Cited by 427Survey Methodology and NonresponseHealth Education and ValidationHealth Systems, Economic Evaluations, Quality of Life

Internet Versus Mailed Questionnaires: A Randomized Comparison

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Ritter, Philip, Lorig, Kate, Laurent, Diana, Matthews, Katy·2004·Journal of Medical Internet Research

Abstract

BACKGROUND: The use of Internet-based questionnaires for collection of data to evaluate patient education and other interventions has increased in recent years. Many self-report instruments have been validated using paper-and-pencil versions, but we cannot assume that the psychometric properties of an Internet-based version will be identical. OBJECTIVES: To look at similarities and differences between the Internet versions and the paper-and-pencil versions of 16 existing self-report instruments useful in evaluation of patient interventions. METHODS: Participants were recruited via the Internet and volunteered to participate (N=397), after which they were randomly assigned to fill out questionnaires online or via mailed paper-and-pencil versions. The self-report instruments measured were overall health, health distress, practice mental stress management, Health Assessment Questionnaire (HAQ) disability, illness intrusiveness, activity limitations, visual numeric for pain, visual numeric for shortness of breath, visual numeric for fatigue, self-efficacy for managing disease, aerobic exercise, stretching and strengthening exercise, visits to MD, hospitalizations, hospital days, and emergency room visits. Means, ranges, and confidence intervals are given for each instrument within each type of questionnaire. The results from the two questionnaires were compared using both parametric and non-parametric tests. Reliability tests were given for multi-item instruments. A separate sample (N=30) filled out identical questionnaires over the Internet within a few days and correlations were used to assess test-retest reliability. RESULTS: Out of 16 instruments, none showed significant differences when the appropriate tests were used. Construct reliability was similar within each type of questionnaire, and Internet test-retest reliability was high. Internet questionnaires required less follow-up to achieve a slightly (non-significant) higher completion rate compared to mailed questionnaires. CONCLUSIONS: Among a convenience sample recruited via the Internet, results from those randomly assigned to Internet participation were at least as good as, if not better than, among those assigned mailed questionnaires, with less recruitment effort required. The instruments administered via the Internet appear to be reliable, and to be answered similarly to the way they are answered when they are administered via traditional mailed paper questionnaires.

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  • All measures were administered online, a method shown to be reliable and as valid as traditional paper-and-pencil administration.

    “All measures were administered online, a method which has been shown to be reliable and as valid as traditional paper-and-pencil administration [40,41].”

    From Acceptability, effectiveness, and cost-effectiveness of internet-based exposure treatment for irritable bowel syndrome in a clinical sample: A randomized controlled trial (2011) · cites this paper as [41]

    The Abstract Results report similar reliability and no significant differences between the Internet and mailed versions of 16 instruments; the Abstract Conclusions say the online instruments appear reliable and are answered similarly to paper questionnaires. The paper does not establish equal validity for online administration of measures generally, as the citing sentence implies. (LLM, conf=0.84)

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Authors
Ritter, P., Lorig, K., Laurent, D., & Matthews, K.
Affiliations
  • Stanford Medicine (US)
  • Stanford University (US)
Corresponding author
Ritter, Philip
Venue
Journal of Medical Internet Research
Published
2004-09-15
Volume
6
Issue
3
Pages
e29
ISSN
1438-8871 (ISSN-L)
OpenAlex
W2072139531
Cited by
427
References
16
Citations by year
2026: 4 · 2025: 5 · 2024: 4 · 2023: 11 · 2022: 9 · 2021: 13 · 2020: 10 · 2019: 13 · 2018: 18 · 2017: 18 · 2016: 22 · 2015: 29 · 2014: 25 · 2013: 27 · 2012: 35
FWCI
69.21
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Journal of Medical Internet Research (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • TSpace (University of Toronto) (submittedVersion, cc-by)
Funders
Robert Wood Johnson Foundation
Topics
  • Social Sciences › Sociology and Political Science › Survey Methodology and Nonresponse
  • Social Sciences › Education › Health Education and Validation
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
Keywords
internet-based questionnaire, mail surveys, self-report measures, psychometric properties, test-retest reliability, construct reliability, questionnaire completion rates, patient education evaluation, patient-reported outcomes
MeSH terms
Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Postal Service, Surveys and Questionnaires, Random Allocation, Internet

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