Enclosing a pen with a postal questionnaire can significantly increase the response rate

L. Sharp, Claire Cochran, Seonaidh Claire Cotton, Nicola Mary Gray, M. E. Gallagher, The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group

Research output: Contribution to journalArticlepeer-review

35 Citations (Scopus)


Background and Objectives: It is important to maximize response rates to postal questionnaires. We compared the impact of three low-cost interventions on response rates.

Methods: A 2 X 2 X 2 factorial trial was conducted, nested within TOMBOLA (Trial Of Management of Borderline and Other Lowgrade Abnormal smears). Three interventions were evaluated: (1) enclosing a TOMBOLA-branded pen with the questionnaire (as opposed to no pen); (2) sending the questionnaires by first class post (as opposed to second class); and (3) enclosing a preaddressed return envelope on which there was a second class postage stamp (rather than a freepost business-reply envelope). Nine hundred thirty women, aged 20-59 years, due to receive a TOMBOLA psychosocial questionnaire by post during June-August 2003 were randomized.

Results: Enclosing a pen resulted in a statistically significant 7.0% increase in the cumulative proportion of questionnaires returned (from 61.5 to 68.5%; P =.002). The adjusted odds of response was significantly raised (odds ratio [OR] = 1.38, 95% confidence interval [CI] 1.04-1.82). Neither first class post nor providing a stamped envelope had a significant impact on response. There were no interactions between the interventions.

Conclusions: Enclosing a pen with a questionnaire can significantly increase response. This low-cost strategy was effective against a background of "good practice" with regard to the administration of postal questionnaires. (c) 2006 Elsevier Inc. All rights reserved.

Original languageEnglish
Pages (from-to)747-754
Number of pages7
JournalJournal of Clinical Epidemiology
Issue number7
Publication statusPublished - Jul 2006


  • factorial trial
  • postal questionnaire
  • response rates
  • randomized controlled trial
  • follow-up
  • general-practice
  • mail surveys
  • incentives
  • monetary
  • participation
  • satisfaction
  • returns
  • impact


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