Using PhenX toolkit measures and other tools to assess urban/rural differences in health behaviors: Recruitment methods and outcomes

Background: The overall study was designed to examine how vacation behavior affects rural and urban Minnesotans and North Dakotans. The purpose of this substudy was to describe the method for sampling, follow-up and response rate by gender and urban/rural location to help inform future studies in this population. Methods: Essentia health primary care patients (n = 1344) were sent a 21-page self-administered questionnaire. The questionnaire included questions on demographics, work history, perceived stress, work productivity, depression and mania screeners, tobacco use, dietary information, vacation habits, and technology use. Participants were offered $10 to complete the questionnaire. Results: The overall response to the three mailings to 1344 adults aged 25-64 was 38.8% for a final sample size of 522 completed surveys. Despite the oversampling of males, the total number of responses from males was lower than for females. The response rates between urban and rural locations were nearly identical for the males (33.3% and 33.0% respectively) but higher for rural females than urban females (47.2% and 42.6% respectively). Seventy-eight percent were currently employed. Sixty-nine percent of the participants reported being married, 5.4% were living with a partner, 14% were divorced widowed or separated and 11% were never married. Forty-seven percent of our population had an associate degree or some college, 29% had a Bachelor's degree or higher, 17% had their diploma or equivalent and 2% had not completed high school. Conclusions: The goal of the sampling frame and recruitment strategy for this study was to assemble a cohort of approximately 1000 working adults, represented equally by age, gender and rural location. We ended up with a smaller cohort than desired. The law of diminishing returns was observed, although the third mailing was more effective for men than women.