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Sawaya’s book examines the reasons some physicians chose to participate in surveys while others do not and the advantages and disadvantages of various survey formats.

By Editor on Nov 18, 2003

Sawaya's book examines the reasons some physicians chose to participate in surveys while others do not and the advantages and disadvantages of various survey formats. It also offers practical advice for improving survey response rates among doctors.

Commercial surveys suffer even weaker response rates than their academic counterparts, Sawaya points out. In fact, according to Richard Harbaugh of CONSILIUM Associates, a marketing research company, the average response rate for mail surveys sponsored by pharmaceutical clients is currently less than 20%. His company's response rates dipped from 60% in the 1970s to about 15% by 1998.

Low response rates jeopardize research validity and make it difficult to relate the results to the larger population. Perhaps, according to Sawaya, that's why many survey reports fail to mention the response rate or provide readers with the information necessary to calculate one.

Sawaya offers 10 reasons doctors are compelled to participate in a survey. They are:

The desire to be helpful;

A belief in the research;

Interest in the research topic;

Financial rewards;

Scientific curiosity;

An opportunity for self-improvement;

The desire to be heard;

Positive identification with the research sponsor;

Social interaction; and

Psychological inclination

The most important driver of response rates for physician surveys is an interest in the research topic. Physicians are more likely to respond to a survey if they perceive the research topic to be relevant to clinical practice and related to the medical specialty and field of expertise, Sawaya writes.

Sawaya notes another key driver is financial reward. Increasingly, many physicians are looking at their participation in survey research as an additional source of income, he said. This trend is driving monetary incentives higher, however, as doctors are conditioned to expect ever large payments for participation.

Key reasons for not participating in survey research include:

Time pressures;

Over-solicitation;

Surveys perceived as additional administrative work;

Concerns about the proper use of the survey data;

Privacy;

The nature of the research topic;

Poor survey design;

Low financial incentives;

Competing and more lucrative research opportunities;

Business considerations;

Bad past experience;

Temporary reasons; and

A lack of contact with prospective respondents;

It's pivotal for researchers to understand the reasons behind physicians's refusal to cooperate,'s and to alleviate physicians's concerns and response burdens, Sawaya writes.

One important stumbling block is the potential improper use or misinterpretation of survey data. This is of particular concern when answering a survey whose sponsor is a commercial entity.

Many physicians decline to participate in research studies commissioned by pharmaceutical companies because they fear the information will help the companies better target's practitioners or become even more aggressive in their marketing approach, Sawaya reports. Some also worry that their individual answers might end up in the hands of pharmaceutical representatives, an eventuality that will disturb the balance of power between a physician and a rep.'s

Many physicians avoid surveys without a strong monetary incentive to participate, another common yet extensive stumbling block to researchers. To achieve acceptable response rates, both marketing and academic researchers are finding it necessary to boost their financial incentives to physicians. In a more ominous development, Sawaya reveals, many physicians are not satisfied anymore by just charging for their time, but are bargaining for a higher price in exchange for the commercial or intellectual value of their information.

Sawaya contends that financial rewards, when used properly and in the right amounts, can boost response rates by 50% or more for mail surveys. Financial incentives, even symbolic ones, will significantly boost response rates, the author said. The offer of some kind or remuneration creates the impression that physicians are not being taken for granted. The larger the incentive the higher the response rate up to a point.

According to Sawaya, monetary incentives almost always outperform non-monetary ones and pre-paid incentives have more pull than post-paid ones.

Another strong driver of response rates is multiple survey reminders. With each subsequent reminder (Sawaya recommends no more than two follow-up contacts), researchers can generate an additional 40-60% of the return achieved on the preceding mailing. Using a different contact mode for these repeat reminders can also boost response rates. For instance, a phone call followed by the mailing of another copy of the survey is often more persuasive than a simple third mailing.

Other tactics that have been shown to moderately increase response rates to mail surveys include: pre-notifying respondents by phone, advertising the survey, personalizing the mail package (especially with stamped return envelopes), emphasizing the reputation of the research sponsor, modifying the length of the survey, and including a prize drawing for participants.

The book also includes detailed examinations of the advantages and disadvantages and offers recommendations for conducting face-to-face, phone, Internet and mixed-mode physician surveys.

In general, Sawaya recommends working to better understand the physician mindset. Questionnaire designers, interviewers and focus group moderators should make an extra effort to learn empathy or the ability to put themselves in the shoes of a physician, he writes. Pharmaceutical marketing researchers should learn more about physicians's clinical decision-making, prescribing algorithms, and general vies of the pharmaceutical industry.

He also advised researchers to:

show respect for their subjects;

build trust and add value;

render the questionnaire interesting, relevant and likeable;

carefully design questions;

choose appropriate sampling frames;

enlist the help of a statistician;

consider hiring experienced research suppliers;

tactfully manage other stakeholders;

always pre-test your questionnaire;

consider conducting a pilot survey;

establish a help desk;

use financial incentives judiciously;

persist; and

assess the significance and extent of non-response bias.

Each of these topics is covered in-depth in the text with the reasoning behind the recommendation, as well as practical tips for implementing the approaches.

The bottom line, Sawaya stresses, is that high response rates to physician surveys are still possible. Pharmaceutical companies, however, face a greater challenge than other researchers.

High response rates in these surveys are hampered by the unscrupulous use of research as guise for selling drugs, he warns. The proliferation of post-marketing surveillance studies and the aggressive recruitment of physicians into so-called research advisory boards are frequently cited by critics as examples of sales masquerading as research's and constitute a great threat to the future of the pharmaceutical marketing research industry.

The book is an easy and enjoyable read. Like in his previous title, Super Reps, Sawaya strives to include a large variety of case studies, third-party evidence and first-hand advice that make putting the book's conclusions to work in your research a practical reality.

To learn more about Doctors Unlimited, visit www.reticulum.ca.