Ways to improve response rates for patient assessments, questionnaires and surveys.
A response rate is the percentage of people who responded to an assessment. There are five types of patient assessments: Screeners, Evaluations, Questionnaires, Measures, and Surveys (See Screeners, Evaluations, Questionnaires, Measures, and Surveys – Oh My). The response rate for each type of assessment should be tracked separately because there are different motivational factors for completing each one of these types of assessments. Generally, evaluations have the best response rates, and surveys have the lowest response rates. Knowing the motivations for taking each type of assessment can help identify drivers for improving response rate.
Some methods of improving response rates for patient assessments, questionnaires and surveys include informing respondents of how their answers will be used, decreasing the number of questions, limiting the amount of time required, and providing incentives for participation. It is important to be sure your questions follow a logical pattern so that patients who start a survey follow it through to completion. Below are 15 ways to improve response rates for assessments.
What is a good response rate for a survey?
A good rule of thumb is to set a goal for assessment response rates at the patient show rates for appointments. No-show rates run around 20% for appointments. Therefore, a good response rate is around 80%.
What are ways to improve response rates for patient assessment, questionnaires and surveys?
Here are 15 best practices to follow to improve patient response rates on assessments.
1. Give it at the right time.
The number one way to improve completion of assessments is to adjust the timing of when it is given relative to other activities of care. The best completion rates are those that occur during an appointment via interview, but they are also the most burdensome to care efficiency. The next highest completion rates are those that are given just before the appointment during a designated waiting period (after arriving at an office visit or after logging into a virtual visit). Next best are those that are sent days prior to a visit but which have instructions to be completed by the time of the visit, so as to give a deadline. The worst response rates occur for those types of assessments which are sent after care is completed and which have no deadline. (Opeeka’s P-CIS schedules assessments to go to the patient at the pre-determined timeframe.)
2. Make it convenient.
Even if an assessment is administered with the most optimal timing, patients will not complete it if there are barriers of convenience. For self-report, the highest completion rates are often for paper/pencil or wipe board assessments given in the waiting period before appointments. These provide no technology fear barrier for patients. However, these are also the most burdensome to collect as staff must key enter or scan the results. Some offices have installed kiosks or hand out electronic tablets for the completion of assessments prior to appointment, but these options do not support virtual care, which is now a large proportion of appointments, thanks to COVID. Texting or emailing assessments is showing to be a good option when patients have phones or computers. Often these options can collect information from patients in a secure manner without requiring a login to a portal. Using a patient portal is another option, but it provides a significant technology barrier as patients must remember passwords and often are required to download applications onto their devices. Assessments sent through patient portals will have lower completion rates. (Opeeka’s P-CIS sends text or email assessments to the patient for easy, quick, and secure completion.)
3. Don’t waste their time.
Don’t make them enter their name and other information already have on file. If it is a paper form, give them only one that asks for the information or the updated information to name and address. If it is electronic, just don’t ask for anything more than an identifier, if needed. So many forms that ask for the same information waste patient and staff time. The skip option for people not knowing the answer to a question is one way to improve response rates. The skip option allows patients or respondents to move on to the next question or just skip it. (Opeeka’s P-CIS automates form completion when information is the same from one form to the next, and it includes options for skip logic and required/non required responses.)
4. Remind, Remind, Remind.
Research done by survey monkey highlights the importance of reminders for survey completion (https://www.surveymonkey.com/curiosity/how-often-should-you-use-email-reminders/). They suggest that reminders should begin 48 to 72 hours after the initial invitation. Their data also suggests best results with four properly spaced reminders. For patient questionnaires, these should be sent equally spaced between the the invitation and the deadline for completion. Reminders can be email, text reminders, or alerts in a patient portal. (Opeeka’s P-CIS send up to six reminders.)
5. Educate the patient.
Be concise in the email or text and tell them why you are sending the assessment. However, go further and tell them what their time in completing the assessment will do for them or others. See this example for a questionnaire which asks about Social Determinants of Health (SDoH) in order to provide whole person, person-centered care.
“This assessment helps us understand more about your unique circumstances. By completing this assessment, we will be able to provider more personalized care to better serve you as an individual.”
Embed the first question. Rather than putting simply putting a link in a text or an email to a assessment that they cannot see, embed the first question with answers in the email or text as a link that will take them to the assessment. Survey Monkey’s research suggests this increases response rates drastically because some of the fear of what they might see or be asked is reduced by viewing the type of question before they commit to leaving the safety of their email or text application.
“If you want to really boost your response rates (and completion rates!), just embed your first question of your survey in the body of your email so that when a respondent chooses an answer option, they’ll automatically be taken to your survey.
We’ve tested it ourselves: Embedding the first question in your survey invitation can boost response rates by as much as 22%. It even increases the rate people actually complete your survey—by 19%, no less. Just be sure you choose the right kind of question to embed in your survey invitation—namely multiple choice questions, star rating questions, or NPS [Net Promoter Score] questions.” https://www.surveymonkey.com/curiosity/3-ways-to-optimize-your-survey-invitations-to-increase-response-rates-3/
6. Provide rewards and incentives.
Establish a process to provide incentives and rewards programs to patients for completing assessments. Restaurants and retailers track information about customers in rewards programs to offer them benefits after certain milestones. Health care providers can follow this well established engagement tool by creating a point system for reaching health goals, not limited to completing surveys and reaching behavioral health outcome goals. These “Healthy Points” might result in a choice between free non-standard screenings (something you may want them to do anyway) or $5 gift cards to the pharmacy. Whatever the reward, a point system with health engagement levels (bronze, gold, platinum) based on patient engagement in care will lead to more patient engagement in care just by the nature of its gamification.
7. Provide praise.
One thing we have all experienced via good customer services is praise from our customer representative. “Thank you for coming in today.” “Thank you for your purchase.” “Thank you for flying our airlines.” All of the businesses do it because it works to engage people. Just because patients have a plan that results in a provider does not mean they don’t have choices to change plans or providers. Customer service skills in the form of praise can engender trust and engage patients into their health care. There seems to have been a historic cultural that instills a fear in staff to feel that if the experience is too warm, that patients will come back too often and flood the system. While in fact, it is has been shown that people more engaged in their care are more self-sufficient and use less services overall.
Establish a protocol for staff to thank patients for their participation in assessment, and the completion rates will soar. If patients feel that their time was valued and that they got a return on that time investment, they will do it again the next time. There are several ways to give praise.
Automated praise. At the end of the online assessment, show a specific phrase related to the assessment they just completed thanking them and reminding them again of how the information will be used to help them or to help others. The following example could be displayed after a parent completes a long assessment about a child with suspected autism or developmental delays.
“Great work! This will help your care team better understand you and your child so they can provide you with the best possible care.”
Praise from human interaction. Thank them – in person, if possible, to let them know appreciation for their time/efforts and demonstrate that the information is used; everyone likes feeling appreciated. Any time a health care coordinator, such as the receptionists or other staff engage with patients, ask them to thank the patient for their time in completing assessments, as appropriate. This is also a good time to thank them for their health engagement by letting them know what they “Healthy Points” level is in the engagement incentive plan.
8. Make it fun and engaging.
Assessments don’t have to be dry, clinical, and judgmental all the time. First of all, choose culturally sensitive and compassionate wording. When a provider can, they should make the assessment fun.
Many assessments identify the desired answer by the judgmental wording of the question. For example, “Do you eat at least 3-4 serving of fruits and vegetables a day? Yes/No.” It is clear from that wording that the socially desired answer is “Yes” and that an answer of “No” will be judged undesirably. Consider instead more compassionate wording, such as: “Do you prefer to eat more or less than 3-4 servings of fruits and vegetables in a day? More/Less.” This gives the same result in data, but it provides a less judgmental tone by offering to respect their preferences.
There are many fun ways to assess cognitive ability through games, art, or avatars. For example, Opeeka’s skill sketches offer coloring pages for patients to track their resilience factors and skills each month. (https://www.opeeka.com/skillsketches/) These tools are designed to engage patients into recognizing and building skills by using color by number to track the level of skill each month. There are many creative ways that assessments can be designed to capture information in an engaging way so that can inform clinicians so that they can guide better care.
9. Make it informative.
Without overwhelming the patient during the assessment, provide expandable sections or a post section of information in the assessment that provides meaningful information about the topics assessed. For example, if the assessment asks a parent to rate a child’s developmental progress, then at the end of the assessment, display information about typical development milestones. Don’t forget to define terms with which the patient may not be familiar. For example, a link to a glossary of terms is helpful, but embedded expandable sections of definitions are the most convenient and accessible. (Opeeka’s P-CIS offers expandable supplemental information sections for each question.)
10. Give back their results.
If possible, provide the patient back their results in a format that they can keep and reference. Ultimately, the onus of managing their health or the health of their loved ones falls to them on a day to day basis. If they or their family members are ill, then even though the information that they provided came from their own mind and experience, the stress of the situation may prevent them from recalling their status a week ago, or a month ago. Give them back their score, a graph, or a simply the same results they input so that they can have their own record of their status at that time. Ideally, this would be accessible to them at any time. In the very least, it should be provided to them in a format that they can keep at the end of the assessment. (Opeeka’s P-CIS offers embedded real-time results graphing during assessment.)
Note: there are exceptions to this recommendation. Assessments that ask about trauma, past behaviors, SDoH, or stigmatized subjects should not be presented back to the patient. Those types of questions are likely difficult to answer in the first, and seeing the answers back “on paper” (so to speak) can be triggering by the nature of the concreteness of the circumstance as seen “on paper in black and white.”
11. Norm the results.
As commonly seen in lab results, patients find it valuable to be told where they stand relative to normal ranges. This can be helpful for other assessments as well. Letting a patient know that their illness, disorder or set of symptoms, especially if it is a mental illness, is experienced by others can help them feel less alone. While not revealing the actual percentage of patients who have an illness, it may be helpful for providers to tell patients a level (common, very common) or a range (5-10%, 35-35%) of patients who also experience this condition.
12. Remove the stigma.
Framing and wording of assessments can be stigmatizing if not done carefully. Frame messages to let patients know that we all struggle with health concerns from time to time. Terms like “rare” and “uncommon” are stigmatizing and isolating terms and should be avoided. Patients would rather hear that they are 1 out of 1,000 patients with a disorder than to hear that their disorder is “rare.” This is especially true if the provider sees thousands of patients, then by virtue, they are not alone. Wording for behavioral health disorders and substance use disorder can be especially stigmatizing and should be carefully reviewed by patient advocates and peer specialists.
13. Help them feel less alone.
Similar to norming the results, providers can make the patient feel less alone by letting them know that they specialize in the type of care needed and that they have successfully served many other patients with similar illnesses before. While this practice if fairly common for patients with cancer, it is uncommon for patients with mental illness. Providers can help patients with mental illness feel less alone by letting them know that there are others who have successfully recovered and lead functional and healthy lives.
14. Connect them with resources.
There is nothing worse for a patient than to complete an assessment where they revealed a variety of personal information – whether that be their symptoms, their history, their lack of progress toward health goals, or their dissatisfaction with their care – and it goes into a black hole and they never hear anything about it again. Ever.
Patients should be offered to be connected with resource immediately after completing the assessment (e.g., and let them know that at the end of the assessment, they will receive links to resources.) Depending on the answers on the assessment, someone or some automated process should contact them within 24 hours to let them know about next steps relative to their responses. The best way to ensure that someone will not complete a second assessment is to ignore them and their responses on the first assessment.
15. Show them progress.
As mentioned in 10 & 11, patients with illness or with family members with illnesses might be challenged to track change or progress due to their stress level. Showing patients their progress toward goals as captured by assessments helps them value the time they put in to take the assessments. For example, showing a patient progress toward reduced anxiety and depression symptoms over time can help them recognize the value of the care they received.
What are some other creative techniques to improve response?
Researchers are adding visuals and videos to keep respondents engaged. This can improve response rates, as well as reduce the length of time needed for surveys.
Summary of techniques
With a little effort and investment in technology, providers can increase their response rate on screeners, evaluations, questionnaires, outcome measures and surveys in order to identify the right people to treat and to provide them the most efficient person-centered, whole person care. With integrated care, joining mental health, behavioral health and physical health, assessing patient circumstances to treat the whole person is becoming more and more a necessity. Staff simply do not have time to interview patients in order to capture all of the information necessary to provide individualized treatment plans. While assessments may have been seen as a burdensome regulatory requirement in the past, new technology, such as Opeeka’s P-CIS, is making assessments easier to capture and more valuable to patients and staff. The future of care is not less assessment, it is more. Much more.
What is the Future of Assessments?
I predict that the days of shortening assessments to two questions to improve response and decrease burden will soon be over. Artificial Intelligence (AI) combined with Natural Language Processing (NLP) and tonal sentiment analysis techniques will soon (in the next 5-10 years) allow most patients to respond verbally to questions while structured information is captured into responses on Likert scales (for example), showing change over time.
Patients will talk into their phone before an appointment in response to audible and readable questions that are texted to them at the time of appointment. The first portion of every appointment will be the 15 minute interaction of patient with compassionate machine, gathering information while providing patient education, praise, incentives, rewards, information, normative results, de-stigmatizing context, resources and updates on progress toward goals. Waiting rooms will contain secure and sound proof phone booths where patients will enter with their phone or clinic tablet to tell their story to prepare clinicians for their visit.
Just before entering the examination room to see the patient, clinicians will review just the pertinent information they need from the assessments, in color-coded and graphical representations to allow quick digestion. Success-focused artificial intelligence (SF-AI), predictive and prescriptive analytics will recommend the most promising course of treatment based on the history of success from people like this patient. Clinicians will adjust recommendations based on nuances of the patient, and care will be more effective and efficient that it has ever been before.
Person-centered, whole person, integrated care requires more assessment, not less
Person-centered, whole person, integrated care requires more information about a patient’s circumstances and context in order to provide individualized treatment that the patient is most likely to respond to. What this means is that ‘gone are the days’ of recommending diet and exercise to everyone. In the future, we will know specifically what behavioral changes are most likely to be endorsed and followed by each patient, in consideration of illness, recovery stage, belief model, culture, SDoH, and preferences. Tomorrow’s care will be one in which we ask more, know more, and treat more, with less burden to staff and lower costs to systems.