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Participant recruitment in sensitive surveys: a comparative trial of ‘opt in’ versus ‘opt out’ approaches

Participant recruitment in sensitive surveys: a comparative trial of ‘opt in’ versus ‘opt out’ approaches

out’ approach is associated with a significantly higher re- sponse than the ‘opt in’ method, is a significant predictor of response, and is not associated with increased distress (calls to the bereavement support line) or complaints about the conduct or nature of the survey. Our data also support the argument that the ‘opt in’ approach is a more time-consuming method [1,25] by demonstrating a significantly shorter response time in the ‘opt out’ group. Whilst only 80% of potential participants returned ques- tionnaires in a Scottish survey where the ‘opt in’ method was imposed [1], we report that 95% of ‘opt in’ group responders returned questionnaires. In fact, we found that overall response, defined as correspondence with the sur- vey administrators in whatever form, was the same in both study groups even though there was a significantly higher number of returned questionnaires in the ‘opt out’ group. The difference is explained by a much higher proportion of potential participants from the ‘opt in’ group declining to participate in the survey. This is an important finding that suggests that if potential participants are given a copy of the questionnaire with the initial invitation, they can make their decision to participate based on all the available infor- mation. This implies that it is fully informed decision- making that determines participation in survey research, which is congruent with established drivers of survey par- ticipation [26]. A general assumption made by the ‘opt in’ approach is that non-responders have withheld consent [1]. However, research suggests that non-response is more likely to result from apathy, lack of interest [3] or miscon- ceptions about the aims of the study [27]. Therefore, one might suggest that the ‘opt in’ method could lead to misconceptions or an incomplete understanding of a study’s aims. Indeed, the ‘opt in’ approach asks potential participants to express an interest in a study that they are insufficiently informed about. Again, our finding that over- all response was the same in both groups, yet questionnaire completion was higher when a copy of the questionnaire was sent with the initial invitation, supports this view.
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Maria Elisabete Ramos, 
Private Enforcement and Opt-out System Risks, Rewards and Legal Safeguards

Maria Elisabete Ramos, Private Enforcement and Opt-out System Risks, Rewards and Legal Safeguards

pros and cons of the opt-in versus opt-out solution. It explains that: ‘An opt-in collective action system would usually result in a smaller number of victims claiming damages than in an opt-out system, thereby limiting corrective justice, and would have as a consequence that some of the illicit gain may be retained by the infringers, thereby limiting the deterrent effect of the mechanism. By requiring the identification of the claimants (and the specification of their alleged harm suffered), an opt-in collective action may also render the litigation in some way more complex since it increases the defendant(s) possibility to dispute each victim’s harm. However, the analysis in the field of competition suggests that an opt-in collective action should be preferred to an opt-out collective action in which a person can bring an action on behalf of a class of unidentified persons. Combined with other features, such opt-out actions have in other jurisdictions been perceived to lead to excesses. There is an increased risk that the claimants lose control of the proceedings and that the agent seeks his own interest in pursuing the claim (principal/agent problem). Opt-in mechanisms are more similar to traditional litigation and would therefore be more easily implemented at national level.’
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Parental opinions regarding an opt-out consent process for inpatient pediatric prospective observational research in the US

Parental opinions regarding an opt-out consent process for inpatient pediatric prospective observational research in the US

indicated support of medical research. Parents also com- monly mentioned the fact that research participation would not affect their children. The primary objections mentioned were concern about privacy of medical records and a desire for more information than the handout contained. These concerns suggest ways to improve an opt-out information sheet, perhaps by including a statement describing privacy protections and including bulleted information points on the reverse side of a handout. We suggest that the reverse side of a handout should describe the study in more depth, including privacy protections and a list of the specific information that will be collected. Additionally, we believe the handout could be improved by including a prominent statement along the lines of: “The people who are doing this research would be happy to speak with you if you have any questions or would like more information. If you would like to speak with a researcher, please ask your child’s nurse or doctor.”
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Active (Opt-In) consent underestimates mean BMI-z and the prevalence of overweight and obesity compared to passive (Opt-Out) consent. Evidence from the healthy together Victoria and childhood obesity study

Active (Opt-In) consent underestimates mean BMI-z and the prevalence of overweight and obesity compared to passive (Opt-Out) consent. Evidence from the healthy together Victoria and childhood obesity study

Difficulties in obtaining accurate and timely estimates of prevalence, trends and intervention effectiveness [6] present challenges to informed policy and service delivery. Several authors have made the case for routine, population-level surveillance/monitoring of anthropometric data among children [7], stressing the importance of sampling that accurately reflects the characteristics of the population under investigation [8]. Most studies among school-children require opt-in (active consent) from parents or guardians and achieve participation rates (PRs) between 30–60% [9]. Opt-out (passive consent) recruitment methods achieve higher PRs [9]; for example the English National Child Measurement Program (NCMP) mandated all children in government schools in reception (aged 4–5 years) and year 6 (aged 10–11 years) have their height and weight measured using an opt-out consent procedure [10]. Beginning in 2006/07, the NCMP currently measures over 1 million primary school children annually with PRs above 93% [10].
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Process evaluation of specialist nurse implementation of a soft opt out organ donation system in Wales

Process evaluation of specialist nurse implementation of a soft opt out organ donation system in Wales

Implementing the new soft opt-out system (the inter- vention) had three components: the Act; public media campaign, and retraining specialist nurses and other key members of NHS staff. A detailed description of the components and how the intervention is intended to work can be found in the study protocol [10]. In brief, the programme theory was that these three components would work together to support family member(s) to put aside their own views and support the organ dona- tion decision made by the deceased person during their lifetime. Welsh citizens were encouraged via a media campaign to make their decision known by; registering it on the Organ Donor Register (ODR) or, verbally ex- pressing it to family member(s) or, doing nothing and consent would be presumed (deemed consent). People could also appoint a representative to convey their dona- tion decision for them. The key intended changes were that unless a person opted out they were presumed to be an organ donor, and family member(s) were no lon- ger the decision makers for deceased potential organ do- nors in Wales. SNODs were expected to support family member(s) to uphold the deceased person’s decision that was made during life. A comparison of the old and new system is outlined in Table 2.
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Practical application of opt-out recruitment methods in two health services research studies

Practical application of opt-out recruitment methods in two health services research studies

Neither Access nor Tailoring included an opt-in com- parison arm, as both studies were funded to study Veterans’ experiences with mental health care rather than recruitment methods per se. Unfortunately, opt-in studies of military Veterans to which to compare our re- sults are scarce, and the few we could find focused on biobank research (e.g. [14]) or involved enriched samples that had already participated in previous studies (e.g. [26]). Opt-out response rates for the Access and Tailor- ing studies can also be compared to published rates from national surveys that recruited via random digit dialing surveys. Past surveys addressed sensitive topics such as sexual violence [27], alcohol use and gambling [28], racial discrimination and workplace harassment by gen- der [29], pharmacogenetic test result preferences [30], and care coordination for the chronically ill [31]. Response rates for these studies varied dramatically, from 27.6% [31] to 65.4% [28]. Variation in response
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The Choice for Differentiated Europe: Why European Union Member States Opt out of Integration

The Choice for Differentiated Europe: Why European Union Member States Opt out of Integration

In treaty revisions, an opt-out is four times more likely in core state powers compared to other policy areas. In accession treaties, the core state power effect is about half the size. Ongoing differentiations and policy-specific treaties raise the probability of differentiations even more strongly, by about a factor of seven. Given that differentiation is generally a rather rare phenomenon, particularly in treaty revisions, these are all substantially important effects. Figure 3 shows the effects of our continuous explanatory variables, identity and wealth. In treaty revisions, moving from the least to the most nationally-minded countries that we actually observe in our data, the probability of a new differentiation increases by a factor of about four from 2.5 percent to around ten percent. Estimating this effect, we hold the core state power variable at one. Otherwise, changes in identity also increase the probability of differentiation, but the absolute level remains extremely low – effectively zero. 7 This corresponds to
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Understanding how, why, for whom, and under what circumstances opt out blood borne virus testing programmes work to increase test engagement and uptake within prison: a rapid realist review

Understanding how, why, for whom, and under what circumstances opt out blood borne virus testing programmes work to increase test engagement and uptake within prison: a rapid realist review

60 articles were synthesised to provide CMOcs explain- ing how, why, for whom, and under what conditions opt-out programmes for HIV, HCV, and HBV might generate a high proportion of test offers and test uptake. The unstructured search conducted during phase one, identified a number of articles highlighting that the De- fault Effect underpins “opt-out”. It was notable that no documents supplied by the expert panel during phase one and none of the articles from phase two mentioned Nudge Theory or the Default Effect as a consideration in the development or subsequent evaluation of opt-out BBV testing within prison [35]. It appears that these concepts, which underpin the intervention, have been widely forgotten, as “opt-out” is reproduced by stake- holders in different contexts [71].
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Pilot for the Australian Breast Device Registry (ABDR): a national opt-out clinical quality registry for breast device surgery

Pilot for the Australian Breast Device Registry (ABDR): a national opt-out clinical quality registry for breast device surgery

surgery involving a breast device at the particular institu- tion were included in the registry. Patients could choose to opt out and remove their data from the registry. On receipt of a completed data collection form, the registry posted an explanatory statement to the patient at the address listed on the form. The explanatory statement used ‘plain language’ and provided clear details of the process for opting out, including the free call telephone number and email address. The patient had 2 weeks from sending the explanatory statement to opt out, then their details were included in the registry. Opt out could occur later, in which case patient details were removed from the
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‘Opt out’ referrals after identifying pregnant smokers using exhaled air carbon monoxide: impact on engagement with smoking cessation support

‘Opt out’ referrals after identifying pregnant smokers using exhaled air carbon monoxide: impact on engagement with smoking cessation support

Only one other study has assessed the implementation of near-identical ‘ opt-out ’ referral processes. 20 This study was set in two West Midlands maternity hospitals and used a ‘ before – after ’ design; the authors found an increase in pregnancy refer- ral numbers, but not in cessation. Proportions setting quit dates were not reported. We are uncertain why similar referral proce- dures used in our study had such a positive impact; however, in our study, referral procedures were implemented more compre- hensively (80% of women attending scan vs 61% in the West Midlands) and these were offered at ultrasound appointments rather than at ‘ booking ’ . 20 Seeing the baby for the fi rst time,
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Loneliness in the Crowd: Why Nobody Wants Opt out Class Members to Assert Offensive Issue Preclusion against Class Defendants

Loneliness in the Crowd: Why Nobody Wants Opt out Class Members to Assert Offensive Issue Preclusion against Class Defendants

Loneliness in the Crowd Why Nobody Wants Opt out Class Members to Assert Offensive Issue Preclusion against Class Defendants SMU Law Review Volume 66 | Issue 1 Article 2 2013 Loneliness in the Crowd W[.]

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Ethical issues surrounding the provider initiated opt – Out prenatal HIV screening practice in Sub – Saharan Africa: a literature review

Ethical issues surrounding the provider initiated opt – Out prenatal HIV screening practice in Sub – Saharan Africa: a literature review

principle of respect for autonomy remains the main ethical principle that can easily be breached with the current provider initiated optout screening approach [18, 23, 24]. The theory of libertarian paternalism has been advocated by some authors, to justify at times a more coercive testing approach like HIV in pregnancy [12, 13, 18, 27]. They argue that the incapacity of individuals at times to make decisions that maximize their own welfare and the protection of the good of third parties especially in infectious disease contexts, make some degree of extra compulsion ethically justifiable [28, 29]. The OptOut approach is framed to encourage person to make the “correct” choice in accepting the HIV test, while still preserving their freedom to decline the test [28, 29]. There exists a persistent ethical tension between the goal of public health to promote the wellbeing of the mother, the child and society (knowing her HIV sta- tus, providing appropriate care, prevent HIV transmission from mother to child, preventing transmission to third par- ties and partner screening) and the at the same time respecting the mother’s autonomy [12, 16, 23]. The current optout approach could be considered an ethically legitimate nudge, that provides a novel paradigm for informed consent with maintenance of mother’s ability to turn down the test if she decides to do so [12, 27]. Cohen is convinced that nudging approaches have the potential to overcome the ethical dilemmas that exist between paternalistic beneficence and respect for patient autonomy [29]. This could be considered ideally ethical if [18]:
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Prenatal HIV screening of pregnant women in Ethiopia using ‘opt out’ approach : the human rights and ethical concerns

Prenatal HIV screening of pregnant women in Ethiopia using ‘opt out’ approach : the human rights and ethical concerns

102 Research reports on HIV testing among pregnant women in Ethiopia are mainly focused on how to increase testing uptake rather than how the routine testing is impinging upon the autonomy of women accessing maternal health care services. 94 However, there are substantial studies from other sub-Saharan African countries that can be used to substantiate the above argued human rights concerns. For instance, a study in Uganda shows that although clinical officer acknowledged the right of pregnant women to opt out, in practice they did not emphasize patient rights, but rather the moral responsibility to protect the unborn child. 95 Another study that enrolled 245 pregnant women after pre-test counselling and prior to the collection of test results in Tanzania found that 52 percent of the participants felt that they lacked autonomy to make decisions about HIV testing because ‘a refusal would have been conceived as a challenge to medical authorities.’ 96 Similar studies in Uganda 97 and Malawi 98 have also reached the conclusion that, women who received ANC from health facilities that provided HIV testing on-site generally perceived testing as compulsory to access antenatal care. Hence, the human rights challenge of ‘opt-out’ HIV testing approach is that some pregnant women are unlikely to opt out of testing for the fear that their health care provider may react to them negatively for doing so.
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Assessing patients’ attitudes to opt out HIV rapid screening in community dental clinics: a cross sectional Canadian experience

Assessing patients’ attitudes to opt out HIV rapid screening in community dental clinics: a cross sectional Canadian experience

The survey questionnaire presented here is part of a study to introduce provider initiated opt-out HIV rapid screening tests in dental settings in Vancouver, Canada. As a provider initiative, all age-eligible patients were offered the HIV screening independent of their gen- der, sexual orientation, socioeconomic status, ethnicity and any other qualifier. As a result, this study cannot be compared to those by Freeman and colleagues [34] who found that males were less likely to be approached for the HIV test than females. Hutchinson and coworkers [26] found that dental faculty and students considered scope of practice, training and patient reaction as factors influ- encing the successful implementation of the HIV rapid screening test in dental settings. Although this current study included only patients, they similarly recognized that such a procedure does fall within the scope of dental practice.
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Antenatal clinic and Stop Smoking Services staff views on "Opt Out" referrals for smoking cessation in pregnancy: a framework analysis

Antenatal clinic and Stop Smoking Services staff views on "Opt Out" referrals for smoking cessation in pregnancy: a framework analysis

All HSWs and SSS staff directly involved in the implementation of the “opt-out” referral pathway were eligible to take part in this study. All eleven staff members involved in the pathway were invited to take part in the interviews (at the antenatal clinic: all five HSWs and their manager, henceforward referred to as HSWs for confidentiality; at the SSS: all five SSS staff involved in the pathway, including two advisers, two administrators, and their manager). Staff were approached by the researchers with the managers’ permission, and they all agreed to take part in the interviews. As a result, all HSWs and all SSS staff involved in this project were interviewed, and 17 face-to-face semi-structured interviews were conducted at three time-points. Details of the interview timeline are presented in Figure 1. Interview topic guides are presented in Figure 2. All staff were female, the time in their current role varied between 1 and 33 years, and one reported to be a current smoker. Interviews were conducted by two authors (KAB, female researcher with midwifery background; and KAC, non-clinical female researcher) in a private room within the interviewees’ places of work. Both researchers were involved in the implementation of the “opt-out” pathway, and had an established relationship with participants as well as past experience in conducting qualitative research. The interviews lasted between 15 and 40 min, were audio-recorded and transcribed verbatim.
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Opt Out Clause Is Not a Blank Check under Good Faith Lens

Opt Out Clause Is Not a Blank Check under Good Faith Lens

may enter the picture either at first level—what to do—or at the second lev- el—how much information to collect before deciding what to do—(Vermeule, 2013). Perfect foresight at the time of the contract signing would have been infi- nitely costly. It would carry a great-unintended cost, squandering many of the benefits of signing the contract without arising the party’s suspicion that “he is foreseeing litigation and angling for an advantage in it” (Posner, 2014). Moreo- ver, gathering more information could possibly cost the timing to contract in the light of Bank Santander needs. Thus, it sounds clear that when the Parties de- cided to bind themselves with this contractual provision, they did not intend to cover a contingency different from an opt-out under ordinary conditions.
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Should Students Be Able to Opt Out of Evolution? Some Philosophical Considerations

Should Students Be Able to Opt Out of Evolution? Some Philosophical Considerations

This is a rational response. Evolution should be taught robustly as a core part of the science curriculum. It is a well- confirmed conclusion of standard scientific methodology, and for most mainstream Christians, it is accepted as such. So long as evolution is not taught improperly as a metaphysically atheist view, there should be no danger of mistaking it for a part of religious studies. The Canadians got this exactly right. Unfortunately, the controversy is not likely to be solved so simply in the United States. In Oklahoma, the proposed legislation that might have led to schools having to heed such requests failed to pass the Senate Education Committee, but just barely, in a narrow seven to six vote (Hoberock 2009). In Niceville, FL, the River of Life Church continues to help its members try to opt out of evolution. Given the extreme and expansionist views that drive the creationist movement, we should not expect that creationists will give up their battle.
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An international comparison of deceased and living organ donation/transplant rates in opt-in and opt-out systems: a panel study

An international comparison of deceased and living organ donation/transplant rates in opt-in and opt-out systems: a panel study

The above evidence suggests that the introduction of opt-out consent is likely to increase the number of organ donors. However, there are three major problems with this research. First, the majority of the studies focused specifically on DBD donor rates. Although an important index of organ donation, the effect of opt-out consent becomes less clear-cut once other forms of organ dona- tion are considered, such as living organ donation. There are good reasons why the majority of existing research has focused on the effect of consent on the deceased ra- ther than the living donor rate; mainly that deceased do- nors produce a greater number and variety of organs. However, given that the majority of people on transplant waiting lists require a kidney and that more than a third of the total kidneys donated in the UK between 2012 and 2013 came from living donors [10], it seems reason- able to suggest that research should assess the effect of consent on both types of donation. This issue is espe- cially important given that living kidney transplants are greater in opt-in than opt-out countries [11]. Also while the focus of consent type policy is specifically targeted at deceased donations, it is not clear how, or even if, opt-in or opt-out policies influence the living donations rate epiphenomenally. That is, an intervention targeted at one behavior influences a second potentially related behavior that it is not the target for. Second, previous research has focused on the number of deceased donors regardless of the type of organ. It is unclear whether opt-out consent increases the number of transplants regardless of organ type. It is important to acknowledge that the number of transplants will be influenced by the number of donors, as well as other factors, such as quality of health care pro- vided and availability of trained surgeons. Given that the majority of transplants are for kidneys [10], it is possible that the higher levels of donation in opt-out consent sys- tems may be predominantly due to this specific organ and that there is little difference for other organs, such as hearts, lungs and livers. Although there is some research assessing the role of opt-out consent on specific types of organ transplants [6,11], to our knowledge no previous study has compared transplant rates for a variety of organs
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Examining the Decision to Opt In versus Opt Out of Section 107 of the JOBS Act of 2012: Determinants and Consequences

Examining the Decision to Opt In versus Opt Out of Section 107 of the JOBS Act of 2012: Determinants and Consequences

The Jumpstart Our Business Startups Act of 2012 (hereafter, JOBS Act) creates a new category of firms, referred to as “Emerging Growth Companies” (hereafter, EGCs). Section 107 of the JOBS Act, titled “Opt-In Right for EGCs,” gives EGCs the choice to take advantage of an extended transition period for complying with new or revised accounting standards. In other words, an EGC can choose to delay the adoption of new or revised accounting standards until those standards would otherwise apply to private companies. Using a logistic regression approach with hand-collected data, we examine the underlying firm characteristics associated with EGCs’ choice of opting in or out of the accounting standards exemption, as provided by Section 107 of the JOBS Act. Using additional ordinary least square regression analyses, we further examine whether the choice of opting in or out is associated with earnings management and financial statement restatement behavior. Our results suggest that EGC firms designated as “smaller reporting companies” are more likely to choose to delay the adoption of a new or revised accounting standard (i.e., opt in). Our findings also show that EGCs that employ Big 4 auditors are more likely to opt out. We further find that EGCs that choose to opt out are less likely to engage in earnings management behavior, proxied by the absolute value of abnormal accruals, and are less likely to restate their financial statements. Taken together, our findings suggest that EGCs that choose to opt out of Section 107 produce higher quality financial statements.
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A randomised controlled trial comparing opt in and opt out home visits for tracing lost participants in a prospective birth cohort study

A randomised controlled trial comparing opt in and opt out home visits for tracing lost participants in a prospective birth cohort study

Calderwood [17] has suggested that using interviewers for tracking without data collection is effective in geographically-based studies. ALSPAC is a regionally- defined birth cohort study, so home visits are more viable than in other cohort studies which are not geo- graphically based. Furthermore, this trial was restricted to those participants thought (based on desk-based ad- dress searching) to be still living in the Bristol area. The cost-effectiveness of the approach trialed here is likely to decrease if a wider geographical area is included. Conversely, the cost-effectiveness of both approaches (opt-in and opt-out) is likely to increase if larger sam- ples were referred for home visits. It is not known whether our findings for opt-in versus opt-out home visits for the purposes of tracing lost participants are also applicable to home visits in prospective cohort studies which aim to collect questionnaire data or bio- samples. While acceptability of the approach trialed in this study was generally high, the feedback from field- workers that participants seemed relieved when they realised they were not being asked to do more than con- sent to their updated details being held on the study database suggests that this approach may be less accept- able if used for data collection.
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