Factors Affecting Non-response in a Cohort Study of Female Participants: The Korea Nurses' Health Study

Document Type

Journal Article

Publication Date

8-17-2025

Journal

JMIR public health and surveillance

DOI

10.2196/68038

Abstract

BACKGROUND: The major drawback of a cohort study design is the loss of follow-up participants, which increases selection bias and threatening external validity, particularly in online website surveys. It is important to identify factors beyond population or demographics that influence non-response rates relevant to cohort studies. OBJECTIVE: This study aimed to examine the non-response rate and factors over a 10-year follow-up period among female participants, using data from initial and subsequent surveys. METHODS: The Korea Nurses' Health Study recruited 20,613 female nurses in 2013, using simple random sampling. The participants were followed up ten times through 2022. We identified the demographic, work-related, survey-related, and psychological characteristics of non-responding nurses with 10-year follow-up and compared them with those who continued to participate. Descriptive, chi-square, and multivariate logistic regression models were used. RESULTS: The non-response rate of the follow-up surveys from the 2nd to the 11th varied between 25.5% (second survey) and 61.2% (sixth survey). The influence of age, education, and the usability of survey websites on non-response lasted up to the 11th survey. Nurses in their 20s were more likely not to respond to the follow-up surveys than those in their 30s. Those who had an associate degree and neutral feelings about the usability of the survey websites were less likely to respond to follow-up surveys than those who were satisfied with the initial survey. The influence of geographic region, hospital size, and psychological factors-including stress, fatigue, and sleep disturbance-was evident from the second to the sixth survey. CONCLUSIONS: When designing and recruiting female nurse participants for community-based cohort studies, researchers should consider the factors that influence non-response and adopt tailored strategies based on demographic characteristics. In addition, it is recommended that the usability of survey websites be improved to reduce non-response at follow-up in cohort studies involving female participants. INTERNATIONAL REGISTERED REPORT: RR2-DOI: https://doi.org/10.4178/epih.e2024048.

Department

Nursing Faculty Publications

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