Abstract
Surveys involving health care providers are characterized by low and declining response rates (RRs), and researchers have utilized various strategies to increase survey RRs among health professionals. Based on 48 studies with 156 subgroups of within-study conditions, a multilevel meta-regression analysis was conducted to summarize the effects of different strategies employed in surveys of health professionals. An estimated overall survey RR among health professionals was 0.53 with a significant downward trend during the last half century. Of the variables that were examined, mode of data collection, incentives, and number of follow-up attempts were all found to be significantly related to RR. The mail survey mode was more effective in improving RR, compared to the online or web survey mode. Relative to the non-incentive subgroups, subgroups receiving monetary incentives were more likely to respond, while nonmonetary incentive groups were not significantly different from non-incentive groups. When number of follow-ups was considered, the one or two attempts of follow-up were found to be effective in increasing survey RR among health professionals. Having noted challenges associated with surveying health professionals, researchers must make every effort to improve access to their target population by implementing appropriate incentive- and design-based strategies demonstrated to improve participation rates.
Introduction
Surveys of physicians, nurses, and allied health professionals are widely used as means to inform health policy, public health, and health services delivery across an array of issues. Despite their importance, however, surveys of health professionals can be challenging. Studies involving health care providers generally—and physicians specifically—are characterized by low or declining response rates (RRs; Cook, Dickinson, & Eccles, 2009; Cull, O’Connor, Sharp, & Tang, 2005; Hill, Fahrney, Wheeless, & Carson, 2006; McLeod, Klabunde, Willis, & Stark, 2013; Ulrich & Grady, 2004). While insufficient as a single indicator of survey quality, poor RRs still pose problems, as they have significant implications for sample size, cost, and potential nonresponse bias (i.e., the likelihood of systematic differences between those who returned a survey and those who did not). Nonresponse bias, in particular, can impact the generalizability or applicability of study results (Asch, Jedrziewski, & Christakis, 1997; Barriball & While, 1999; Cull et al., 2005; Cummings, Savitz, & Konrad, 2001; Curtis & Redmond, 2009; Templeton, Deehan, Taylor, Drummond, & Strang, 1997), as well as have probable consequences for measurement quality (Olson, 2006). Despite these challenges, surveys are still preferred as a cost-effective means of gathering information on care delivery. In response, researchers have utilized a number of techniques designed to stimulate survey RRs among health professionals, as well as to improve the overall quality of surveys in these populations (Klabunde et al., 2012).
Strategies employed to improve the quality of surveys of health professionals generally fall into either design- or incentive-based interventions and include monetary and nonmonetary response incentives, personalized mailings, prompts and follow-up contacts, postage, and sponsorship. Many of these interventions are derived from the tailored design method, which provides guidelines for instrument development (i.e., surveys) and also specifies the type and timing for initial contact, follow-up mailings, telephone follow-up, and incentives in order to stimulate response (Dillman, Smyth, & Christian, 2009). Although limited to physicians and nurses, systematic reviews have found a number of these practices to be successful in inducing response (Field et al., 2002; Kellerman & Herold, 2001; Klabunde et al., 2012; Martins et al., 2012; VanGeest & Johnson, 2011; VanGeest, Johnson, & Welch, 2007). Monetary incentives, in particular, have been shown to be effective in increasing clinician response. Moreover, even modest US$1 incentives are effective, with diminishing returns to serial increments above that amount (VanGeest et al., 2007). Token nonmonetary incentives (e.g., continuing medical education credits, pens, and candy), on the other hand, appear to have little or no impact unless sufficiently valued. A number of design-based interventions are also identified as effective in improving health professional response, including use of mixed-mode formats, brevity in questionnaire design, personalization, adequate follow-up contacts, and use of certified mail and/or courier companies such as FedEx. Consensus on applicability of best practices for clinician surveys, however, remains elusive, with more needed to be known on issues related to incentivizing providers, as well as key design aspects to improve the quality of clinician surveys (Klabunde et al., 2012).
Although helpful, systematic reviews are limited in that they typically fail to take into account explicit differences in studies due to sample size, composition, or study design. A meta-analysis offers distinct advantages in enabling us to address these limitations. In a meta-analysis, the findings of each study are treated as an independent observation, which may be combined to allow examination of overall or average effect. Additionally, by controlling for the unique properties of studies, the meta-analytic technique allows for the examination of potential sources of between study heterogeneity. In this article, we report a meta-analysis conducted to determine which incentive- and/or design-based strategies are most effective in improving clinician participation in survey research.
Method
Search Strategy and Study Selection
Experimental studies examining methods to improve clinician response to surveys were identified through key word searches of the MEDLINE, Scopus, Sociological Abstracts, and PsychINFO databases from 1958 to 2013. Searches by author using the same databases were also conducted for investigators with identified relevant articles. Finally, several seed sources (e.g., Evaluation and the Health Professions, BMC Medical Research Methodology, Public Opinion Quarterly, Medical Care, Health Services Research, Nursing Research, and Applied Nursing Research) were also referenced manually in an effort to establish a comprehensive set of studies to be included in the analyses. Further relevant articles and books were selected from the reference listings of the primary journal articles. Additional reports, conference papers, and other related resources were identified through online searches on Google, Google Scholar, and other Internet searches of specific organizations known to support survey research (e.g., American Association for Public Opinion Research, American Statistical Association, etc.).
All authors reviewed unique entries from the database and literature searches based on the following eligibility criteria for population (physicians, medical school faculty, medical students, nurses, nursing school faculty, nursing students, pharmacists, and other allied health professionals), studies that report design- or incentive-based strategies to improve survey response, outcome (RR), and study design (randomized controlled trial [RCT], case-control study, case studies, etc., examining the effectiveness of strategies of interest to improve clinician survey participation). Descriptive observational studies were excluded. Studies that did not report subgroup-specific sample sizes, without which we cannot estimate sample variance, were also not included. We identified a total of 48 studies with 156 subgroups within studies (see Appendix).
Data Extraction
The primary author (Y.C.) independently conducted the abstraction of data. Where necessary, questions were resolved via discussion and/or consultation with the other coauthors (T.J. and J.V.G.). Data regarding characteristics of the sample, intervention, and outcomes of interest were extracted. Specific variables coded for the meta-analysis included year of publication, location where survey was conducted (United States or elsewhere), type of respondents (e.g., physicians, nurses, and allied health professionals), mode of data collection, incentives (no incentives, monetary, or nonmonetary compensation), follow-up contact attempts, and subgroup-specific sample size and RRs. With regard to the primary outcome of interest, the RR was calculated as a proportion of all eligible respondents who completed the survey in order to have a consistent and comparable measure between studies.
Statistical Analysis
We conducted multilevel meta-analysis with variance known models (Raudenbush & Bryk, 2002), using hierarchical linear and nonlinear modeling 7 (Raudenbush et al., 2011). With these hierarchical models, we can estimate an average survey RR after accounting for random variations between studies and between subgroups within each study, and simultaneously controlling for the effects of subgroup- and study-level attributes of interest. The models are specified as following:
Level-1 (Within-Subgroup) Model
for subgroups
Level-2 (Between-Subgroups) Model
where the true RR of the population, π0jk
, depends on subgroup-level attributes (i.e., data collection mode, monetary or nonmonetary incentives, type of respondents, and number of follow-ups) and a Level-2 random error, r
0jk
for which we assume
Level-3 (Between-Studies) Model
where γ001, γ002, and γ003 are regression coefficients of study characteristics, publication year, RCT versus non-RCT study, and the place of study conducted, respectively. u
00k
is a Level-3 random effect with the normality assumption,
Results
Descriptive statistics for the variables included in the model are presented in Table 1. An overall average RR among 154 subgroups of studies was 0.50 (SD = 0.22). Mail surveys were used for 111 subgroups (72%). Mixed modes of data collection were used for 23 subgroups (15%). Surveys for the remaining 20 subgroups were conducted via online or web. In the multilevel model, two nominal variables were included representing (1) online or web subgroups and (2) mixed-mode subgroups, with an omitted category of mail subgroups as the reference category. Forty-seven percent of the subgroups received monetary incentives and 9% received nonmonetary compensation. In terms of respondent type, there were 104 subgroups (67%) of medical doctors, faculty, or medical students, 34 subgroups (21%) of nurses, nurse practitioners, nursing students, or faculty, and 18 subgroups consisting of other health professionals, such as dentists, pharmacists, and so on (11.7%). Of the 154 subgroups, 46 (30%) were not followed up after the initial survey request. Twenty-six (17%) and 41 subgroups (27%) were categorized as being followed-up once and twice, respectively. The remaining 41 subgroups were followed-up 3 or more times. At the study level, we found that a majority were published after the year 2002. Twenty-eight studies were conducted with RCT design (66.7%) and the remaining third employed non-RCT designs. Most studies (72.4%) were conducted with U.S. samples.
Descriptive Statistics.
As presented in Table 2, multilevel meta-analysis estimated that an overall survey RR among health professionals was 53% (b = 0.127, standard error [SE] = 0.118) after controlling for study subgroup and study characteristics and adjusting for random variance between subgroups and studies. The random variances at both levels were found to be highly significant as indicated at the bottom of Table 2. The random variances at the study subgroup level and study level without controlling for any attributes were 0.336 (χ2 = 3502.6; p < .001) and 0.653 (χ2 = 276.6; p < .001), respectively.
Multilevel Meta-Regression Coefficients for Survey Response Rates Among Health Professionals.
Note. RCT = randomized controlled trial.
Of the variables that were examined at the study subgroup level, mode of data collection, incentives, and number of follow-ups were found to be significantly related to RR. The estimated RR for the mail survey mode was 57% (see Figure 1A), which was significantly higher compared to the online or web survey mode (RR = 38%). The difference between mail and mixed survey modes was not statistically significant. Compared to the non-incentive subgroup, those receiving monetary incentives had significantly higher RRs (b = 0.474, SE = 0.141). The estimated RRs for non-incentivized versus monetarily incentivized groups were 48% and 60%, respectively (see Figure 1B). The subgroup with nonmonetary incentives did not differ from the non-incentive subgroup. Relative to the medical doctors group (RR = 55%), RRs among nurses (RR = 51%) were not significantly different, and other allied health professionals (RR = 46%) had slightly lower RRs compared to medical doctors, a difference that was marginally significant (b = −0.353; SE = 0.209; see Figure 1C). When four levels of follow-up were considered, the one (RR = 57%) and two attempt (RR = 66%) follow-up subgroups showed significantly higher RRs compared to the no-follow-up subgroup (RR = 43%). Those with three or more follow-ups (RR = 49%) were not significantly different from the no-follow-up subgroup (RR = 43%; see Figure 1D).

Estimated response rates by study subgroup-level characteristics.
Generally, there was a downward trend in terms of survey RR across years, indicating that there was a significant negative association between recency of the study and RR (Figure 2A). The study design (i.e., RCT vs. non-RCT) was not found to be associated with the RR. RRs of surveys conducted in the United States were slightly lower than those conducted elsewhere (b = −0.474; SE = 0.268, p = .084).

Estimated response rates by study-level characteristics.
Discussion
Our analysis of strategies for improving clinician survey response presents some interesting, although not unexpected, results. What is unique is the use of meta-analysis, a replicable method of synthesizing and analyzing findings from across multiple studies to further identify evidence-based strategies most likely to improve clinician survey participation. Of the various techniques analyzed, use of financial incentives clearly improves survey participation among health care professionals. This is consistent with recent systematic reviews examining monetary incentives in surveys of clinicians and medical groups (Burns et al., 2008; Klabunde et al., 2012; McLeod et al., 2013; VanGeest et al., 2007; VanGeest & Johnson, 2011). While the optimal incentive amount remains elusive, incentives as small as US$1 may be sufficient to improve participation, with previously noted diminishing returns above that amount (Halpern, Ubel, Berlin, & Asch, 2002; VanGeest et al., 2007). McLeod, Klabunde, Willis, and Stark (2013), in their review of large health care provider surveys, did find that incentives over US$30 were more likely to achieve a target 60% RR compared to those offering a lower or no incentives. This same review also supported the use of prepaid versus contingent incentives in improving clinician participation. Additionally, with regard to our findings for subgroups receiving nonmonetary incentives, this too is consistent with previous evidence suggesting that these inducements work only if physicians find them of sufficient value (VanGeest et al., 2007).
While effective, incentives can add a sizable component to the overall costs of administering a survey. Their advantage lies in potential cost savings associated with reduced follow-up. In addition, there are ethical issues associated with employing incentives. The National Cancer Institute’s (NCI) workshop on surveys of physicians and medical groups expressed concern about escalating incentive amounts and the potential for incentives to influence item response; ultimately concluding that incentives remain an important—and cost effective—means of communicating the importance of survey participation (Klabunde et al., 2012). Ethical analyses further suggest that the key factor is whether or not incentives can be considered coercive; a judgment that entails balancing potential risks and harms of a study and informed consent with the incentive amount employed (Singer & Couper, 2008).
The two principal design-based interventions shown to be effective in improving participation—survey mode and follow-up—are also consistent with previous research. Evidence supporting mode effects in clinician survey participation is substantial (Klabunde et al., 2012; McLeod et al., 2013; VanGeest et al., 2007; VanGeest & Johnson, 2011). Despite the dramatic increase in use of information technologies generally in our society, postal surveys still typically result in higher average return rates among health professionals. Existing evidence also supports the use of mixed-mode or sequential mixed-mode formats that include fax and possibly e-mail options, as these give health professionals more alternatives by which to respond; allowing them greater flexibility to fit the survey within their busy schedules. Caution may still be necessary when considering web or electronic survey modes, as researchers need to be cognizant of the capabilities and/or habits of the target populations, as well as the availability of valid e-mail addresses in sample frames. The potential for item nonresponse may also higher in online surveys, particularly if it involves sending confidential information; due to familiarity with and trust in the Internet (Scott et al., 2011). The NCI workshop, noting poor availability of valid e-mail addresses overall as well as barriers (both institutional and individual) to electronic or web-based administration of surveys, recommended focusing on the practice environment specifically, particularly gatekeepers. Additionally, they point to the need for more information on why clinicians react to particular modes and to inform when it is appropriate to utilize electronic administration options (Klabunde et al., 2012).
Regarding the need for follow-up, there is consensus in the literature that multiple contacts may be necessary in maximizing clinician survey participation (Klabunde et al., 2012). For example, in one study, over 30% of the completed surveys were obtained after one contact, but another 20% required 11 or more contact attempts (Parsons, Warnecke, Czaja, Barnsley, & Kaluzny, 1994). This same study highlighted differences in number of contact attempts by mode of data collection, with only 6% of telephone interviews completed after one contact attempt compared with 60% finalized mail surveys in one mailing of the questionnaire. Similarly, the NCI workshop participants estimated that one third or more of final data will likely be obtained through follow-up (Klabunde et al., 2012). Tailoring or personalizing this follow-up may further improve response, but this may entail cost/quality trade-offs as some options are expensive. Follow-up does have its limits, with some diminishing returns associated with efforts to convert particularly difficult cases (Berk, 1985; Cull et al., 2005).
Finally, of note is the demonstrated decline in RRs between 1958 and 2012. Clinicians are busy, with surveys competing against other—arguably more important—priorities. Lack of time, is compounded by the increasing volume of surveys clinicians are asked to respond to, as well as practice environments (with various gatekeepers) serving as additional barriers to survey participation. Regardless, the trend noted here is a stark reminder of the challenges associated with surveying health professionals. As a result, researchers must make every effort to improve access to their target population by implementing appropriate incentive- and design-based strategies demonstrated to improve participation rates.
Limitations
Other reviews and studies have explored other options, particularly design-based strategies that may also contribute to improved clinician survey response, including questionnaire length and type of mailing. Limitations related to method and study selection criteria in the present study constrain the full range of interventions considered. Klabunde et al. (2012) present a wider research agenda to further our understanding of which interventions (or combination of interventions) will contribute to higher RRs. Examples extend beyond different design-based interventions to include our inability to differentiate between incentive amounts. This is critical given the obvious cost implications of incentives in planning studies of health care professionals. While incentives work, research is still needed to determine to most effective amount relative to the populations of interest (Klabunde et al., 2012). Additionally, there is a clear lack of diversity in our “health care provider” category. The overwhelming proportion of available studies involves physician samples, severely limiting our ability to test between-group differences in provider response to various incentive- or design-based interventions.
Ultimately, decisions regarding what methodologies to employ are embedded within cost-quality trade-offs. The good news is that previous reviews identified smaller than anticipated differences between clinician respondents and nonrespondents and between early and late responders (Field et al., 2002; Kellerman & Herold, 2001; McFarlane, Olmsted, Murphy, & Hill, 2006), suggesting low rates of nonresponse bias due to the within-group homogeneity of clinicians—nurses and physicians specifically—with regard to their respective knowledge, training, attitudes, and behavior (Barriball & While, 1999; Field et al., 2002; Ford & Bammer, 2009; Kellerman & Herold, 2001). We also wish to acknowledge that RRs are no longer understood to be the optimal indicator of survey quality. Rather, nonresponse bias, which is not necessarily correlated with RR, is of greater importance for evaluating the validity of survey findings (Johnson & Wislar, 2012). Future research should focus on the methodological correlates of nonresponse bias in surveys of health care professionals.
Footnotes
Appendix
Summary of Studies.
| Study | Lead author | Year published | Place of survey | Design | Subgroup | N eligible | N completed | Response ratea | Sample variance | Mode | Incentive | Follow-ups | Respondent type |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | Akl | 2005 | United States | Non-RCT | 1 | 60 | 38 | 0.633 | 0.113 | Online | No incentives | 2 | Resident |
| 2 | 59 | 47 | 0.797 | 0.131 | No incentives | 2 | Resident | ||||||
| 3 | 41 | 35 | 0.854 | 0.228 | Online | No incentives | 2 | Faculty | |||||
| 4 | 42 | 34 | 0.810 | 0.190 | No incentives | 2 | Faculty | ||||||
| 2 | Asch | 1994 | United States | RCT | 1 | 452 | 154 | 0.341 | 0.028 | No incentives | 0 | Physician | |
| 2 | 449 | 184 | 0.410 | 0.022 | No incentives | 0 | Physician | ||||||
| 3 | Asch | 1996 | United States | RCT | 1 | 830 | 635 | 0.765 | 0.008 | Monetary | 2 | Nurse | |
| 2 | 730 | 504 | 0.690 | 0.009 | Monetary | 2 | Nurse | ||||||
| 4 | Asch | 1998 | United States | RCT | 1 | 482 | 221 | 0.459 | 0.018 | Monetary | 3+ | Physician | |
| 2 | 484 | 296 | 0.612 | 0.014 | Monetary | 3+ | Physician | ||||||
| 5 | Becker | 2000 | United States | Non-RCT | 1 | 833 | 286 | 0.343 | 0.015 | No incentives | 0 | Nurse | |
| 2 | 596 | 217 | 0.364 | 0.019 | No incentives | 0 | Nurse | ||||||
| 3 | 833 | 322 | 0.387 | 0.013 | No incentives | 1 | Nurse | ||||||
| 4 | 596 | 232 | 0.389 | 0.018 | No incentives | 1 | Nurse | ||||||
| 5 | 833 | 356 | 0.427 | 0.011 | No incentives | 2 | Nurse | ||||||
| 6 | 596 | 273 | 0.458 | 0.014 | No incentives | 2 | Nurse | ||||||
| 6 | Beebe | 2007 | United States | RCT | 1 | 245 | 154 | 0.629 | 0.027 | Mixed | No incentives | 2 | Physician |
| 2 | 244 | 172 | 0.705 | 0.028 | Mixed | No incentives | 2 | Physician | |||||
| 7 | Berk | 1985 | United States | Non-RCT | 1 | 6,685 | 4,947 | 0.740 | 0.001 | No incentives | 2 | Physician | |
| 8 | Berry | 1987 | United States | RCT | 1 | 1,011 | 783 | 0.774 | 0.007 | Monetary | 3+ | Physician | |
| 2 | 1,017 | 670 | 0.659 | 0.006 | Monetary | 3+ | Physician | ||||||
| 9 | Bhandari | 2003 | Canada | RCT | 1 | 196 | 117 | 0.597 | 0.035 | No incentives | 0 | Surgeon | |
| 2 | 199 | 93 | 0.467 | 0.043 | No incentives | 0 | Surgeon | ||||||
| 10 | Bonevski | 2011 | Australia | RCT | 1 | 1,617 | 451 | 0.279 | 0.011 | Mixed | No incentives | 1 | Physician |
| 2 | 587 | 27 | 0.046 | 0.844 | Mixed | Monetary | 2 | Physician | |||||
| 3 | 576 | 22 | 0.038 | 1.237 | Mixed | Monetary | 1 | Physician | |||||
| 11 | Bostick | 1992 | Australia | Non-RCT | 1 | 262 | 172 | 0.656 | 0.025 | Online | No incentives | 0 | Physician |
| 2 | 262 | 241 | 0.920 | 0.056 | Online | No incentives | 1 | Physician | |||||
| 12 | Camuňas | 1990 | Canada | RCT | 1 | 100 | 16 | 0.160 | 0.465 | No incentives | 0 | Nurse | |
| 2 | 100 | 11 | 0.110 | 0.928 | No incentives | 0 | Nurse | ||||||
| 3 | 100 | 21 | 0.210 | 0.287 | No incentives | 0 | Nurse | ||||||
| 4 | 200 | 90 | 0.450 | 0.044 | Monetary | 0 | Nurse | ||||||
| 5 | 200 | 42 | 0.210 | 0.143 | No incentives | 0 | Nurse | ||||||
| 13 | Cartwright | 1968 | England | RCT | 1 | 57 | 55 | 0.965 | 0.537 | No incentives | 3+ | Physician | |
| 2 | 59 | 46 | 0.780 | 0.126 | No incentives | 3+ | Physician | ||||||
| 3 | 58 | 48 | 0.828 | 0.146 | No incentives | 3+ | Physician | ||||||
| 4 | 58 | 39 | 0.672 | 0.116 | No incentives | 3+ | Physician | ||||||
| 14 | del Valle | 1997 | United States | Non-RCT | 1 | 1,750 | 1,336 | 0.763 | 0.004 | No incentives | 2 | Physician | |
| 2 | 143 | 59 | 0.413 | 0.069 | No incentives | 3+ | Physician | ||||||
| 3 | 266 | 66 | 0.248 | 0.081 | No incentives | 3+ | Physician | ||||||
| 15 | Donaldson | 1999 | United States | RCT | 1 | 100 | 48 | 0.480 | 0.083 | No incentives | 0 | Physician | |
| 2 | 100 | 55 | 0.550 | 0.073 | Monetary | 0 | Physician | ||||||
| 3 | 100 | 43 | 0.430 | 0.094 | Mixed | No incentives | 1 | Physician | |||||
| 4 | 100 | 60 | 0.600 | 0.069 | Mixed | Monetary | 1 | Physician | |||||
| 16 | Dykema | 2011 | United States | RCT | 1 | 500 | 15 | 0.030 | 2.291 | No incentives | 0 | Physician | |
| 2 | 500 | 31 | 0.062 | 0.554 | No incentives | 0 | Physician | ||||||
| 3 | 500 | 31 | 0.062 | 0.554 | Monetary | 0 | Physician | ||||||
| 4 | 500 | 33 | 0.066 | 0.491 | Monetary | 0 | Physician | ||||||
| 5 | 500 | 43 | 0.086 | 0.295 | Monetary | 0 | Physician | ||||||
| 6 | 350 | 47 | 0.134 | 0.183 | Monetary | 0 | Physician | ||||||
| 7 | 350 | 54 | 0.154 | 0.141 | Monetary | 0 | Physician | ||||||
| 8 | 350 | 89 | 0.254 | 0.059 | Monetary | 0 | Physician | ||||||
| 17 | Everett | 1997 | United States | RCT | 1 | 261 | 164 | 0.628 | 0.026 | Monetary | 0 | Physician | |
| 2 | 260 | 118 | 0.454 | 0.034 | No incentives | 0 | Physician | ||||||
| 18 | Gattellari | 2001 | Australia | RCT | 1 | 108 | 91 | 0.843 | 0.082 | Monetary | 0 | Surgeon | |
| 2 | 111 | 104 | 0.937 | 0.162 | No incentives | 0 | Surgeon | ||||||
| 19 | Gore-Felton | 2002 | United States | Non-RCT | 1 | 987 | 671 | 0.680 | 0.006 | No incentives | 2 | Psychologist | |
| 20 | Grava-Gubins | 2008 | Canada | Non-RCT | 1 | 60,811 | 19,239 | 0.316 | 0.000 | Mixed | Monetary | 3+ | Physician |
| 2 | 9,162 | 2,822 | 0.308 | 0.001 | Online | Monetary | 3+ | Medical Student | |||||
| 3 | 2,627 | 733 | 0.279 | 0.006 | Online | Monetary | 3+ | Resident | |||||
| 21 | Guise | 2010 | England | Non-RCT | 1 | 148 | 48 | 0.324 | 0.095 | Online | No incentives | 3+ | Nurse |
| 2 | 148 | 81 | 0.547 | 0.049 | Mixed | No incentives | 3+ | Nurse | |||||
| 22 | Halpern | 2011 | United States | RCT | 1 | 1,382 | 422 | 0.305 | 0.011 | Online | Monetary | 2 | Physician |
| 2 | 414 | 129 | 0.312 | 0.036 | Online | Monetary | 2 | Physician | |||||
| 3 | 410 | 133 | 0.324 | 0.034 | Online | No incentives | 2 | Physician | |||||
| 4 | 738 | 291 | 0.394 | 0.014 | Monetary | 1 | Nurse | ||||||
| 5 | 250 | 147 | 0.588 | 0.028 | Monetary | 1 | Nurse | ||||||
| 6 | 385 | 183 | 0.475 | 0.021 | Online | Monetary | 2 | Physician | |||||
| 7 | 400 | 223 | 0.558 | 0.018 | Online | Monetary | 2 | Physician | |||||
| 23 | Hart | 2009 | United States | Non-RCT | 1 | 236 | 116 | 0.492 | 0.034 | Online | No incentives | 1 | Nurse program director |
| 2 | 76 | 34 | 0.447 | 0.119 | Online | No incentives | 1 | Nurse program director | |||||
| 24 | Hawley | 2009 | United States | Non-RCT | 1 | 98 | 39 | 0.398 | 0.107 | No incentives | 2 | Mental health provider | |
| 2 | 98 | 41 | 0.418 | 0.100 | Nonmonetary | 2 | Mental health provider | ||||||
| 3 | 100 | 51 | 0.510 | 0.078 | Monetary | 2 | Mental health provider | ||||||
| 4 | 99 | 60 | 0.606 | 0.069 | Monetary | 2 | Mental health provider | ||||||
| 5 | 99 | 64 | 0.646 | 0.068 | Monetary | 2 | Mental health provider | ||||||
| 25 | Heywood | 1995 | Canada | Non-RCT | 1 | 16 | 7 | 0.438 | 0.580 | No incentives | 2 | Physician | |
| 2 | 172 | 115 | 0.669 | 0.039 | No incentives | 3+ | Physician | ||||||
| 3 | 69 | 56 | 0.812 | 0.116 | No incentives | 2 | Physician | ||||||
| 26 | James | 2011 | United States | Non-RCT | 1 | 263 | 90 | 0.342 | 0.049 | Monetary | 2 | Physician | |
| 2 | 255 | 50 | 0.196 | 0.126 | Monetary | 2 | Physician | ||||||
| 3 | 265 | 26 | 0.098 | 0.434 | Monetary | 2 | Physician | ||||||
| 4 | 266 | 20 | 0.075 | 0.719 | Monetary | 2 | Physician | ||||||
| 27 | Kanaan | 2010 | England | RCT | 1 | 214 | 151 | 0.706 | 0.031 | Monetary | 1 | Physician | |
| 2 | 147 | 79 | 0.537 | 0.050 | Monetary | 1 | Physician | ||||||
| 3 | 230 | 121 | 0.526 | 0.033 | No incentives | 1 | Physician | ||||||
| 28 | Keating | 2008 | United States | RCT | 1 | 549 | 286 | 0.521 | 0.014 | Mixed | Monetary | 3+ | Physician |
| 2 | 431 | 292 | 0.677 | 0.015 | Mixed | Monetary | 3+ | Physician | |||||
| 29 | Kephart | 1958 | United States | RCT | 1 | 100 | 52 | 0.520 | 0.077 | No incentives | 0 | Nurse | |
| 2 | 100 | 53 | 0.530 | 0.075 | No incentives | 0 | Nurse | ||||||
| 3 | 100 | 68 | 0.680 | 0.067 | No incentives | 1 | Nurse | ||||||
| 4 | 100 | 67 | 0.670 | 0.067 | No incentives | 1 | Nurse | ||||||
| 5 | 100 | 60 | 0.600 | 0.069 | No incentives | 0 | Nurse | ||||||
| 6 | 100 | 66 | 0.660 | 0.067 | No incentives | 0 | Nurse | ||||||
| 7 | 100 | 55 | 0.550 | 0.073 | Monetary | 0 | Nurse | ||||||
| 8 | 100 | 54 | 0.540 | 0.074 | Monetary | 0 | Nurse | ||||||
| 9 | 100 | 57 | 0.570 | 0.071 | Monetary | 0 | Nurse | ||||||
| 10 | 100 | 70 | 0.700 | 0.068 | Monetary | 0 | Nurse | ||||||
| 30 | Lusk | 2007 | United States | RCT | 1 | 4,887 | 3,201 | 0.655 | 0.001 | Monetary | 3+ | Health professionals | |
| 2 | 3,527 | 328 | 0.093 | 0.036 | Online | Monetary | 3+ | Health professionals | |||||
| 31 | Malin | 2000 | United States | Non-RCT | 1 | 169 | 28 | 0.166 | 0.258 | No incentives | 0 | Medical director | |
| 2 | 169 | 46 | 0.272 | 0.109 | Mixed | No incentives | 1 | Medical director | |||||
| 3 | 165 | 124 | 0.752 | 0.043 | Mixed | Monetary | 2 | Medical director | |||||
| 32 | Martins | 2012 | United States | Non-RCT | 1 | 190 | 84 | 0.442 | 0.048 | Mixed | Monetary | 1 | Physician |
| 2 | 190 | 131 | 0.689 | 0.035 | Mixed | Monetary | 2 | Physician | |||||
| 33 | Matteson | 2011 | United States | Non-RCT | 1 | 802 | 262 | 0.327 | 0.017 | Online | No incentives | 3+ | Physician |
| 2 | 802 | 417 | 0.520 | 0.009 | Mixed | No incentives | 3+ | Physician | |||||
| 34 | McLaren | 2000 | Australia | RCT | 1 | 305 | 188 | 0.616 | 0.022 | Nonmonetary | 2 | Physician | |
| 2 | 316 | 194 | 0.614 | 0.021 | Nonmonetary | 2 | Physician | ||||||
| 3 | 311 | 197 | 0.633 | 0.021 | Nonmonetary | 2 | Physician | ||||||
| 4 | 310 | 185 | 0.597 | 0.022 | Nonmonetary | 2 | Physician | ||||||
| 35 | Myerson | 1993 | England | Non-RCT | 1 | 85 | 50 | 0.588 | 0.082 | No incentives | 0 | Physician | |
| 2 | 85 | 63 | 0.741 | 0.082 | No incentives | 1 | Physician | ||||||
| 3 | 85 | 72 | 0.847 | 0.107 | No incentives | 2 | Physician | ||||||
| 36 | Nicholls | 2011 | United States | Non-RCT | 1 | 2,378 | 609 | 0.256 | 0.008 | Mixed | Monetary | 3+ | Physician |
| 37 | Olson | 1993 | United States | RCT | 1 | 5,500 | 1,293 | 0.235 | 0.004 | Mixed | Monetary | 3+ | Physician |
| 2 | 5,500 | 1,122 | 0.204 | 0.005 | Mixed | No incentives | 3+ | Physician | |||||
| 3 | 611 | 426 | 0.697 | 0.011 | Monetary | 0 | Physician | ||||||
| 4 | 624 | 405 | 0.649 | 0.010 | Monetary | 0 | Physician | ||||||
| 5 | 629 | 438 | 0.696 | 0.010 | Monetary | 0 | Physician | ||||||
| 38 | Paul | 2005 | Australia | RCT | 1 | 334 | 220 | 0.659 | 0.020 | Monetary | 2 | Pharmacist | |
| 2 | 331 | 177 | 0.535 | 0.022 | No incentives | 2 | Pharmacist | ||||||
| 39 | Puleo | 2002 | United States | Non-RCT | 1 | 761 | 286 | 0.376 | 0.014 | Monetary | 0 | Physician | |
| 2 | 761 | 460 | 0.604 | 0.009 | Monetary | 1 | Physician | ||||||
| 3 | 761 | 509 | 0.669 | 0.008 | Monetary | 2 | Physician | ||||||
| 4 | 761 | 621 | 0.816 | 0.010 | Mixed | Monetary | 3+ | Physician | |||||
| 40 | Recklitis | 2009 | United States | RCT | 1 | 136 | 111 | 0.816 | 0.060 | Mixed | Monetary | 1 | Physician |
| 2 | 135 | 85 | 0.630 | 0.050 | Mixed | Nonmonetary | 1 | Physician | |||||
| 3 | 135 | 103 | 0.763 | 0.053 | Mixed | Monetary | 1 | Physician | |||||
| 41 | Temple-Smith | 1998 | Australia | Non-RCT | 1 | 520 | 294 | 0.565 | 0.013 | Nonmonetary | 0 | Physician | |
| 2 | 520 | 397 | 0.763 | 0.013 | Nonmonetary | 1 | Physician | ||||||
| 3 | 520 | 444 | 0.854 | 0.018 | Nonmonetary | 2 | Physician | ||||||
| 42 | Thorpe | 2008 | United States | Non-RCT | 1 | 98 | 72 | 0.735 | 0.071 | Monetary | 3+ | Physician | |
| 2 | 239 | 182 | 0.762 | 0.030 | Monetary | 3+ | Physician | ||||||
| 3 | 320 | 154 | 0.481 | 0.026 | No incentives | 3+ | Physician | ||||||
| 4 | 2,240 | 1,647 | 0.735 | 0.003 | Monetary | 3+ | Physician | ||||||
| 43 | Ulrich | 2005 | United States | RCT | 1 | 470 | 226 | 0.481 | 0.017 | No incentives | 3+ | Nurse | |
| 2 | 491 | 178 | 0.363 | 0.024 | No incentives | 3+ | Physician aid | ||||||
| 3 | 474 | 231 | 0.487 | 0.017 | Monetary | 3+ | Nurse | ||||||
| 4 | 508 | 207 | 0.407 | 0.020 | Monetary | 3+ | Physician aid | ||||||
| 5 | 496 | 345 | 0.696 | 0.013 | Monetary | 3+ | Nurse | ||||||
| 6 | 523 | 307 | 0.587 | 0.013 | Monetary | 3+ | Physician aid | ||||||
| 44 | VanGeest | 2001 | United States | RCT | 1 | 292 | 176 | 0.603 | 0.023 | Monetary | 3+ | Physician | |
| 2 | 291 | 198 | 0.680 | 0.023 | Monetary | 3+ | Physician | ||||||
| 3 | 290 | 189 | 0.652 | 0.023 | Monetary | 3+ | Physician | ||||||
| 45 | Viera | 2012 | United States | RCT | 1 | 4,245 | 509 | 0.120 | 0.018 | Online | Monetary | 0 | Physician |
| 2 | 4,232 | 703 | 0.166 | 0.010 | Online | Monetary | 0 | Physician | |||||
| 46 | VonRiesen | 1979 | United States | RCT | 1 | 396 | 166 | 0.419 | 0.024 | No incentives | 1 | Veterinarian | |
| 2 | 390 | 195 | 0.500 | 0.020 | No incentives | 1 | Veterinarian | ||||||
| 3 | 392 | 155 | 0.395 | 0.027 | No incentives | 0 | Veterinarian | ||||||
| 47 | Wilson | 2010 | Canada | RCT | 1 | 244 | 122 | 0.500 | 0.032 | Online | Nonmonetary | 3+ | Researcher |
| 2 | 241 | 110 | 0.456 | 0.036 | Online | Nonmonetary | 3+ | Researcher | |||||
| 48 | Ziegenfuss | 2012 | United States | RCT | 1 | 620 | 88 | 0.142 | 0.093 | Monetary | 0 | Physician | |
| 2 | 630 | 100 | 0.159 | 0.074 | Monetary | 0 | Physician |
Note. aProportion.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
