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.
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.
To address the purpose of the study, descriptive statistics were used.
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%.
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]
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: firstname.lastname@example.org
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