Increasing follow-up questionnaire response rates in a randomized controlled trial of telehealth for depression: three embedded controlled studiesReportar como inadecuado

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, 17:107

First Online: 24 February 2016Received: 28 August 2015Accepted: 16 February 2016DOI: 10.1186-s13063-016-1234-3

Cite this article as: Edwards, L., Salisbury, C., Horspool, K. et al. Trials 2016 17: 107. doi:10.1186-s13063-016-1234-3


BackgroundAttrition is problematic in trials, and may be exacerbated in longer studies, telehealth trials and participants with depression – three features of The Healthlines Study. Advance notification, including a photograph and using action-oriented email subject lines might increase response rates, but require further investigation. We examined the effectiveness of these interventions in three embedded Healthlines studies.

MethodsBased in different trial sites, participants with depression were alternately allocated to be pre-called or not ahead of the 8-month follow-up questionnaire Study 1, randomized to receive a research team photograph or not with their 12-month questionnaire Study 2, and randomized to receive an action-oriented ‘ACTION REQUIRED’ or standard ‘Questionnaire reminder’ 12-month email reminder Study 3. Participants could complete online or postal questionnaires, and received up to five questionnaire reminders. The primary outcome was completion of the Patient Health Questionnaire PHQ-9. Secondary outcome measures were the number of reminders and time to questionnaire completion.

ResultsOf a total of 609 Healthlines depression participants, 190, 251 and 231 participants were included in Studies 1–3 intervention: 95, 126 and 115, respectively. Outcome completion was ≥90 % across studies, with no differences between trial arms Study 1: OR 0.38, 95 % CI 0.07–2.10; Study 2: OR 0.84, 95 % CI 0.26–2.66; Study 3: OR 0.53 95 % CI 0.19–1.49. Pre-called participants were less likely to require a reminder 48.4 % vs 62.1 %, OR 0.41, 95 % CI 0.21–0.78, required fewer reminders adjusted difference in means −0.67, 95 % CI −1.13 to −0.20, and completed follow-up quicker median 8 vs 15 days, HR 1.35, 95 % CI 1.00–1.82 than control subjects. There were no significant between-group differences in Studies 2 or 3.

ConclusionsEventual response rates in this trial were high, with no further improvement from these interventions. While the photograph and email interventions were ineffective, pre-calling participants reduced time to completion. This strategy might be helpful when the timing of study completion is important. Researchers perceived a substantial benefit from the reduction in reminders with pre-calling, despite no overall decrease in net effort after accounting for pre-notification.

Trial registrationCurrent Clinical Trials ISRCTN14172341

KeywordsDepression Email reminders Embedded study Photographs Pre-notification Recruitment Response rates Retention Telehealth Trials AbbreviationsCIconfidence interval

CONSORTConsolidated Standards of Reporting Trials

HRhazard ratio

ORodds ratio

PHQ-9Patient Health Questionnaire

Electronic supplementary materialThe online version of this article doi:10.1186-s13063-016-1234-3 contains supplementary material, which is available to authorized users.

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Autor: Louisa Edwards - Chris Salisbury - Kimberley Horspool - Alexis Foster - Katy Garner - Alan A. Montgomery


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