Implementing a Multi-Mode Approach to 

Household Eligibility Screening in NHANES

Juliana McAllister, Allan Uribe, Denise Schaar, Chia-Yih Wang & Jessica Graber

2021 Federal Committee on Statistical Methodology (FCSM) Conference

November 2, 2021
1. To describe the implementation and challenges of operationalizing 

a multi-mode screening process on a national health survey

2. To present completion rates by each of the four screening modes 

(web, paper, telephone, in-person) using pretest data collected 

from a single location

Purposes 

1
• The National Health and Nutrition Examination Survey (NHANES) is 

designed to assess the health and nutritional status of adults and children 

in the United States. 

• The survey began in 1960 and is unique in that it combines interviews 

and physical examinations with biological specimen collection. 

• NHANES is a nationally representative survey that historically determined 

eligibility through in-person household screening. 

NHANES

2
In 2021, NHANES

introduced a multimode screening 

approach to include 

self-response (web 

and mail) and 

intervieweradministered 

(telephone and inperson) modes.

Background

3
• To increase field efficiency by reducing the resources spent 

on household screening

– This would leave more time to focus on tasks targeting identified 

eligible respondents (e.g., gaining cooperation, refusal conversion, 

and interview administration)

• To minimize in-person contact between respondents and field 

staff due to safety concerns in the COVID-19 environment.

Implementation Goals

4
• Push-to-web approach

• Contact Strategy – 4 mailings

– Initial mailing 6 weeks prior to Field Interviewer visit

– Intervals between mailings: 7 days, 10 days, 10 days

• Undeliverable addresses excluded from mailings 3 & 4

• Each mailing included unique respondent passcode

– Useful paradata for future research

NHANES Multi-Mode Approach

5
Multi-Mode Screening – Mailings

6

Contact Activity Available Modes

Invitation letter (First class mail) Web, Phone

Reminder postcard Web, Phone

Follow-up letter & Hard Copy Questionnaire

(FedEx package) Web, Phone, Paper

Final reminder letter noting upcoming FI visit Web, Phone, Paper

• Push-to-web approach with 4 unique mailings
Mailing #1: 

Invitation Letter

7
8

Mailing #2: 

Reminder Postcard
9

Mailing #3: 

Follow-up Letter & Paper Screener
10

Mailing #4: 

Final Reminder
Multi-Mode Screener N %

Households Selected 447 100.0

Screeners Completed 293 65.5

In-person 229 78.2

Web 33 11.3

Paper 18 6.1

Phone 13 4.4

Findings

11
• Limited data (one single location during a 2-month period)

• No comparison to completion rates from this multi-mode approach 

and the previous mode

Limitations of Research

12
• The approach was implemented to increase field efficiency and 

minimize in-person contact between respondents and field staff due 

to safety concerns related to COVID-19 

• The majority of screeners were administered in-person via 

interviewers (78.2%) which is similar to earlier survey cycles. 

Conclusion

13
• Comprehensive analysis of the multi-mode approach with additional 

data collected in the cycle

• Comparative analysis of completion rates in conjunction with prior 

data collection cycles

• Analysis of respondent burden by mode

• Analysis of potential effect of the multiple mailings on the participantfield interviewer interactions downstream

Future Analyses

14
QUESTIONS?

Presenters Contact Information:

Allan Uribe

auribe@cdc.gov

Denise Schaar

dschaar@cdc.gov

Jessica Graber

jgraber@cdc.gov

Chia-Yih Wang

cwang@cdc.gov

Juliana McAllister

jmcallister2@cdc.gov