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01.12.2018 | Research | Ausgabe 1/2018 Open Access

Archives of Public Health 1/2018

Mixing modes in a population-based interview survey: comparison of a sequential and a concurrent mixed-mode design for public health research

Archives of Public Health > Ausgabe 1/2018
Elvira Mauz, Elena von der Lippe, Jennifer Allen, Ralph Schilling, Stephan Müters, Jens Hoebel, Patrick Schmich, Matthias Wetzstein, Panagiotis Kamtsiuris, Cornelia Lange
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Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s13690-017-0237-1) contains supplementary material, which is available to authorized users.



Population-based surveys currently face the problem of decreasing response rates. Mixed-mode designs are now being implemented more often to account for this, to improve sample composition and to reduce overall costs. This study examines whether a concurrent or sequential mixed-mode design achieves better results on a number of indicators of survey quality.


Data were obtained from a population-based health interview survey of adults in Germany that was conducted as a methodological pilot study as part of the German Health Update (GEDA). Participants were randomly allocated to one of two surveys; each of the surveys had a different design. In the concurrent mixed-mode design (n = 617) two types of self-administered questionnaires (SAQ-Web and SAQ-Paper) and computer-assisted telephone interviewing were offered simultaneously to the respondents along with the invitation to participate. In the sequential mixed-mode design (n = 561), SAQ-Web was initially provided, followed by SAQ-Paper, with an option for a telephone interview being sent out together with the reminders at a later date. Finally, this study compared the response rates, sample composition, health indicators, item non-response, the scope of fieldwork and the costs of both designs.


No systematic differences were identified between the two mixed-mode designs in terms of response rates, the socio-demographic characteristics of the achieved samples, or the prevalence rates of the health indicators under study. The sequential design gained a higher rate of online respondents. Very few telephone interviews were conducted for either design. With regard to data quality, the sequential design (which had more online respondents) showed less item non-response. There were minor differences between the designs in terms of their costs. Postage and printing costs were lower in the concurrent design, but labour costs were lower in the sequential design. No differences in health indicators were found between the two designs. Modelling these results for higher response rates and larger net sample sizes indicated that the sequential design was more cost and time-effective.


This study contributes to the research available on implementing mixed-mode designs as part of public health surveys. Our findings show that SAQ-Paper and SAQ-Web questionnaires can be combined effectively. Sequential mixed-mode designs with higher rates of online respondents may be of greater benefit to studies with larger net sample sizes than concurrent mixed-mode designs.
Additional file 1: Table S1. Missing values for health indicators by survey design and mode of data collection. (PDF 26 kb)
Additional file 2: Figure A1. Model-adjusted prevalence rates (95% confidence intervals) for basic health indicators by mixedmode design, adjusted for age, sex, marital status, household type, education, income, employment status, and migration background. (TIFF 208 kb)
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