Reducing systematic bias in any group of study participants should be a priority of any researcher. This can be achieved by ensuring the sampling framework is adequate and by increasing response rates. Response rates in studies of general practitioners have to date tended to be low. Generalization of results to the wider population of GPs is therefore reduced. This paper systematically examines those factors which can reduce bias, recognising accurate identification of the target population, gaining good access to respondents, and maximising response rates as crucial factors. The importance of a medical peer in recruitment is examined. Applying these factors to a study situation, three different recruitment strategies were tested. As the strategy improved, there was an incremental improvement in the response rate (44%, 67%, 78%). These results indicate that by specifically addressing strategies which facilitate access to the target population, and increase the legitimacy and credibility of the study, significant improvements in response rates can be achieved.

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2. an unsuccessful offer to take a Pap smear or making an appointment for a smear. In a cross-sectional study of 3478 women presenting to 230 randomly selected general practitioners in Brisbane and Toowoomba, information about most recent Pap smear, screening in the consultation, and independent variables were collected from patients and doctors. Relationships between three levels of outcome variable (no action, Pap smear taken or referral, appointment or refusal), and independent variables (practitioner variables, consultation variables, patient variables) were modelled using polytomous logistic regression. Presenting for a routine checkup and breast cancer screening were associated with all types of action. Younger age, longer consultations and consultations with a female practitioner were associated with Pap smear taking and referrals, and not appointments or refusals. Being due for a Pap smear, having blood pressure measured, consulting a younger general practitioner and one who ascribed to current guidelines on screening were associated with an appointment or a refusal, when compared with no action. Results i d e n q different profiles of those who get a Pap smear and those who do not, the former indicating a more proactive patient group, while the latter suggest more active general practitioners who attempted opportunistic screening of passive patients, or women who do not specifically seek Pap smears. We have identified factors that have significance for developing public health programs focused on consumers and providers. (Aust N ZJPublic Heatth 199% 20: 260-6) ERVICAL cancer is the fifth most common cancer of women.' It is potentially preventable, C and incidence is reduced in populations in which screening programs are intense.'^^ Screening of Australian women occurs primarily in general p r a c t i~e .~.~ While screening of women in Australia may well have reached the targets set for 1995,6 there still remains a proportion of the female population who continue to be screened inadequately or not at a11.45~7-9 To develop strategies to improve uptake of Pap smear screening, we need to understand better those factors associated with both provision and acceptance of this procedure in general practice. Studies have identified patient factors (younger age, oral contraceptive user, higher income, higher education, urban dweller, higher morbidity, patient's intention, long-time attendance, patient's mobility) ,%I6 provider factors (female, younger age, perceiving the test efficacious, salaried, higher level of continuing education) ,l6I9 and practice factors (smaller patient clientele, organised screening program)15 associated with Pap smear provision and uptake. Various measurement procedures have been used in these studies, with the majority relying on retrospective self-report of physician or patient.m Only one study matched actual care provided in the consultation with patient information."All of these studies focused on Pap smear taking, but none reported practitioners' failed attempts, or deferral of act...