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The fifty-eight percent of the questionnaires returned was not an optimal response rate.
Our study has some obvious weaknesses with a relatively small number of cases, which is partially due to a less than optimal response rate in cases.
The study showed an optimal response rate (91%), which is similar to the one reported from other studies following the ISAAC protocol in Latin America [ 6].
The less than optimal response rate may also be accounted for by the fact that many staff are employed on a part-time or rotational basis, which makes effective contact difficult to establish and maintain.
There is no universally accepted suitable response rate in surveys because that depends on many factors, but following the strategies for ensuring optimal response rate reported in the literature we obtained a reasonable rate: using the right kind of sponsors, appropriate inducement, the questionnaire format, the cover letter and a follow up strategy.
Where possible, other suggestions made in the literature for obtaining an optimal response rate were followed, including: making personal contact and building rapport by informing participants to enhance personal ownership of the project [ 26]; and planned follow-up [ 33] in the form of a reminder email.
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In addition, given less than optimal response rates, nonresponse bias is possible.
The advantages in terms of access, mutual understanding and optimal response rates were the rationales for their choice as research assistants; training was relied upon to minimize the risks of such biases.
Optimal response rates can be obtained only through an accumulation of design features that yield marginal gains, including a clear explanation of the utility of the survey, an attractive layout, incentives, and reminders [ 2].
The non-optimal response rate of the present study is another limitation, with possibility of bias in prevalence estimates.
Initially, a follow-up questionnaire was planned for 1 year after the guidelines were distributed, however, this plan was aborted due to the sub-optimal response rate from the first questionnaire.
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CEO of Professional Science Editing for Scientists @ prosciediting.com