title: Randomized trial of 5 dollars versus 10 dollars monetary incentives, envelope size, and candy to increase physician response rates to mailed questionnaires.
abstract: BACKGROUND
  The validity of the results of mailed surveys is often threatened by nonresponse bias, which is made more likely when response rates are low. However, the effectiveness and cost-effectiveness of several strategies to increase response rates are uncertain.
  
  
  OBJECTIVE
  To assess three strategies to increase response rates to mailed physician surveys: including a 10 dollars versus a 5 dollars cash incentive in the initial mailing, including a mint candy or not, and using a large versus small outgoing envelope.
  
  
  METHODS
  Using a 2 x 2 x 2 factorial design, a randomized trial of these strategies was conducted in a survey of 1200 physicians randomly selected from the American Medical Association's Master File.
  
  
  RESULTS
  Including a 10 dollars incentive yielded a significantly higher response rate (60.5% vs. 52.8%) (P = 0.009). The mailing and incentive costs per completed response were 12.24 dollars (95% CI, 11.75 dollars, 13.64 dollars) in the 5 dollars group and 18.48 dollars (95% CI, 17.77 dollars, 20.69 dollars) in the 10 dollars group. Each additional response obtained in the 10 dollars group came at an incremental cost of 61.26 dollars (95% CI, 36.98 dollars, 200.80 dollars). Neither inclusion of a mint nor use of a large envelope influenced the response rate.
  
  
  CONCLUSIONS
  Investigators may increase response rates by including more money in the initial questionnaire packet, but there may be diminishing returns to serial increments in incentives greater than 5 dollars. Including smaller incentives in more questionnaires may maximize total responses.
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Halpern
authors.forename: Peter A
authors.initials: PA
authors.lastname: Ubel
authors.forename: Jesse A
authors.initials: JA
authors.lastname: Berlin
authors.forename: David A
authors.initials: DA
authors.lastname: Asch
mesh_terms: D002182:Candy; D003362:Cost-Benefit Analysis; D006801:Humans; D009042:Motivation; D010820:Physicians / Q000523:psychology*; D011177:Postal Service; D011795:Surveys and Questionnaires / Q000191:economics*; D014481:United States