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Related Experiment Video

Updated: Nov 17, 2025

Methodology for Establishing a Community-Wide Life Laboratory for Capturing Unobtrusive and Continuous Remote Activity and Health Data
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A framework for exploring non-response patterns over time in health surveys.

Famke J M Mölenberg1,2, Chris de Vries3, Alex Burdorf4

  • 1Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands. f.molenberg@erasmusmc.nl.

BMC Medical Research Methodology
|February 19, 2021
PubMed
Summary

Declining health survey response rates may not bias health behavior trends. A new framework shows that despite a significant drop in participation, estimated trends in behaviors like sport participation remained stable, indicating no increased non-response bias over time.

Keywords:
Epidemiological methodsHealth surveysNon-response biasResponseSurveys and questionnaires

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Area of Science:

  • Public Health
  • Epidemiology
  • Survey Methodology

Background:

  • Health surveys face declining response rates, raising concerns about potential bias in estimated health behavior trends.
  • A structured approach is needed to assess if decreasing and selective survey response over time impacts the accuracy of health behavior trend estimations.

Purpose of the Study:

  • To develop and apply a framework for evaluating the impact of differential non-response over time on health behavior trends.
  • To investigate whether a declining response rate in a repeated cross-sectional survey biased estimated trends in health behaviors.

Main Methods:

  • Utilized data from a biannual survey (1995-2017) in Rotterdam, The Netherlands, including sociodemographic information for respondents and non-respondents.
  • Applied a four-step framework: analyzing response determinants, estimating health behavior variation, comparing weighted/unweighted prevalence, and assessing changes in behavior-determinant associations over time.

Main Results:

  • The overall survey response rate decreased from 47% in 1995 to 15% in 2017, with faster declines observed in younger individuals and those with non-Western ethnicity.
  • Despite the declining response rate, variation in health behaviors remained constant, and prevalence estimates and associations did not show bias related to response changes.
  • The probability of sport participation gradually converged between males and females, irrespective of differential changes in response rates.

Conclusions:

  • Insights into non-response patterns over time are crucial for understanding potential biases in health behavior trends.
  • The developed framework effectively assesses the influence of declining response rates on survey data.
  • In this study, a significant decline in response rate did not lead to an increased risk of non-response bias in estimated health behavior trends.