title: Enclosing a pen reduced time to response to questionnaire mailings.
abstract: To assess the effectiveness of including a pen in postal questionnaires on response rate, necessity of reminders, time to response, and completeness of response to the primary outcome question (POQ).
  
  
  
  A two-arm randomized controlled trial (RCT) embedded within the screening of older women for prevention of fracture trial (SCOOP). Women, aged 70-75 years, were randomized to receive a pen with their questionnaire (n = 3,826) or to receive the questionnaire alone (n = 3,829). The results were combined with another embedded RCT in a meta-analysis.
  
  
  
  A response rate of 92.4% was observed in the pen group compared with 91.3% in the control group (odds ratio [OR] = 1.16; 95% confidence interval [CI]: 0.98, 1.37; P = 0.08). There was a difference in reminders required (OR = 0.88; 95% CI: 0.79, 0.98; P = 0.02), time to response (hazard ratio = 1.06; 95% CI: 1.01, 1.11; P = 0.01) and some difference in the completeness of response to the POQ (OR = 1.18; 95% CI: 1.00, 1.39; P = 0.05). The pooled OR from the meta-analysis for response rate was 1.21 (95% CI: 1.05, 1.39; P = 0.01).
  
  
  
  Inclusion of a pen with postal questionnaires potentially has a positive impact on response rates and the number of reminders required. There may be some reduction in time to response. Studies of different participant groups are needed to test the effectiveness over more diverse populations.
authors.affiliation: York Trials Unit, Health Sciences Department, University of York, York YO10 5DD, UK. Electronic address: kerry.bell@york.ac.uk.
authors.forename: Kerry
authors.initials: K
authors.lastname: Bell
authors.affiliation: York Trials Unit, Health Sciences Department, University of York, York YO10 5DD, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Clark
authors.affiliation: York Trials Unit, Health Sciences Department, University of York, York YO10 5DD, UK.
authors.forename: Caroline
authors.initials: C
authors.lastname: Fairhurst
authors.affiliation: York Trials Unit, Health Sciences Department, University of York, York YO10 5DD, UK.
authors.forename: Natasha
authors.initials: N
authors.lastname: Mitchell
authors.affiliation: Norwich Medical School, University of East Anglia, MED Building, Norwich NR4 7TJ, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lenaghan
authors.affiliation: Norwich Medical School, University of East Anglia, MED Building, Norwich NR4 7TJ, UK.
authors.forename: Jeanette
authors.initials: J
authors.lastname: Blacklock
authors.affiliation: MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton SO16 6YD, UK.
authors.forename: Janet
authors.initials: J
authors.lastname: Cushnaghan
authors.affiliation: MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton SO16 6YD, UK.
authors.forename: Cyrus
authors.initials: C
authors.lastname: Cooper
authors.affiliation: Department of Endocrinology, Queen Elizabeth Medical Centre, Queen Elizabeth Hospital, Wolfson Endocrinology-University Hospitals Birmingham NHS Foundation Trust, Old QEH 3rd Floor, 3-05D & 2nd Floor, Birmingham B15 2TH.
authors.forename: Neil
authors.initials: N
authors.lastname: Gittoes
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9NT, UK; NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9NT, UK.
authors.forename: Terence W
authors.initials: TW
authors.lastname: O'Neill
authors.affiliation: Norwich Medical School, University of East Anglia, MED Building, Norwich NR4 7TJ, UK.
authors.forename: Lee
authors.initials: L
authors.lastname: Shepstone
authors.affiliation: York Trials Unit, Health Sciences Department, University of York, York YO10 5DD, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Torgerson
mesh_terms: D000368:Aged; D005260:Female; D037921:Gift Giving; D006801:Humans; D009042:Motivation; D011177:Postal Service; D017010:Reminder Systems; D011795:Surveys and Questionnaires; D013995:Time; D014956:Writing
keywords: Embedded trial; Incentive; Pen; Postal questionnaire; Randomized controlled trial; Response rate