Enhancing Recruitment Methodologies: Leveraging the Tailored Design Method to Survey Populations with Varied Engagement in Healthcare

Background Successfully recruiting respondents to complete surveys is integral for ensuring representative samples and providing adequate power for analyses that researchers can extrapolate to the population of interest. However, obtaining survey responses for public health and health services research can be challenging, especially when working with populations with varied engagement with the providers of the institution conducting the study. Recruitment is even more challenging when selecting participants based on historical events, which they may not remember, such as a brief health screen. Many researchers implement the Tailored Design Method (TDM) to optimize response rates. Methods We surveyed a national sample of 9,775 US Iraq and Afghanistan war veterans who had been screened between 2007 and 2018 for post-deployment health concerns in the Veterans Health Administration (VHA). We implemented a modified TDM to recruit respondents through USPS mail and an online data collection platform (i.e., Qualtrics) between July 2020 and August 2021. Results Twenty-one percent (N = 2,025) responded. It took a median of 21 and 69 days to receive responses via electronic survey (i.e., Qualtrics) and USPS, respectively. Participants had varied levels of engagement with the VHA at the time of screening and survey. Respondents and non-respondents used equal amounts of neurology, physical medicine and rehabilitation, and mental health VHA services in the 6 months post-screens. At the time of the survey, 20.82% of respondents reported not having recently used VHA services. Respondents were more likely to be older, White, and female than non-respondents, although differences were small in magnitude. Compared to online respondents, paper respondents were more likely to be older, rural, and screened earlier, and less likely to live in the same state as the research team. Conclusions This manuscript describes TDM implementation techniques and modifications that comply with federal regulations, and factors associated with response rates and contact methods. Researchers in federal institutions seeking to optimize response rates may find our TDM adaptations useful when surveying populations drawn from historical cohorts or without regular interaction with the research institution.