Bridging the digital divide: increasing response rates to electronic pain questionnaires in outpatient neurosurgery

PURPOSE: Pain questionnaires are widely used in healthcare; however, response rates-particularly for electronic surveys-are often low and difficult to improve without significant resources. This study aimed to analyze and identify strategies to boost response rates to electronic pain questionnaires distributed prior to first-time consultations for patients with low-back pathologies. METHODS: Between June 2023 and June 2024, referred patients were invited to complete an electronic low-back pain questionnaire before their first neurosurgical consultation. Implementation occurred in three stages: email-only (period 1), with an added notice in the appointment letter (period 2), and with a supplementary informational flyer (period 3). Non-respondents were offered the option to complete the questionnaire at the day of the consultation on a hospital-provided tablet-computer or on paper. Patient demographics, response timing and mode, age-related differences, and potential language barriers were assessed. RESULTS: Of 1017 patients contacted, 665 responses were eligible for analysis. The overall at-home response rate was 54% (n = 359), increasing significantly from 43% in period 1 to 56% in period 3 (p = 0.027). Of the remaining 306 patients, 226 (40%) were willing to answer the questionnaires by providing a tablet-computer at the day of consultation. Response patterns differed significantly across age groups (p < 0.001) - youngest (age < 51 years), oldest (age > 76 years) and patients with a migration background were less likely to complete the questionnaire. CONCLUSION: At-home electronic questionnaire response rates can be significantly boosted for pre-consultation pain assessments when supported by targeted interventions. Response rates are affected by age, migration status, language proficiency, and digital access. With a hospital provided tablet-computer based backup, 40% of patients who initially did not respond at home were able to complete the questionnaire at the hospital prior to consultation.