ePROs: Why We Should Be Mobile-First

Capturing electronic patient-reported outcomes via a mobile device is a growing trend but you need to think mobile-first

Electronic patient-reported outcomes (ePROs) and in particular with Bring Your Own Device (BYOD) are increasingly being used to collect data directly from patients. The advantages include bigger, faster and more efficient trials, avoiding missing data on a questionnaire, time-stamped data and complex question branching.

However, with people’s attention spans shortening, there is a growing need to make surveys lean. With more and more surveys taken on mobile phones, if the survey is too long or badly designed participants will drop out.

While there are established guidelines for measuring equivalence between electronic and paper-based PRO measures, what do we really know about respondent behavior using a mobile to complete a ePRO and best practice in the design of a mobile friendly questionnaire?

Despite the scarcity of research on mobile responses, there is market research evidence from multiple countries that can be used as a potential guide in the design and application of ePROs.

Mobile respondent behavior
First, let’s look at some of the evidence around mobile respondent behavior (references available on request):

  • Respondents insist on using a device of their own choice – in general, they will not switch devices to complete a survey even if prompted by the researcher
  • More mobile responders will complete the survey outside the home than PC users
  • Most mobile responders will complete the survey at home
  • Smartphone users take longer to complete a survey compared to other devices
  • Breakoffs (failure to complete the survey) are higher among smartphone users than computer users
  • Response rates are lower with mobile responses compared to computer users.

One of the most important issues facing survey designers is poor response behavior, where either the participant fails to answer the survey or fails to answer one or more questions. This is particularly notable with mobile users compared to PC users, so poor response behavior can have a significant impact on data quality when the questionnaire has not been optimized for mobile. 

Why do participants drop out of mobile surveys?
There are many factors involved in participant breakoff in surveys conducted online or via a mobile device. These include technical challenges, such as slow page load due to a graphic-rich questionnaire, or if the survey is tedious or repetitive in how the questions are worded or presented. 

Questionnaire design plays a critical role in survey experience; for example, it’s widely recognized that the use of matrix or table-based questions, long answer lists and long/wide scales does not render well on a mobile device, leading to participant fatigue, frustration and higher dropout.

Research shows that data quality differs between small smartphones (a screen smaller than four inches) and larger devices. Survey respondents who use small-screen smartphones are more likely to break off the survey and provide shorter answers to open questions compared to respondents with larger devices. However, there is some evidence that people using smartphones can provide high-quality responses if they are presented with question formats that are easy to use on small touchscreens.

Clearly, mobile-unfriendly questionnaire design will lead to the exclusion of people who will only participate via mobile, compromising the research. So, the advice is that if it doesn’t work on mobile, don’t do it.

This said, it’s worth noting that of the seven billion mobile phones in use around the world, fewer than three billion are smartphones, so focusing on smartphone will excluded the majority of mobile phone users, although this is a marginal problem in some countries.

What is a mobile-first survey?
‘Mobile first’ is the current mantra where a questionnaire is designed for a mobile device at the outset and then scaled up for larger screen sizes, and is tested on mobile devices to overcome the design problems mentioned above. 

For example, while it is generally accepted that grids and matrices are inappropriate for use on mobile devices, adopting a mobile-first approach where the number of scale points is minimal, the labels are short or to present the rows of the grid one row at a time, can perform in a similar way to a grid on a PC. However, it is worth noting that grids remain one of the most disliked question formats.

In addition to those mentioned above, other aspects of best practice for a mobile-optimized questionnaire include:

  • One question per screen (or the number of questions that fit comfortably on the screen) to avoid having to scroll
  • Limit the number of words per question
  • Avoid progress bars; great for online surveys, there is simply no room on mobile screens
  • Avoid drop-down menus that are difficult for mobile respondents to use
  • Avoid open-ended questions
  • Avoid images and videos.

While there will always be a place for surveys, as we rethink the survey of the future we need to ensure we are seeing through the eyes of future participants. 

Dr Keith Meadows is the founder and CEO of DHP Research & Consultancy.


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