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A systematic literature review on response rates across racial and ethnic populations.

Understanding and reducing health disparities as well as promoting equality for ethnic or racial population health have become important priorities among researchers and governments as populations of western countries are becoming ethnically and racially diverse. For example, to date, over 5 million (16.2%) Canadians consider themselves non-White and nonAboriginal (i.e., visible minorities) and it is estimated that this number will steadily increase over the next decade due to immigration. (1) Therefore, researchers are either analyzing available data or are collecting ethnic or racial information to document ethnic/racial disparities and monitor population health.

Ethnicity/racial information is not commonly collected in Canada (such as in hospital discharge abstract data) as it presents challenges due to the sensitivity and ethical responsibilities when acquiring this information from individuals. To fully use the available secondary administrative data, surnames, geographic codes and country of birth indicators have been used in research as proxies to define ethnicity or race.2-4 However, these methods are limited due to misclassification of ethnicity for some individuals. Thus, many researchers are relying on primary data collection through various survey methods, such as the Canadian Community Health Survey or the National Population Health Survey that collected self-reported ethnicity.

Obtaining valid information from a representative sample is crucial for primary data collection. As there is no systematic review on this subject, we questioned whether minority ethnic populations participate in surveys as actively as the majority ethnic population, which in developed countries is most commonly Whites. The rationale for raising this question among ethnic minority populations is related to: limited language capacity, limited interests in research, inexperience in participation in studies, as well as cultural differences and sensitivities. This paper describes a systematic literature review to document response rates across racial and ethnic populations in order to provide evidence to estimate potential response bias of ethnic study populations.

METHODS

A literature search was conducted using MEDLINE, SOCI Index with Full Text, PubMed, Sociological Abstracts and Academic OneFile online databases. Search words included: survey response rates or non-response rates and racial or ethnic populations (White, African American, Asian, and Hispanic); survey modes or survey methods (mail, telephone, face to face, e-mail); and response bias (non-response bias, response bias or social desirability). The search was limited to English language and articles published from January 1990 to June 2009. We also conducted a grey literature search of government reports, databases and websites using the above search terms in Canada, the United States, Australia, New Zealand and the United Kingdom.

Abstract and full-text review

Abstracts were excluded if they did not describe response rates across racial and ethnic minorities or did not report on research based in Canada, the US, Australia, New Zealand or the UK. These countries were included as they are multi-ethnic developed countries.

Subsequently, full-text articles were excluded if they did not include a study response rate per ethnic or racial group. Prior to the extraction of the data, a definition of response rate (RR) was established as follows: RR = n/N where n is the number of participants who responded to the survey (analyzed data) and N is the number within the total population or sample size contacted. Among the abstracts selected from the process above, the following information was extracted from each full-text article: geographic location of the study, year of publication, survey mode, study population characteristics, sample size, survey language, and the response rate from ethnic and racial populations.

Analysis

To address the purpose of the study, descriptive statistics were used.

RESULTS

We initially identified 559 abstracts using the aforementioned search terms. Upon applying the inclusion and exclusion criteria, the number of articles was reduced to 121 (Figure 1). Next, 35 articles on ethnicities and response rates to survey modes were identified.

Six of 121 articles compared survey mode and response rate for multiple racial and ethnic populations (Table 1). The response rate in these articles ranged from 22.0% to 68.8% in Whites. Similarly, response rates in other ethnic groups ranged from 15.4% in African Americans to 70.9% in Latino Americans.

Twenty-nine of 121 articles presented survey mode and response rate for a specific ethnicity or race (Table 2). Among response rates with one ethnicity or race reported, the highest was from African Americans (92.5%) and the lowest was from Cambodian Americans (30.3%). Response rates ranged from 50.0% to 80.0% in 23 studies. Among studies using face-to-face surveys (n=11), response rates ranged from 30.3% to 82.0%. In studies using mail surveys (n=7), the response rates ranged from 31.0% to 80.0%. The response rate among telephone surveys (n=9) ranged from 41.0% to 85.6%.

DISCUSSION

Our systematic review found that the majority of studies on ethnicity reported overall response rate, without specifying the rate by ethnicity. Among the studies included in the review, response rate is similar across ethnicities/race, including Whites. Seventy-nine percent (23 of 29) of individual ethnic studies reported reasonable response rates, ranging from 50.0% to 80.0%.

We found that response rate was not consistently calculated and reported across studies and faced challenges to compare response rates across studies. A survey process includes multiple steps; from defining potential study population, to screening and determining eligible individuals (which includes removing those who are noneligible), inviting them to participate in the survey, collecting information from participants, and cleaning the data at analysis stage (see Figure 2). Response rate is related to selection of denominator and numerator (RR = n/N) as these numbers may change in the survey process as described above. Aday (5) provides a sophisticated method of estimating response rates (i.e., estimating and removing non-eligibles from non-contacts and estimating and retaining refusals among the non-contacts) specific to the method of survey data collection.

[FIGURE 1 OMITTED]

This study found that some authors used the number of individuals who agreed to participate as their denominator (N) and other studies used the number of respondents before excluding those with unit missing values, as a result providing inaccurate response rates. Also, in some studies some authors used the potential or screened population(s) as the denominator (instead of the eligible population) which underestimated the response rate. Other studies did not remove item non-response from the analysis (numerator, n), thus creating an overestimated response rate. Therefore due to the improper and inconsistent measurements of response rates, this study found that quoted response rates were often over- and under- represented. We highly recommend that authors specify their definition of response rate through providing "n" and "N" in their papers and that editors/reviewers examine these definitions. (6)

Further, through examination of the literature, we found that response rates are directly correlated to the study design and sampling frame. For example, the response rate from a convenient sample (a type of non-probability sampling which involves the sample being drawn from that part of the population which is close to hand) is likely to be higher compared to a telephone survey. This is because in convenient sampling, individuals may be more willing or feel more pressured to participate in the survey compared to a random-digit-dialling survey (RDD). However, Quan et al. (7) based their sampling frame on RDD from surnames listed in a telephone book and reported similar response rates between White and Chinese in Canada.

We questioned the modality effects and which would be ideal for ethnic populations. In our review, there were only two papers that studied differences in survey modes across multiple racial and ethnic groups. Mailing is generally not a recommended survey mode for ethnic populations. (8) As well, language capacity, cultural sensitivity, content and time may be factors affecting response rate. Mailed surveys followed by face-to-face interviews as a means of survey mode is recommended due to the ability to communicate directly and the available time to clarify objectives. (9)

In the literature, there is much discussion on factors that affect response rates in surveys among ethnicities. (10) Researchers commonly acknowledge that it is essential to use culturally sensitive terms and material when designing surveys for ethnic groups. The type of survey mode (mail, telephone, face-to-face) and the length and content of the questionnaire are important to consider. (11) The survey mode chosen is important as ethnic groups may differ in the way they prefer to be contacted (telephone, mail, e-mail or face-to-face). This may also change within ethnic groups for sex and age. Choosing an appropriate interviewer for face-to-face interviews who does not inflict personal bias and is culturally sensitive may increase participation and response rates. (12,13) For some modes, offering incentives (i.e., monetary) for study participation may be valuable for increased participation. It is also important to take into consideration the expense of each mode. Another factor affecting ethnic response rates is personal salience. (10) It is expected that this is present when a significantly high response rate is found in studies specifically about respondents' ethnicity/race (e.g., studies called 'African American Health Survey' or 'South Asians in Canada Health Study') or ethnic minorities in general, compared to studies in the general population. As well, the title of the study might explain the range in response rates; which thus provides compelling evidence that the study title affects response rates among ethnic groups. (11) Therefore, survey modes affect the response differences at the individual level due to the mode of data collection or the way respondents interact with the questionnaire, which may change per ethnic group. Thus, by addressing these variables, the methodological implication for any choice of survey methods can be justified.

Our review also attempted to assess data validity across ethnicities or races. Unfortunately, there was no study addressing data quality by survey mode. Future studies are needed on this topic as the combination of response rate and data validity informs validity of study findings.

The limitations encountered during our review are as follows: first, we limited our search to articles published in English; thus our findings may not be generalizeable to countries where English is not the main language spoken. Second, we also limited our search to specific countries with diversity in minorities as well as a certain level of geographical development. Third, although this study conducted a comprehensive literature search, it is possible that we may have missed articles due to varied paper search terms or key words. Fourth, in the literature the number of categories and the specific definition(s) of race and ethnicity vary. For example, census definition(s) in the US and Canada have some key differences (e.g., Pacific Islanders in the US, Inuit and Metis in Canada). However, this study accepted the race/ethnicity definitions provided in each article included in the systematic review. As with any systematic review, this could raise inherent validity and reliability issues not seen with variables such as sex and age.

[FIGURE 2 OMITTED]

In conclusion, response rate varied across studies but is similar across ethnicities/race. The response rate may be related to many factors, including survey mode, length of questionnaire, survey language and cultural sensitivity to content. Our review indicates that ethnic populations who participate in surveys are as likely to participate in research as Whites. In literature, data validity across ethnicity is still unknown and should be studied in the future.

Received: October 8, 2009

Accepted: January 23, 2010

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Lindsay L. Sykes, [1,2] Robin L. Walker, MSc, [3,4] Emmanuel Ngwakongnwi, MSc, [1,3] Hude Quan, MD, PhD [1,3,4]

Author Affiliations

University of Calgary, Calgary, AB

[1.] The Centre for Health and Policy Studies

[2.] Faculty of Nursing

[3.] Department of Community Health Sciences

[4.] Department of Medicine

Correspondence: Dr. Hude Quan, Department of Community Health Sciences, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB T2N 4N1, Tel: 403-210-8617, Fax: 403-210-3818, E-mail: hquan@ucalgary.ca

Conflict of Interest: None to declare.
Table 1. Response Rate Reported by Studies of Multiple
Ethnicities

Corresponding       Author's                  Author's
Author              Affiliation Field         Affiliated
                                              Country

Steffen, AD (14)    Cancer Research           USA
                    Center of Hawaii,
                    University of Hawaii,
                    Honolulu, Hawaii

Quan, H (7)         Faculty of Medicine,      CANADA
                    University of
                    Calgary, Calgary,
                    Alberta

Gilliss, CL (15)    Yale University           USA
                    School of Nursing,
                    New Haven,
                    Connecticut

Sax, LJ (16)        Higher Education          USA
                    Research Institute,
                    University of
                    California,
                    Los Angeles,
                    California

Davies, MJ (17)     Leicester Royal           UNITED KINGDOM
                    Infirmary, Leicester,
                    United Kingdom

Lee, MM (18)        Harvard Medical           USA
                    School, Boston, MA

Corresponding       Geographic          Survey Mode
Author              Location of
                    Study /
                    Publication Year

Steffen, AD (14)    USA                 Mail
                    2008

Quan, H (7)         CANADA              Telephone
                    2008

Gilliss, CL (15)    USA                 Mixed methods
                    2001                (face-to-face;
                                        internet website
                                        recruitment; mail)

Sax, LJ (16)        USA                 Mixed methods
                    2003                (paper only; paper
                                        with web option;
                                        web only with
                                        response incentive;
                                        web only without
                                        response incentive)

Davies, MJ (17)     UNITED KINGDOM      Mail
                    1999

Lee, MM (18)        USA                 Telephone
                    2000

Corresponding       Study Population         Sample Size
Author                                       (n)

Steffen, AD (14)    A multiethnic            201,461
                    cohort from Hawaii
                    and California ages
                    45-75

Quan, H (7)         White and Chinese        1655
                    >18 years old

Gilliss, CL (15)    Females ages 40-48       346

Sax, LJ (16)        College students         948

Davies, MJ (17)     Asian                    2134
                    Caucasians               1991

Lee, MM (18)        Alternative therapies    Blacks: 163
                    used by women            Chinese: 160
                    with breast cancer       Latinos: 141
                    in four ethnic           Non-Hispanic
                    populations              Whites: 141

Corresponding       Language Used        Response Rate            %
Author              in Survey

Steffen, AD (14)    Spanish / English    Overall:                25.6
                                         White:                  34.1
                                         African American        21.1
                                         Native Hawaiian:        33.7
                                         Japanese American:      45.3
                                         Latino:                 16.5

Quan, H (7)         English /            Overall:                45.0
                    Cantonese /          White:                  41.2
                    Mandarin             Chinese                 49.2

Gilliss, CL (15)    English              Overall:                47.9
                                         African American:       46.1
                                         European American:      51.4
                                         Mexican/Central
                                         American:               44.3

Sax, LJ (16)        English              Overall:                21.5
                                         White:                  22.0
                                         African American:       15.4
                                         American Indian:        16.5
                                         Asian American:         30.8
                                         Latina/o                21.0
                                         Other                   29.1

Davies, MJ (17)     English              Asians                  34.4
                                         Caucasians              54.0

Lee, MM (18)        English, Chinese,    Blacks                  61.3
                    Spanish              Chinese                 51.3
                                         Latinos                 70.9
                                         Non-Hispanic
                                         Whites                  68.8

Table 2. Response Rate Reported by Studies of Single Ethnic
Population

First Author        Author's                     Author's
                    Affiliation Field            Affiliated
                                                 Country

Fitzpatrick,        Professor and Jones          USA
KM (19)             Chair, University of
                    Arkansas, Fayetteville,
                    Arkansas

Horn, IB (20)       Department of General        USA
                    Pediatrics and Adolescent
                    Medicine, Children's
                    National Medical Center,
                    Washington, DC

Waterman, AD (21)   Internal Medicine,           USA
                    Washington University
                    School of Medicine,
                    St. Louis, Missouri

Solberg, VS (22)    Department of                USA
                    Educational Psychology,
                    University of Wisconsin,
                    Milwaukee, Wisconsin

Gorell, E (23)      Department of                USA
                    Dermatology,
                    Stanford University
                    School of Medicine,
                    Stanford, California

Croucher, RE (24)   Institute of Dentistry,      UNITED
                    Barts & The London           KINGDOM
                    (QMUL), Turner
                    Street, London, UK

Tu, SP (25)         Department of Medicine,      USA
                    University of Washington,
                    Seattle, WA

Lai, DW (26)        Faculty of Social Work,      CANADA
                    The University of Calgary,
                    Calgary, Alberta

Lai, DW (27)        Faculty of Social Work,      CANADA
                    The University of Calgary,
                    Calgary, Alberta

Ramirez, AG (28)    University of Texas          USA
                    Health Science Center
                    at San Antonio, Texas

Mas, FGS (29)       University of Texas          USA
                    El Paso, Texas

Ortiz, BI (30)      Department of Pharmacy       USA
                    Practice, College of
                    Pharmacy, Nova
                    Southeastern University-
                    West Palm Beach, Florida

Trinidad, DR (31)   Cancer Prevention and        USA
                    Control, Moores UCSD
                    Cancer Center, La Jolla,
                    California

Ortega, AN (32)     University of California,    USA
                    Los Angeles, California

Chaudhry, S (33)    General Internal Medicine    USA
                    and Outcomes Research,
                    University of Chicago,
                    Chicago, Illinois

Lai, DW (34)        Faculty of Social Work,      CANADA
                    The University of Calgary,
                    Calgary, Alberta

Taylor, VM (35)     Division of Public Health    USA
                    Sciences, Fred Hutchinson
                    Cancer Research Center,
                    Seattle, Washington

Taylor, VM (36)     Division of Public Health    USA
                    Sciences, Fred Hutchinson
                    Cancer Research Center,
                    Seattle, Washington

Pham, H (37)        School of Medicine,          USA
                    University of Washington,
                    Seattle, Washington

Chow, C (38)        St. Michael's Hospital,      CANADA,
                    University of Toronto,
                    Toronto, Ontario

McPhee, SJ (39)     University of California,    USA
                    San Francisco, California

Pham, CT (40)       University of California,    USA
                    San Francisco, California

Tang, TS (41)       University of Michigan       USA
                    Medical School, Ann
                    Arbor, Michigan

Wismer, BA (42)     School of Public Health,     USA
                    Berkeley, California

Yi, JK (43)         University of Houston,       USA
                    Houston, Texas

Jenkins, CNH (44)   University of California,    USA
                    San Francisco, California

Palacios, C (45)    University of British        CANADA
                    Columbia, Vancouver,
                    British Columbia

Hislop, TG (46)     Cancer Control Research,     CANADA
                    BC Cancer Agency,
                    Vancouver, BC

Lubetkin, EI (47)   Department of                USA
                    Community Health and
                    Social Medicine, CUNY
                    Medical School, New
                    York, NY

First Author        Geographic         Survey Mode
                    Location of
                    Study /
                    Publication Year

Fitzpatrick,        USA, 2007          Mail
KM (19)

Horn, IB (20)       USA, 2004          Online

Waterman, AD (21)   USA, 2008          Telephone

Solberg, VS (22)    USA, 1994          Mail

Gorell, E (23)      USA, 2009          Online

Croucher, RE (24)   USA, 2007          Face-to-face

Tu, SP (25)         USA, 2001          Face-to-face

Lai, DW (26)        CANADA, 2009       Telephone

Lai, DW (27)        CANADA, 2009       Telephone

Ramirez, AG (28)    USA, 2000          Telephone

Mas, FGS (29)       USA, 2005          Face-to-face

Ortiz, BI (30)      USA, 2006          Mail

Trinidad, DR (31)   USA, 2006          Telephone

Ortega, AN (32)     USA, 2008          Face-to-face

Chaudhry, S (33)    USA, 2003          Mail

Lai, DW (34)        CANADA, 2009       Telephone

Taylor, VM (35)     USA, 2004          Mixed method
                                       (Mail / face-
                                       to-face)

Taylor, VM (36)     USA, 2005          Face-to-face

Pham, H (37)        USA, 2004          Mail

Chow, C (38)        CANADA, 2008       Telephone

McPhee, SJ (39)     USA, 1997          Face-to-face

Pham, CT (40)       USA, 1992          Mail

Tang, TS (41)       USA, 2000          Self-administered

Wismer, BA (42)     USA, 1998          Telephone

Yi, JK (43)         USA, 1994          Telephone

Jenkins, CNH (44)   USA, 1996          Face-to-face

Palacios, C (45)    CANADA, 1992       Face-to-face

Hislop, TG (46)     CANADA, 2007       Face-to-face

Lubetkin, EI (47)   USA, 2003          Face-to face

First Author        Study Population        Sample Size (n)

Fitzpatrick,        African American        1542
KM (19)             adolescents from a
                    single school
                    district

Horn, IB (20)       African American        175
                    English-speaking
                    parents of children
                    <48 months

Waterman, AD (21)   African Americans       856
                    regarding early
                    detection of kidney
                    disease

Solberg, VS (22)    Graduate and            705
                    undergraduate
                    Asian American
                    students

Gorell, E (23)      Adult volunteers        546
                    who self-identified
                    as Asian Americans

Croucher, RE (24)   UK-resident             325
                    Bangladeshi males

Tu, SP (25)         Cambodian American      413
                    women

Lai, DW (26)        Chinese Canadians       2272
                    >55 years old

Lai, DW (27)        Chinese adults >65      339
                    years old

Ramirez, AG (28)    Hispanic women          2239

Mas, FGS (29)       US Hispanic             45
                    physicians

Ortiz, BI (30)      Hispanic adults         142

Trinidad, DR (31)   Hispanic Women          1996: 1406
                                            1999: 1379
                                            2002: 2912

Ortega, AN (32)     Latino adults           2554
                    with IED

Chaudhry, S (33)    South Asian women       615

Lai, DW (34)        South Asians >55        220
                    years old

Taylor, VM (35)     Vietnamese              345
                    American men

Taylor, VM (36)     Vietnamese              370
                    American women

Pham, H (37)        Vietnamese              278
                    American church
                    attendees and
                    students attending
                    a major university

Chow, C (38)        Chinese Canadians       2443

McPhee, SJ (39)     Vietnamese
                    Americans in San
                    Francisco and           306
                    Sacramento              339

Pham, CT (40)       Vietnamese women        107

Tang, TS (41)       Chinese American        100
                    women

Wismer, BA (42)     Korean American         1090
                    women

Yi, JK (43)         Vietnamese              141
                    American women

Jenkins, CNH (44)   Vietnamese              215
                    Americans

Palacios, C (45)    Hispanic Canadians      72

Hislop, TG (46)     Chinese immigrants      504
                    to British Columbia,
                    Canada

Lubetkin, EI (47)   Low-income              429
                    Chinese American
                    primary care patients

First Author        Language Used
                    in Survey

Fitzpatrick,        English
KM (19)

Horn, IB (20)       English

Waterman, AD (21)   English

Solberg, VS (22)    English

Gorell, E (23)      English

Croucher, RE (24)   English / Sylheti

Tu, SP (25)         Khmer / English

Lai, DW (26)        English / Chinese
                    dialect

Lai, DW (27)        English /Cantonese /
                    Chinese Canadian
                    Mandarin /
                    Toishanese / Other
                    Chinese dialect

Ramirez, AG (28)    English / Spanish

Mas, FGS (29)       English

Ortiz, BI (30)      English / Spanish

Trinidad, DR (31)   English

Ortega, AN (32)     English / Spanish

Chaudhry, S (33)    English

Lai, DW (34)        English / Hindu /
                    Urdu / Punjabi /
                    Gurjarati

Taylor, VM (35)     Vietnamese /
                    English

Taylor, VM (36)     Vietnamese

Pham, H (37)        English

Chow, C (38)        English and two
                    major Chinese
                    dialects

McPhee, SJ (39)     Vietnamese

Pham, CT (40)       Vietnamese

Tang, TS (41)       Chinese and English

Wismer, BA (42)     Korean and English

Yi, JK (43)         Vietnamese and
                    English

Jenkins, CNH (44)   Vietnamese and
                    English

Palacios, C (45)    Spanish

Hislop, TG (46)     English, Cantonese,
                    Mandarin

Lubetkin, EI (47)   English, Chinese

First Author        Response Rate        %

Fitzpatrick,        African American     80.0
KM (19)

Horn, IB (20)       African American     92.5

Waterman, AD (21)   African American     42.4

Solberg, VS (22)    Asian American       53.8

Gorell, E (23)      Asian American       74.4

Croucher, RE (24)   Bangladeshi          59.0

Tu, SP (25)         Cambodian American   30.3

Lai, DW (26)        Chinese Canadian     77.0

Lai, DW (27)                             85.6

Ramirez, AG (28)    Hispanic             47.4

Mas, FGS (29)       Hispanic             55.5

Ortiz, BI (30)      Hispanic             71.0

Trinidad, DR (31)   Hispanic             1996: 69.8
                                         1999: 64.2
                                         2002: 56.1

Ortega, AN (32)     Latino               75.5

Chaudhry, S (33)    South Asian          32.1

Lai, DW (34)        South Asian          66.9%

Taylor, VM (35)     Vietnamese           58.1
                    American

Taylor, VM (36)     Vietnamese           61.5
                    American

Pham, H (37)        Vietnamese           79.7
                    American

Chow, C (38)        Chinese Canadians    41.0

McPhee, SJ (39)     Vietnamese
                    Americans
                    San Francisco        77.1
                    Sacramento           74.0

Pham, CT (40)       Vietnamese           31.0
                    Americans

Tang, TS (41)       Chinese American     71.0
                    women

Wismer, BA (42)     Korean American      80.0
                    women

Yi, JK (43)         Vietnamese           60.5
                    American women

Jenkins, CNH (44)   Vietnamese           55.0
                    Americans

Palacios, C (45)    Hispanic Canadians   49.0

Hislop, TG (46)     Chinese              59.0

Lubetkin, EI (47)   Chinese              82.0
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Title Annotation:SYSTEMATIC REVIEW
Publication:Canadian Journal of Public Health
Article Type:Report
Geographic Code:1CANA
Date:May 1, 2010
Words:4903
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