Research Techniques Made Simple: Web-Based Survey Research in Dermatology: Conduct and Applications

      Web-based surveys, or e-surveys, are surveys designed and delivered using the internet. The use of these survey tools is becoming increasingly common in medical research. Their advantages are appealing to surveyors because they allow for rapid development and administration of surveys, fast data collection and analysis, low cost, and fewer errors due to manual data entry than telephone or mailed questionnaires. Internet surveys may be used in clinical and academic research settings with improved speed and efficacy of data collection compared with paper or verbal survey modalities. However, limitations such as potentially low response rates, demographic biases, and variations in computer literacy and internet access remain areas of concern. We aim to briefly describe some of the currently available Web-based survey tools, focusing on advantages and limitations to help guide their use and application in dermatologic research.

      Abbreviations:

      CHERRIES (Checklist for Reporting Results of Internet E-Surveys), HIPAA (Health Insurance Portability and Accountability Act)
      CME Activity Dates: 20 June 2018
      Expiration Date: 19 June 2019
      Estimated Time to Complete: 1 hour
      Planning Committee/Speaker Disclosure: All authors, planning committee members, CME committee members and staff involved with this activity as content validation reviewers have no financial relationships with commercial interests to disclose relative to the content of this CME activity.
      Commercial Support Acknowledgment: This CME activity is supported by an educational grant from Lilly USA, LLC.
      Description: This article, designed for dermatologists, residents, fellows, and related healthcare providers, seeks to reduce the growing divide between dermatology clinical practice and the basic science/current research methodologies on which many diagnostic and therapeutic advances are built.
      Objectives: At the conclusion of this activity, learners should be better able to:
      • Recognize the newest techniques in biomedical research.
      • Describe how these techniques can be utilized and their limitations.
      • Describe the potential impact of these techniques.
      CME Accreditation and Credit Designation: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Beaumont Health and the Society for Investigative Dermatology. Beaumont Health is accredited by the ACCME to provide continuing medical education for physicians. Beaumont Health designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
      Method of Physician Participation in Learning Process: The content can be read from the Journal of Investigative Dermatology website: http://www.jidonline.org/current. Tests for CME credits may only be submitted online at https://beaumont.cloud-cme.com/RTMS-July18 – click ‘CME on Demand’ and locate the article to complete the test. Fax or other copies will not be accepted. To receive credits, learners must review the CME accreditation information; view the entire article, complete the post-test with a minimum performance level of 60%; and complete the online evaluation form in order to claim CME credit. The CME credit code for this activity is: 21310. For questions about CME credit email [email protected] .

      Summary Points

      • Web-based surveys are often useful, versatile, and cost-effective tools for gathering information.
      • Web-based surveys provide researchers with a fast, flexible, and far-reaching tool for data collection and analysis.
      • Despite many advantages, there are important limitations to consider when using Web-based surveys, including low response rates, potential biases, and ethical concerns.

      Introduction

      Surveys are well-established tools used in the collection of both quantitative and qualitative data. Their application in dermatology ranges from collection of opinions, attitudes, and behavioral trends to measures of quality of life and outcomes (
      • Asarch A.
      • Chiu A.
      • Kimball A.B.
      • Dellavalle R.P.
      Survey research in dermatology: Guidelines for success.
      ,
      • Saczynski J.S.
      • McManus D.D.
      • Goldberg R.J.
      Commonly used data-collection approaches in clinical research.
      ). Since the first e-mail survey was published in 1986, there has been a shift from traditional survey methods (in-person interviews, telephone, and paper-based surveys) to Web-based surveys (
      • Wright K.B.
      Researching internet-based populations: advantages and disadvantages of online survey research, online questionnaire authoring software packages, and Web survey services.
      ). Given the widespread popularity of Web-based surveys, it is valuable for investigators to be familiar with this modality. In this article, we aim to describe the applications, advantages, and limitations of Web-based survey tools.

      Survey-Based Research

      Survey-based research collects participants’ responses using a questionnaire that aims to analyze characteristics of a defined population. The methods of data collection can be quantitative, using numerical items or scores; qualitative, via open-ended questions; or a mix of both (
      • Ponto J.
      Understanding and evaluating survey research.
      ). Surveys provide information ranging from disease incidence, attitudes, behaviors, perceptions, satisfaction, and quality of life measures to the assessment of medical knowledge, patient management, and evaluation of medical training institutions (
      • Asarch A.
      • Chiu A.
      • Kimball A.B.
      • Dellavalle R.P.
      Survey research in dermatology: Guidelines for success.
      ,
      • Ponto J.
      Understanding and evaluating survey research.
      ).

      Methods of Data Collection

      There are multiple survey modalities used for data collection, the most common being questionnaires, which can be delivered on paper (either in person or by mail), electronically, or by direct contact (e.g., over the phone or in-person interview) (
      • Mandal A.
      • Eaden J.
      • Mayberry M.K.
      • Mayberry J.F.
      Questionnaire surveys in medical research.
      ). The far-reaching potential of the internet has made the Web-based format a compelling choice. With over 300 Web-based survey software programs available (
      • Gill F.J.
      • Leslie G.D.
      • Grech C.
      • Latour J.M.
      Using a Web-based survey tool to undertake a delphi study: Application for nurse education research.
      ), there are many options and factors to consider when deciding which is the most appropriate tool for one’s research investigation (
      • Wright K.B.
      Researching internet-based populations: advantages and disadvantages of online survey research, online questionnaire authoring software packages, and Web survey services.
      ). Although use of these automated and electronic systems may augment survey creation, proper development is always and unavoidably a time-consuming process, given the need for careful question design and the testing that is needed for validation. Some advantages and disadvantages of Web-based surveys compared with traditional methods are listed in Table 1.
      Table 1Advantages and disadvantages of Web-based surveys
      Adapted from Wright (2005) and Dykema et al. (2013).
      AdvantagesDisadvantages
      • Rapid development
      • Fast administration
      • Flexible questionnaire design
      • Low cost
      • Access to traditionally hard-to-reach groups
      • Low data entry errors
      • Possibly higher data quality compared with other survey modalities
      • Sampling biases
      • Self-selection bias
      • Internet access required
      • Computer literacy required
      • Relatively lower response rates
      • Technical problems
      1 Adapted from
      • Wright K.B.
      Researching internet-based populations: advantages and disadvantages of online survey research, online questionnaire authoring software packages, and Web survey services.
      and
      • Dykema J.
      • Jones N.R.
      • Piche T.
      • Stevenson J.
      Surveying clinicians by Web: current issues in design and administration.
      .

      Sample Selection

      The main objective of sample selection is to garner participants who are representative of the desired study population. Sample selection may be random, nonrandom, or a combination of the two. Random sampling is commonly used when collecting quantitative data and can be aided by an online randomizer. Nonrandom sampling is often used for qualitative data collection, aimed toward a specific group of interest (
      • Kelley K.
      • Clark B.
      • Brown V.
      • Sitzia J.
      Good practice in the conduct and reporting of survey research.
      ). In addition, Web survey sampling may be classified into nonprobability and probability types. Nonprobability sampling, also described as convenience sampling, is subject to the judgment of the researcher, and the sample is composed of volunteers and self-selected persons. Although these samples limit generalizability and statistical significance, they have utility in developing hypotheses or collecting non-inferential data (
      • Fielding N.G.
      • Lee R.M.
      • Blank G.
      The sage handbook of online research methods.
      ). Examples of nonprobability surveys include those using e-mail lists and opt-in panels (
      • Fielding N.G.
      • Lee R.M.
      • Blank G.
      The sage handbook of online research methods.
      ). Conversely, probability samples attempt to select participants randomly and minimize nonresponse bias to capture a broader representation (
      • Fan W.
      • Yan Z.
      Factors affecting response rates of the Web survey: a systematic review.
      ). Surveys using non–list-based sampling with pop-up surveys and mixed-mode surveys with online options are probability based (
      • Fielding N.G.
      • Lee R.M.
      • Blank G.
      The sage handbook of online research methods.
      ). Although Web-based surveys offer the benefit of broad sampling without incurring additional cost, it is important to be aware of issues that may arise with sample selection, most importantly that of sampling and coverage errors. For example, these may occur when participants may not equally access the survey or have access to the internet (
      • Fan W.
      • Yan Z.
      Factors affecting response rates of the Web survey: a systematic review.
      ). However, Web-based surveys may also augment access to traditionally hard-to-reach populations who share specific interests and form virtual cohorts on the internet (
      • Wright K.B.
      Researching internet-based populations: advantages and disadvantages of online survey research, online questionnaire authoring software packages, and Web survey services.
      ). Mitigating sample bias may be achieved by providing computer access to desired survey participants, randomizing pop-ups on a Web page, or randomizing participants from an e-mail list server (
      • Fielding N.G.
      • Lee R.M.
      • Blank G.
      The sage handbook of online research methods.
      ).

      Data Collection Tools

      Online data collection tools facilitate survey and data management in clinical and translational research. Researchers have the option of selecting among hundreds of online survey software tools for their projects (
      • Vehovar V.
      • Čehovin G.
      • Močnik A.
      Survey software in 2014.
      ). Although the process of data collection may vary according to the selected tool, it generally follows a common framework (Figure 1). There are many tools available, two of which we have chosen to expand on given their current high rates of use. Research electronic data capture (i.e., REDCap) is a widely used tool in academic settings and has been used in over 4,000 articles. It is an example of a tool used for secure data collection. REDCap allows researchers to construct and manage online surveys and to save and export obtained data to statistical analysis software or as raw data files. Because of its cost, this tool is mainly available in academic research settings (
      • Harris P.A.
      • Taylor R.
      • Thielke R.
      • Payne J.
      • Gonzalez N.
      • Conde J.G.
      Research electronic data capture (redcap)—a metadata-driven methodology and workflow process for providing translational research informatics support.
      ). Another example is SurveyMonkey, which is overall the most used tool. It is a low-cost, user-friendly software with the highest Web traffic of all survey tools, often used for market and health research (
      • Gill F.J.
      • Leslie G.D.
      • Grech C.
      • Latour J.M.
      Using a Web-based survey tool to undertake a delphi study: Application for nurse education research.
      ,
      • Vehovar V.
      • Čehovin G.
      • Močnik A.
      Survey software in 2014.
      ). It is important to consider cost and design when selecting a survey tool. However, most importantly, one should choose a tool that is compliant with subject protection and data privacy as per the Health Insurance Portability and Accountability Act (i.e., HIPAA). Examples of HIPAA-compliant Web-based survey tools can be found in Table 2.
      Figure 1
      Figure 1The Web survey process.
      Adapted from
      • Fan W.
      • Yan Z.
      Factors affecting response rates of the Web survey: a systematic review.
      .
      Table 2Examples of online survey tools and websites
      Survey ToolWebsiteHIPAA Compliant
      Blank cells indicate an unknown status for HIPAA compliancy and cost.
      Cost
      Blank cells indicate an unknown status for HIPAA compliancy and cost.
      Dermatology Citations
      Active Web Surveyhttp://www.websm.org/db/18/3581/Software/Active_Websurvey/Yes
      Apian Softwarehttp://www.apian.com
      Campaign Monitor GetFeedbackhttps://www.getfeedback.com/pricingYes
      CheckBox Surveyhttps://www.checkbox.com/pricing/online-subscriptionYesYes
      CHOIRhttps://choir.stanford.edu/clinical-practice/ (via institution website)
      comScorehttp://www.comscore.com/
      DADOS surveyhttps://www.dadosproject.comYes
      EZsurvey/Raosofthttp://www.raosoft.com/products/ezsurvey/
      Formstackhttps://www.formstack.com/YesYes
      Formsitehttp://formsite.comYesYes
      HostedSurveyhttp://www.hostedsurvey.com/home.html
      GoogleFormhttps://www.google.com/forms/about/
      InfoPollhttp://infopoll.com/live/surveys.dll/web
      Instasurveyhttp://instasurvey.appdictive.dk
      Key Surveyhttps://www.keysurvey.com/request/free-trial/Yes
      LimeSurveyhttps://www.limesurvey.orgFree
      Free basic package.
      LoopSurveyhttps://www.loopsurvey.comYesYes
      eSurveyProhttps://www.esurveyspro.com/Prices.aspx
      Obsurveyhttp://obsurvey.com
      PatientGainhttps://www.patientgain.com/
      Perseushttp://www.perseusuk.co.uk/survey/software/professional.html
      PollDaddyhttps://polldaddy.comYes
      PollProhttp://www.pollpro.com
      PopSurveyhttps://www.popsurvey.com
      Qualtrics
      Free basic package.
      www.qualtrics.comYesYes
      • Ahmad R.C.
      • Bruckner A.L.
      A survey of epidermolysis bullosa care in the United States and canada.
      ,
      • Fogel A.L.
      • Teng J.M.
      Pediatric teledermatology: a survey of usage, perspectives, and practice.
      ,
      • Gupta A.
      • Chong A.H.
      • Scarff C.E.
      • Huilgol S.C.
      Dermatology teaching in australian medical schools.
      QuestionProhttps://www.questionpro.com/tour/Yes
      QuickTap Surveyhttps://www.quicktapsurvey.com
      SmartSurveyhttps://www.smartsurvey.co.uk
      SoGo Surveyhttps://www.sogosurvey.comYesFree
      SurveyCrafterhttps://www.surveycrafter.com/interim2/default.asp
      SurveyLegendhttps://www.surveylegend.com
      SurveyNutshttps://surveynuts.com/en
      SurveyMethodshttps://surveymethods.com
      SurveyMonkey
      Free basic package.
      https://www.surveymonkey.com
      • Carter J.
      • Zug K.A.
      Phototherapy for cutaneous t-cell lymphoma: online survey and literature review.
      ,
      • Donovan J.C.
      A survey of dermatology residency program directors’ views on mentorship.
      ,
      • Ekroll V.
      • Faul F.
      Transparency perception: the key to understanding simultaneous color contrast.
      ,
      • Kirby J.S.
      • Adgerson C.N.
      • Anderson B.E.
      A survey of dermatology resident education in cosmetic procedures.
      ,
      • Kunde L.
      • McMeniman E.
      • Parker M.
      Clinical photography in dermatology: ethical and medico-legal considerations in the age of digital and smartphone technology.
      SurveyMozhttp://www.surveymoz.com
      SurveyActhttp://www.surveyact.com
      SurveyMetricshttps://survmetrics.com
      SurveyGizmohttps://www.surveygizmo.comYesFree
      • Oliver B.
      • Durrani S.
      • Cohen J.L.
      • Friedman A.J.
      Current perspectives among u.S. Dermatologists on chemoprevention of nonmelanoma skin cancer: a survey-based study.
      Survey Planethttps://www.esurveyspro.com/Prices.aspx
      SurveyPalhttps://www.surveypal.com
      Rational Surveyhttp://www.rationalsurvey.com
      REDCaphttps://www.project-redcap.orgYes
      • Gan S.D.
      • Hsu S.H.
      • Chuang G.
      • Konnikov N.
      • Liang C.A.
      Ablative fractional laser therapy for the treatment of actinic keratosis: a split-face study.
      ,
      • Liu K.X.
      • Prajapati V.H.
      • Liang M.G.
      • Mulliken J.B.
      • Lee M.S.
      A cross-sectional survey of long-term outcomes for patients with diffuse capillary malformation with overgrowth.
      ,
      • Mostaghimi A.
      • Wanat K.
      • Crotty B.H.
      • Rosenbach M.
      A national survey of residents in combined internal medicine and dermatology residency programs: educational experience and future plans.
      ,
      • Nelson K.C.
      • Grossman D.
      • Kim C.C.
      • Chen S.C.
      • Curiel-Lewandrowski C.N.
      • Grichnik J.M.
      • et al.
      Management strategies of academic pigmented lesion clinic directors in the United States.
      ,
      • Sobanko J.F.
      • Zhang J.
      • Margolis D.J.
      • Etzkorn J.R.
      • Shin T.M.
      • Sarwer D.B.
      • et al.
      Patient-reported quality of life and psychosocial health prior to skin cancer treatment—a cross-sectional study.
      ,
      • Zhang W.R.
      • Garrett G.L.
      • Cleaver J.E.
      • Arron S.T.
      Absence of skin cancer in the DNA repair-deficient disease cockayne syndrome (cs): A survey study.
      TypeFormhttps://www.typeform.com/
      WorldApp KeySurveyhttps://www.keysurvey.com
      Wufoohttps://www.wufoo.com/pricing/Free
      Free basic package.
      Zoomeranghttps://www.zoomerang.com/YesFree
      Free basic package.
      Zorohttps://www.zoho.com/survey/
      Abbreviation: HIPAA, Health Insurance Portability and Accountability Act.
      1 Blank cells indicate an unknown status for HIPAA compliancy and cost.
      2 Free basic package.

      Survey Design

      Most online survey websites allow users to customize their questions and show responses in various formats, including dichotomous, multiple choice, or rating scales. Allowing for rapid development of Web-based surveys may be augmented by software tools, which may autopopulate survey design. A user-friendly design that is easy to navigate and presented in a simple, effective, and aesthetically appealing format is advisable and might serve as a motivational factor to a surveyed subject. Another component to take into consideration is the length of the questionnaire. Although there is no consensus in the literature, it is generally reported that briefer is better, with a concise questionnaire (<10 minutes) often preferred (
      • Revilla M.
      • Ochoa C.
      Ideal and maximum length for a Web survey.
      ). Providing the surveyed subject with the estimated time required for completion or number of questions to be answered may be a powerful strategy to aid in enhancing response rates (
      • Oppenheimer A.J.
      • Pannucci C.J.
      • Kasten S.J.
      • Haase S.C.
      Survey says? A primer on Web-based survey design and distribution.
      ). It is essential to check for quality of the survey content with standardized guidelines such as the Checklist for Reporting Results of Internet E-Surveys (i.e., CHERRIES) (
      • Eysenbach G.
      Improving the quality of Web surveys: the checklist for reporting results of internet e-surveys (cherries).
      ), and important to pre-test the survey, making sure it is accessible across different operating systems and browsers.
      Following is a list of key principles that might help to increase survey participation and improve the accuracy of responses (
      • Dillman D.A.
      • Smyth J.D.
      • Christian L.M.
      Internet, phone, mail, and mixed-mode surveys: The tailored design method.
      ):
      • 1.
        Consider whether using a Web-based survey is appropriate for your research project. Design a research question requiring input from a population with access to the internet.
      • 2.
        Write a brief introduction including the study goals and investigators involved.
      • 3.
        Create a concise, easy-to-understand, and “eye pleasing” screen that allows questions to be easily visible and read in entirety.
      • 4.
        Make sure the font size and spacing are adequate for easy readability. Be consistent with wording and style.
      • 5.
        Avoid horizontal scrolling and visually distracting backgrounds.
      • 6.
        When possible, avoid open-ended questions.
      • 7.
        Consider allowing the option of “not applicable” as an answer choice.
      • 8.
        Check for possible biases in the wording or order of questions. Consider randomization of questions to avoid priming respondents, or place opinion questions toward the beginning of the questionnaire to prevent bias.
      • 9.
        Avoid similar or overlapping answer choices. Consider listing choices in alphabetical order.
      • 10.
        Pilot test the questionnaire to evaluate feasibility, validity, and reliability.
      • 11.
        Pre-test the Web survey before going live.
      • 12.
        Carefully check the e-mail list for duplicate e-mail addresses. Consider choosing Web-based survey tools that are able to block duplicate responses from the same IP address.

      Survey Validity and Reliability

      Web-based surveys have the advantage of simultaneously storing data, thus bypassing data entry errors (Table 3). In addition, Web-based surveys allow for the calculation of response rate or view rates to understand the extent of distribution. The view rate is specific to Web-hosted surveys and is defined as the ratio of unique survey visitors divided by unique site visitors (
      • Eysenbach G.
      Improving the quality of Web surveys: the checklist for reporting results of internet e-surveys (cherries).
      ). Errors that may arise from electronic surveys, including coverage, measurement, and nonresponse errors, can be more readily identified and addressed. Strategies proposed to reduce these errors include the development of a multimodal design, (i.e., having Web-based and paper-based surveys available to reduce coverage errors); adoption of valid and reliable questionnaires to reduce measurement errors; and use of e-mail reminders to reduce nonresponses (
      • Ponto J.
      Understanding and evaluating survey research.
      ). Another advantage of Web-based surveys is the ability to insert missing question reminders, which may result in higher completion rates (
      • Dykema J.
      • Jones N.R.
      • Piche T.
      • Stevenson J.
      Surveying clinicians by Web: current issues in design and administration.
      ).
      Table 3Key aspects of survey design (
      • Fielding N.G.
      • Lee R.M.
      • Blank G.
      The sage handbook of online research methods.
      )
      Sampling
      • Consider nonprobability vs. probability sampling depending on research question and accessibility of sample.
      Navigation
      • Decide on a “scrolling” vs. “paging” format depending on how many questions are visible on a single Web page.
      • Create visually appealing and simple Web page design with “welcome” and “thank you” screens.
      Question composition
      • Consider the data needed, write questions to answer the research goal, and avoid extraneous data collection.
      • Choose either open-ended or close-ended questions.
      • Include time frames to avoid recall bias.
      • Avoid “double-barreled” questions.
      • Avoid leading words to prevent bias.
      • Avoid negative questions.
      Validity
      • Measure how question addresses its intended purpose.
      • Write questions with clear intent with unambiguous answer choices.
      Reliability
      • Measure answer consistency.
      • Identify all points on rating scales with words to allow consistent interpretation.
      • Reliability may be verified with pilot studies of questionnaire.

      Addressing Nonresponse Rates

      One important limitation of Web-based surveys compared with other modalities is that despite providing higher rates of questionnaire completeness and shorter response time, they may be associated with lower response rates (
      • Oppenheimer A.J.
      • Pannucci C.J.
      • Kasten S.J.
      • Haase S.C.
      Survey says? A primer on Web-based survey design and distribution.
      ). Although response rates vary among studies, there is more literature to support lower response rates in Web-based survey design than otherwise compared with mail (
      • Fan W.
      • Yan Z.
      Factors affecting response rates of the Web survey: a systematic review.
      ,
      • Sebo P.
      • Maisonneuve H.
      • Cerutti B.
      • Fournier J.P.
      • Senn N.
      • Haller D.M.
      Rates, delays, and completeness of general practitioners' responses to a postal versus Web-based survey: a randomized trial.
      ). Several strategies, such as sending e-mail or phone call reminders, using a postal prenotification letter/invitation, and offering a link for a paper survey to be printed, have been shown to improve response rates (
      • Dykema J.
      • Jones N.R.
      • Piche T.
      • Stevenson J.
      Surveying clinicians by Web: current issues in design and administration.
      ). For instance, a randomized controlled trial analyzing response rates to mailed surveys among dermatologists found that having a personalized invitation was associated with a 7–10% increase in response rate (
      • Levy R.M.
      • Shapiro M.
      • Halpern S.D.
      • Ming M.E.
      Effect of personalization and candy incentive on response rates for a mailed survey of dermatologists.
      ). Another method often used to improve response rates is the offer of monetary or nonmonetary incentives. However, this approach has not been shown to increase rates of survey completion and may introduce sampling biases (
      • Oppenheimer A.J.
      • Pannucci C.J.
      • Kasten S.J.
      • Haase S.C.
      Survey says? A primer on Web-based survey design and distribution.
      ). Instead, lottery incentives have more efficacy in improving response rates (
      • Oppenheimer A.J.
      • Pannucci C.J.
      • Kasten S.J.
      • Haase S.C.
      Survey says? A primer on Web-based survey design and distribution.
      ).

      Standardization

      Similar to checklists developed to ensure quality in randomized controlled trials and systemic reviews, the CHERRIES has been developed by the Journal of Medical Internet Research as a standardized approach to Web-based surveys (
      • Eysenbach G.
      Improving the quality of Web surveys: the checklist for reporting results of internet e-surveys (cherries).
      ). This checklist comprises 8 categories: design, institutional review board (IRB) approval and informed consent, development and pretesting, recruitment process, survey administration, response rate calculation, preventing multiple entries, and analysis. CHERRIES aims to provide a clear framework, providing readers and reviewers a comprehensive understanding of studies using e-surveys (
      • Eysenbach G.
      Improving the quality of Web surveys: the checklist for reporting results of internet e-surveys (cherries).
      ).

      Ethical Issues

      E-survey studies are often anonymous and exempt from institutional review board approval, thus not requiring signed informed consent. Investigators should consider data security measures such as encryption to protect the privacy of surveyed subjects. Web surveys offer a unique feature in which IP addresses could be collected, allowing geographic tracking of responses; however, this may be viewed as identifiable data, and researchers should consider stripping IP addresses from the dataset or turning off this feature with commercial Web survey tools (
      • Buchanan E.A.
      • Hvizdak E.E.
      Online survey tools: Ethical and methodological concerns of human research ethics committees.
      ). With regard to data security, many surveys are HIPAA compliant. Nonetheless, it is recommended that participants be informed that as with any online interaction, nothing is fully secure and that the possibility of hacking exists (
      • Buchanan E.A.
      • Hvizdak E.E.
      Online survey tools: Ethical and methodological concerns of human research ethics committees.
      ).

      Applications in Dermatologic Research

      Web-based surveys have been used for a wide range of investigations in dermatology regarding patient care (
      • Del Rosso J.Q.
      • Tanghetti E.A.
      • Baldwin H.E.
      • Rodriguez D.A.
      • Ferrusi I.L.
      The burden of illness of erythematotelangiectatic rosacea and papulopustular rosacea: findings from a Web-based survey.
      ), epidemiological investigations (
      • Lingala B.
      • Li S.
      • Wysong A.
      • Truong A.K.
      • Kim D.
      • Chang A.L.
      Low rate of dermatology outpatient visits in asian-americans: an initial survey study for associated patient-related factors.
      ), medical education (
      • Asarch A.
      • Chiu A.
      • Kimball A.B.
      • Dellavalle R.P.
      Survey research in dermatology: Guidelines for success.
      ), diagnostic criteria (
      • Carrera C.
      • Marchetti M.A.
      • Dusza S.W.
      • Argenziano G.
      • Braun R.P.
      • Halpern A.C.
      • et al.
      Validity and reliability of dermoscopic criteria used to differentiate nevi from melanoma: a Web-based international dermoscopy society study.
      ), and clinical trials (
      • Buller D.B.
      • Berwick M.
      • Lantz K.
      • Buller M.K.
      • Shane J.
      • Kane I.
      • et al.
      Evaluation of immediate and 12-week effects of a smartphone sun-safety mobile application: a randomized clinical trial.
      ). Web-based surveys have been shown to improve adherence to treatment serving as a “virtual office visit” to drive patient compliance, as seen, for instance, in a weekly questionnaire asking respondents to verify compliance to using topical benzoyl peroxide (
      • Yentzer B.A.
      • Wood A.A.
      • Sagransky M.J.
      • et al.
      An internet-based survey and improvement of acne treatment outcomes.
      ). Surveys have also been used to analyze physician diagnostic methods and management patterns for dermatologic conditions (
      • Asarch A.
      • Chiu A.
      • Kimball A.B.
      • Dellavalle R.P.
      Survey research in dermatology: Guidelines for success.
      ). Finally, surveys may be used in academic dermatology to consider the perceptions of residents and fellows in training and teaching (
      • Asarch A.
      • Chiu A.
      • Kimball A.B.
      • Dellavalle R.P.
      Survey research in dermatology: Guidelines for success.
      ).

      Mobile Web Surveys

      As mobile technology advances, applications on consumer smart devices have attracted considerable attention as a modality for surveying. Mobile surveys on smartphones and tablets are often more convenient for patients and providers, allowing robust data collection. Immediacy of data entry reduces recall bias, because responders can enter information on a portable platform (
      • Marcano Belisario J.S.
      • Jamsek J.
      • Huckvale K.
      • O’Donoghue J.
      • Morrison C.P.
      • Car J.
      Comparison of self-administered survey questionnaire responses collected using mobile apps versus other methods.
      ). Additionally, smart devices are capable of capturing environmental information, such as photographs, videos, and physiologic data from sensors, which may broaden the scope of data collection (
      • Marcano Belisario J.S.
      • Jamsek J.
      • Huckvale K.
      • O’Donoghue J.
      • Morrison C.P.
      • Car J.
      Comparison of self-administered survey questionnaire responses collected using mobile apps versus other methods.
      ,
      • Torous J.
      • Kiang M.V.
      • Lorme J.
      • Onnela J.P.
      New tools for new research in psychiatry: a scalable and customizable platform to empower data driven smartphone research.
      ). Smartphone and tablet-based surveys have data equivalence to paper results, and respondents across all age groups prefer mobile methods to traditional paper surveys (
      • Marcano Belisario J.S.
      • Jamsek J.
      • Huckvale K.
      • O’Donoghue J.
      • Morrison C.P.
      • Car J.
      Comparison of self-administered survey questionnaire responses collected using mobile apps versus other methods.
      ). Mobile surveys have been used in biomedical research methods. For example, the DADOS platform, a CHERRIES-compliant mobile survey software, allows for the collection of patient data using mobile tablets in clinical settings (
      • Shah A.
      • Jacobs D.O.
      • Martins H.
      • Harker M.
      • Menezes A.
      • McCready M.
      • et al.
      Dados-survey: An open-source application for cherries-compliant web surveys.
      ).

      Summary

      Web-based surveys are practical and invaluable resources for researchers and dermatologists. They are rapid and convenient, allowing efficient and often cost-effective data collection. Several platforms, both open source and subscription based, are available for research use and customization. Although there are important limitations, including nonresponse rates and technical challenges across platforms, internet-based surveys have the potential for wide-ranging applications if they are well designed. In dermatology, the Web-based survey has been successfully used to investigate a variety of research questions, including in clinical, academic, and administrative settings.

      Conflict of Interest

      The authors state no conflict of interest.

      Multiple Choice Questions

      • 1.
        Which of the following is a disadvantage of Web-based surveys?
        • A.
          Access to difficult-to-reach groups
        • B.
          Reduced cost
        • C.
          Sampling bias
        • D.
          Rapid administration
      • 2.
        What is NOT an important consideration of Web-based survey construction?
        • A.
          Avoid horizontal scrolling
        • B.
          Avoid “not applicable” as an answer choice
        • C.
          Avoid similar answer choices
        • D.
          Avoid visually distracting backgrounds
      • 3.
        What is the view rate?
        • A.
          Number of unique site visitors
        • B.
          Number of total site visitors
        • C.
          Ratio of unique survey visitors to unique site visitors
        • D.
          Ratio of unique site visitors to unique survey visitors
      • 4.
        Which of the following is unique to Web-based surveys compared with traditional paper surveys?
        • A.
          Using incentives for survey completion
        • B.
          Use of the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) checklist
        • C.
          Making a concise questionnaire
        • D.
          Writing clear, understandable questions
      • 5.
        Which of the following is a potential application of Web-based survey research?
        • A.
          Assessing medical education
        • B.
          Analyzing treatment outcomes
        • C.
          Measuring patient satisfaction
        • D.
          All of the above

      Supplementary Material

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