONS

Internet-based surveys provide an attractive alternative to postal and telephone surveys of health professionals, but they raise important technical and methodological issues which should be carefully considered before widespread implementation. The major obstacle is external validity, and specifically how to obtain a representative sample and adequate response rate. Controlled access to a national list of NHSnet e-mail addresses of health professionals could provide a solution.