title: Assessing the Effects of Participant Preference and Demographics in the Usage of Web-based Survey Questionnaires by Women Attending Screening Mammography in British Columbia.
abstract: BACKGROUND
  Increased usage of Internet applications has allowed for the collection of patient reported outcomes (PROs) and other health data through Web-based communication and questionnaires. While these Web platforms allow for increased speed and scope of communication delivery, there are certain limitations associated with this technology, as survey mode preferences vary across demographic groups.
  
  
  OBJECTIVE
  To investigate the impact of demographic factors and participant preferences on the use of a Web-based questionnaire in comparison with more traditional methods (mail and phone) for women participating in screening mammography in British Columbia, Canada.
  
  
  METHODS
  A sample of women attending the Screening Mammography Program of British Columbia (SMPBC) participated in a breast cancer risk assessment project. The study questionnaire was administered through one of three modes (ie, telephone, mail, or website platform). Survey mode preferences and actual methods of response were analyzed for participants recruited from Victoria General Hospital. Both univariate and multivariate analyses were used to investigate the association of demographic factors (ie, age, education level, and ethnicity) with certain survey response types.
  
  
  RESULTS
  A total of 1192 women successfully completed the study questionnaire at Victoria General Hospital. Mail was stated as the most preferred survey mode (509/1192, 42.70%), followed by website platform (422/1192, 35.40%), and telephone (147/1192, 12.33%). Over 80% (955/1192) of participants completed the questionnaire in the mode previously specified as their most preferred; mail was the most common method of response (688/1192, 57.72%). Mail was also the most preferred type of questionnaire response method when participants responded in a mode other than their original preference. The average age of participants who responded via the Web-based platform (age 52.9, 95% confidence interval [CI] 52.1-53.7) was significantly lower than those who used mail and telephone methods (age 55.9, 95% CI 55.2-56.5; P<.001); each decade of increased age was associated with a 0.97-fold decrease in the odds of using the website platform (P<.001). Web-based participation was more likely for those who completed higher levels of education; each interval increase leading to a 1.83 increase in the odds of website platform usage (P<.001). Ethnicity was not shown to play a role in participant preference for the website platform (P=.96).
  
  
  CONCLUSIONS
  It is beneficial to consider participant survey mode preference when planning to collect PROs and other patient health data. Younger participants and those of higher education level were more likely to use the website platform questionnaire; Web-based participation failed to vary across ethnic group. Because mail questionnaires were still the most preferred survey mode, it will be important to employ strategies, such as user-friendly design and Web-based support, to ensure that the patient feedback being collected is representative of the population being served.
authors.affiliation: British Columbia Cancer Agency, Sindi Ahluwalia Hawkins Centre for the Southern Interior, Kelowna, BC, Canada. rebecca.mlikotic@alumni.ubc.ca.
authors.forename: Rebecca
authors.identifier: http://orcid.org/0000-0002-6949-5123
authors.initials: R
authors.lastname: Mlikotic
authors.forename: Brent
authors.identifier: http://orcid.org/0000-0002-9792-5207
authors.initials: B
authors.lastname: Parker
authors.forename: Rasika
authors.identifier: http://orcid.org/0000-0003-2149-7274
authors.initials: R
authors.lastname: Rajapakshe
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D001955:British Columbia; D002170:Canada; D003142:Communication; D003710:Demography; D055088:Early Detection of Cancer; D004522:Educational Status; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D020407:Internet; D016015:Logistic Models; D008327:Mammography; D008875:Middle Aged; D015999:Multivariate Analysis; D057240:Patient Preference / Q000208:ethnology / Q000706:statistics & numerical data*; D011177:Postal Service; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D013689:Telephone
keywords: Internet; Web-based system; breast cancer screening; patient preference; patient reported outcome measures; patient reported outcomes; questionnaires; survey methods