Participant recruitment in sensitive surveys: A comparative trial of 'opt in' versus 'opt out' approaches

Katherine J. Hunt, Natalie Shlomo, Julia Addington-Hall

Research output: Contribution to journalArticlepeer-review


Background: Although in health services survey research we strive for a high response rate, this must be balanced against the need to recruit participants ethically and considerately, particularly in surveys with a sensitive nature. In survey research there are no established recommendations to guide recruitment approach and an 'opt-in' system that requires potential participants to request a copy of the questionnaire by returning a reply slip is frequently adopted. However, in observational research the risk to participants is lower than in clinical research and so some surveys have used an 'opt-out' system. The effect of this approach on response and distress is unknown. We sought to investigate this in a survey of end of life care completed by bereaved relatives. Methods: Out of a sample of 1422 bereaved relatives we assigned potential participants to one of two study groups: an 'opt in' group (n=711) where a letter of invitation was issued with a reply slip to request a copy of the questionnaire; or an 'opt out' group (n=711) where the survey questionnaire was provided alongside the invitation letter. We assessed response and distress between groups. Results: From a sample of 1422, 473 participants returned questionnaires. Response was higher in the 'opt out' group than in the 'opt in' group (40% compared to 26.4%: chi2 =29.79, p-value
Original languageEnglish
Pages (from-to)3
JournalBMC Medical Research Methodology
Publication statusPublished - 11 Jan 2013


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