Objectives-We sought to determine whether failure to locate hard-to-reach respondents in longitudinal studies causes biased and inaccurate study results.Methods-We performed a nonresponse simulation in a survey of 498 low-income women who received cash aid in a California county. Our simulation was based on a previously published analysis that found that women without children who applied for General Assistance experienced more violence than did women with children who applied for Temporary Assistance to Needy Families. We compared hard-to-reach respondents whom we reinterviewed only after extended follow-up effort 12 months after baseline with other respondents. We then removed these hard-to-reach respondents from our analysis.Results-Other than having a greater prevalence of substance dependence (14% vs 6%), there were no significant differences between hard-and easy-to-reach respondents. However, excluding the hard to reach would have decreased response rates from 89% to 71% and nullified the findings, a result that did not stem primarily from reduced statistical power.Conclusions-The effects of failure to retain hard-to-reach respondents are not predicable based on respondent characteristics. Retention of these respondents should be a priority in public health research.Respondents who participate in all phases of longitudinal studies are likely to differ from those who are lost to follow-up. [1][2][3][4][5] Differential attrition, or nonrandom loss of respondents, can lead to bias in a study's findings by changing the composition of the sample so that it no longer represents the study population, especially when response rates are low and there are large differences between responders and nonresponders. 6 Attrition also reduces sample sizes, contributing to the risk of type 2 error by decreasing statistical power to detect effects. 7 Requests for reprints should be sent to Donna H. Odierna, Department of Clinical Pharmacy, University of California, San Francisco, 3333 California St, Suite 420, San Francisco, CA 94118 (donna.odierna@ucsf.edu or dodierna@gmail.com).. Contributors D. H. Odierna developed the concept for the article, carried out the statistical analysis, and wrote versions of the article. L. A. Schmidt contributed substantially to the overall themes, writing, and editing at each stage; she also originated the Welfare Client Longitudinal Study (WCLS) and supervised all aspects of its implementation.
Human Participant ProtectionThe survey design, survey instrument, and consent documents were approved by the institutional review boards at the University of California, San Francisco, and the Public Health Institute. Participants were protected by a federal Certificate of Confidentiality from the US Department of Health and Human Services. This secondary analysis was conducted after appropriate review and exemption by the institutional review board at the University of California, Berkeley.
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Author ManuscriptAm J Public Health. Author manuscript; available in PMC 2010 August ...