Are patients willing to participate in surveys?

Key words::

• study modality
• questionnaire
• medication adherence
• clinical research
• financial incentive
• the Internet

Nonadherence to medication virtually affects every branch of medicine (1). Nonadherence is a major contributor to patient morbidity and, consequently, preventable healthcare expense (2). Increasing patient–physician contact, with methods such as extra office visits, improves adherence (3). However, increasing the number of office visits can be financially and logistically impractical. A more feasible solution is to have patients report their treatment progress without a visit; a periodic electronic survey can be used (4,5). For patients with acne, periodic surveys, in which patients reported their treatment experiences over the Internet, more than doubled their use of medication (5).

This type of intervention could be easily scaled up at low costs to reach large populations. While this survey approach was effective for research subjects who participated in the study, we do not know how willing patients are to being surveyed. We asked patients, 18 years or older, to complete a brief questionnaire during their visit (with IRB approval) about willingness to participate in surveys, including the method of delivery, the health professional providing the survey, type of compensation for the survey and type of results the patient is presented from participating in the survey.

Of 400 patients invited to participate in our survey, 373 (93%) patients agreed to participate and completed a survey. Twenty-one (6%) participants reported unwillingness to complete a survey regardless of the form or setting. Other patients generally were willing to participate in a survey through any mode of survey, except for text messages. Participants were most willing to participate if a physician was administering the survey (Table I). When subjects were asked their most preferred modes of survey, incentive, administrator or results received, the most common responses were online surveys, surveys with a financial incentive, surveys administered by physicians, and surveys at which group results were presented (Table II). Text messages were the least-preferred method overall, with only 4% of subjects preferring text messages. Twenty-one participants (6%) reported that they would not participate in a survey under any of the listed circumstances. Younger participants and females were more willing to complete surveys (Tables III and IV).

Table I. Overall response rate and participant willingness to complete a survey of various modes of distribution, type of incentive, type of presenter, and type of results shared.

	Percentage of Patients willing (95% confidence interval)	Response rate
Mode of survey
In person	61% 54, 68	185/188
Online	66% 60, 73	185/188
Phone	53% 46, 60	186/188
Text message	28% 22, 35	184/188
Mail	69% 62, 76	185/188
Type of incentive
No incentive	65% 58, 72	176/186
Financial	78% 72, 84	181/186
Contest	61% 54, 68	174/186
Type of presenter
Physician	85% 79, 90	182/185
Nurse	66% 59, 73	179/185
Study team member	60% 52, 67	178/185
Type of results shared
None	49% 42, 57	186/187
Individual	85% 80, 91	186/187
All results	75% 69, 82	183/187

Table II. Responses from when subjects were asked to report their most preferred method to be surveyed.

	Percentage of Patients	Response rate
Preferred mode of delivery		173/188
Online	46
In person	21
Mail	16
Phone	13
Text message	4
Preferred incentive type		153/186
Financial	64
No incentive	23
Contest	13
Preferred person to present the survey		166/185
Physician	79
Study staff member	13
Nurse	9
Preferred type of results to be given after participating		164/187
Group results	48
Individual results	46
No results	5

Table III. Willingness of participants, stratified by age, to complete a survey of various modes of distribution, types of incentive, types of presenter, and type of results shared.

	< = 45 years old	>45 years old	p-Value
Mode of survey
In person	56%	65%	0.23
Online	79%	57%	0.002
Phone	47%	57%	0.18
Text message	44%	17%	0.001
Mail	60%	42%	0.003
Type of incentive
No incentive	55%	73%	0.02
Financial	80%	76%	0.59
Contest	60%	62%	0.88
Type of presenter
Physician	86%	84%	0.83
Nurse	67%	66%	0.99
Study team member	63%	58%	0.53
Type of results shared
None	66%	42%	0.003
Individual	90%	67%	0.37
All results	79%	73%	0.46

Table IV. Willingness of participants, stratified by gender, to complete a survey of various modes of distribution, types of incentive, types of presenter, and type of results shared.

	Males	Females	p-Value
Mode of survey
In person	67%	61%	0.50
Online	62%	68%	0.49
Phone	53%	54%	0.99
Text message	29%	28%	0.99
Mail	71%	69%	0.86
Type of incentive
No incentive	60%	69%	0.30
Financial	70%	83%	0.08
Contest	52%	67%	0.09
Type of presenter
Physician	79%	92%	0.02
Nurse	64%	70%	0.41
Study team member	55%	65%	0.20
Type of results shared
None	40%	49%	0.76
Individual	86%	88%	0.65
All results	76%	77%	0.99

Most of our sampled patients were willing to participate in surveys; few refused to participate. Because our clinic is a research institution, it is possible the patients who visit the dermatology clinic may be more willing than private practice patients to participate in research and surveys, though there are other reasons patients may choose the academic institution including perceptions of quality and convenience. Use of surveys may be a very practical tool for improving patients' adherence and outcomes.

Declaration of interest

The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, L.P. SF is a consultant and speaker for Galderma, Stiefel/GlaxoSmithKline, Abbott Labs, Warner Chilcott, Janssen, Amgen, Photomedex, Genentech, BiogenIdec, and Bristol Myers Squibb. SF has received grants from Galderma, Astellas, Abbott Labs, Warner Chilcott, Janssen, Amgen, Photomedex, Genentech, BiogenIdec, Coria/Valeant, Pharmaderm, Ortho Pharmaceuticals, Aventis Pharmaceuticals, Roche Dermatology, 3M, Bristol Myers Squibb, Stiefel/GlaxoSmithKline, Novartis, Medicis, Leo, HanAll Pharmaceuticals, Celgene, Basilea, and Anacor and has received stock options from Photomedex. SF is the founder and holds stock in Causa Research. JH, KH, AT, LS, and WH have no conflicts to disclose.