F1000Research F1000Research 2046-1402 F1000 Research Limited London, UK 10.12688/f1000research.168558.1 Research Article Articles Reflections on the development and implementation of a university student health and well-being online survey: the BOOST-Well project

[version 1; peer review: 1 approved with reservations, 1 not approved]

 Keogh Justin Conceptualization Investigation Methodology Project Administration Writing – Original Draft Preparation Writing – Review & Editing https://orcid.org/0000-0001-9851-1068 a 1 Rathbone Evelyne Conceptualization Data Curation Formal Analysis Methodology Project Administration Resources Software Writing – Original Draft Preparation Writing – Review & Editing 1 Brown Wendy J Conceptualization Investigation Methodology Project Administration Resources Writing – Original Draft Preparation Writing – Review & Editing 1 Mozolic-Staunton Beth Conceptualization Investigation Methodology Project Administration Resources Writing – Original Draft Preparation Writing – Review & Editing 1 Cox Gregory Conceptualization Investigation Methodology Project Administration Resources Writing – Original Draft Preparation Writing – Review & Editing https://orcid.org/0000-0003-4334-608X 1 Furness James Conceptualization Data Curation Formal Analysis Investigation Methodology Project Administration Resources Software Writing – Original Draft Preparation Writing – Review & Editing 1 Szkwara Jaclyn Conceptualization Investigation Methodology Project Administration Resources Writing – Original Draft Preparation Writing – Review & Editing 1 Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, 4227, Australia jkeogh@bond.edu.au

No competing interests were disclosed.

 20 8 2025 2025 14 808 12 8 2025 Copyright: © 2025 Keogh J et al. 2025 This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background

First year university students may be at risk of poor health behaviours and outcomes. Traditionally, online surveys assessing multiple aspects of the health and well-being of university students have poor response rates, meaning the representative of such data may be questionable. Therefore, the purpose of the study was to develop an online survey of health behaviours, health and well-being for university students with higher participation and completion rates than what is typically reported.

 Methods

An online survey was developed following the six recommendations from Javidan et al. 1 to maximise the participation and response rates. All new students (defined as commencing a degree that semester) from medical and allied health postgraduate programs from one Faculty 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 online survey on their own device during scheduled class time.

 Results

Of the 273 eligible students, 217 (79.5%) participants viewed the initial section of the questionnaire, with 201 (73.6%) partially ( n=27, 9.9%); or fully ( n=174; 63.7%) completing the survey. Median completion time was 14.4 (12.3 – 16.8) minutes. Questions that asked students to report on frequency or duration of health behaviours such as physical activity had some interpretation issues, whereby it was unclear if ‘zero’ and ‘blank’ responses meant non-participation or true ‘missing’ values for some items.

 Conclusions

Our response rate (63%) was substantially greater than in other Australian and international university student health surveys, which are typically <15%. We feel our substantially greater response rates than the literature reflected our attempt to follow the recommendations of Javidan et al. 1 which included enlisting Faculty support, assigning student representatives, incorporating participant input, offering incentives and allowing students time to complete the survey in scheduled class time.

 College health behaviours questionnaires recruitment response rate Administration Community Health Experimental Design Health Education The author(s) declared that no grants were involved in supporting this work. Introduction

Lifestyles and health behaviours of students are important determinants of their ongoing health, as well as their academic achievement and future career success. 2, 3 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. 2, 4, 5 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. 6, 7

A 2018 report from the World Health Organization World Mental Health International College Student Initiative (which surveyed 20,842 respondents from 24 universities across 9 countries), found that most students (93.7%) reported some stress in at least one of six areas (i.e. financial situation, health, love life, relationships with family, relationships at work/school and problems experienced by loved ones). 8 A follow-up study examined relationships between these six life stress areas and the odds of at least one of six mental health disorders (i.e. major depressive, bipolar, generalized anxiety, panic, alcohol use, or drug use disorders) in the next 12 months. 9 Estimates of population attributable risk suggested that these life stresses accounted for between 47-80% of the prevalence of mental health disorders in the following year. 9

Recent research conducted in Australian universities has also identified the potential for students to experience mental health and stress challenges, 10, 11 as well as physical health problems including poor nutrition, and low levels of physical activity. 12, 13 These issues may be greater in specific subgroups, such as international students, 2, 14, 15 with the potential for other sociodemographic characteristics including sex, age and university location to also influence the prevalence or severity of these health and well-being issues. 16– 18

Therefore, the establishment, maintenance and ongoing refinement of systems for monitoring university students’ health and well-being is essential, so that updated policies and procedures can be developed in areas where improvements in student health and well-being are indicated. Such information is important, as a recent Australian study identified that many service utilisation gaps exist in on-campus mental health services for university students. 16 Specifically, Francis-Taylor et al. 16 identified a number of areas for potential improvements, including increased access to specialist support services, as well as more educational, health promotion and prevention programs, particularly for international and male students.

Health and well-being information about university students is typically obtained through surveys. However, health survey research traditionally has a number of 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. 19 By addressing the limitations of survey design, 19 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.

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. 4, 13, 20, 21 A few exceptions report greater but still potentially suboptimal response rates, for example 22% for an Australian university-wide survey 2 and 31% for a USA-based nursing program. 22 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.

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 at a private Australian university. As the survey data will be used to inform the development of evidence-based and targeted strategies for improvement of students’ health and well-being, a key objective was to achieve a high response rate, by utilising strategies suggested in earlier student health research. A second objective was to create a resource for students to develop research skills in data management and analysis in their research subjects, using de-identified data to provide meaningful insights for discussion and reflection of student health issues from an interdisciplinary perspective.

 Materials and methods Study design and setting

Data were collected in 2024 in the Faculty of Health Sciences and Medicine (FHSM) at a private Australian university (Bond University). The CROSS (Checklist for Reporting of Survey Studies) checklist was utilised as a framework for how to conduct and report on the survey. 23

Survey development

The BOOST-Well survey was developed over 18 months with initial input from 45 students who responded to a single question student survey “What are the five most important issues that affect your health and well-being?” in June 2022. The authors worked with faculty staff, and with student representatives from each program to refine the survey questions and formatting, and to develop clear response options. In light of problems detected while cleaning data from initial data collection (in May 2024), minor changes were made to improve the clarity of required responses. For example, changes were made to the questions that asked about program of study and language spoken at home (where only one response was required) and about physical activity (where the authors added an instruction to enter zero for no activity instead of leaving the response blank).

The survey was pilot tested with three student leaders as well as all members of the research team. Minor changes to the survey were made to improve clarity, without altering any wording in previously validated scales. Based on results of pilot testing, it was estimated it would take the participants 20-25 minutes to complete the survey. The survey can be found in Appendix 1.

 Participants and recruitment

The authors worked with elected student representatives and staff from each program (Medicine, Physiotherapy, Occupational Therapy (OT) and Nutrition and Dietetics (N&D)) to develop recruitment strategies, which were based on ideas from previous student surveys 2, 4, 13, 15, 20, 22 and the recommendations of Javidan et al. 1 on ways to maximise response rates. All new and enrolled students (defined as commencing a degree that semester) from the medical and allied health programs were invited to participate. Students completed the online survey through Qualtrics 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 N&D students completed the survey in May 2024 and OT 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. 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 vouchers to be used in a local supermarket.

 Statistical analysis

Descriptive statistics were 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 were reported as median (IQR). Differences in categorical variables between study programs were compared using the chi-square test, provided the assumption for expected counts was met. Where this assumption was not met, tables reporting these results will include the acronym “NR”, meaning “Not Reported”. The non-parametric Kruskal-Wallis test was used to compare skewed continuous variables between programs. Statistical significance was set at the 0.05 level a priori. All analyses were conducted using Jamovi software version 2.3.28.

 Results

A summary of the data is available on the project’s Open Science Framework page. 25 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 survey, which included questions in six groups, with a total of 135 items. These included demographic characteristics (as used by the Australian Bureau of Statistics 26 ) 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.

Summary of survey content and item response rates for the 135 survey variables (based on valid cases, <italic toggle="yes">N </italic>= 201).
Survey section Variable/measure or scale Reference Items (#) Response rate (%)
Demographic characteristics Age Adapted from ABS census 33 1 88.6
Gender Adapted from ABS census 33 1 100.0
Country of birth Adapted from ABS census 33 1 100.0
Language usually spoken at home Adapted from ABS census 33 1 99.5
Student status Internal university item 1 100.0
Indigenous origin ABS census 33 1 99.5
Highest qualification Adapted from ABS census 33 1 100.0
Program of study Internal university item 1 100.0
Living arrangements ABS census 33 1 99.5
Employment status Adapted from ABS census 33 1 99.5
Income management ALSWH 33 1 99.5
Postcode Adapted from ABS census 33 1 99.5
Quality of Life (physical and mental health) SF-12 version 1 (standard) for physical and mental health Ware et al. 34 12 94.0
Top 3 health concerns Self-developed 1 56.2 a
Kessler K10 mental health scale Kessler et al. 35 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 33 5 75.1 – 92.0
Stress Bell and Lee 36 11 92.0
MOS social support Sherbourne and Stewart 37 19 91.0 – 92.0
Health behaviours Smoking, vaping and alcohol consumption Based on or adapted from ALSWH 33 13 53.3 b – 100
Physical activity Modified Active Australia survey 38 8 85.6
Muscle strengthening Adapted from NHS 26 2 >86.0
Transport Modified from HABITAT 39 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. 40 & Clark et al. 41 2 77.6
Fruit and vegetable consumption NHS 26 2 ~86.0
Diet and meals bought Adapted from NHANES 42 4 ~86.0
Height and weight Adapted from NHS 26 2 81.6 – 84.6
Sun protection ALSWH 33 6 ~86.0
Health services and medications Visits to health professionals ALSWH 33 13 ~86.0 c
Medications and supplements ALSWH 33 2 22.9 – 32.3 a

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.

Qualitative data unlikely to apply to all students.

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

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

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 2 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.

Of 273 registered students, 217 (79.5%) viewed the initial section of the online questionnaire, which preceded the actual survey questions. Of these, 201 (73.6%) proceeded to either fill out the survey partially ( n=27, 9.9%); or completely ( n=174; 63.7%). A summary of participants’ demographic characteristics is provided in Table 2 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 OT and N&D students were less likely to speak English at home than the other students.

Demographic and study enrolment characteristics of participants.
Characteristics Programs
All ( N = 201) Medicine ( n = 114) Physiotherapy ( n = 48) Occupational Therapy ( n = 27) Nutrition and Dietetics ( n = 12) p-value
Age (years), median (IQR) 20.5 (18–25) 18 (18–19) a 25 (24–27) 24 (23–30) 25 (21.8–26) <.001 *
 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 (%) NR
 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 1 (0.5) 1 (0.9) 0 (0.0) 0 (0.0) 0 (0.0)
 Other 1 (0.5) 0 (0.0) 0 (0.0) 1 (3.7) 0 (0.0)
Indigenous origin, n (%) NR
 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 (%) NR
 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 (%) <.001 *
 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 (%) NR
 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 (%) NR
 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 (%) NR
 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 (%) NR
 Undergraduate 114 (56.7) 114 (100.0)
 Postgraduate 87 (43.3) 48 (100.0) 27 (100.0) 12 (100.0)

Percentages were calculated from valid cases. Percentages for missing values were based on total within group. NR = Not Reported (due to low counts in some cells or when testing was not applicable).

Statistically significant <.05.

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

Data on survey completion rates and time taken to complete the survey are shown in Table 3. Of the 201 students who commenced the survey, 87% completed it, with rates ranging 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 OT students took significantly longer to complete the survey than the Medicine or Physiotherapy groups.

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
13.4 19.3 2.1 11.1 8.3
 Complete 174 92 47 24 11
86.6 80.7 97.9 88.9 91.7
Duration (mins) of fully completed survey Median Median Median Median Median
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

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

Statistically significant <.05.

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

 Discussion

The primary aim of this study was to develop and implement an online survey to examine the health and well-being of medical and allied health students at a private Australian university. 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 of the health professional programs. The response rates of 73.6% (at least partial completion) and 63.7% (full completion) were markedly higher than those reported in previous studies in Australia, 4, 11 Canada 18 and the UK 19 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% 2 and a USA based study that recruited only Nursing students with a response rate of 31%. 22

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. 1 as being critical for maximising response rates to student surveys. This overlap is summarised in Table 4, which also demonstrates considerable variations in how these recommendations have been implemented (or not) in previous studies.

Summary of seven previous surveys with response rates and factors used to support recruitment based on the six recommendations of Javidan et al. <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>
Author date and place Participants Response numbers Response rate (%) Time to complete Javidan et al. 1 six recommendations
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., 22 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, 21 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., 20 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., 2 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
Skromaniset al., 4 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., 13 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., 15 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

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

For BOOST-Well, key strategies included the incorporation of student input throughout the survey development process (Javidan Recommendation #3). This involved conducting a small survey to ask students about the five main issues they believed most affected their health and well-being, prior to developing a pilot version of the survey. Elected student representatives (Javidan Recommendation #2) were invited from each program to complete pilot versions of the questionnaires and provide feedback on content and formatting of the survey, as well as advice on recruitment strategies and incentives. Reichel et al. 20 and Sanci et al. 2 who obtained response rates of 14% and 22% respectively to university-wide surveys, also incorporated some student input into their survey development.

In addition to ‘in-kind’ support in terms of staff time, space, and IT resources (Javidan Recommendation #1), Faculty support included budget for the incentives (20 x $100 grocery shopping vouchers) (Javidan Recommendation #5). Incentives were also used in six of the seven studies summarised in Table 4, with the majority using financial incentives such as gift vouchers (typically between $15-100 in value). 4, 13, 20, 22 As two recent meta-analyses indicate it is still not clear what constitutes appropriate incentives for maximising response rates to online surveys, 27, 28 it is unclear if the incentive approach substantially added to the increased response rates compared to other studies.

As student awareness (Javidan Recommendation #6) was obtained during specific orientation sessions, there was no need to use initial or follow-up reminder emails, or promotional materials such as posters, slides, or social media, as was the case in previous studies. 2, 4, 13, 20, 22 A promotional video was also developed to ensure that consistent information was provided to each group of students before they completed the survey.

A major difference between the methodology in the present study and most of the wider literature is the protected time (Javidan Recommendation #4) provided in class for the participants to complete the survey. The only similar approach was by Yeh et al., 15 who provided hard copy surveys to their students during class-time but required them to complete the survey in their own time. The 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 the majority of previous surveys, which often took 20-45 minutes to complete. 2, 4, 13, 20 As a review by Sammut et al. 29 indicated that short surveys of ~10 minutes had substantially better response rates than longer surveys, the brevity of the survey may also have been an important determinant of the response rates. Such findings may reflect the concept of survey (respondent) fatigue, in which a variety of factors including survey length, complexity of the topic and individual questions as well as the percentage of open-ended questions may all be related to reduced response rates and greater amounts of missing data. 30

Overall, the combination of recruitment strategies, which align well with those proposed by Javidan et al. 1 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. 31 This, together with the focus on health professional students, may help to explain the strong response rate.

Strengths and limitations

The overall student-informed survey content is a strength of this study. The survey included questions on quality of life and well-being (including physical, mental and general health), as well as health behaviours and use of health services and medications. Inclusion of questions on time use, stress and social support was seen to be critical to the current generation of university students. However, survey development required a balance between comprehensiveness and conciseness, and the need to minimise completion time 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.

Another strength is the high response rate, but this may reflect the fact that students came from one faculty in a small private university. As their health priorities may not be applicable to students across different programs from larger public institutions, the findings may not be generalised to other student populations. A further limitation is that it was difficult to differentiate between ‘zero’ and ‘blank’ responses to distinguish between non-participation and ‘missing’ values for some items. This will be addressed by formatting questions differently in future surveys, so to eliminate outliers in questions that ask about frequency and duration of behaviours.

 Next steps

The BOOST-Well survey has identified a range of health and wellness behaviours that appear to be positively contributing to the overall health and well-being of the medical and allied health student cohort. It has also identified some areas in which further support could be offered to some groups of students to improve aspects of their health and well-being, with ongoing discussions being held on how to best implement such improvements. This cohort of students has also recently repeated this survey that will provide some additional insight into how these health and wellness behaviours may change across their first year of study within their current degree.

The data obtained will also be a valuable resource for students’ coursework research requirements. The data has already been used by students enrolled in research subjects to learn about data cleaning, coding and statistical analysis. This is a very important outcome as it has been challenging for the medical and allied health students to access ‘real world’ data for the development of these research skills, because of time restrictions associated with obtaining ethical clearance and collecting data in a single trimester. Educators will continue to encourage students to work in interprofessional groups to further investigate the data, to inform the development of targeted health promotion strategies and disease prevention initiatives. 32 In the 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

An online survey was developed to better understand the health behaviours and health and well-being for medical and allied health students, with a completion rate that is substantially higher than that typically reported. The data will inform the development of evidence-based and targeted strategies for improvement of students’ health and well-being. The resulting database is already being used as a resource for students to develop research skills, using data which should provide meaningful insights for discussion and reflection of student health issues from an interdisciplinary perspective.

 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. 24 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).

 Data availability Underlying data

Open Science Framework: BOOST-Well: BOnd Online Survey for Student Health and Wellbeing Tracking, https://doi.org/10.17605/OSF.IO/DHQBY 43

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 Wellbeing Tracking, https://doi.org/10.17605/OSF.IO/DHQBY 43

This project contains the following underlying data:

Multimedia Appendix 1.pdf

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

 Acknowledgments

The authors would like to offer special thank you 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.

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Ranking excellence, the Australian way: Methodology. 2024. Reference Source Bogossian F Craven D : A review of the requirements for interprofessional education and interprofessional collaboration in accreditation and practice standards for health professionals in Australia. J. Interprof. Care. 2021;35(5):691–700. 32935599 10.1080/13561820.2020.1808601 Australian Bureau of Statistics: Health: Census. ABS. 2021. Reference Source Ware J Jr Kosinski M Keller SD : A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med. Care. 1996;34(3):220–233. 8628042 10.1097/00005650-199603000-00003 Sampasa-Kanyinga H Zamorski MA Colman I : The psychometric properties of the 10-item Kessler Psychological Distress Scale (K10) in Canadian military personnel. PLoS One. 2018;13(4):e0196562. 29698459 10.1371/journal.pone.0196562 PMC5919406 Bell S Lee C : Perceived stress revisited: The Women's Health Australia project Young cohort. Psychol. 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Sports Med. 2011;45(15):1216–1222. 21947817 10.1136/bjsports-2011-090214 Clark BK Pavey TG Lim RF : Past-day recall of sedentary time: Validity of a self-reported measure of sedentary time in a university population. J. Sci. Med. Sport. 2016;19(3):237–241. 25766507 10.1016/j.jsams.2015.02.001 National Health and Nutrition Examination Survey Questionnaire [database on the Internet]. Department of Health and Human Services, Centers for Disease Control and Prevention;2020. Reference Source Rathbone E : BOOST-Well: BOnd Online Survey for Student Health and Wellbeing Tracking. 2025, August 11. 10.17605/OSF.IO/DHQBY 10.5256/f1000research.185745.r416932 Reviewer response for version 1 Flinn Clodagh 1 2 Referee University College Dublin, Dublin, Ireland Psychology, Carleton University (Ringgold ID: 6339), Ottawa, Ontario, Canada

Competing interests: No competing interests were disclosed.

 10 10 2025 Copyright: © 2025 Flinn C 2025 This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. recommendation approve-with-reservations

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?

No

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.

 10.5256/f1000research.185745.r407853 Reviewer response for version 1 Al-Jumaili Ali Azeez 1 Referee https://orcid.org/0000-0003-4691-0280 Department of Clinical Pharmacy, University of Baghdad, Baghdad, Baghdad Governorate, Iraq

Competing interests: No competing interests were disclosed.

 16 9 2025 Copyright: © 2025 Al-Jumaili AA 2025 This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. recommendation reject

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?

No

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?

No

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

No

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.