Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Oct 26, 2024
Date Accepted: Aug 17, 2025
Date Submitted to PubMed: Aug 17, 2025
Factors Affecting Non-response in a Cohort Study of Female Participants: The Korea Nurses' Health Study
ABSTRACT
Background:
The major drawback of a cohort study design is the loss of follow-up participants, increasing selection bias and threatening external validity more seriously in online website surveys. It is important to identify various factors beyond population or demographics that influence non-response rates relevant to cohort studies.
Objective:
To examine the non-response rate and factors that predict non-response for up to 10 years of follow-up surveys using initial and follow-up surveys from the Korean Nurses’ Health Study.
Methods:
The Korea Nurses’ Health Study recruited 20,613 female nurses in 2013 using simple random sampling. The participants were followed up with 10 times up until 2022. We identified the demographic, work-related, survey-related, and psychological variable characteristics of non-responding nurses with 10-year follow-ups and compared them with those who continued to participate in the study.
Results:
Descriptive, chi-square test and multivariate logistic regression models were used. The non-response rate varied between 25.5% (second survey) and 61.2% (sixth survey), with the sixth survey having the highest non-response rate. The influence of age, education, and the usability of survey websites on non-response lasted up to the 11th survey. Registered nurses who were in their 30s compared to those in their 20s, who had bachelor’s degrees or higher compared to those with associate degrees, and who were satisfied with the survey websites compared to those who perceived neutrality at the baseline survey were less likely to be lost at follow-up surveys up to the 11th survey. The influence of geographic regions, hospital size, and psychological factors such as stress, fatigue, and sleep disturbance on non-response lasted until the second to sixth surveys.
Conclusions:
When designing and recruiting female nurse participants for community-based cohort studies, researchers should consider factors that influence non-response and adopt tailored strategies to recruit based on demographic characteristics. In addition, it is recommended that the usability of survey websites be increased to reduce non-response at follow-up in cohort studies. Clinical Trial: N/A
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