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American Journal of Epidemiology Advance Access published online on June 22, 2005
American Journal of Epidemiology, doi:10.1093/aje/kwi194
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American Journal of Epidemiology Copyright © 2005 by the Johns Hopkins Bloomberg School of Public Health All rights reserved
Received December 16, 2004
Accepted March 22, 2005

PRACTICE OF EPIDEMIOLOGY

Increasing Response to Mailed Questionnaires by Including a Pencil/Pen

Emily White 1*, Patricia A. Carney 2, and Ann Shattuck Kolar 3

1 Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA
2 Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH
3 Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA

* To whom correspondence should be addressed.
Emily White, E-mail: ewhite{at}fhcrc.org


  Abstract

Nonmonetary incentives lead to small increases in response rates to mailed questionnaires. However, inclusion of a pen or pencil, which may be a facilitating factor as well as a reward, has not been shown to improve response to health surveys in prior trials. In 2001 and 2002, the authors conducted two US trials in which a study-logo pen or pencil was randomly included in a second questionnaire mailed to nonresponders to a first mailing. In the first study, of 10,686 nonresponders to a cohort recruitment mailing, response to the second mailing was 55% with inclusion of a pen versus 40% without one (p < 0.001). In the second study, of 141 nonresponders to a pilot follow-up survey conducted 2 years after entry into a cohort, response was 43% with inclusion of a pencil versus 24% without one (p = 0.02). This 15-19 percentage point increase for mailing 2 translated to a 5-6 percentage point increase after the two mailings combined. In a simulated study of three mailings based on these studies, the overall response rate increased by 4 percentage points at no added cost through inclusion of a pencil in the second mailing. The additional cost of the pencil was compensated for by the reduced number of nonrespondents sent packets at the third mailing. This study supports including a study-logo pen or pencil in a second questionnaire mailing to nonrespondents as a cost-effective method of increasing response rates.

Keywords: data collection; epidemiologic methods; questionnaires.
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