Predictors of response rates of safety culture questionnaires in healthcare: a systematic review and analysis

Abstract

Objectives Safety culture questionnaires are widely used in healthcare to understand how staff feel at work, their attitudes and views, and the influence this has on safe and high-quality patient care. A known challenge of safety culture questionnaires is achieving high response rates to enhance reliability and validity. This review examines predictors of response rates, explores reasons provided for low response rates and identifies strategies to improve those rates. Methods Four bibliometric databases were searched for studies assessing safety culture in hospitals from January 2008 to May 2022. Data were extracted from 893 studies that included a safety culture questionnaire conducted in the hospital setting. Regression was used to predict response rate based on recruitment and data collection methods (incentives, reminders, method of survey administration) and country income classification. Reasons for low response were thematically analysed and used to identify strategies to improve response rates. Results Of the 893 studies that used a questionnaire to assess safety culture in hospitals, 75.6% reported a response rate. Response rates varied from 4.2% to 100%, with a mean response rate of 66.5% (SD=21.0). Regression analyses showed that safety culture questionnaires conducted in low-income and middle-income countries were significantly more likely to yield a higher response rate compared with high-income countries. Mode of administration, questionnaire length and timing of administration were identified as key factors. Remote methods of questionnaire data collection (electronic and by post) were significantly less likely to result in a higher response rate. Reasons provided for low response included: survey fatigue, time constraints, and lack of resources. Conclusion This review presents strategies for researchers and hospital staff to implement when conducting safety culture questionnaires: principally, distribute questionnaires in-person, during meetings or team training sessions; use a local champion; and consider the appropriate time of distribution to manage survey fatigue.

The language of healthcare worker emotional exhaustion: A linguistic analysis of longitudinal survey

“…Increasingly, there is interest in signals that predict which groups and work settings are more vulnerable to EE (18,19). Identifying unobtrusive signals of EE in HCWs could be welcomed by leaders in need of data, and HCWs themselves, who may be unenthusiastic to fill out another burnout survey (20).…”

“…The second study examined the efficacy of a web-based gratitude letter-writing intervention for improving American healthcare workers' well-being (20). In a sub-analysis, the study assessed correlations between linguistic categories used in gratitude letters by one) baseline EE (n = 1179; cross-sectional design) and change in EE at a 1-week follow-up (n = 238; baseline linguistics predicting EE change).…”

Issues and complexities in safety culture assessment in healthcare

“…Low response rates are particularly problematic as they can increase bias, where non-responders may be systematically different from responders ( 49 ). An overall response rate above 60% is often believed to be needed in order to establish sufficient reliability and validity of the data captured ( 50 ). Some researchers argue that anything less is considered more of an assessment of “ opinion ” rather than “ culture ” ( 51 ).…”

“…Low response rates are increasingly being reported due to duplicative survey efforts, creating survey fatigue, and isolated datasets that do not produce a consistent snapshot of safety culture ( 50 , 52 , 53 ). Since the COVID-19 pandemic, additional time constraints, lack of resources and survey fatigue are being reported, and thus the need for survey integration has never being more acute ( 31 ).…”

“…Moving to an agreed gold standard survey approach across healthcare settings would certainly make benchmarking more reliable. Research has also pointed to some strategies that are available to assist in increasing response rates, such as distributing the questionnaire in person during training sessions or staff meetings, or by allocating a local champion who can motivate non-responders to consider participating ( 50 ).…”