Reflections on the Development and Implementation of a University Student Health and Well-being Online Survey: the BOOST-Well Project

Justin Keogh; Evelyne Rathbone; Wendy J Brown; Beth Mozolic-Staunton; Gregory Cox; James Furness; Jaclyn Szkwara

doi:10.12688/f1000research.168558.4

. 2026 Sep 18;14:808. Originally published 2025 Aug 20. [Version 4] doi: 10.12688/f1000research.168558.4

Reflections on the Development and Implementation of a University Student Health and Well-being Online Survey: the BOOST-Well Project

Justin Keogh ^1,^a, Evelyne Rathbone ¹, Wendy J Brown ¹, Beth Mozolic-Staunton ¹, Gregory Cox ¹, James Furness ^1,^#, Jaclyn Szkwara ^1,^#

PMCID: PMC13616052 PMID: 42806958

Version Changes

Revised. Amendments from Version 3

1. further justification for the medical and allied health students in this project 2. additional information regarding how the participants completed the survey 3. additional information about some of the potential bias is that participants may have felt regarding their participation 4. how were absent students from the classroom dealt with? 5. additional information was provided regarding the the identification and confidentiality of students in small programs 6. additional limitations regarding the recruitment process provided

Abstract

Background

First year university students may be at risk of poor health behaviours and outcomes. Unfortunately, online surveys assessing multiple aspects of the health and well-being of university students have poor response rates, meaning the representativeness of such data may be questionable. This study sought to develop and implement an online survey to examine the health and well-being behaviours of medical and allied health students, with higher participation and response rate than have been reported in previous surveys.

Methods

A cross-sectional online survey was developed following recommendations to maximise the participation and response rates. All new students (defined as commencing a degree in May or September 2024) from undergraduate medical and postgraduate allied health programs from one Australian university were requested to participate. The survey included 136 items, most of which were validated questionnaires commonly used in national surveys. Participants were requested to complete the survey on their own device during scheduled class time within the first two weeks of their degree.

Results

Of 273 eligible students, 217 (79.5%) accessed the survey, with 201 (73.6%) completing it at least partially and 63.7% completing it fully. Median completion time was 14.4 (IQR: 12.3–16.8) minutes, and item-level response rates were high across disciplines. Differences in completion rates and survey duration were observed, with occupational therapy students taking the longest time to complete the survey (17.4 min).

Conclusions

The BOOST-Well survey achieved markedly higher response rates than comparable studies. This may reflect the student-informed survey design, concise format, strategic timing, and evidence-based recruitment and implementation strategies.

Keywords: College, health behaviours, questionnaires, recruitment, response rate, Administration, Community Health, Experimental Design, Health Education

Introduction

Lifestyles and health behaviours of students are important determinants of their ongoing health, as well as their academic achievement and future career success. ^1,
2 However, many students face a variety of physical, emotional, social and academic challenges that may negatively impact their health behaviours and ongoing health and well-being. ^1,
3,
4 Such challenges may be greater in university than school-age students, as university students may perceive additional study, financial and graduate employability stress, which may be compounded by leaving home, the need for casual/part-time employment and loss of some social connections. ^5–
8 There is also some evidence demonstrating that these challenges faced by university students may differ based on their country of study ⁹ and their sex. ¹⁰

Health and well-being information about university students is typically obtained through surveys. However, health survey research traditionally have limitations, including poor reporting of the survey or core questions, questionable validity and reliability of the survey items, poor reporting of the response rate, unclear representativeness of the sample and limited information about how missing data are handled. ⁸ Moreover, response rates to online surveys which seek to assess multiple aspects of the health and well-being of university students are typically low, ranging from 9 to 14% in recent studies. ³ ^, ⁸ ^, ¹¹ ^, ¹² A few exceptions report greater but potentially suboptimal response rates, for example 22% for an Australian university-wide survey ¹ and 31% for a USA-based nursing program. ¹³ Such low response rates are problematic for universities who wish to accurately identify and better manage the health and well-being challenges faced by their students.

By addressing the limitations of survey design, ¹⁴ university educators, administrators and support service staff may gain a better understanding of the health and well-being challenges of their students. This understanding is an important step in ensuring appropriate resources and services are available and easily accessible by students when required.

The primary aim of this study was therefore to develop and implement an online survey to examine the health and well-being behaviours of medical and allied health students, with higher participation and response rate than have been reported in previous surveys.

Materials and methods

Study design and setting

A cross-sectional online survey, BOnd Online Survey for Student Health and WELL-being Tracking (BOOST-Well) survey, was developed and then administered in May or September 2024 at the Faculty of Health Sciences and Medicine (FHSM) at a private Australian university (Bond University). Within this faculty, students from Medicine and several allied health programs (Physiotherapy, Occupational Therapy, and Nutrition and Dietetics) were eligible to participate. These programs were selected because they share the potential for high student stress reflecting students’ contact hours, hospital-based practicums and challenging assessments. Further students in these programs all need to complete research coursework subjects, whereby the inclusion of student survey data could provide an alternative to the systematic reviews or clinical audits typically conducted.

The Consensus-based Checklist for Reporting of Survey Studies checklist (CROSS) was utilised as a framework for conducting and reporting on the survey ¹⁵ and recruitment methods were informed by the work of Javidan et al. ¹⁶ Baseline data were collected to inform a planned prospective cohort study of student health and behaviours.

Survey development

The BOOST-Well survey was developed over 18 months with initial input from 45 students who responded to a single question preliminary survey “What are the five most important issues that affect your health and well-being?” in June 2022. After review of the preliminary survey findings, the authors worked with faculty staff and with student representatives from each program to select and refine the survey questions with formatting to support clear response options.

The BOOST-Well survey was reviewed by three student leaders for the FHSM, the FHSM Community Health and Well-being Officer, one academic from FHSM and all members of the research team, for critical content and layout. Minor changes were made to improve clarity, without altering any wording in previously validated scales. Based on this review, it was estimated it would take the participants 20-25 minutes to complete the survey. The survey is included in Appendix 1.

Participants and recruitment

During the development of the survey, the authors worked with elected student representatives and staff from each program (Medicine, Physiotherapy, Occupational Therapy and Nutrition and Dietetics). The student representatives were asked to provide some feedback on the topics to include in the survey, potential responses to the questions as well as wording of individual questions and responses to ensure they were appropriate and sensitive to the potential participants. Student representatives also provided advice regarding recruitment strategies, with this advice appearing consistent with many of the recommendations within reviews of previous student surveys ¹ ^, ³ ^, ⁸ ^, ⁹ ^, ¹¹ ^– ¹³ and the recommendations of Javidan et al. ¹⁶ on ways to maximise response rates.

All new and enrolled students (defined as commencing a degree that semester) from the undergraduate medical and postgraduate allied health programs were invited to participate. Students completed the online survey through Qualtrics ( https://www.qualtrics.com/) on their own device (laptop or phone) during program specific class time in Orientation Week (O-Week), the week prior to formal classes commencing, or within the first two weeks of commencing their degree. Scheduling for each group was based on maximising the expected number of students who would attend the selected class. Physiotherapy and Nutrition and Dietetics students completed the survey in May 2024 and Occupational Therapy and Medical students in either May or September 2024. To minimise coercion, lead research academics, who were not directly involved in the specific program in which each group of students was enrolled, presented ‘in person’ PowerPoint slides alongside a video to explain the aims and rationale of the study. The PowerPoint presentation typically lasted 5-10 minutes and focused on issues related to informed consent as well as how issues such as data privacy and confidentiality, minimising harm and maximising benefits of participation to themselves and future students would reflect their involvement in the study. It was also made explicitly clear to the students that their participation was voluntary and that there was no requirement for them to complete the survey, or that their decision not to participate would negatively influence their grades in any way. A QR code was provided for participants to access the survey and to enter a draw for an incentive on completion, with randomly selected students winning one of twenty $100 AUD gift cards. Only students who were present in class at the time the PowerPoint presentation describing the survey was given were eligible to participate in this study i.e. students who did not attend class on their respective days could not participate in the study.

Statistical analysis

Descriptive statistics are presented as counts and percentages for categorical variables. For continuous variables, normality was assessed using histograms, normal Q-Q plots and the Shapiro-Wilk test. Skewed variables are reported as (medians with IQR). Differences in categorical variables between study programs were compared using the chi-square test, provided the assumption for expected counts was met. The non-parametric Kruskal-Wallis test was used to assess program differences in skewed continuous variables. Statistical significance was set at the 0.05 level. All analyses were conducted using Jamovi software version 2.3.28. ¹⁷

Results

The five most important issues identified by students in the preliminary survey in 2022 were stress (study and financial), time pressure, social support, general health (physical and mental health), and healthy lifestyle (nutrition, sleep, smoking and alcohol consumption). These issues were incorporated into the BOOST-Well survey, which included questions in six groups, with a total of 136 items. These included demographic characteristics (as used by the Australian Bureau of Statistics ¹⁸) and wherever possible, validated questions or scales which have been used in national surveys in Australia, or in prior surveys of university students. When no suitable measures were found, the authors developed or modified questions, for example in relation to the students’ top three health concerns, swimming ability, training in life saving, first aid and resuscitation. Items included in each section of the survey, with sources and response rates, are shown in Table 1.

Table 1. Summary of survey content and item response rates for the 136 survey variables (based on valid cases, N = 201).

Survey section	Variable/measure or scale	Reference	Items (#)	Response rate (%)
Demographic characteristics	Age	Adapted from ABS census ¹⁸	1	88.6
	Gender	Adapted from ABS census ¹⁸	1	100.0
	Country of birth	Adapted from ABS census ¹⁸	1	100.0
	Language usually spoken at home	Adapted from ABS census ¹⁸	1	99.5
	Student status	Internal university item	1	100.0
	Indigenous origin	ABS census ¹⁸	1	99.5
	Highest qualification	Adapted from ABS census ¹⁸	1	100.0
	Program of study	Internal university item	1	100.0
	Living arrangements	ABS census ¹⁸	1	99.5
	Employment status	Adapted from ABS census ¹⁸	1	99.5
	Income management	ALSWH ¹⁹	1	99.5
	Postcode	Adapted from ABS census ¹⁸	1	99.5
Quality of Life (physical and mental health)	SF-12 version 1 (standard) for physical and mental health	Ware et al. ²⁰	12	94.0
	Top 3 health concerns	Self-developed	1	56.2 ^a
	Kessler K10 mental health scale	Kessler et al. ²¹	10	93.5 – 94.0
Time use, stress and social support	Time management, use of time, and amount of time that work/study affected physical and emotional well-being	ALSWH ¹⁹	5	75.1 – 92.0
	Stress	Bell and Lee ²²	11	92.0
	MOS social support	Sherbourne and Stewart ²³	19	91.0 – 92.0
Health behaviours	Smoking, vaping and alcohol consumption	Based on or adapted from ALSWH ¹⁹	13	53.3 ^b – 100
	Physical activity	Modified Active Australia survey ²⁴	8	85.6
	Muscle strengthening	Adapted from NHS ²⁵	2	>86.0
	Transport	Modified from HABITAT ²⁶	2	~86.0
	Swimming ability	Self-developed	3	~86.0
	Training in life saving, first aid and/or resuscitation	Self-developed	6	67.0 – 78.6
	Sedentary behaviour	Chau et al. ²⁷ & Clark et al. ²⁸	2	77.6
	Fruit and vegetable consumption	NHS ²⁵	2	~86.0
	Diet and meals bought	Adapted from NHANES ²⁹	4	~86.0
	Height and weight	Adapted from NHS ²⁵	2	81.6 – 84.6
	Sun protection	ALSWH ¹⁹	6	~86.0
Health services and medications	Visits to health professionals	ALSWH ¹⁹	13	~86.0 ^c
Health services and medications	Medications and supplements	ALSWH ¹⁹	2	22.9 – 32.3 ^a

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Note: Values in bold font are confirmed; values in regular font are estimated.

Abbreviations: ABS Australian Bureau of Statistics; ALSWH Australian Longitudinal Study on Women’s Health; HABITAT How Areas in Brisbane Influence healTh And acTivity; MOS Medical Outcomes Study; NHANES National Health and Nutrition Examination Survey; NHS National Health Survey; SF Short Form.

^{^a}

Qualitative data unlikely to apply to all students.

^{^b}

Percentage based on applicable cases (only 8 of 15 smokers or ex-smokers gave the age when they started smoking).

^{^c}

Rate based on items excluding question about any other health professional seen.

In consultation with our student representatives, and the recommendations of Javidan et al., ¹⁶ recruitment strategies adopted for the BOOST-Well survey included: Faculty and ‘in-kind’ support in terms of staff time, space, and IT resources, (Recommendation #1); student input throughout the survey development process (Recommendation #3); Faculty budget support for incentives (20 x $100 AUD gift cards for the student group) (Recommendation #5); and generation of student awareness in the form of a promotional video which was developed to ensure that consistent information was provided to each group of students before they completed the survey (Recommendation #6). These strategies are compared with those used in seven earlier student surveys ^{1,
3,
8,
9
11–
13} in Table 2. These seven studies are a non-exhaustive list of studies published since 2015 that report survey-based health and well-being data from university students.

Table 2. Comparisons of recruitment strategies and response rates in previous student surveys based on the six recommendations of Javidan et al. ¹⁶ .

Author date and place	Participants	Response numbers	Response rate (%)	Time to complete	Javidan et al. ¹⁶ six recommendations
Author date and place	Participants	Response numbers	Response rate (%)	Time to complete	Faculty support	Assigned student reps	Incorporated participant input into survey design	Protected time in class to complete survey	Incentives offered	Generated student awareness
Fruh et al., ¹³ 2021 USA	Undergraduate Nursing, 570 students	176 completed	31%	NR	Faculty supported recruitment processes; provided access to Qualtrics survey and statistical software; provided financial incentives for survey completion	NR	NR	NR	$15 eligible for electronic gift card	Initial email for distribution; 7 automated email reminders
Holt and Powell, ¹² 2017 UK	University wide, available online to 32,000 students	3683 commenced (3428 completed)	11%	NR	Faculty supported recruitment processes; provided access to Qualtrics survey and statistical software	NR	Engaged student services to inform included questions	NR	NR	Initial email for distribution
Reichel et al., ¹¹ 2021 Germany	University wide, available online to 31,213 students	4714 commenced (4351 completed)	14%	Estimated 35–45 minutes	Faculty supported recruitment emails; provided access to physical spaces for participant recruitment and survey completion, Unipark survey and statistical software; provided financial incentives for survey completion	NR	12 students completed a pre-test, minor adjustments made thereafter	NR	Incentives provided, fresh fruit @ physical space; charitable donation if > 5000 students completed survey (1000€), individual gift cards (13 x 24-40€) for local restaurants and for online store (15 x 20-100€)	Initial email for distribution; 4 reminder emails; research team members attended lectures; lecturers included slides; promotional material – posters, leaflets, newspaper press release, social media
Sanci et al., ¹ 2022 Australia	University wide, available online to 56,375 students	14,880 commenced (12,347 completed)	22%	Estimated 20 minutes	Faculty supported recruitment processes; provided access to Qualtrics survey and statistical software; provided financial incentives for survey completion	NR	The project team was Advised by a stakeholder advisory group including student association; pilot tested in a 4h workshop with 15 students. Students provided feedback on framing and comprehension of questions, survey length and item order	NR	Random draw >50 prizes (ipads, cycle vouchers, gift cards)	Initial email distribution; 2-weeks prior posters, flyers, digital slides for lecturers, online student social media channels, promotional video; reminder emails weekly – 8 weeks
Skromanis et al., ³ 2018 Australia	University wide, available online to 15,259 students	1,013 AUS 382 INT	9% 9%	Estimated 20 minutes	Faculty supported recruitment processes; provided access to survey and statistical software; provided financial incentives for survey completion	NR	Pilot study to elicit feedback	NR	Gift vouchers, value not reported	Initial email distribution; single reminder email & SMS; social media, flyers and postcards
Whatnall et al., ⁸ 2019 Australia	University wide, available online to 33,783 students	3,529 commenced (3077 completed); Optional questions: 3025 drug use; 1786 sexual health; 2962 mental health	9%	Estimated 15 minutes plus optional sensitive questions on drug use, sexual health and mental health	Faculty supported recruitment processes; provided access to Survey Monkey survey and statistical software; provided financial incentives for survey completion	NR	NR	NR	Gift vouchers (5 x $100 AUD)	Bulk email distribution; 2 reminder emails; university staff prompted to promote the survey; social media; digital signage; posters
Yeh et al., ⁹ 2023 Australia and Taiwan	Nursing, available via pen and paper to an unknown number of eligible students	381 completed survey (201 Australian, 180 Taiwanese)	NR	Estimated 30 minutes	Faculty supported recruitment processes; provided students access to hardcopy questionnaires and pencils survey; financial incentives for survey completion	NR	NR	NR	$2 chocolate	Verbal explanation by researchers during class; written material provided to students in class
Number of studies following Javidan’s Recom					7 of 7	0 of 7	4 of 7	0 of 7	6 of 7	7 of 7

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NR = not reported, Recom = recommendations, Reps = representatives.

Data on survey completion rates and time taken to complete the survey are shown in Table 3.

Table 3. Summary of survey completion rates and times taken to complete the survey for the overall cohort and each discipline group.

	Total( N = 201)	Medicine ( n = 114)	Physiotherapy ( n = 48)	Occupational therapy ( n = 27)	Nutrition & dietetics ( n = 12)	Group differences (p-value)
Survey completion	N %	n %	n %	n %	n %	NR
Partial	27	22	1	3	1
Partial	13.4	19.3	2.1	11.1	8.3
Complete	174	92	47	24	11
Complete	86.6	80.7	97.9	88.9	91.7
Duration (mins) of fully completed survey	Median	Median	Median	Median	Median
Duration (mins) of fully completed survey	IQR	IQR	IQR	IQR	IQR
	14.4	14.4	14.2	17.4	16.8	.006 ^*
	12.3–16.8	12.1–16.2	12.3–16.3	13.4–22.2 ^a	14.2–19.7	.006 ^*

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Percentages based on valid cases. NR = Not Reported (due to low counts in some cells).

^{^*}

Statistically significant <.05.

^{^a}

Significantly shorter in Medicine ( p = .016) and Physiotherapy ( p = .042) groups.

Of 273 registered students, 217 (79.5%) viewed the initial section of the online questionnaire, which preceded the actual survey questions. Of these, 201 proceeded to either fill out the survey, (either partially ( n = 27; or completely ( n = 174)), for an overall response rate of 73.6% (201/273) at least partial completions and 63.7% full completions. Full completion was defined at the participant level as completing all questions within the survey; with partial completion being defined as completing at least all the demographic information questions. Completion rates ranged from 80.7% to 97.9% for individual programs, with medical students having the lowest completion rate. The median (IQR) time taken for completion was 14.4 (12.3-16.8) minutes.

The Occupational Therapy students took significantly longer to complete the survey than the medicine or physiotherapy students (see Table 3).

Response rates to each section of the survey were high, but missing data were common in questions which did not apply to some individuals or required students to recall events that may have occurred more than two months before the survey (e.g., age when started smoking, year of completing resuscitation training). Response rates to open-ended questions, such as ‘top 3 health concerns’ and ‘medications and supplements’ were also low (see Table 1).

A summary of participants’ demographic characteristics is provided in Table 4 for the total sample and for students in each of the four program groups. There were significant group differences in age and language spoken at home. Medical students were younger than students in the three allied health programs and the Occupational Therapy and Nutrition and Dietetics students were less likely to speak English at home than the other students.

Table 4. Demographic and study enrolment characteristics of participants.

Characteristics	Programs
Characteristics	All ( N = 201)	Medicine ( n = 114)	Physiotherapy ( n = 48)	Occupational Therapy ( n = 27)	Nutrition and Dietetics ( n = 12)
Age (years), median (IQR)	20.5 (18–25)	18 (18–19) ^a	25 (24–27)	24 (23–30)	25 (21.8–26)
Range	18–48	18–31	21–48	19–39	20–48
Missing, n (%)	23 (11.4)	14 (12.3)	8 (16.7)	1 (3.7)	0 (0.0)
Gender, n (%)
A woman	130 (64.7)	70 (61.4)	27 (56.2)	22 (81.5)	11 (91.7)
A man	69 (34.3)	43 (37.7)	21 (43.8)	4 (14.8)	1 (8.3)
Prefer not to say/Other	<5%	<5%	<5%	<5%	<5%
Indigenous origin, n (%)
No	200 (100)	113 (100)	48 (100)	27.0 (100)	12 (100)
Missing	1 (0.5)	1 (0.9)	0 (0.0)	0 (0.0)	0 (0.0)
Country of birth, n (%)
Australia	83 (41.3)	65 (57.0)	10 (20.8)	6 (22.2)	2 (16.7)
Other English-speaking country	49 (24.4)	18 (15.8)	25 (52.1)	4 (14.8)	2 (16.7)
Non-English-speaking country in Asia	58 (28.9)	26 (22.8)	11 (22.9)	17 (63.0)	4 (33.3)
Other	11 (5.5)	5 (4.4)	2 (4.2)	0 (0.0)	4 (33.3)
Language usually spoken at home, n (%)
English	129 (64.5)	78 (69.0)	38 (79.2)	9 (33.3)	4 (33.3)
Other	71 (35.5)	35 (31.0)	10 (20.8)	18 (66.7)	8 (66.7)
Missing	1 (0.5)	1 (0.9)	0 (0.0)	0 (0.0)	0 (0.0)
Living arrangements, n (%)
Live alone	39 (19.5)	22 (19.3)	7 (14.9)	7 (25.9)	3 (25.0)
On campus – shared	68 (34.0)	60 (52.6)	5 (10.6)	3 (11.1)	0 (0.0)
Off campus – shared	60 (30.0)	19 (16.7)	28 (59.6)	9 (33.3)	4 (33.3)
Other	33 (16.5)	13 (11.4)	7 (14.6)	8 (29.6)	5 (41.7)
Missing	1 (0.5)	0 (0.0)	1 (2.1)	0 (0.0)	0 (0.0)
Income source, n (%)
No paid work	106 (53.0)	54 (47.4)	32 (68.1)	15 (55.6)	5 (41.7)
Regular paid work	55 (27.5)	30 (26.3)	8 (17.0)	10 (37.0)	7 (58.3)
Irregular paid work	39 (19.5)	30 (26.3)	7 (14.9)	2 (7.4)	0 (0.0)
Missing	1 (0.5)	0 (0.0)	1 (2.1)	0 (0.0)	0 (0.0)
Highest qualification, n (%)
School only	96 (47.8)	96 (84.2)	0 (0.0)	0 (0.0)	0 (0.0)
Bachelor’s degree	86 (42.8)	13 (11.4)	44 (91.7)	19 (70.4)	10 (83.3)
Other	19 (9.5)	5 (4.4)	4 (8.3)	8 (29.6)	2 (16.7)
Level of study, n (%)
Undergraduate	114 (56.7)	114 (100.0)
Postgraduate	87 (43.3)		48 (100.0)	27 (100.0)	12 (100.0)

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Percentages were calculated from valid cases. Percentages for missing values were based on total within group.

^{^a}

Significantly different from all other groups (p < .001 for all post-hoc pairwise comparisons).

A summary of the data is available on the project’s Open Science Framework page. ³⁶

Discussion

The primary aim of this study was to develop and implement an online survey to examine the health and well-being behaviours of medical and allied health students, with higher participation and response rates than have been reported in previous surveys. As the survey data will be used to inform the development of evidence-based and targeted health promotion strategies, and as a resource for students to develop research skills in data management and analysis within their research subjects, it was important to achieve a high response rate across all the health professional programs. The completion rates of 73.6% (at least partial completion) and 63.7% (full completion) were markedly higher than those reported in previous studies in Australia, ^3,
8 Germany ¹¹ and the UK ¹² that typically had response rates of 9-14%. There are however a small number of recent studies with higher response rates, including one Australian university-wide study that had a response rate of 22% ¹ and a USA based study that recruited only nursing students with a response rate of 31%. ¹³

The higher response rate for the BOOST-Well survey may be explained by several factors; many of which overlap with the six strategies recommended by Javidan et al. ¹⁶ as being critical for maximising response rates to student surveys.

We involved students throughout the survey development process to inform survey content, recruitment strategies and incentives. Reichel et al. ¹¹ and Sanci et al. ¹ (who obtained response rates of 14% and 22% respectively to university-wide surveys), also incorporated some student input into their survey development. Incentives have been widely used in previous studies, usually in the form of gift vouchers with value between $15 and $100. ³ ^, ⁸ ^, ¹¹ ^, ¹³ Two recent meta-analyses have concluded that appropriate incentives for maximising response rates to online surveys are unclear, ^30,
31 so we cannot say whether our incentive approach affected our response rate. Our use of a video to explain the survey on the day of completion precluded the need for initial or follow-up reminder emails, or promotional materials such as posters, slides, or social media, as was the case in previous studies. ¹ ^, ³ ^, ⁸ ^, ¹¹ ^, ¹³

A major difference between our approach and that used in previous studies is that we provided protected time in class for students to complete the survey. The only similar approach was by Yeh et al., ⁹ who provided hard copy surveys to their students during class-time but required them to complete the survey in their own time. Our students completed the survey in class time during Orientation week or within the first two weeks of commencing their degree. At this time, they were new to the university and were not overly encumbered with classes and assessments, nor other requests to complete formal feedback surveys for the university (i.e. teaching evaluations). The survey was also kept as short as possible, so that completion time would be minimised. The median completion time (14.4 minutes) was a little shorter than anticipated and substantially shorter than most previous surveys, which often took 20-45 minutes to complete. ^1,
3,
8,
11 A review by Sammut et al. ³² indicates that short surveys of ~10 minutes have substantially better response rates than longer surveys; the brevity of the survey may therefore have positively influenced our response rate. Others have shown that survey length and the complexity of individual questions, as well as the percentage of open-ended questions, may be related to reduced response rates and greater amounts of missing data. ³³

Overall, the combination of codesigned survey development and recruitment strategies, which align well with those proposed by Javidan et al. ¹⁶ probably underpin the high response rates to the BOOST-Well survey. However, it is acknowledged that Bond University is a small institution with a strong culture of student engagement, small class sizes and personalised teaching. ³⁴ This, together with the focus on health professional students, may help to explain the strong response rate.

Strengths and limitations

A major strength of this study was the student-informed and co-designed development of the survey methodology. This process incorporated input from both students and staff across multiple programs within a single faculty and aligned closely with the recommendations of Javidan et al. ¹⁶ As survey development requires a balance between comprehensiveness and conciseness, and the need to minimise completion time, our survey focused on health and well-being topics that an earlier pilot test of 45 of our students felt were most important. This meant that some health issues were not included. While this is a limitation, new issues, such as alternative dietary patterns, sleep, social media and/or screen use and reproductive health may be included in follow-up surveys. As the entire population of newly registered students in these programs was only 273, we also need to acknowledge the small sample size and lack of power analysis. Partially due to the small sample size, another limitation of the BOOST-Well surveys is that the external validity of this study in that the health priorities identified by Bond students may not be applicable to students from larger public institutions.

A further limitation is that completing the survey during class time may have created perceived participation or social desirability bias pressure, and some students may have felt less privacy when seated near classmates. We sought to minimise these risks by emphasising that participation was voluntary, that their answers should reflect their own opinions, that non-participation would have no academic consequences, and that they should not view others’ responses. Most students completed the survey on personal smartphones, which likely helped protect privacy by further reducing the potential that classmates could see each other’s responses.

Next steps

The BOOST-Well data will be used to develop targeted strategies for improving student health and well-being. The data will also be used as a resource for students to learn about data cleaning, coding and statistical analysis. This is important because it is challenging to access ‘real world’ data for development of research skills, because of time restrictions associated with obtaining ethical clearance for collection of data in a single trimester. Educators will now encourage students to work in interprofessional groups, to provide meaningful insights for discussion and reflection of student health issues from an interdisciplinary perspective. ³⁵ In future, it is planned to evaluate student perspectives on their involvement in this project and assess whether the project is useful for development of research interests, literacy and skills and interprofessional practice skills.

Conclusion

By following a series of recommendations from the literature, we developed an online health and well-being survey that had a completion rate that is substantially higher than that typically reported for other studies involving university students. The data will inform the future development of evidence-based and targeted strategies for improvement of students’ health and well-being, and as a resource for students to develop research skills.

Ethical considerations

A data custodian team was created to establish secure data storage and processing protocols, with the faculty statistician as the lead data custodian. To ensure that data from individual respondents could not be identified in subsequent analyses, each participant created a self-generated identification code (SGIC) before completing the survey. SGICs were based on elements of personal information known only to the student, in order to enable effective longitudinal tracking, should the survey be completed again in the future by the same students. ³⁶ Data linked to the SGICs were initially extracted from Qualtrics and saved in a separate data store, accessible only to the lead data custodian, who then created a new identifier code to replace the SGIC created by individual students. The SGIC code elements were re-ordered and recoded according to a mapping system created by the lead data custodian, with details in a password protected file that is only accessible by the lead data custodian. Once all potentially identifying variables were removed, data were transferred to a separate data store for use by members of the research team. Participants provided informed consent electronically prior to completing the online survey through Qualtrics. The study adhered to the Declaration of Helsinki and was approved by the Bond University Human Research Ethics Committee (JK02927).

Acknowledgments

The authors would like to offer special thanks to Professor Kevin J Ashton whose guidance, mentorship and support greatly impacted this work. Though Professor Ashton is no longer with us, his dedication to the BOOST-Well Project and research team inspired and guided the research. The authors would also like to thank the Executive Dean of the Faculty of Health Sciences and Medicine, Professor Nick Zwar, as well as Assistant Professors Elisa Canetti and Paul Dunn and Mrs Tanya Forbes for their support and assistance with this project. The authors also thank the FHSM student leadership representatives for sharing their student perspectives and all the students who participated in this study.

Funding Statement

The author(s) declared that no grants were involved in supporting this work.

[version 4; peer review: 2 approved

Data availability

Underlying data

Open Science Framework: BOOST-Well: BOnd Online Survey for Student Health and Well-being Tracking, https://doi.org/10.17605/OSF.IO/DHQBY ³⁷

This project contains the following underlying data:

2024_May_BOOST_data_201.xlsx

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Extended data

Open Science Framework: BOOST-Well: BOnd Online Survey for Student Health and Well-being Tracking, https://doi.org/10.17605/OSF.IO/DHQBY ³⁷

This project (2024_May_BOOST_data) contains the following underlying data:

2024_May_BOOST_data_201.xlsx

Multimedia Appendix 1.pdf

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

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F1000Res. 2026 Oct 10. doi: 10.5256/f1000research.210716.r522394

Reviewer response for version 4

Ali Azeez Al-Jumaili ¹

I would like to thank the authors for addressing all of my previous comments. I have no further comments.

Is the work clearly and accurately presented and does it cite the current literature?

If applicable, is the statistical analysis and its interpretation appropriate?

Partly

Are all the source data underlying the results available to ensure full reproducibility?

Partly

Is the study design appropriate and is the work technically sound?

Partly

Are the conclusions drawn adequately supported by the results?

Are sufficient details of methods and analysis provided to allow replication by others?

Reviewer Expertise:

Pharmaceutical Socioeconomics, Pharmaceutical/Medical Education, Clinical and Social Pharmacy, Pharmacy Practice, Pharmacy Policy, and Pharmacoeconomics.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

F1000Res. 2026 Sep 26. doi: 10.5256/f1000research.210716.r522392

Reviewer response for version 4

Hengki Yandri ¹

I have assessed the revisions made by the authors based on the previous review report, I am pleased to inform that the revisions are appropriate and fully address my previous comments. Therefore, I would like to change the status of this article to Approved.

Is the work clearly and accurately presented and does it cite the current literature?

Partly

If applicable, is the statistical analysis and its interpretation appropriate?

Yes

Are all the source data underlying the results available to ensure full reproducibility?

Yes

Is the study design appropriate and is the work technically sound?

Yes

Are the conclusions drawn adequately supported by the results?

Partly

Are sufficient details of methods and analysis provided to allow replication by others?

Partly

Reviewer Expertise:

Spiritual Counseling, Counseling, Educational Psychology, and Mental Health

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

F1000Res. 2026 Sep 11. doi: 10.5256/f1000research.199248.r491959

Reviewer response for version 3

Clodagh Flinn ^1,²

General Comment

Thank you for inviting me to review this article again. I believe that the authors have greatly improved this manuscript. I believe that the integrity of this manuscript is sound, and it can provide useful information for researchers on how to increase participation in research surveys. There remain, however, several points which should be addressed before it can go to indexation. Some of these were raised in previous versions of the manuscript, but I do not feel they have been comprehensively addressed yet. However, I believe that the integration of the points below will improve clarify and aid interpretation of this interesting and beneficial study. A point-by-point response to the review comments would be useful.

Specific Comments

Introduction:

- The justification for including students in the study is presented well. However, further justification for the inclusion of medical and allied health programmes specifically is needed and will provide important context for the study. This was raised in my previous review of this manuscript. Please add this at the end of the first paragraph.

Method:

- Appendix 2 is still not available to view.

- Can you provide some more information about how the student representatives involved in developing recruitment strategies selected? (Perhaps this information is in Appendix 2?).

- Thank you for adding more information about how/when the participants completed the survey. In line with reviewer 5, please add a few sentences in the limitations section about how completing the survey during class time may have created participation pressure for.

Further, is it possible that some participants may have felt a reduced sense of privacy to complete the survey if they were sitting in a lecture hall among their peers? This may have resulted in a social desirability bias. Was this considered? If so, how?

- My previous point about how absent students were dealt with (e.g., whether they were provided another opportunity to participate, etc.) has not been addressed. This has also been raised by reviewer 4.

Results:

- How were the seven earlier student surveys presented in Table 2 selected?

- Small frequencies remain in Table 4 which may put the anonymity of participants at risk, particularly given that the name of the institution and specific course names are provided (e.g., one "man" in the Nutrition and Dietetics course).

This point has been raised in response to previous versions of the manuscript and by other reviewers. Please ensure that the appropriate measures are taken to protect participants' identities, and are applied consistently across the entire table.

Discussion:

- Add explicit acknowledgment of the participation pressure and social desirability bias due to completing the survey during class time into the limitations section.

Is the work clearly and accurately presented and does it cite the current literature?

Partly

If applicable, is the statistical analysis and its interpretation appropriate?

Yes

Are all the source data underlying the results available to ensure full reproducibility?

Yes

Is the study design appropriate and is the work technically sound?

Yes

Are the conclusions drawn adequately supported by the results?

Yes

Are sufficient details of methods and analysis provided to allow replication by others?

Reviewer Expertise:

Psychological wellbeing and resilience. Chronic health conditions. Developmental transitions.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

F1000Res. 2026 Sep 15.

JUSTIN Keogh ¹

General Comment

Response: we thank the reviewer for the positive comments regarding some aspects of the manuscript as well is identifying other areas for further improvement.

Specific Comments

Introduction:

Response: some additional information has been provided as requested. However, it was felt best not to include this at the end of the first paragraph in the introduction but in the first paragraph of the section entitled Materials and Methods / Study Design and Setting, as that is where we first mentioned the faculty from which these students were recruited.

In this section, we have now provided some additional detail regarding how the inclusion of these programs reflected a combination of commonalities between these programs in terms of: 1) the students’ high contact hours, hospital-based practicums and challenging assessments that could adversely affect their physical and mental health; and 2) coursework research subjects that are contained in these degrees in which student-focused survey data might provide interesting alternatives to the systematic reviews and clinical audits commonly performed by the students in these programs.

Method:

- Appendix 2 is still not available to view.

Response: we apologise for this mistake, with Appendix 2 now being included in the main manuscript as requested by a previous reviewer and labelled Table 2.

Can you provide some more information about how the student representatives involved in developing recruitment strategies selected? (Perhaps this information is in Appendix 2?).

Response: some additional information is now provided regarding the student’s involvement in the recruitment strategies in the Participants and recruitment section within Materials and methods.

Response: some additional detail has been provided in the Limitations section regarding the limitations of our in-class recruitment process.

Response: while it is possible that some participants may have some reduced sense of privacy, the students routinely participate in a range of online surveys in class assessing their understanding of the subject content. In these typical classroom situations as well is this online survey, the students complete the surveys on personal smartphones and not on classroom computer screens, further reducing any uneasiness about privacy would be minimal, if any. It was also made clear to the participants that they should not look at their classmates responses.

Response: any students who were absent from class on the day the survey was to be completed were not eligible to be included in the survey. This information is provided at the end of the Participants and recruitment section within Materials and methods.

Results:

- How were the seven earlier student surveys presented in Table 2 selected?

Response: the studies were identified from our reading of the literature and database searches using keywords that included “university or college”, “student” and “health survey”, with a date range between 2015 and present, so to ensure that such studies’ results are likely still to be relevant to university students studying today. It has now been made more explicit that these seven studies is not an exhaustive list, but merely an example of the research conducted in this area since 2015.

Response: we agree that protecting participant confidentiality is important and feel that we have addressed this comment already. Whilst the results table might still contain some lower frequencies, we have taken all necessary steps to protect any potential identification. Other than a single person (the data custodian not linked to the medical or allied health programs) who produced the results for this table, no one else had access to any information related to the small group of individuals since all the IDs collected anonymously were recoded and participants from programs (physiotherapy, occupational therapy, and nutrition and dietetics) were merged into one subgroup called ‘Allied Health’ prior to the data being made available to anyone else, so that no particular individuals from the smaller allied health programs can be identified. This de-identified data set in which each individual is categorised as “Medicine” or “Allied Health” can be found in the appendices (2024_May_BOOST_data_201.xlsx)

Discussion:

- Add explicit acknowledgment of the participation pressure and social desirability bias due to completing the survey during class time into the limitations section.

Response: this has been done as requested.

F1000Res. 2026 Aug 25. doi: 10.5256/f1000research.199248.r507586

Reviewer response for version 3

Shaimaa Ezzat Basha ¹

I have reviewed Version 3 of the article "Reflections on the development and implementation of a university student health and well-being online survey: the BOOST-Well project."

The manuscript is scientifically sound overall and addresses an important methodological issue: how to improve participation and response rates in online health and well-being surveys among university students. The study is clearly framed as a cross-sectional online survey conducted among new medical and allied health students at one Australian university. The authors provide useful details on survey development, student-informed design, recruitment during scheduled class time, use of validated items where possible, and strategies intended to maximize response and completion rates.

The article has several strengths. First, the survey development process was informed by student input and relevant survey-design recommendations. Second, the recruitment strategy was practical and well described, including use of scheduled class time, clear consent procedures, and an incentive draw. Third, the reported participation and completion rates are meaningfully higher than those reported in many comparable online student health surveys. Fourth, the authors provide data availability information and ethical approval details, which strengthen transparency and reproducibility.

However, I still have some reservations.

1. The manuscript should more clearly distinguish between the aim of the survey itself and the aim of the current article. The article states that the survey was designed to examine student health and well-being behaviors, but the manuscript mainly reports survey development, implementation, response rates, and completion time. If the health and well-being outcomes will be reported separately, this should be stated more explicitly in the Introduction, Results, and Conclusion.

2. The possibility of implicit participation pressure should be acknowledged more directly as a limitation. Although the authors state that participation was voluntary and would not affect grades, completing the survey during scheduled class time may still have increased perceived pressure to participate.

3. The manuscript would benefit from slightly clearer terminology regarding "participation rate," "response rate," "accessed the survey," "partial completion," and "full completion." These terms should be used consistently throughout the abstract, results, and discussion.

4. Given the small numbers in some program groups, the authors should ensure that all demographic reporting sufficiently protects participant confidentiality, especially where categories contain very small cell counts.

5. The limitations should more explicitly state that the high response rate may reflect the specific institutional context: a small private university, health professional students, scheduled class-time completion, and a strong student engagement culture. Therefore, the approach may not generalize directly to larger public universities or less structured teaching contexts.

Overall, the manuscript is acceptable as a methodological report, but I recommend approval with reservations. The remaining issues do not fundamentally undermine the article, but addressing them would improve clarity, interpretation, and generalizability.

Is the work clearly and accurately presented and does it cite the current literature?

Partly

If applicable, is the statistical analysis and its interpretation appropriate?

Yes

Are all the source data underlying the results available to ensure full reproducibility?

Yes

Is the study design appropriate and is the work technically sound?

Yes

Are the conclusions drawn adequately supported by the results?

Partly

Are sufficient details of methods and analysis provided to allow replication by others?

Partly

Reviewer Expertise:

Mental health and well-being • Clinical psychology • Positive psychology• Occupational health psychology • Cultural and cross-cultural psychology • Health psychology• Family and relationship studies • Trauma and resilience • Sleep and psychological health• Digital and cyberpsychology • Gender and psychology • Forensic psychology• Criminal psychology • Political psychology • Artificial intelligence and psychology

F1000Res. 2026 Aug 19. doi: 10.5256/f1000research.199248.r510559

Reviewer response for version 3

Hengki Yandri ¹

Abstract.

Revise the aim to be more explicit. For instance: "This study sought to develop and implement an online survey... with the primary goal of achieving higher participation and response rates than previously reported, by employing a co-design and in-class administration strategy. " In the conclusions, focus on the methodological achievement rather than the implications of findings that are not presented in this paper.

Introduction.

Add a brief paragraph explaining why this specific student population was chosen. Was it due to accessibility within the faculty, or because they are viewed as future health promoters whose own well-being is particularly critical?

Clearly articulate the research gap. It is not just the low response rate, but the lack of studies that systematically test a combination of evidence-based strategies (like Javidan et al.'s recommendations) simultaneously. This is the study's original contribution.

Remove the sentence "The survey data will be used to inform..." from the end of the introduction, as it describes a future goal, not the aim of the current methodological paper.

Methods

Participants and Recruitment

Clarify how the student representatives were selected. Were they elected by their peers, appointed by faculty, or self-selected? This is important for the transparency of the co-design process.

Recruitment (Continued)

State clearly whether students who were absent on the day of data collection were given an alternative opportunity to complete the survey. If not, this is a limitation that should be acknowledged.

Data Analysis

Provide a more rigorous, a priori definition of "partial completion" in the methods section, rather than introducing it in the results. For example: "Partial completion was defined as completing all items in the demographic section (Section 1)."

Appendices: Ensure the link to Multimedia Appendix 2 is active and accessible, as it contains crucial information for replicating the implementation of the Javidan strategies.

Results

Anonymity

As suggested by reviewer Flinn, carefully review Table 4. For variables with very low frequencies (e.g., <5 in a cell), combine categories or report as <5 to protect participant identities, especially given that the institution and specific programs are named.

Participation Bias

Acknowledge that in-class administration, while effective, may introduce an implicit pressure to participate, which could artificially inflate the response rate. This is an important point to discuss (more appropriate for the Limitations section).

Discussion

Reinforce the Aim

Begin the discussion by reaffirming the methodological focus of the paper. Discuss the success of the recruitment strategies as the central finding.

Preliminary Findings (Optional)

If you wish to provide a glimpse, you could add one brief, descriptive paragraph about the most basic finding (e.g., "Descriptively, the sample reported high levels of perceived stress..."). However, if a separate manuscript is planned for the full analysis, state this explicitly: "A comprehensive analysis of the health and well-being data is underway and will be presented in a separate publication." This manages reader expectations.

Strengths and Limitations

Strengthen this section. Acknowledge the limitations more candidly: the limited generalizability (single, small, private institution), the potential for social desirability bias (filling out the survey in a classroom setting), and the lack of a power analysis for subgroup comparisons.

Is the work clearly and accurately presented and does it cite the current literature?

Partly

If applicable, is the statistical analysis and its interpretation appropriate?

Yes

Are all the source data underlying the results available to ensure full reproducibility?

Yes

Is the study design appropriate and is the work technically sound?

Yes

Are the conclusions drawn adequately supported by the results?

Partly

Are sufficient details of methods and analysis provided to allow replication by others?

Partly

Reviewer Expertise:

Spiritual Counseling, Counseling, Educational Psychology, and Mental Health

F1000Res. 2026 Mar 28. doi: 10.5256/f1000research.193546.r465772

Reviewer response for version 2

Alba Madrid Cagigal ¹

Thank you for the opportunity to review this manuscript describing the development and implementation of the BOOST-Well survey, an online instrument designed to assess health behaviours and well-being among medical and allied health students at an Australian university. The authors report a response rate of 73.6% (partial completion) and 63.7% (full completion), which is substantially higher than rates reported in prior literature.

Below, I highlight some issues for consideration to strengthen the manuscript:

1. Insifficient justification for the study and unclear novelty. While the introduction highlights limitations of existing surveys (e.g., low response rates), it does not clearly articulate why a new survey was required, and what specifically differentiates the BOOST-Well survey from existing approaches.

Recommendation: The authors should explicity clarify what the novel contribution is, why existing surveys were insufficient for their context, and what gap this study fills beyong simply reporting higher response rates.

2. Limited justification for use of survey methodology: The manuscript assumes surveys are the appropriate method without justification.

Recommendation: Include a brief rational for why a survey is appropriate for captiring multidimensional health and wellbeing data, and why alternative approaches (e.g., interviews) were not suitable.

3. Some methodological details are missing or unclear. In terms of the timing of data collection, why were surveys administered at two different time points (May and September)? were there differences between cohorts? No justification or rationale is provided for sample size; while a formal power calculation may not be required for a descriptive methodological study, this should be explicitly stated.

4. Potential participation bias. Although the authors state that steps were taken to minimise coercion, administering the survey during scheduled class time may introduce implicit pressure to participate.

Recommendation: More explicitly acknowledge this as a limitation, and discuss how this may have influenced participation rates and the generalisability of findings.

5. Interpretation and clarity of response rate comparisons. The discussion contains unclear phrasing when comparing response rates with prior studies. The manuscript states that previous studies had “higher response rates” (22% and 31%), which are in fact lower than those reported here.

6. Limited discussion of survey findings. While the stated aim is methodological, the manuscript provides almost no discussion of the actual health and well-being data collected. This creates a disconnect, as readers are told the data will inform interventions, but no insight is provided into what was found.

Recommendation: Include at least a brief summary of key findings, or a claer statement that these findings will be reported separately in another manuscript.

7. Minor issues: Minor wording issue: “Skewed variables are reported as (medians with IQR)”, parentheses unnecessary. Ensure consistency of terms such as "response rate", "completion rate", "participation rate"; these are currently used somewhat interchangeably. The manuscript claims the survey was kept “as short as possible,” yet includes 136 items. This tension should be acknowledged and justified more clearly.

Is the work clearly and accurately presented and does it cite the current literature?

Yes

If applicable, is the statistical analysis and its interpretation appropriate?

Yes

Are all the source data underlying the results available to ensure full reproducibility?

Partly

Is the study design appropriate and is the work technically sound?

Yes

Are the conclusions drawn adequately supported by the results?

Yes

Are sufficient details of methods and analysis provided to allow replication by others?

Partly

Reviewer Expertise:

University students mental health and digital mental health

F1000Res. 2026 Mar 5. doi: 10.5256/f1000research.193546.r461071

Reviewer response for version 2

Clodagh Flinn ^1,²

Thank you for your work revising this manuscript.

Introduction:

Point 1: Why did the authors choose to examine medical and allied health students specifically, as opposed to university students more broadly? Building this rationale into the introduction would be useful.

Point 2: In the last paragraph it says, "The survey data will be used to inform the development of evidence-based and targeted strategies for improvement of students’ health and well-being..."

Given that the actual survey data is not discussed or analysed in this manuscript, I think this should be removed. The aim of this manuscript vs. the survey itself is summed up well in the first sentence in the discussion but should be clearly distinguished in the introduction too.

Method:

Point 3: How exactly were potential participants invited to take part? During class time?

Point 4: There were 273 students registered. Do you know how many were present on the data collection days? Were students who were absent on those days given the chance to complete the survey at a later date?

(If participants completed the survey during class time only).

Results:

Point 5: "partial" survey completion in vague. Please be specific here - for example, did participants fill in 90% of the survey or stop after the demographics?

Please also update the abstract if needed.

Point 6: Thank you for updating the tables in response to my previous comment.

Can you please review table 4 in full to ensure changes are made throughout? E.g., some very low frequencies remain in the gender and country of birth rows (although not all are technically <5%, there are very few - less than 5 - participants).

You could consider combining the OT and N&D groups - although I understand this is not ideal, it would avoid very small frequencies and help to protect the identities of participants.

Discussion:

Point 7: Strengths and limitations. I think reframing the strength regarding the student-informed survey would be beneficial. As it stands, this section reads as though the actual content included in the survey is the strength, but the actual survey data isn't what this manuscript examined.

I think that the student engagement in the study design could be reframed as a key methodological strength - PPI in research is so important and a major strength of this study - don't underplay it! Also discuss the integration of relevant faculty, etc. in the survey -this adds knowledge and feedback from a range of experts.

Minor points:

Introduction. Paragraph 2 begins with, "Unfortunately, health and well-being information about university students is typically obtained through surveys."

Consider rephrasing this sentence - there is nothing fundamentally wrong with collecting data with surveys, although there are challenges limitations (like with any methodology) which are discussed.

Methods. Add citation for statistical software, Jamovi.

The link to appendix 2 does not appear to be active.

Is the work clearly and accurately presented and does it cite the current literature?

Partly

If applicable, is the statistical analysis and its interpretation appropriate?

Yes

Are all the source data underlying the results available to ensure full reproducibility?

Yes

Is the study design appropriate and is the work technically sound?

Yes

Are the conclusions drawn adequately supported by the results?

Yes

Are sufficient details of methods and analysis provided to allow replication by others?

Reviewer Expertise:

Psychological wellbeing and resilience. Chronic health conditions. Developmental transitions.

F1000Res. 2025 Oct 10. doi: 10.5256/f1000research.185745.r416932

Reviewer response for version 1

Clodagh Flinn ^1,²

The study aimed to develop an online survey on health, health behaviours and wellbeing for university students, implementing Javidan et al.'s recommendations in order to maximise response/participation rates.

The collaborative development of the survey with students is a clear strength of the study, it is great to see this being actively integrated into the work.

Overall, I believe this is a good study which addresses an important area - dealing with low response rates for research on student wellbeing.

As it stands, the introduction/methods suggest that the main aim is to explore health and wellbeing, not to design and implement a survey. Based on the intro/methods, I expected to see findings of the actual survey in the results, e.g., are students reporting depressive symptoms, high levels of smoking, etc. I believe the aims may be somewhat confusing to readers - is it to develop a survey and boost/report response rates, or to investigate health and wellbeing in students?

I think that the implementation of recommendations and strategies to increase participation are very important and central to the study, and so this should be highlighted as the primary main aim. This is a paper on the development of a survey and how you increased participation, but I did not feel that this was clear until the results/discussion.

Clearly stating your aims and structuring your results accordingly would be useful. You could also consider splitting results into the initial pilot study (in 2022) and the main study (2024).

Lastly, although this study is focused on how the researchers developed a survey and implemented a range of measures in order to increase participation, there is little description of this process in the methods section.

Introduction:

-Given that this is a methodological/technical paper (survey development and implementation), the introduction focuses more on the general literature on student mental health. Because of this I expected to read about the actual health of the sample, and not only the response rates, etc.

Method:

-The paper is about the development and implementation of a survey - there should be more detailed information on how exactly this was done.

-Add more detail into the method about which topics specifically the survey covered, why were they chosen (e.g., based on the pilot study). How exactly was the survey developed?

-More information should be included regarding specific measures, and especially the development of questions by the researchers. Why were certain measures used? -Were questions developed by the researchers based on previous research or the pilot study?

-More detail on recruitment is needed - e.g., how did authors work with student/staff representatives? How were the representatives selected? What recruitment ideas were used from previous research? How were students invited to take part?

-What are Javidan's recommendations and how were they implemented? (Given the centrality of maximising participation to the research, I expected to see more about how this was done).

-Add explicit ethical acknowledgement into the methods section unless there is a reason not to.

Results:

-Table 1 is very useful for showing exactly what was included in the survey. I think it should be moved up into the method section as it is helpful for contextualising the study.

-There are some very small frequencies reported in the demographics (e.g., one participant responded "other" for gender within the occupational therapy group). I am concerned that some participants could be identified by this given the name of the research institution and area of study are available. Please check that this cannot occur, and consider changing smaller frequencies to <5% instead.

Discussion:

-There is more information about the survey development/recruitment in the discussion than the methods, but this is not where it should be encountered for the first time. Much of this should be moved to the methods section - e.g., procedures, incentives, etc. used in the present study.

The discussion could consider why these initiatives worked, etc.

-Could further develop the point about how the findings can be used for teaching purposes - you could also discuss how these implications go beyond the classroom, expanding them to broader researchers/policy makers too. This study is a great example of how response rates can be significantly increased, possibly yielding more representative samples, etc.

Very minor points:

- Some very minor grammatical error (e.g., abstract: "meaning the representative of such data") - please do a thorough proof read.

- Please include full explanations for all abbreviations within the tables.

Is the work clearly and accurately presented and does it cite the current literature?

Partly

If applicable, is the statistical analysis and its interpretation appropriate?

Yes

Are all the source data underlying the results available to ensure full reproducibility?

Yes

Is the study design appropriate and is the work technically sound?

Yes

Are the conclusions drawn adequately supported by the results?

Yes

Are sufficient details of methods and analysis provided to allow replication by others?

Reviewer Expertise:

Psychological wellbeing and resilience. Chronic health conditions. Developmental transitions.

F1000Res. 2025 Sep 16. doi: 10.5256/f1000research.185745.r407853

Reviewer response for version 1

Ali Azeez Al-Jumaili ¹

Reflections on the development and implementation of a university student health and well-being online survey: the BOOST-Well project

Reviewer Comments

Abstract

– The abstract lacks clarity and should be rewritten to clearly reflect the study’s aim, methodology, key findings, and conclusions.

– Please remove citations from the abstract, as referencing other studies is not appropriate in this section.

Methods

– The methodology section is currently vague. It should explicitly state the study design (e.g., cross-sectional survey), the setting (e.g., university faculty), the country of study (Australia), and the data collection period (month/year).

– Clarify how participants were selected and provide justification for the sample size.

Results

– Please specify the academic level of the student participants (e.g., undergraduate, postgraduate).

– The results section lacks substantive findings. Include key outcomes supported by descriptive statistics or thematic summaries.

– Participant demographics and characteristics should be clearly presented to contextualize the findings.

Introduction

– The stated aim is overly detailed and should be streamlined. Consider summarizing the aim in one concise sentence.

– Clarify whether the study has one primary aim or multiple objectives, and ensure these are aligned with the abstract and methods sections.

Methods

Could you provide a completed CROSS checklist as supplementary material or clarify which specific items were most influential in shaping your survey design and reporting?

Were any psychometric properties (e.g., reliability, construct validity) assessed for the BOOST-Well survey items?

Why were only three student leaders included in the pilot phase? Would broader pilot testing have helped capture more diverse feedback?

How was the sample size determined to ensure adequate power for subgroup comparisons?

Were any demographic groups underrepresented in the final sample, and if so, how might this affect the generalizability of your findings?

How were missing or incomplete responses handled during analysis, particularly for questions with revised instructions (e.g., physical activity)?

Which specific variables were marked as “NR” due to unmet assumptions, and how did this affect interpretation of group comparisons?

Why was Jamovi selected for analysis, and were any limitations encountered compared to other platforms like SPSS or R?

Results

Table 2-It is better to separate results those with NR from those with P-value (using different tables)

Table 4 seems part of review article summarizing previous studies.

Please justify why your research includes such a summary, given it is a research article.

Conclusion

“ An online survey was developed to better understand the health behaviors and health and well-being for medical and allied health students, with a completion rate that is substantially higher than that typically reported.”

This sentence is not supported by results (at least they are not shown in the abstract results).

Is the work clearly and accurately presented and does it cite the current literature?

If applicable, is the statistical analysis and its interpretation appropriate?

Partly

Are all the source data underlying the results available to ensure full reproducibility?

Partly

Is the study design appropriate and is the work technically sound?

Partly

Are the conclusions drawn adequately supported by the results?

Are sufficient details of methods and analysis provided to allow replication by others?

Reviewer Expertise:

Social and Administrative Pharmacy, Pharmacy Education, Pharmacy Practice, Clinical Pharmacy, Public Health, and Pharmacoeconomics.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

F1000Res. 2025 Dec 15.

JUSTIN Keogh ¹

Reflections on the development and implementation of a university student health and well-being online survey: the BOOST-Well project

Reviewer Comments

Abstract

– The abstract lacks clarity and should be rewritten to clearly reflect the study’s aim, methodology, key findings, and conclusions.

– Please remove citations from the abstract, as referencing other studies is not appropriate in this section.

Response: we have rewritten the abstract to more closely align with the intended aim of the study i.e. developing a health and well-being survey methodology that increases response rates in university students. We have also removed the reference from this section as requested

Methods

– Clarify how participants were selected and provide justification for the sample size.

Response: some additional detail regarding the study design, country and collection period has been provided. However, we would like to reiterate that some of this information regarding the setting, how participants were selected and sample size had already been provided in the initial submission.

Results

– Please specify the academic level of the student participants (e.g., undergraduate, postgraduate).

– The results section lacks substantive findings. Include key outcomes supported by descriptive statistics or thematic summaries.

– Participant demographics and characteristics should be clearly presented to contextualize the findings.

Response: The method section had stated that participants were undergraduate medical and postgraduate allied health students. Additional demographic characteristics was attempted to be added in the results section. however, this request and other requests that the abstracts exceeded 400 words, much beyond the 300 word maximum capacity for an abstract to this journal. Hence, these demographic details cannot be included. In regards to the lack of reporting of key outcomes, that may reflect a lack of clarity regarding the focus of the paper, which is now been rewritten in the revised manuscript to be “The primary aim of this study was therefore to develop and implement an online survey to examine the health and well-being behaviours of medical and allied health students, with higher participation and response rate than have been reported in previous surveys.”. As such, reporting on the actual health and well-being survey results was not a focus of this paper; with such results to be presented in additional follow-on manuscripts.

Introduction

– The stated aim is overly detailed and should be streamlined. Consider summarizing the aim in one concise sentence.

– Clarify whether the study has one primary aim or multiple objectives, and ensure these are aligned with the abstract and methods sections.

Response: The primary aim has been rewritten to “The primary aim of this study was therefore to develop and implement an online survey to examine the health and well-being behaviours of medical and allied health students, with higher participation and response rate than have been reported in previous surveys.”. The secondary aim of developing a resource for students to develop their research skills has been retained; with some discussion of this component still retained in the manuscript.

Methods

Could you provide a completed CROSS checklist as supplementary material or clarify which specific items were most influential in shaping your survey design and reporting?

Response: we thank the reviewer for this comment and have provided some additional detail in the methodology and result sections of the manuscript in regard to how they more explicitly addressed requirements of the CROSS checklist and the limitations identified by Bennett et al. [1] survey based medical research.

In a systematic review of 165 medical journals regarding survey-based research, Bennett et al. [1] identified a number of major methodological issues regarding survey-based research. Of the 117 published survey studies they reviewed, only 35% of studies provided the survey or core questions, 19% provided any data on the validity or reliability of the instruments, 25% defined the response rate, 11% discussed the representativeness of the sample and 11% identified how missing data were handled. To address these issues identified by Bennett et al. [1] , the most important areas of the CROSS checklist that were influential in shaping our survey design are described below.

Data collection methods

Describe the questionnaire (e.g., number of sections, number of questions, number and names of instruments used).

Describe all questionnaire instruments that were used in the survey to measure particular concepts. Report target population, reported validity and reliability information, scoring/classification procedure, and reference links (if any).

Questionnaire if possible, should be fully provided (in the article, or as appendices or as an online supplement).

Sample characteristics

Describe the study population (i.e., background, locations, eligibility criteria for participant inclusion in survey, exclusion criteria).

Describe how representative the sample is of the study population (or target population if possible), particularly for population-based surveys.

Survey

administration

Provide information on modes of questionnaire administration, including the type and number of contacts, the location where the survey was conducted (e.g., outpatient room or by use of online tools, such as SurveyMonkey).

Provide information of survey’s time frame, such as periods of recruitment, exposure, and follow-up days.

Were any psychometric properties (e.g., reliability, construct validity) assessed for the BOOST-Well survey items?

Response: The current Table 1 which is found in the results provides references for all the validated and commonly used questionnaires utilised to examine the topics included in the survey which include: quality of life; time use, stress and social support; health behaviours e.g. physical activity, fruit and vegetable consumption etc; and health services and medications. Table 1 also provides references for the demographic characteristics used. In our approach we adapted the questions from a range of validated health surveys. This table and some additional detail regarding these assessments and the rationale for their choice has been provided in a text section in the revised method section.

Why were only three student leaders included in the pilot phase? Would broader pilot testing have helped capture more diverse feedback?

Response: Student leaders were the specific leaders of the three medical and allied health groups that represented our participants. As such, these three leaders attended meetings as representatives of their degree cohorts and of the Community Health and Well-Being Officer. Prior to this we also posted a survey to selected individuals across these programs in which 45 students responded regarding what they thought the five main health and well-being issues/topics should be. Mention of this was provided in the third paragraph of the discussion within the initial version of the manuscript, although we realise that should have been included in the methods, with this revision now made in the revised manuscript.

How was the sample size determined to ensure adequate power for subgroup comparisons?

Response: as the focus of this study was to develop a survey methodology that increases response rates, it was felt that a power analysis for subgroup comparisons was not required. Further, as stated in the Participants and Recruitment sub-section within the Materials and Methods section, “All new and enrolled students (defined as commencing a degree that semester) from the undergraduate medical and postgraduate allied health programs were invited to participate.” Hence, we were unable to recruit any more participants than those who were starting those degrees in the recruitment semesters (this being 273 registered students). We have however noted in limitations to the study that no power analyses were performed for subgroup comparisons and that this may most affect comparisons with the nutrition and dietetics degree due to their smallest sample size.

Were any demographic groups underrepresented in the final sample, and if so, how might this affect the generalizability of your findings?

Response: An inspection of the participants who fully completed the survey and those who either partially or failed to complete the survey did not reveal any major differences in their demographic characteristics. This suggests that the sample of participants who provided full responses was representative of the entire cohort.

How were missing or incomplete responses handled during analysis, particularly for questions with revised instructions (e.g., physical activity)?

Response: Questions that subsequently had minor revisions like program of study and language spoken at home either did not have any missing data after data cleaning or had very low missing data (0.5%) that were not used in analysis. Physical activity responses are covered in a separate piece of work being considered for publication and follow a series of data cleaning and processing that handle missing or incomplete data in a systematic way following the methods of Brown et al. [2] that were cited in the original article.

Which specific variables were marked as “NR” due to unmet assumptions, and how did this affect interpretation of group comparisons?

Response: The variables marked as NR for unmet assumptions were all the ones reported “NR” in the p-value column in Table 2 (now Table 4), apart from ‘Indigenous origin’ where testing was not applicable as the responses were always ‘No’, if not missing. We did not rely on hypothesis testing in our interpretation of group comparisons that were mostly descriptive, and have therefore removed the p-value column, and mentioned any significant differences tested in the text instead.

Why was Jamovi selected for analysis, and were any limitations encountered compared to other platforms like SPSS or R?

Response: there were no limitations encountered using Jamovi compared to SPSS or R in this study. Jamovi conveniently combines both a familiar interface for SPSS users, as well as the features of R since it incorporates commonly used R packages as well as R packages for more complex analyses all under one software that is very user-friendly. Two of the authors (Keogh and Rathbone) have successfully utilised Jamovi as being statistical analysis package in several other of their recent peer-reviewed journal publications. Examples include:

https://pmc.ncbi.nlm.nih.gov/articles/PMC9135035/

https://pmc.ncbi.nlm.nih.gov/articles/PMC10959102/

https://pubmed.ncbi.nlm.nih.gov/35651742/

https://www.pathologyjournal.rcpa.edu.au/article/S0031-3025(23)00076-4/fulltext

https://link.springer.com/article/10.1007/s00586-025-08926-6

Results

Table 2-It is better to separate results those with NR from those with P-value (using different tables)

Response: Table 2 (now Table 4) gives a snapshot of demographic characteristics, so we can compare all the variables, mostly in a descriptive way and this type of format is common in survey results reporting. However, if we split the tables, we would be putting more emphasis on p-values which have only been added where possible to complement the essential statistics.

As stated above, we have now removed the p-value column so that the focus is on descriptive statistics, whilst we have summarised the results of a couple of significance tests in the main text

Table 4 seems part of review article summarizing previous studies.

Please justify why your research includes such a summary, given it is a research article.

Response: based on the good points from the reviewer to make it more explicit that this manuscript focuses on the development of a survey that increases response rates, this summary table and some of the associated text has now been moved to the introduction to further support the importance of this study.

Conclusion

This sentence is not supported by results (at least they are not shown in the abstract results).

Response: we acknowledge the way this has been interpreted and have changed the sentence to “By following a series of recommendations from the literature, we developed an online health and well-being survey that had a completion rate that is substantially higher than that typically reported for other studies involving university students”.

Reviewer Report

1 Views

10 Oct 2025 | for Version 1

Clodagh Flinn, University College Dublin, Dublin, Ireland; Psychology, Carleton University (Ringgold ID: 6339), Ottawa, Ontario, Canada

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The collaborative development of the survey with students is a clear strength of the study, it is great to see this being actively integrated into the work.

Overall, I believe this is a good study which addresses an important area - dealing with low response rates for research on student wellbeing.

Response: we thank the reviewer for these comments and have now altered the Introduction, Method and Results sections to be more closely aligned with the developmental focus of this study in regards to improving response rates for student health and well-being surveys.

Clearly stating your aims and structuring your results accordingly would be useful. You could also consider splitting results into the initial pilot study (in 2022) and the main study (2024).

Response: we have restated the aims and the structure of the results to make it clearer that this manuscript describes the development of the survey approach and focuses its results on the response rates and associated outcomes relevant to improving response rates in similar samples of university students.

Response: additional information is now provided regarding the development of the survey in the methods section.

Introduction:

Response: the emphasis of introduction has now been adapted as requested to focus more on survey response rates and associated methodological concerns rather than student health and well-being.

Method:

-The paper is about the development and implementation of a survey - there should be more detailed information on how exactly this was done.

Response: additional detail has now been provided in the revised methods and result sections regarding the development and implementation of the survey.

-Add more detail into the method about which topics specifically the survey covered, why were they chosen (e.g., based on the pilot study). How exactly was the survey developed?

Response: additional detail regarding the process by which specific topics were identified by the researchers and students as being most important from the pilot study have also now been provided.

Response: the current Table 1 which is found in the Results section provides references for all the validated and commonly used questionnaires utilised to examine all of the important topics included in the survey which include: quality of life; time use, stress and social support; health behaviours e.g. physical activity, fruit and vegetable consumption etc; and health services and medications. Table 1 also provides references for the references for the demographic characteristics that were typically slightly adapted from a range of validated health surveys. This table and some additional detail regarding these assessments and the rationale for their choice has been provided in a text section in the revised method section.

Response: additional detail regarding this point has now been added to the revised methods.

-What are Javidan's recommendations and how were they implemented? (Given the centrality of maximising participation to the research, I expected to see more about how this was done).

Response: an additional table and text describing the six recommendations has now been added to the method section.

-Add explicit ethical acknowledgement into the methods section unless there is a reason not to.

Response: the ethical acknowledgement section has been reinstated into the method section.

Results:

-Table 1 is very useful for showing exactly what was included in the survey. I think it should be moved up into the method section as it is helpful for contextualising the study.

Response: We agree with this request and would normally do this. However, since we have also included the response rate to each of the different questionnaire items in this table, we feel it is better having all of this included in the results section. Repeating this entire table with the response rate information in the results section would therefore appear redundant.

Response: Data about students from individual programs were only available to the lead data custodian who also analysed them but was not involved with any of the cohorts. Prior to issuing data to other researchers, the data from the physiotherapy, occupational therapy and nutrition and dietetics groups were combined to create the allied health group, so that any such identification cannot occur. We appreciate the suggestion to change the smaller frequencies; as an additional precaution, we have combined the ‘Prefer not to say’ and ‘Other’ categories within Gender into one and replaced the low counts within the individual programs with ‘<5%’.

Discussion:

Response: this has been done as requested.

The discussion could consider why these initiatives worked, etc.

Response: additional detail has been provided regarding the wider implications of these findings as requested.

Very minor points:

- Some very minor grammatical error (e.g., abstract: "meaning the representative of such data") - please do a thorough proof read.

- Please include full explanations for all abbreviations within the tables.

Response: an additional proofread and all explanations underneath tables have been checked for abbreviations.

References included in this response document

1. Bennett C, Khangura S, Brehaut JC, Graham ID, Moher D, Potter BK, et al. Reporting guidelines for survey research: An analysis of published guidance and reporting practices. PLOS Medicine. 2010;8(8):e1001069. doi: 10.1371/journal.pmed.1001069.

2. Brown WJ, Burton NW, Marshall AL, Miller YD. Reliability and validity of a modified self-administered version of the Active Australia physical activity survey in a sample of mid-age women. Aust N Z J Public Health. 2008;32(6):535-41. PMID: 19076744. doi: 10.1111/j.1753-6405.2008.00305.x.

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

Underlying data

Open Science Framework: BOOST-Well: BOnd Online Survey for Student Health and Well-being Tracking, https://doi.org/10.17605/OSF.IO/DHQBY ³⁷

This project contains the following underlying data:

2024_May_BOOST_data_201.xlsx

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Extended data

Open Science Framework: BOOST-Well: BOnd Online Survey for Student Health and Well-being Tracking, https://doi.org/10.17605/OSF.IO/DHQBY ³⁷

This project (2024_May_BOOST_data) contains the following underlying data:

2024_May_BOOST_data_201.xlsx

Multimedia Appendix 1.pdf

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

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PERMALINK

Reflections on the Development and Implementation of a University Student Health and Well-being Online Survey: the BOOST-Well Project

Justin Keogh

Evelyne Rathbone

Wendy J Brown

Beth Mozolic-Staunton

Gregory Cox

James Furness

Jaclyn Szkwara

Roles

Version Changes

Revised. Amendments from Version 3

Abstract

Background

Methods

Results

Conclusions

Introduction

Materials and methods

Study design and setting

Survey development

Participants and recruitment

Statistical analysis

Results

Table 1. Summary of survey content and item response rates for the 136 survey variables (based on valid cases, N = 201).

Table 2. Comparisons of recruitment strategies and response rates in previous student surveys based on the six recommendations of Javidan et al. 16 .

Table 3. Summary of survey completion rates and times taken to complete the survey for the overall cohort and each discipline group.

Table 4. Demographic and study enrolment characteristics of participants.

Discussion

Strengths and limitations

Next steps

Conclusion

Ethical considerations

Acknowledgments

Funding Statement

Data availability

Underlying data

Extended data

References

Reviewer response for version 4

Ali Azeez Al-Jumaili

Roles

Reviewer response for version 4

Hengki Yandri

Roles

Reviewer response for version 3

Clodagh Flinn

Roles

JUSTIN Keogh

Reviewer response for version 3

Shaimaa Ezzat Basha

Roles

Reviewer response for version 3

Hengki Yandri

Roles

Reviewer response for version 2

Alba Madrid Cagigal

Roles

Reviewer response for version 2

Clodagh Flinn

Roles

Reviewer response for version 1

Clodagh Flinn

Roles

Reviewer response for version 1

Ali Azeez Al-Jumaili

Roles

JUSTIN Keogh

Associated Data

Data Availability Statement

Underlying data

Extended data

ACTIONS

PERMALINK

RESOURCES

Similar articles

Cited by other articles

Links to NCBI Databases

Table 2. Comparisons of recruitment strategies and response rates in previous student surveys based on the six recommendations of Javidan et al. ¹⁶ .