Zuidgeest Marloes, Hendriks Michelle, Koopman Laura, Spreeuwenberg Peter, Rademakers Jany
Tranzo, Academic Research Centre for Health and Social Care, Tilburg University, Tilburg, Netherlands.
J Med Internet Res. 2011 Sep 27;13(3):e68. doi: 10.2196/jmir.1241.
The Internet is increasingly considered to be an efficient medium for assessing the quality of health care seen from the patients' perspective. Potential benefits of Internet surveys such as time efficiency, reduced effort, and lower costs should be balanced against potential weaknesses such as low response rates and accessibility for only a subset of potential participants. Combining an Internet questionnaire with a traditional paper follow-up questionnaire (mixed-mode survey) can possibly compensate for these weaknesses and provide an alternative to a postal survey.
To examine whether there are differences between a mixed-mode survey and a postal survey in terms of respondent characteristics, response rate and time, quality of data, costs, and global ratings of health care or health care providers (general practitioner, hospital care in the diagnostic phase, surgeon, nurses, radiotherapy, chemotherapy, and hospital care in general).
Differences between the two surveys were examined in a sample of breast care patients using the Consumer Quality Index Breast Care questionnaire. We selected 800 breast care patients from the reimbursement files of Dutch health insurance companies. We asked 400 patients to fill out the questionnaire online followed by a paper reminder (mixed-mode survey) and 400 patients, matched by age and gender, received the questionnaire by mail only (postal survey). Both groups received three reminders.
The respondents to the two surveys did not differ in age, gender, level of education, or self-reported physical and psychological health (all Ps > .05). In the postal survey, the questionnaires were returned 20 days earlier than in the mixed-mode survey (median 12 and 32 days, respectively; P < .001), whereas the response rate did not differ significantly (256/400, 64.0% versus 242/400, 60.5%, respectively; P = .30). The costs were lower for the mixed-mode survey (€2 per questionnaire). Moreover, there were fewer missing items (3.4% versus 4.4%, P = .002) and fewer invalid answers (3.2% versus 6.2%, P < .001) in the mixed-mode survey than in the postal survey. The answers of the two respondent groups on the global ratings did not differ. Within the mixed-mode survey, 52.9% (128/242) of the respondents filled out the questionnaire online. Respondents who filled out the questionnaire online were significantly younger (P < .001), were more often highly educated (P = .002), and reported better psychological health (P = .02) than respondents who filled out the paper questionnaire. Respondents to the paper questionnaire rated the nurses significantly more positively than respondents to the online questionnaire (score 9.2 versus 8.4, respectively; χ²₁ = 5.6).
Mixed-mode surveys are an alternative method to postal surveys that yield comparable response rates and groups of respondents, at lower costs. Moreover, quality of health care was not rated differently by respondents to the mixed-mode or postal survey. Researchers should consider using mixed-mode surveys instead of postal surveys, especially when investigating younger or more highly educated populations.
从患者角度来看，互联网越来越被视为评估医疗质量的一种有效媒介。互联网调查的潜在优势，如时间效率高、工作量小和成本低，应与潜在劣势，如低回复率以及仅部分潜在参与者可参与等相权衡。将互联网问卷与传统纸质后续问卷相结合（混合模式调查）可能会弥补这些劣势，并为邮寄调查提供一种替代方式。
研究混合模式调查与邮寄调查在受访者特征、回复率和时间、数据质量、成本以及医疗保健或医疗服务提供者（全科医生、诊断阶段的医院护理、外科医生、护士、放疗、化疗以及一般医院护理）的总体评分方面是否存在差异。
使用消费者质量指数乳房护理问卷，在一组乳房护理患者样本中研究这两种调查方式的差异。我们从荷兰健康保险公司的报销档案中选取了800名乳房护理患者。我们让400名患者在线填写问卷，随后发送纸质提醒（混合模式调查），另外400名按年龄和性别匹配的患者仅通过邮件接收问卷（邮寄调查）。两组都收到三次提醒。
两种调查的受访者在年龄、性别、教育程度或自我报告的身心健康方面没有差异（所有P值>.05）。在邮寄调查中，问卷返回时间比混合模式调查早20天（中位数分别为12天和32天；P<.001），而回复率没有显著差异（分别为256/400，64.0%和242/400，60.5%；P =.30）。混合模式调查的成本较低（每份问卷2欧元）。此外，混合模式调查中缺失项目较少（3.4%对4.4%，P =.002），无效答案也较少（3.2%对6.2%，P<.001）。两组受访者在总体评分上的答案没有差异。在混合模式调查中，52.9%（128/242）的受访者在线填写了问卷。在线填写问卷的受访者比填写纸质问卷的受访者明显更年轻（P<.001），受高等教育的比例更高（P =.002），且心理健康状况更好（P =.02）。纸质问卷的受访者对护士的评分明显高于在线问卷的受访者（分数分别为9.2和8.4；χ²₁ = 5.6）。
混合模式调查是邮寄调查的一种替代方法，能产生相当的回复率和受访者群体，且成本更低。此外，混合模式调查或邮寄调查的受访者对医疗保健质量的评分没有差异。研究人员应考虑使用混合模式调查而非邮寄调查，尤其是在调查年轻或受教育程度较高的人群时。
