Respond with ease

Editor’s note: Tara Olson and Sherrie Aycock are the owners of AllPoints Research, Winston-Salem, N.C.

As a woman-owned firm, we have always been interested in the priorities and concerns of women. When we began to study women’s knowledge of and attitudes toward various reproductive and sexual health issues, we decided to employ technology-based research - specifically, online surveys - for several reasons.

We felt this project was important, not only so that we could start with deeper knowledge than our competitors when working with pharmaceutical and health care clients, but also so that our staff members could gain experience with the ever-evolving methodologies available.

We did not do this project for a specific client, and so we had no budget beyond what we were willing to invest in-house. We knew that online surveys would help us control costs - no interviewers, no focus group facilities, no mailings or printing - and save time. After survey execution, data synthesis and compilation are greatly simplified, time is freed up for analysis.

Cost, however, was not our biggest concern. We wanted the best data. And that’s another reason why we used online surveys for this project: We’ve seen how they can potentially deliver better data. For example, questions aren’t loaded with the inflection of the interviewer - removing a significant bias. Additionally, online surveys allow designers to standardize the entire flow of the survey for every possible combination of answers. Key language or types of answers then trigger standardized follow-up questions, which is important, because we know that even a slight change of wording in a question or follow-up can greatly influence not only the corresponding answer but also the entire flow of the survey responses.

Online surveys allowed us to reach a broad geographic sample and made participation fast and easy. Medical professionals, for example, are notoriously hard to reach because their time is always at a premium - though this can also be said of most women, particularly if they work and/or have children.

Finally, perhaps the most important benefit of using online surveys for this project was the privacy they provided respondents. We were asking questions about sensitive and emotionally charged subject matter. One of our questions, for example, was whether respondents would allow the new HPV (human papillomavirus) vaccine to be administered to their 12-year-old daughters, assuming they had a daughter that age. (HPV is transmitted sexually, and the FDA has recommended administering the vaccine to girls as early as age 11.) We felt that women would be more comfortable answering questions such as these in private, at their computers, without fear of being judged by fellow respondents or by an interviewer, and would therefore be more candid.

HPV and emergency contraceptives were the focus of our first two surveys in a series planned to continue through 2007, at which time we’ll address other sexual health topics such as low sex drive and vaginal dryness. We’ll also revisit previously surveyed topics to determine whether attitudes toward, or familiarity with, those subjects has changed.

Different experience

Obviously, online surveys are a materially different experience for respondents than in-person interviews or focus groups. The key is to clearly understand these differences and use them to your best advantage.

The most important factor in designing a successful online survey is the phrasing of the questions. Of course, this is true for all surveys, and this was particularly true given the sensitive nature of our subject matter. But the advantage we mentioned above - the lack of interviewer inflection in terms of creating bias - also means that there’s no interviewer to provide clarification. So it is of utmost importance that questions are appropriate for the online medium - easy to understand without elaboration or discussion of meaning. If there’s any concern that clarification might be necessary, then resources should also be available online. Though, with that said, the less time people have to spend reading directions, the more likely they’ll complete the survey.

Also, just as important, the Web interface must be user-friendly and not an obstacle to good results. If visuals are used, presentation must be clear and easy to access - no long downloads, no attachments, and if possible, no utilities required to support viewing. Optimize images for Web viewing so that they appear quickly and any loss of detail is minimized.

A final note on challenges - and this relates to client confidence: Clients seem to be more concerned about how honest the responses are in online surveys than in traditional surveys or focus groups. We have often been asked, “How do you know they’re not lying?” This is no more of an issue than with other methodologies, but clients’ lack of familiarity with technology inspires more uncertainty. While no one can guarantee total honesty from a respondent base, the relative lack of bias employed in the delivery of online surveys goes a long way toward more dependable data.

Range of strong opinions

In the past, we had conducted limited qualitative research as part of another project which provided some basis for the questions we chose to ask. We had a general idea, from these previous interviews, that lack of knowledge or misconceptions about HPV and emergency contraceptives might be common in the marketplace, and yet there might also be a range of strong opinions - such as whether emergency contraceptives might increase the likelihood of unprotected sex. Based on this background, we designed our questions to explore the extent to which these attitudes existed - and whether there might be other opinions or concerns out there of which we were not yet aware.

For these two surveys, we chose not to use visuals because we weren’t trying to determine if respondents recognized or favored one brand over another. Rather, we were trying to understand what women knew or didn’t know about HPV and emergency contraceptives, and so we wanted to avoid giving them any visual clues. But if, for example, we were to conduct a survey focusing on comfort levels with various methods of birth control (pills, IUDs, rings, patches, etc.), we could include photography of each method to clarify and remove the hindrance of unfamiliarity with newer methods.

We invited 2,000 women to participate in both surveys, offering the incentive of a drawing for $100. We sent prospective participants an e-mail with a link to the Web survey.

About 300 women responded to each survey, typical for a study with this respondent group, with results subject to a maximum sampling error of + 5.66 percent at the 95 percent confidence level, which falls within the standard expectation.

Respondents to both surveys were divided into two age groups, 25-39 and 40+. We did this to see if there were any distinctions in attitudes toward HPV and emergency contraceptives between younger and older women, and between women within the typical childbearing age range and women who had passed the typical childbearing years. On average between these two groups, 10 percent were single and had never married, 5 percent were single and living with a partner or fiancé, 12 percent were divorced, separated or widowed, and 73 percent were married.

On average, 19 percent had a high school diploma, GED or some high school; 46 percent had some college or an associate’s degree, and 35 percent had a college degree or beyond. In terms of ethnicity, nearly 90 percent of our respondents identified themselves as Caucasian, 6 percent as African-American, and 3 percent as Hispanic/Latino. We plan to achieve greater ethnic representation in upcoming surveys.

Survey one: women and emergency contraception

Key finding 1: Women overall tend to be accepting of emergency contraceptives (ECs) in the marketplace. The majority of women believe that ECs will decrease unplanned pregnancies and abortions and do not feel that ECs are immoral.

Key finding 2: Most women believe ECs to be acceptable in cases of rape and incest. Women are fairly divided with regard to ECs being acceptable “at any time.” However, only 6 percent of women believe that ECs are never acceptable. Women are also split regarding their views on whether the availability of ECs would increase the incidence of unprotected sex and the transmission of STDs.

Key finding 3: Women ages 55 and older generally have a lower acceptance of ECs compared to women younger than 55 years of age. Women who are trying to have a child are the least accepting of ECs and are more likely than other women to believe that ECs are never acceptable.

Key finding 4: There is a lack of awareness of Plan B (the brand name of the leading emergency contraception) among women. Only 20 percent of women are aware of Plan B, and less than 8 percent really understand Plan B’s mechanism and the situations in which the pill is medically appropriate or effective.

Survey two: women and HPV

Key finding 1: Overall, women are not well-informed regarding human papillomavirus and the primary diseases/conditions connected with HPV. An alarming 69 percent of all women are not aware of the primary diseases/conditions for which HPV can be the root cause and many have not even heard the term HPV at all. Approximately 60 percent of women indicate they have heard of HPV. Of the women indicating an awareness of HPV, 52 percent correctly linked it to cervical cancer and/or genital warts. Of those who were aware of this link, 8 percent associated HPV with both cervical cancer and genital warts, 33 percent associated HPV with cervical cancer only, and 11 percent associated HPV with genital warts only.

Key finding 2: 72 percent of women indicated they would allow administration of an HPV vaccine to their 12-year-old daughter(s), if they had a daughter this age. Of the 28 percent opposing the vaccine in this situation, 35 percent believe 12 is too young and another 35 percent mentioned that they do not want to promote sexual activity or that they planned to talk with their daughters about safe sex.

Increased the capabilities

Even in the last two years, improvements in technology - broadband access, easier design tools and more user-friendly interfaces - as well as the enhanced sophistication of users have increased the capabilities of online surveys. For example, users’ growing familiarity with the Web allows us to build more complex questionnaires without worry that responses or response rates will be negatively impacted.

The total population online is growing, providing a larger and more representative sample. Even a few years ago, using the Internet would have skewed the respondent base heavily toward the younger, wealthier and better-educated. But these days, the demographics of Internet users are beginning to correlate more closely to that of the general population. There are still some limitations. For example, according to eMarketer, whites comprise 75 percent of Internet users and about 79 percent of the total population. But Hispanics comprise only 9 percent of Internet users, while they represent about 14 percent of the total population. Still, the demographics of the population online continue to evolve, providing more options for technology-based research.

Now we’re branching out beyond online surveys. Blogs provide an interactive forum for people to discuss and respond qualitatively to questions without the limiting structure of multiple-choice questionnaires and still without interviewer bias or privacy concerns.

We’ve found that these methods help us access better population samples with more reliable and robust results. Of course, we also appreciate the efficiencies and lower costs, as do our clients.

And though we continue to use the full range of research methodologies as appropriate, we believe technology-based research will become a bigger part of everyone’s approach, as the technology - and its users’ comfort levels - continue to grow.