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Edwards PJ, Roberts I, Clarke MJ, DiGuiseppi C, Woolf B, Perkins C. Methods to increase response to postal and electronic questionnaires. Cochrane Database Syst Rev 2023; 11:MR000008. [PMID: 38032037 PMCID: PMC10687884 DOI: 10.1002/14651858.mr000008.pub5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
BACKGROUND Self-administered questionnaires are widely used to collect data in epidemiological research, but non-response reduces the effective sample size and can introduce bias. Finding ways to increase response to postal and electronic questionnaires would improve the quality of epidemiological research. OBJECTIVES To identify effective strategies to increase response to postal and electronic questionnaires. SEARCH METHODS We searched 14 electronic databases up to December 2021 and manually searched the reference lists of relevant trials and reviews. We contacted the authors of all trials or reviews to ask about unpublished trials; where necessary, we also contacted authors to confirm the methods of allocation used and to clarify results presented. SELECTION CRITERIA Randomised trials of methods to increase response to postal or electronic questionnaires. We assessed the eligibility of each trial using pre-defined criteria. DATA COLLECTION AND ANALYSIS We extracted data on the trial participants, the intervention, the number randomised to intervention and comparison groups and allocation concealment. For each strategy, we estimated pooled odds ratios (OR) and 95% confidence intervals (CI) in a random-effects model. We assessed evidence for selection bias using Egger's weighted regression method and Begg's rank correlation test and funnel plot. We assessed heterogeneity amongst trial odds ratios using a Chi2 test and quantified the degree of inconsistency between trial results using the I2 statistic. MAIN RESULTS Postal We found 670 eligible trials that evaluated over 100 different strategies of increasing response to postal questionnaires. We found substantial heterogeneity amongst trial results in half of the strategies. The odds of response almost doubled when: using monetary incentives (odds ratio (OR) 1.86; 95% confidence interval (CI) 1.73 to 1.99; heterogeneity I2 = 85%); using a telephone reminder (OR 1.96; 95% CI 1.03 to 3.74); and when clinical outcome questions were placed last (OR 2.05; 95% CI 1.00 to 4.24). The odds of response increased by about half when: using a shorter questionnaire (OR 1.58; 95% CI 1.40 to 1.78); contacting participants before sending questionnaires (OR 1.36; 95% CI 1.23 to 1.51; I2 = 87%); incentives were given with questionnaires (i.e. unconditional) rather than when given only after participants had returned their questionnaire (i.e. conditional on response) (OR 1.53; 95% CI 1.35 to 1.74); using personalised SMS reminders (OR 1.53; 95% CI 0.97 to 2.42); using a special (recorded) delivery service (OR 1.68; 95% CI 1.36 to 2.08; I2 = 87%); using electronic reminders (OR 1.60; 95% CI 1.10 to 2.33); using intensive follow-up (OR 1.69; 95% CI 0.93 to 3.06); using a more interesting/salient questionnaire (OR 1.73; 95% CI 1.12 to 2.66); and when mentioning an obligation to respond (OR 1.61; 95% CI 1.16 to 2.22). The odds of response also increased with: non-monetary incentives (OR 1.16; 95% CI 1.11 to 1.21; I2 = 80%); a larger monetary incentive (OR 1.24; 95% CI 1.15 to 1.33); a larger non-monetary incentive (OR 1.15; 95% CI 1.00 to 1.33); when a pen was included (OR 1.44; 95% CI 1.38 to 1.50); using personalised materials (OR 1.15; 95% CI 1.09 to 1.21; I2 = 57%); using a single-sided rather than a double-sided questionnaire (OR 1.13; 95% CI 1.02 to 1.25); using stamped return envelopes rather than franked return envelopes (OR 1.23; 95% CI 1.13 to 1.33; I2 = 69%), assuring confidentiality (OR 1.33; 95% CI 1.24 to 1.42); using first-class outward mailing (OR 1.11; 95% CI 1.02 to 1.21); and when questionnaires originated from a university (OR 1.32; 95% CI 1.13 to 1.54). The odds of response were reduced when the questionnaire included questions of a sensitive nature (OR 0.94; 95% CI 0.88 to 1.00). Electronic We found 88 eligible trials that evaluated over 30 different ways of increasing response to electronic questionnaires. We found substantial heterogeneity amongst trial results in half of the strategies. The odds of response tripled when: using a brief letter rather than a detailed letter (OR 3.26; 95% CI 1.79 to 5.94); and when a picture was included in an email (OR 3.05; 95% CI 1.84 to 5.06; I2 = 19%). The odds of response almost doubled when: using monetary incentives (OR 1.88; 95% CI 1.31 to 2.71; I2 = 79%); and using a more interesting topic (OR 1.85; 95% CI 1.52 to 2.26). The odds of response increased by half when: using non-monetary incentives (OR 1.60; 95% CI 1.25 to 2.05); using shorter e-questionnaires (OR 1.51; 95% CI 1.06 to 2.16; I2 = 94%); and using a more interesting e-questionnaire (OR 1.85; 95% CI 1.52 to 2.26). The odds of response increased by a third when: offering survey results as an incentive (OR 1.36; 95% CI 1.16 to 1.59); using a white background (OR 1.31; 95% CI 1.10 to 1.56); and when stressing the benefits to society of response (OR 1.38; 95% CI 1.07 to 1.78; I2 = 41%). The odds of response also increased with: personalised e-questionnaires (OR 1.24; 95% CI 1.17 to 1.32; I2 = 41%); using a simple header (OR 1.23; 95% CI 1.03 to 1.48); giving a deadline (OR 1.18; 95% CI 1.03 to 1.34); and by giving a longer time estimate for completion (OR 1.25; 95% CI 0.96 to 1.64). The odds of response were reduced when: "Survey" was mentioned in the e-mail subject (OR 0.81; 95% CI 0.67 to 0.97); when the email or the e-questionnaire was from a male investigator, or it included a male signature (OR 0.55; 95% CI 0.38 to 0.80); and by using university sponsorship (OR 0.84; 95%CI 0.69 to 1.01). The odds of response using a postal questionnaire were over twice those using an e-questionnaire (OR 2.33; 95% CI 2.25 to 2.42; I2 = 98%). Response also increased when: providing a choice of response mode (electronic or postal) rather than electronic only (OR 1.76 95% CI 1.67 to 1.85; I2 = 97%); and when administering the e-questionnaire by computer rather than by smartphone (OR 1.62 95% CI 1.36 to 1.94). AUTHORS' CONCLUSIONS Researchers using postal and electronic questionnaires can increase response using the strategies shown to be effective in this Cochrane review.
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Affiliation(s)
- Philip James Edwards
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ian Roberts
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Mike J Clarke
- Centre for Public Health, Queens University Belfast, Belfast, UK
| | - Carolyn DiGuiseppi
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Benjamin Woolf
- School of Psychological Science, University of Bristol, Bristol, UK
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Li Y, Marquez R. Can government subsidies and public mechanisms alleviate the physical and mental health vulnerability of China's urban and rural residents? Int J Equity Health 2023; 22:59. [PMID: 37005599 PMCID: PMC10067002 DOI: 10.1186/s12939-022-01805-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 12/12/2022] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Poverty vulnerability has been defined as the likelihood of a family falling into poverty in the upcoming months. Inequality is a major cause of poverty vulnerability in developing countries. There is evidence that establishing effective government subsidies and public service mechanisms significantly reduces health poverty vulnerability. One of the ways to study poverty vulnerability is by using empirical data such as income elasticity of demand to perform the analysis. Income elasticity refers to the extent to which changes in consumers' income affect changes in demand for commodities or public goods. In this work, we assess health poverty vulnerability in rural and urban China. We provide two levels of evidence on the marginal effects of the design and implementation of government subsidies and public mechanisms in reducing health poverty vulnerability, before and after incorporating the income elasticity of demand for health. METHODS Multidimensional physical and mental health poverty indexes, according to the Oxford Poverty & Human Development Initiative and the Andersen model, were implemented to measure health poverty vulnerability by using the 2018 China Family Panel Survey database (CFPS) as the data source for empirical analysis. The income elasticity of demand for health care was used as the key mediating variable of impact. Our assessment was conducted by a two-level multidimensional logistic regression using STATA16 software. RESULTS The first level regression indicates that the marginal utility of public mechanism (PM) in reducing urban and rural vulnerability as expected poverty on physical and mental health (VEP-PH&MH) was insignificant. On the other hand, government subsidies (GS) policies had a positive suppression effect on VEP-PH&MH to a relatively low degree. The second level regression found that given the diversity of health needs across individual households, i.e., the income elasticity of demand (HE) for health care products, PM and GS policies have a significant effect in reducing VEP-PH&MH in rural and urban areas. Our analysis has verified the significant positive impact of enacting accurate GS and PM policies on effectively reducing VEP-PH&MH in rural as well as urban areas. CONCLUSIONS This study shows that implementing government subsidies and public mechanisms has a positive marginal effect on reducing VEP-PH&MH. Meanwhile, there are individual variations in health demands, urban-rural disparities, and regional disparities in the effects of GS and PM on inhibiting VEP-PH&MH. Therefore, special consideration needs to be given to the differences in the degree of health needs of individual residents among urban and rural areas and regions with varying economic development. Furthermore, considerations of this approach in the current worldwide scenario are analyzed.
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Affiliation(s)
- Yali Li
- School of Business, Jiangxi University of Science and Technology, Nanchang, 330013, China.
| | - Ronald Marquez
- Laboratoire Physico-Chimie des Interfaces Complexes, ESPCI Paris, 10 rue Vauquelin, F-75231, Paris, France
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Gibson DG, Kibria GMA, Pariyo GW, Ahmed S, Ali J, Labrique AB, Khan IA, Rutebemberwa E, Flora MS, Hyder AA. Promised and Lottery Airtime Incentives to Improve Interactive Voice Response Survey Participation Among Adults in Bangladesh and Uganda: Randomized Controlled Trial. J Med Internet Res 2022; 24:e36943. [PMID: 35532997 PMCID: PMC9127645 DOI: 10.2196/36943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/10/2022] [Accepted: 03/31/2022] [Indexed: 11/30/2022] Open
Abstract
Background Increased mobile phone penetration allows the interviewing of respondents using interactive voice response surveys in low- and middle-income countries. However, there has been little investigation of the best type of incentive to obtain data from a representative sample in these countries. Objective We assessed the effect of different airtime incentives options on cooperation and response rates of an interactive voice response survey in Bangladesh and Uganda. Methods The open-label randomized controlled trial had three arms: (1) no incentive (control), (2) promised airtime incentive of 50 Bangladeshi Taka (US $0.60; 1 BDT is approximately equivalent to US $0.012) or 5000 Ugandan Shilling (US $1.35; 1 UGX is approximately equivalent to US $0.00028), and (3) lottery incentive (500 BDT and 100,000 UGX), in which the odds of winning were 1:20. Fully automated random-digit dialing was used to sample eligible participants aged ≥18 years. The risk ratios (RRs) with 95% confidence intervals for primary outcomes of response and cooperation rates were obtained using log-binomial regression. Results Between June 14 and July 14, 2017, a total of 546,746 phone calls were made in Bangladesh, with 1165 complete interviews being conducted. Between March 26 and April 22, 2017, a total of 178,572 phone calls were made in Uganda, with 1248 complete interviews being conducted. Cooperation rates were significantly higher for the promised incentive (Bangladesh: 39.3%; RR 1.38, 95% CI 1.24-1.55, P<.001; Uganda: 59.9%; RR 1.47, 95% CI 1.33-1.62, P<.001) and the lottery incentive arms (Bangladesh: 36.6%; RR 1.28, 95% CI 1.15-1.45, P<.001; Uganda: 54.6%; RR 1.34, 95% CI 1.21-1.48, P<.001) than those for the control arm (Bangladesh: 28.4%; Uganda: 40.9%). Similarly, response rates were significantly higher for the promised incentive (Bangladesh: 26.5%%; RR 1.26, 95% CI 1.14-1.39, P<.001; Uganda: 41.2%; RR 1.27, 95% CI 1.16-1.39, P<.001) and lottery incentive arms (Bangladesh: 24.5%%; RR 1.17, 95% CI 1.06-1.29, P=.002; Uganda: 37.9%%; RR 1.17, 95% CI 1.06-1.29, P=.001) than those for the control arm (Bangladesh: 21.0%; Uganda: 32.4%). Conclusions Promised or lottery airtime incentives improved survey participation and facilitated a large sample within a short period in 2 countries. Trial Registration ClinicalTrials.gov NCT03773146; http://clinicaltrials.gov/ct2/show/NCT03773146
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Affiliation(s)
| | | | | | - Saifuddin Ahmed
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Joseph Ali
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | - Iqbal Ansary Khan
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Elizeus Rutebemberwa
- Makerere University School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Adnan Ali Hyder
- Milken Institute School of Public Health, George Washington University, Washington DC, MD, United States
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Arulanandam B, Selvarajan A, Piche N, Sheldon S, Bloom R, Emil S, Li P, Janvier A, Baird R, Sampalis JS, Haggerty J, Guadagno E, Daniel SJ, Poenaru D. Use of a risk communication survey to prioritize family-valued outcomes and communication preferences for children undergoing outpatient surgical procedures. J Pediatr Surg 2022; 57:788-797. [PMID: 35063255 DOI: 10.1016/j.jpedsurg.2021.12.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 12/28/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Effective shared decision-making in pediatric surgery requires clarity regarding which surgical outcomes are most important to patients and their families, and how they prefer to receive the information. Despite how essential this is for effective risk communication, little is known about the communication needs and preferences of patients and their families in elective pediatric surgery. METHODS We administered a mailed and online cross-sectional survey in English and French to 548 families before or after surgery for hernia/hydrocele repair or tonsillectomy/adenoidectomy between July 2019 and February 2021. The survey consisted of 22 questions eliciting most valued patient-reported outcomes (PROs) across 4 domains: health-related quality of life (5), functional status (5), symptoms and symptom burden (5), health behaviours and patient experience (7), as well as overall impressions (3), surgical risks (5), communication preferences (4), and demographic questions (16). RESULTS The survey was completed by 368 patient families (60 preoperative, 308 postoperative, response rate 67.2%). Most respondents (72%) indicated a significant desire to be informed on all listed PROs alongside surgical complications, and highly valued all functional and quality of life outcomes (92.9% & 89.8%, respectively). Preoperatively, patient families preferred to receive information in the form of pamphlets and websites, whereas postoperatively they preferred direct communication. CONCLUSION Families value functional and quality of life PROs as much as clinical outcomes, and increasingly seek more contemporary (electronic) means of risk communication than we currently offer. This data will inform the development of mobile tools for personalized communication in pediatric surgery.
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Affiliation(s)
- Brandon Arulanandam
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Arthega Selvarajan
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Nelson Piche
- Division of Pediatric General Surgery, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Signy Sheldon
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Robert Bloom
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Sherif Emil
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Patricia Li
- Division of General Pediatrics, The Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Annie Janvier
- Division of Neonatology, Research Center, Clinical Ethics Unit, Palliative Care Unit, Centre d'excellence en éthique clinique, CHU Sainte-Justine, Montreal, Quebec, Canada. Department of Pediatrics, Bureau de l'Éthique Clinique, Université de Montréal, Montreal, QC, Canada
| | - Robert Baird
- Division of Pediatric General Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Jeannie Haggerty
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Sam J Daniel
- Division of Otolaryngology - Head and Neck Surgery, The Montreal Children's Hospital, Montreal, QC, Canada
| | - Dan Poenaru
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
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5
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Hathaway CA, Chavez MN, Kadono M, Ketcher D, Rollison DE, Siegel EM, Peoples AR, Ulrich CM, Penedo FJ, Tworoger SS, Gonzalez BD. Improving Electronic Survey Response Rates Among Cancer Center Patients During the COVID-19 Pandemic: Mixed Methods Pilot Study. JMIR Cancer 2021; 7:e30265. [PMID: 34156965 PMCID: PMC8360334 DOI: 10.2196/30265] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Surveys play a vital role in cancer research. During the COVID-19 pandemic, the use of electronic surveys is crucial to improve understanding of the patient experience. However, response rates to electronic surveys are often lower compared with those of paper surveys. OBJECTIVE The aim of this study was to determine the best approach to improve response rates for an electronic survey administered to patients at a cancer center during the COVID-19 pandemic. METHODS We contacted 2750 patients seen at Moffitt Cancer Center in the prior 5 years via email to complete a survey regarding their experience during the COVID-19 pandemic, with patients randomly assigned to a series of variations of prenotifications (ie, postcard, letter) or incentives (ie, small gift, modest gift card). In total, eight combinations were evaluated. Qualitative interviews were conducted to understand the level of patient understanding and burden with the survey, and quantitative analysis was used to evaluate the response rates between conditions. RESULTS A total of 262 (9.5%) patients completed the survey and 9 participated in a qualitative interview. Interviews revealed minimal barriers in understanding or burden, which resulted in minor survey design changes. Compared to sending an email only, sending a postcard or letter prior to the email improved response rates from 3.7% to 9.8%. Similarly, inclusion of an incentive significantly increased the response rate from 5.4% to 16.7%, especially among racial (3.0% to 12.2%) and ethnic (6.4% to 21.0%) minorities, as well as among patients with low socioeconomic status (3.1% to 14.9%). CONCLUSIONS Strategies to promote effective response rates include prenotification postcards or letters as well as monetary incentives. This work can inform future survey development to increase response rates for electronic surveys, particularly among hard-to-reach populations.
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Affiliation(s)
- Cassandra A Hathaway
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, United States
| | - Melody N Chavez
- Participant Research, Interventions, and Measurements Core, Moffitt Cancer Center, Tampa, FL, United States
| | - Mika Kadono
- The AltaMed Institute for Health Equity, Los Angeles, CA, United States
| | - Dana Ketcher
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
| | - Dana E Rollison
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, United States
| | - Erin M Siegel
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, United States
| | - Anita R Peoples
- Huntsman Cancer Institute, Salt Lake City, UT, United States.,Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - Cornelia M Ulrich
- Huntsman Cancer Institute, Salt Lake City, UT, United States.,Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - Frank J Penedo
- Departments of Medicine and Psychology, University of Miami, Coral Gables, FL, United States
| | - Shelley S Tworoger
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, United States.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
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Kilpatrick K, Tchouaket E, Fernandez N, Jabbour M, Dubois CA, Paquette L, Landry V, Gauthier N, Beaulieu MD. Patient and family views of team functioning in primary healthcare teams with nurse practitioners: a survey of patient-reported experience and outcomes. BMC FAMILY PRACTICE 2021; 22:76. [PMID: 33866963 PMCID: PMC8054435 DOI: 10.1186/s12875-021-01406-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 03/07/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Nurse practitioners (NPs) have been added to primary healthcare teams to improve access to care. Team processes, including communication and decision-making, explicate how patients and families view team functioning. Yet, important gaps exist in our understanding of patient-reported experience and outcomes at the level of the healthcare team. We aimed to examine the influence of individual, team, and organizational characteristics, and role clarity on outcomes of care mediated by team processes in primary healthcare teams that include NPs. METHODS A cross-sectional survey across six sites representing practices with NPs in Québec, Canada, was conducted between March 2018 and April 2019 as part of a multiple-case study. Patients and families (n = 485; response rate: 53%) completed a validated questionnaire, which included a patient-reported experience measure (PREM) and a patient-reported outcome measure (PROM) of team functioning (Cronbach alpha: 0.771 (PROM) to 0.877 (PREM)). We performed logistic regression and mediation analyses to examine relationships between the individual, team, and organizational characteristics, role clarity, and outcomes of care mediated by team processes. RESULTS Patients and families expressed positive perceptions of team functioning (mean 4.97/6 [SD 0.68]) and outcomes of care (5.08/6 [0.74]). Also, high team processes (adjusted odds ratio [AOR] 14.92 [95% CI 8.11 to 27.44]) was a significant predictor of high outcomes of care. Role clarity (indirect effect coefficient ab = 6.48 [95% CI 3.79 to 9.56]), living in an urban area (-1.32 [-2.59 to -0.13]), patient as respondent (-1.43 [-2.80 to -0.14]), and income (1.73 [0.14 to 3.45]) were significant predictors of outcomes of care mediated by team processes. CONCLUSIONS This study provides key insights on how primary healthcare teams with NPs contribute to team functioning, using a validated instrument consistent with a conceptual framework. Results highlight that high role clarity, living in a non urban area, family as respondent, and adequate income were significant predictors of high outcomes of care mediated by high team processes. Additional research is needed to compare teams with and without NPs in different settings, to further explicate the relationships identified in our study.
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Affiliation(s)
- Kelley Kilpatrick
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada.
| | - Eric Tchouaket
- Department of Nursing, Université du Québec en Outaouais (UQO), St-Jérôme Campus, Saint-Jérôme, Québec, Canada
| | - Nicolas Fernandez
- Centre for Pedagogy Applied to the Health Sciences, Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Mira Jabbour
- Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, Maisonneuve-Rosemont Hospital Site, Montréal, Québec, Canada
| | - Carl-Ardy Dubois
- Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montréal, Québec, Canada
| | - Lysane Paquette
- Faculty of Nursing, Université de Montréal, Montréal, Québec, Canada
| | - Véronique Landry
- Faculty of Nursing, Université de Montréal, Montréal, Québec, Canada
| | - Nathalie Gauthier
- Nursing and Physical Health Directorate, Centre intégré universitaire de santé et de services sociaux de La Capitale-Nationale, Québec, Québec, Canada
| | - Marie-Dominique Beaulieu
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
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Gillies K, Kearney A, Keenan C, Treweek S, Hudson J, Brueton VC, Conway T, Hunter A, Murphy L, Carr PJ, Rait G, Manson P, Aceves-Martins M. Strategies to improve retention in randomised trials. Cochrane Database Syst Rev 2021; 3:MR000032. [PMID: 33675536 PMCID: PMC8092429 DOI: 10.1002/14651858.mr000032.pub3] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Poor retention of participants in randomised trials can lead to missing outcome data which can introduce bias and reduce study power, affecting the generalisability, validity and reliability of results. Many strategies are used to improve retention but few have been formally evaluated. OBJECTIVES To quantify the effect of strategies to improve retention of participants in randomised trials and to investigate if the effect varied by trial setting. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Scopus, PsycINFO, CINAHL, Web of Science Core Collection (SCI-expanded, SSCI, CPSI-S, CPCI-SSH and ESCI) either directly with a specified search strategy or indirectly through the ORRCA database. We also searched the SWAT repository to identify ongoing or recently completed retention trials. We did our most recent searches in January 2020. SELECTION CRITERIA We included eligible randomised or quasi-randomised trials of evaluations of strategies to increase retention that were embedded in 'host' randomised trials from all disease areas and healthcare settings. We excluded studies aiming to increase treatment compliance. DATA COLLECTION AND ANALYSIS We extracted data on: the retention strategy being evaluated; location of study; host trial setting; method of randomisation; numbers and proportions in each intervention and comparator group. We used a risk difference (RD) and 95% confidence interval (CI) to estimate the effectiveness of the strategies to improve retention. We assessed heterogeneity between trials. We applied GRADE to determine the certainty of the evidence within each comparison. MAIN RESULTS We identified 70 eligible papers that reported data from 81 retention trials. We included 69 studies with more than 100,000 participants in the final meta-analyses, of which 67 studies evaluated interventions aimed at trial participants and two evaluated interventions aimed at trial staff involved in retention. All studies were in health care and most aimed to improve postal questionnaire response. Interventions were categorised into broad comparison groups: Data collection; Participants; Sites and site staff; Central study management; and Study design. These intervention groups consisted of 52 comparisons, none of which were supported by high-certainty evidence as determined by GRADE assessment. There were four comparisons presenting moderate-certainty evidence, three supporting retention (self-sampling kits, monetary reward together with reminder or prenotification and giving a pen at recruitment) and one reducing retention (inclusion of a diary with usual follow-up compared to usual follow-up alone). Of the remaining studies, 20 presented GRADE low-certainty evidence and 28 presented very low-certainty evidence. Our findings do provide a priority list for future replication studies, especially with regard to comparisons that currently rely on a single study. AUTHORS' CONCLUSIONS Most of the interventions we identified aimed to improve retention in the form of postal questionnaire response. There were few evaluations of ways to improve participants returning to trial sites for trial follow-up. None of the comparisons are supported by high-certainty evidence. Comparisons in the review where the evidence certainty could be improved with the addition of well-done studies should be the focus for future evaluations.
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Affiliation(s)
- Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Anna Kearney
- Dept. of Health Data Science, University of Liverpool, Liverpool, UK
| | - Ciara Keenan
- Campbell UK & Ireland, Centre for Evidence and Social Innovation, Queen's University, Belfast, UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jemma Hudson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Valerie C Brueton
- Department of Adult Nursing, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, King's College, London, UK
| | - Thomas Conway
- Clinical Research Facility Galway, National University of Ireland Galway, Galway, Ireland
| | - Andrew Hunter
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Louise Murphy
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Peter J Carr
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Paul Manson
- Health Services Research Unit (HSRU), University of Aberdeen, Aberdeen, UK
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8
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Liu S, Coyte PC, Fu M, Zhang Q. Measurement and determinants of catastrophic health expenditure among elderly households in China using longitudinal data from the CHARLS. Int J Equity Health 2021; 20:62. [PMID: 33608014 PMCID: PMC7893946 DOI: 10.1186/s12939-020-01336-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 11/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Catastrophic health expenditure (CHE) among the Chinese elderly warrants attention. However, the incidence, intensity and determinants of CHE have not been fully investigated. This study explores the incidence, intensity and determinants of CHE among elderly Chinese citizens, i.e., those aged 60 years or older. METHODS Data were obtained from three waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011, 2013 and 2015. The cut-off points used in this study for CHE were 10% of the total expenditures and 40% of non-food expenditure. Under the guidance of Andersen's model of health services utilization, this study used logistic regression analysis to explore the determinants of CHE. RESULTS The incidence of CHE defined as more than 40% of non-food expenditure rose over the study period, 2011-2015, from 20.86% (95% CI: 19.35 to 22.37%) to 31.00% (95% CI: 29.28 to 32.72%). The intensity of CHE also increased. The overshoot (O) based on non-food expenditure rose from 3.12% (95% CI: 2.71 to 3.53%) to 8.75% (95% CI: 8.14 to 9.36%), while the mean positive overshoot (MPO) rose from 14.96% (95% CI: 12.99 to 16.92%) to 28.23% (95% CI: 26.26 to 30.19%). Thus, the problem of CEH was even more serious in 2015 than in 2011. Logistic regression revealed that households were more likely to face CHE if they had a spouse as a household member, reported an inpatient event in the last year, reported an outpatient visit in the last month, were disabled, were members of a poor expenditure quartile, lived in the middle and western zones or resided in an urban area. In contrast, CEH was not significantly affected by respondents being older than 75 years or having a chronic health condition, by household size or by insurance type. CONCLUSIONS Key policy recommendations include the gradual improvement of medical assistance and the expansion of the use of health insurance to reduce household liability for health expenditures.
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Affiliation(s)
- Shiai Liu
- Center for Social Security Studies of Wuhan University, Wuhan, Hubei, China
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Mingqi Fu
- Center for Social Security Studies of Wuhan University, Wuhan, Hubei, China
| | - Qilin Zhang
- Center for Social Security Studies of Wuhan University, Wuhan, Hubei, China.
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9
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Jia P, Furuya-Kanamori L, Qin ZS, Jia PY, Xu C. Association between response rates and monetary incentives in sample study: a systematic review and meta-analysis. Postgrad Med J 2020; 97:501-510. [PMID: 32848082 DOI: 10.1136/postgradmedj-2020-137868] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/12/2020] [Accepted: 06/18/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To investigate the effect of monetary incentive and the dose-response relationship of participants' response rates in surveys. METHODS Three databases were searched for randomised controlled trials (RCTs) that investigated the effect of monetary incentives on participants' first and final response rates. First response is defined as the responses after the participant was initially contacted and final response is defined as the responses after several reminders were sent. The potential dose-response relationship of the amount of monetary incentive on the relative response rate (RRR) was established by fitting a restricted cubic spline function based on the robust-error meta-regression model. RESULTS 105 RCTs were identified. The first RRR increased by 49% (RRR=1.49; 95% CI 1.29 to 1.72) when monetary incentives were provided. Dose-response analysis revealed that an amount between US$6.25 and US$8 had the maximum effect on increasing the first response rate. On average, the final RRR increased almost by 20% (RRR=1.18; 95% CI 1.11 to 1.25) with monetary incentive compared to no-monetary incentive. An amount between US$10 and US$15 had the maximum effect on the final response rate, with an increase in the final RRR of 34% (RRR=1.34; 95% CI 1.19 to 1.51). There was a significant increase in the response rate when two or more reminders were sent. CONCLUSION Monetary incentives and reminders improve the response rates. Future studies need to consider providing monetary incentives and sending at least two reminders to increase the response rate and reduce the chances of non-response bias.
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Affiliation(s)
- Pengli Jia
- School of Management, Shanxi Medical University, Taiyuan, China
| | - Luis Furuya-Kanamori
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Zong-Shi Qin
- School of Chinese Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Peng-Yan Jia
- State Key Laboratory of Grassland Agro-ecosystems, College of Pastoral Agricultural Science and Technology, Lanzhou University, Lanzhou, China
| | - Chang Xu
- Department of Population Medicine, College of Medicine, Qatar University, Doha, Qatar
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10
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Bulkley JE, O'Keeffe-Rosetti M, Wendel CS, Davis JV, Danforth KN, Harrison TN, Kwan ML, Munneke J, Brooks N, Grant M, Leo MC, Banegas M, Weinmann S, McMullen CK. The effect of multiple recruitment contacts on response rates and patterns of missing data in a survey of bladder cancer survivors 6 months after cystectomy. Qual Life Res 2019; 29:879-889. [PMID: 31811594 DOI: 10.1007/s11136-019-02379-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The Bladder Cancer Quality of Life Study collected detailed and sensitive patient-reported outcomes from bladder cancer survivors in the period after bladder removal surgery, when participation in survey research may present a burden. This paper describes the study recruitment methods and examines the response rates and patterns of missing data. METHODS Detailed surveys focusing on quality of life, healthcare decision-making, and healthcare expenses were mailed to patients 5-7 months after cystectomy. We conducted up to 10 follow-up recruitment calls. We analyzed survey completion rates following each contact in relation to demographic and clinical characteristics, and patterns of missing data across survey content areas. RESULTS The overall response rate was 71% (n = 269/379). This was consistent across patient clinical characteristics; response rates were significantly higher among patients over age 70 and significantly lower among racial and ethnic minority patients compared to non-Hispanic white patients. Each follow-up contact resulted in marginal survey completion rates of at least 10%. Rates of missing data were low across most content areas, even for potentially sensitive questions. Rates of missing data differed significantly by sex, age, and race/ethnicity. CONCLUSIONS Despite the effort required to participate in research, this population of cancer survivors showed willingness to share detailed information about quality of life, health care decision-making, and expenses, soon after major cancer surgery. Additional contacts were effective at increasing participation. Response patterns differed by race/ethnicity and other demographic factors. Our data collection methods show that it is feasible to gather detailed patient-reported outcomes during this challenging period.
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Affiliation(s)
- Joanna E Bulkley
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA.
| | - Maureen O'Keeffe-Rosetti
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
| | | | - James V Davis
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
| | - Kim N Danforth
- Kaiser Permanente Department of Research and Evaluation, Pasadena, CA, USA
| | - Teresa N Harrison
- Kaiser Permanente Department of Research and Evaluation, Pasadena, CA, USA
| | - Marilyn L Kwan
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Julie Munneke
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Neon Brooks
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
| | - Marcia Grant
- City of Hope/Beckman Research Institute, Duarte, CA, USA
| | - Michael C Leo
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
| | - Matthew Banegas
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
| | - Sheila Weinmann
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
| | - Carmit K McMullen
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
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11
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Quinones C, Griffiths MD. Reducing compulsive Internet use and anxiety symptoms via two brief interventions: A comparison between mindfulness and gradual muscle relaxation. J Behav Addict 2019; 8:530-536. [PMID: 31505967 PMCID: PMC7044623 DOI: 10.1556/2006.8.2019.45] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Compulsive Internet use (CIU) refers to those individuals who experience a loss of control regarding their online use. Although suffered by a minority, a much larger proportion of adults report to be experiencing early signs of CIU, which can become more problematic if sustained over time, especially when used as a coping mechanism for stress. Since compulsive behaviors are characterized by executing behaviors on "automatic pilot," mindfulness techniques, which help individuals relate more consciously with their environment, could help develop a more adaptive relationship with technology. However, mindfulness interventions are often lengthy hence not ideal for busy individuals with early signs of CIU. AIMS This study tested the effectiveness of a brief mindfulness intervention (10 min a day for 2 weeks) to reduce CIU and anxiety and depression symptoms, in relation to an equivalent length classic arousal descending technique (i.e., gradual-muscle-relaxation), and a wait-list control group. METHODS A randomized controlled trial (RCT) was used with assessments at pre- and post-phases. Participants showing initial signs of CIU were allocated to a mindfulness-group (n = 343), gradual-relaxation (n = 301), or a wait-list control group (n = 350). RESULTS The mindfulness and gradual-muscle-relaxation participants were equally effective in reducing anxiety and depression. The mindfulness intervention was more effective reducing CIU symptoms. DISCUSSION Given the large sample sizes of this RCT, these results are promising, although follow-up studies are needed. Considering health hazards of the "always-on-culture" and the popularity of bite-sized learning, the effectiveness of easy-to fit-in daily life health practices is a positive development.
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Affiliation(s)
- Cristina Quinones
- Department of People and Organisations, Open University Business School, Milton Keynes, UK,Corresponding author: Cristina Quinones; Open University Business School, Walton Hall, Milton Keynes, MK7 6AA, UK; Phone: +44 01908 632763; E-mail:
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12
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Cohen AJ, Washington S, Butler C, Kamal P, Patino G, Tresh A, Mena J, Ndoye M, Breyer BN. Altruistic donation to improve survey responses: a global randomized trial. BMC Res Notes 2019; 12:113. [PMID: 30819217 PMCID: PMC6396474 DOI: 10.1186/s13104-019-4146-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/21/2019] [Indexed: 12/04/2022] Open
Abstract
Objective Web-based platforms have revolutionized the ability for researchers to perform global survey research. Methods to incentivize participation have been singularly focused on European and North American participants with varied results. With an ever increasing proportion of biomedical research being performed in non-western countries, assessment of novel methods to improve global survey response is timely and necessary. To that end, we created a three-arm nested randomized control trial (RCT) within a prospective cohort study to assess the impact of incentives on survey responsiveness in a global audience of biomedical researchers. Results Email invitations were sent to authors and editors involved in online publishing totaling 2426 participants from 111 countries. Overall we observed a 13.0% response rate: 13.3% for the control group, 14.4% for a group entered to win a gift card, and 11.1% for a group whose participation lead to donation to charity (p = 0.17). Year of publication nor country impacted response rate. Within subgroups, editors were significantly less likely to respond to the survey as compared to authors (6.5% vs. 18.9%; p-value < 0.01). With power to detect a 4.8% difference among groups, we could not detect an impact of incentives on global survey response.
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Affiliation(s)
- Andrew J Cohen
- Department of Urology, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA
| | - Sam Washington
- Department of Urology, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA
| | - Christi Butler
- Department of Urology, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA
| | - Puneet Kamal
- Department of Urology, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA
| | - German Patino
- Department of Urology, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA
| | - Anas Tresh
- Department of Urology, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA
| | - Jorge Mena
- Department of Urology, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA
| | - Medina Ndoye
- Department of Urology, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA
| | - Benjamin N Breyer
- Department of Urology, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA. .,Department of Biostatistics and Epidemiology, University of California-San Francisco, San Francisco, CA, USA.
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