Methodology
Summary
The Cowichan Patient Attachment Survey was widely promoted throughout the region. The survey was
conducted between February 11 and March 31, 2011. Survey participants were identified through
convenience sampling. Surveys were available in hard copy at a wide number of public locations through
the Cowichan Region, and through an online link on the Social Planning Cowichan website. Incentives
were provided for people to complete the survey. The final survey sample was 1,261 people. The sample
is in many ways representative of the population in the Cowichan Region despite not being randomly
generated.
People likely to have been missed by the survey were people who do not use public, community or
medical services and people not comfortable with online surveys. Some demographic groups are
underrepresented, most notably men and, to a lesser extent, people living in South Cowichan. However,
both groups still had a high number of respondents. While we decided not to use quota sampling, survey
collection did include a focus on monitoring demographic group’s representation, and adjusting
surveying techniques to better capture these groups. The high response rate from Aboriginal people, a
group typically underrepresented in surveys, is one indication of the success of the surveying process.
Overall, while it is important for readers to be aware of the limitations of the sample, survey findings
represent a large and diverse sample of the population of the Cowichan Region.
Sampling
Survey participants were identified through convenience sampling. As the sample was not randomly
generated, readers should be cautious about assuming results are representative of the population of
the Cowichan Region. However, survey techniques with randomly generated participants typically use
land-line phones lists to reach participants. This sampling technique has been documented to be
increasingly limited in its ability to represent youth 16-24 (many of whom only have cell phones) and
people on low incomes (many of whom do not have phones). Both of these groups were key
demographics the Division wished to reach, as they represent some of the groups other research has
found are most likely not to have a family doctor. Therefore, a telephone survey was deemed not to be
an appropriate method.
Survey methods
The survey questionnaire was developed in collaboration with Impact BC and the Cowichan Valley
Division of Family Practice. Surveys were available in hard copy at a wide number of public locations
throughout the Cowichan Region, and via an online link on the Social Planning Cowichan website. Table
1 below details the locations of the boxes.
Community
# of boxes
Chemainus
Cobble Hill
Cowichan
Bay
Cowichan
Region
Cowichan
Territory
Duncan
Halalt
Territory
Ladysmith
Lake
Cowichan
Mill Bay
Penelakut
Island
Shawnigan
Lake
4
2
1
Total
47
1
1
22
1
4
5
3
1
2
Survey Promotion
Letters were sent to over 80 community agencies asking them to assist in promoting the survey through
posters, newsletter announcements and direct contact with their members and clients. Over two-thirds
of these agencies promoted the survey in some way.
Advertisements were placed in four local papers on two separate occasions and in two monthly
periodicals.
An email announcement was sent to a number of individual community members, with a request to
forward through to other community contacts.
A Facebook page was developed, and an advertisement placed on Facebook for Cowichan users. 92 fans
promoted the Facebook page through their networks.
Cards were distributed promoting the survey with the link to the Social Planning Cowichan website.
Community members were contracted to promote the survey through their individual networks, with a
focus on engaging groups with lower representation in the sample.
Survey outreach was conducted through tables at public events throughout the region.
Community
Tabling events
Cobble Hill
1
Cowichan
Territory
1
Duncan
6
Lake
Cowichan
1
Mill Bay
1
North
Cowichan
2
Shawnigan
Lake
1
Total
13
Incentives were provided for people to complete the survey; for each survey completed, a contribution
was made to a local charity promoting the social determinants of health. Respondents who completed
the survey at public events where surveyors were tabling also had the opportunity to enter for a draw
prize of $100.
Survey completions
The final survey sample was 1,261 people and – despite not being randomly generated - in many ways
represents the population in the Cowichan Region. See Demographics section (page 15) for more details.
Completion
method
Number
(Percent)
Hard copy
919 (73%)
Online
342 (27%)
Total
1,261 (100%)
Limitations
Had the sample been randomly generated, the response rate necessary to be representative of a
population the size of the Cowichan Region (with a margin of error of +/- 3% and a confidence level of
95%) would be 1,0546. In other words, a random sampling that achieved a response rate of 1,054 could
be said to represent 95% of Cowichan residents, with a margin of error of 3%. As the final sample size
was 1,261 (20% larger than 1,054), this somewhat mitigates concerns about shortcomings of the
sampling technique, yet caution must still be exercised in generalizing survey responses to the full
population.
People likely to have been missed by the survey were people who do not use public, community or
medical services (as most drop boxes were located in community, public or medical services) and are not
comfortable with online surveys (which was available to anyone, regardless of their service use). Some
demographic groups are under-represented, most notably men and, to a lesser extent, people living in
South Cowichan. However, both groups still had a high number of respondents (men=318, South
Cowichan=201).
While the survey did not use quota sampling, survey collection did include a focus throughout on
monitoring demographic group’s representation, and adjusting surveying techniques to better capture
these groups.
Significant effort was made to reach men, including contracting men in diverse communities to promote
the surveys through their networks of male friends, placing drop boxes in pubs, promoting the survey
through local sports, business, agricultural and service groups, and tabling at sports events and liquor
stores. While women were also captured through all of these sampling processes, many of these groups
tend to be more heavily male dominated. The survey developers did consider using quotas to adjust the
sample to be more representative of the gender breakdown in the population, given the larger final
sample size, but felt that since there was only a slight difference between men and women’s responses,
to do so would only reduce the diversity of other demographic groups.
Similar efforts were made in South Cowichan. There are fewer community and public organizations
located in South Cowichan, and so a number of private sector organizations were asked to host drop
boxes or promote the survey. Unfortunately, most refused. Tabling was conducted at three community
events in South Cowichan, and a community member in the region was contracted to promote the
survey through their local networks.
One indication of the success of the surveying process is the high response of Aboriginal people to the
Cowichan Patient Attachment Survey, people who are typically under-represented in surveys.
Overall, while it is important for readers to be aware of the limitations of the sample, survey findings
represent a large and diverse sample of the population of the Cowichan Region. Results will provide
useful information for the Division to consider as they work towards transforming the primary health
care system.
5 Three surveys were deleted as duplicates where content, including comments, were identical; two surveys were deleted as out of
area (completed by residents of Seattle and Nanaimo).
6 The confidence interval (also called margin of error) is the plus-or-minus figure usually reported in newspaper or television opinion
poll results. For example, if you use a confidence interval of 4 and 47% percent of your sample picks an answer you can be “sure”
that if you had asked the question of the entire relevant population between 43% (47-4) and 51% (47+4) would have picked that
answer. The confidence level tells you how sure you can be. It is expressed as a percentage and represents how often the true
percentage of the population who would pick an answer lies within the confidence interval.