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Original Article

Sample size estimation and sampling techniques

for selecting a representative sample
Aamir Omair
Department of Medical Education, Research Unit, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

ABSTRACT
Introduction: The purpose of this article is to provide a general understanding of the concepts of sampling as applied to health-
related research.
Sample Size Estimation: It is important to select a representative sample in quantitative research in order to be able to generalize
the results to the target population. The sample should be of the required sample size and must be selected using an appropriate
probability sampling technique. There are many hidden biases which can adversely affect the outcome of the study. Important factors
to consider for estimating the sample size include the size of the study population, confidence level, expected proportion of the
outcome variable (for categorical variables)/standard deviation of the outcome variable (for numerical variables), and the required
precision (margin of accuracy) from the study. The more the precision required, the greater is the required sample size.
Sampling Techniques: The probability sampling techniques applied for health related research include simple random sampling,
systematic random sampling, stratified random sampling, cluster sampling, and multistage sampling. These are more recommended
than the nonprobability sampling techniques, because the results of the study can be generalized to the target population.

Keywords: Sample, sample size, sampling techniques

INTRODUCTION the importance of sampling in health research and to

Selecting a sample that is representative of the general
population is an important part of quantitative research.
One of the major reasons that articles are rejected
by good quality peer-reviewed journals is due to a
nonrepresentative sample or not having an adequate
sample size.[1] The results of a poorly selected sample
that is different from the target population cannot be
applied to the general population.[2] A smaller than
required sample size may not have the appropriate
power to identify significant differences or associations
that may be present in the target population. The
purpose of this article is to provide an overview of
Access this article online
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DOI:
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Address for correspondence:
Dr. Aamir Omair, Department of Medical Education,
Research Unit, King Saud bin Abdulaziz University
for Health Sciences, Riyadh, Saudi Arabia.
E-mail: omaira@ksau-hs.edu.sa
provide the readers with useful tips and resources for
selecting a representative sample.
The first step in understanding the sampling process is
to be familiar with the terminology [Table 1]. A sample
is a subset of the total population that is of interest for
the study topic. This “total” population is called the
target population, to which the results of the study can
be generalized.[3] For example, the outcomes of a study
based on patients admitted in a tertiary care hospital in
a major city cannot be generalized to patients presenting
with the same condition to other types of health care
facilities in smaller towns. The sample itself is selected
from a section of the target population that is accessible
to the researcher, which is called the study population.[4]
The study population may be as simple as a list of
patients admitted with a certain disease, or it may be as
obscure as all patients visiting any health care facility
with different signs and symptoms.
Even if all the available study population is being
selected, it is important to keep in mind that the study
population may still be inherently different from
the target population.[5] Patients who present with a
specific disease to a tertiary health care facility are
not representative of all the patients with that disease
in that area. The difference may be in the severity
of the disease or even with the demographics of the

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Omair: Sample size estimation and sampling techniques
Table 1: Sampling framework – from target population to the sample
Sampling unit Description
Target population This is a larger population – the results from a representative
sample can be generalized to this level
Study population This is the accessible part of the target population from where
the sample is selected
Sampling frame This is a list of all the members in the study population (may
not be available in all cases)
Sample Members of the study population who are selected for the
study – should be representative of the study and target population
patients depending on the type of health care facility,
that is, Ministry of Health, Military hospital, Private
hospital, etc. Patients who present to a specific health
care center may be different from those who go to
another health center or another health care provider.
Hence, it is not advisable to generalize the results from
a single hospital-based study to the whole city let
alone the entire country.[6,7] Another important point
to consider is that people who agree to participate in
the study may be different from the nonresponders. In
general responders tend to be more health conscious
and more literate, or they may be more likely to
have a chronic condition as compared to an acute
exacerbation of the disease. Hence, the results of the
study may be different from the outcome in the general
population either in a positive or negative direction,
depending on how the responders are different from
the nonresponders.[8]
It is important to show that the selected sample is
representative of the study and the target population
with regards to the demographic and other relevant
characteristics that may affect the outcome of the
study. [9] For example, in a study to compare the
outcomes of diabetic patients being managed by an
endocrinologist as compared to those being managed
by family physicians. It is important to consider
that the two groups have the same socioeconomic
characteristics with regards to age, gender, income,
and education since all of these are related to the
outcome. [10] It is also important to consider the
severity and duration of disease since patients
presenting to the endocrinologist may be more
likely to be already having complications due to
diabetes mellitus. It is recommended to obtain the
relevant demographic and background information
from the responders to demonstrate that they are
representative of the target/study population. [10]
Additional information that may be easily obtained
should also be collected about the nonresponders/
lost to follow-up cases, like area of residence, body
mass index (BMI), smoking status, etc. This will
be useful to demonstrate that the responders are
similar to the nonresponders with regards to these
background variables.[11]
Journal of Health Specialties / October 2014 / Vol 2 | Issue 4
SAMPLE SIZE ESTIMATION
A sample must be of the required size in order to have the
required degree of accuracy in the results as well as to
be able to identify any significant difference/association
that may be present in the study population. [12]
Determining the minimum required sample size for
achieving the main objectives of the study is of prime
importance for all studies but is generally neglected by
most novice researchers. A common practice is to select
all the cases that are available (consecutive sampling) in
a given period of time or to select a sample size based
on a previous study.[13] Another practice is to select a
sample of 50 or 100 patients depending upon the time
and resources available.[14] While the above assumptions
may be adequate in some cases, they are generally not
appropriate, especially for studies which require the
comparison of two or more groups with respect to one
or more outcomes of interest.
The factors that need to be considered when determining
the required sample size include the size of the study
population (from which the sample is to be selected),
the confidence level (generally set at 95% confidence
level), the expected prevalence or variance of the main
outcome variable that is being studied, and the required
margin of error/accuracy that is acceptable for the
study.[12,15] In studies comparing two or more groups, the
power of the study is generally set at 80% and additional
information regarding the expected difference between
the two groups, will also be required.[16] Nowadays, it is
not required to go about looking up difficult formulae
and going through complicated calculations in order to
determine the required sample size. There are a number
of free online software and easily accessible websites
like Open-Epi,[17] RaoSoft,[18] Pi-face,[19] etc., which can
estimate a number of permutations for the required
sample size based on the estimated parameters for the
study population.
The researcher does need to do some preparation in
advance before estimating the required sample size. The
simplest scenario is a single sample study, where the
prevalence of a specific variable is required in the study
population, e.g., prevalence of diabetes mellitus or its
complications. The additional information to determine
the required sample size includes the estimated size of
the study population (if very large then use 20,000), the
expected prevalence of the main variable (if unknown
then use 50%), and the required margin of accuracy
(generally set at 10% or 5%).[20] The margin of accuracy
is related to how accurate the required result is with
regards to being close to the expected population value,
the more precise the required results, the greater is
the sample size required. Generally for an expected
prevalence of around 50% for the outcome variable
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Omair: Sample size estimation and sampling techniques

a margin of accuracy of ±10% requires a sample size the general rule is that the more precise the required
of around 100, which increases to around 400 for accuracy, the greater is the required sample size.[24] A
an accuracy of ±5% and 10,000 for ±1% margin of summary of the information required for estimating the
accuracy. sample size is given in Table 2.

In case of determining the sample size for determining
the mean value for a numerical variable (e.g., BMI,
cholesterol level, etc.,), the additional information
required is for the expected variance of the required
variable in the target population.[21] This information
can be obtained from the literature review of similar
studies in the form of the standard deviation (SD) for
the required variable. The higher the SD, the greater
will be the required sample size. In case the SD is not
known for the target population, it can be estimated by
taking the difference between the estimated “highest”
and “lowest” values in the population and dividing it by
four (±2 SD on either side of the mean for the “normal”
distribution).[22] For example, the BMI for a group of
diabetics is expected to have a high value of 48 and
a low value of 16 kg/m2. Hence, the “normal” range is
48-16 = 32, which gives an estimated value for the SD
of ±8 (32 divided by 4). The other information required
for determining the sample size is the accuracy of the
estimated mean, that is, how close it should be to the
actual population mean.[23] In the above example, for
BMI, the accuracy can be set as ±1, ±2 or ±4 kg/m2,
The requirements for determining the sample size for
comparing between two (or more) groups becomes more
complex with the requirements for estimation about the
expected prevalence in both the groups (for categorical
variables) and the expected difference of means (for
numerical values). But the basic rule is the same – the
greater the variability of the variable under study or the
the more precise the required accuracy, the greater is
the required sample size.[12] Table 3 shows the estimated
sample sizes for a categorical variable (hypertension)
and a numerical variable (systolic blood pressure)
for comparing these variables between smokers and
nonsmokers for different level of accuracies. It is up to
the researcher to select the required criteria according
to the study objectives and the available resources.
It should be kept in mind that these are all based on
estimates and if the sample results are found to have
more variability than used in the estimation then the
P values will not be statistically significant. If there is
provision for doing a pilot study, then the estimated
prevalence or SD can be more accurately determined
based on a smaller sample from within the study

Table 2: Information required for estimating the required sample size

Type of outcome variable
Categorical Numerical
Estimating proportion (%) for “one sample” Estimating mean value for “one sample”
Estimated size of study population Estimated size of study population
Confidence level (usually set at 95%) Confidence level (usually set at 95%)
Anticipated proportion of outcome variable in the target population (if not Expected SD of the outcome variable in the target population
known then set at 50%)
Precision required (i.e., ± % difference in sample result from actual Acceptable margin of error (i.e., ± difference of the sample mean from the population
population value) mean)
Comparing a proportion between two samples Comparing the mean between two samples
Confidence level (usually set at 95%) Confidence level (usually set at 95%)
Power (usually set at 80%) Power (usually set at 80%)
Ratio of the two groups (e.g., 1:1) Ratio of the two groups (e.g., 1:1)
Expected proportion of the outcome variable in each of the two groups Expected mean value in the two groups or the expected difference in the mean value
Expected SD/variance of the outcome variable in each group
SD: Standard deviation

Table 3: Estimated sample sizes required for varying expected differences between two samples (nonsmokers versus smokers) for a categorical
and numerical variable
Confidence level = 95%, Power = 80%, Ratio of nonsmokers:smoker = 1:1
Hypertension (%) Systolic blood pressure (mmHg)
Nonsmokers Smoker Expected Required Nonsmokers Smoker Expected difference Required
% % difference % sample size (SD: ±15) (SD: ±20) (mmHg) sample size
20 30 10 315+315 (630) 120 125 5 200+200 (400)
20 35 15 150+150 (300) 120 130 10 50+50 (100)
20 40 20 90+90 (180) 120 135 15 25+25 (50)
SD: Standard deviation

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Omair: Sample size estimation and sampling techniques
population for determining the required sample size
more accurately.[25]
SAMPLING TECHNIQUES
The other important issue related to sampling is
selecting the required sample size in a manner, so that
the sample is representative of the study population.[7]
It is a common pitfall to opt for the easier option of
convenience sampling where “all” the available persons
in the study population are selected for the study
until the required sample size is reached. This is
nonprobability sampling, where the sample is less likely
to be representative of the study population due to
inherent biases in the sampling process.[13] Other forms
of nonprobability sampling include purposive sampling,
quota sampling, and snowball sampling, where the
sample is selected according to some predetermined
criteria. These type of sampling techniques are more
appropriate for small level studies which are not meant
to be generalized to a larger population.[13]
The more relevant sampling technique is called
“probability sampling” or “random sampling.”[26] It is
important to note here that the word “random” as used
in this context is different from the normal usage in the
everyday terms. It is misleading to state that the sample
was chosen at random from all the patients coming to
the outpatient clinic. In order to be classified as random
or probability sampling, every person in the study
population must have an equal or known probability of
being included in the sample.[7] It is quite common to
overlook some hidden biases in the sampling process
which adversely affect the outcome of the study. For
example, if a study was to be conducted to determine
the satisfaction of patients coming to a health care
center and the decision was to sample every third
patient who was coming out of the center. Apparently,
this seems to be “unbiased” if every third person was
selected accordingly. But one hidden factor is related
to the outcome of the study, that is, satisfaction with
the care provided. A person who is not satisfied with
the health care provided would be unlikely to return
to the center or would come only once a month, while
a person who is satisfied would be returning more
frequently maybe 2-3 times a month. Hence, it is quite
likely that the result of the satisfaction survey shows a
more positive result than the actual perception.[27] One
way to account for this hidden bias is to interview only
“new” patients who are visiting the clinic for the 1st
time or it may be sufficient to just ask the respondent
how many times s/he has visited the clinic in the last
month or year.[28] The same bias may be associated with
random digit dialing for a phone survey. Apparently, the
computer dials a number randomly so there should be
no bias in the sample selection? Actually, there is still a
Journal of Health Specialties / October 2014 / Vol 2 | Issue 4
hidden bias that people who have two phones (or double
SIM phones) are twice as more likely to be selected as
compared to the majority of people who have only one
number.[29] The people with >1 phone are more likely
to have a higher income so this may bias any study
which may be asking about their perceptions about
health care insurance or even about choosing between
prepaid/postpaid mobile phone services. This type of
bias can be controlled for by simply recognizing this as
a bias at the planning stage of the survey and including
a question on “How many phone numbers do you have?”
in the survey. This can be used to appropriately weight
the responses of such respondents in the final analysis
stage.[29]
The types of probability sampling methods include
simple random sampling, systematic random sampling,
and stratified random sampling [Table 4] – these three
methods are more relevant when a sample frame (list
of the people in the study population) is available.[7]
Simple random sampling is as simple as picking up chits
(names or numbers written on pieces of paper) from the
box for a small study population of up to 30-50 people.
For larger study population, a computer-generated
random number table can be used to select the
respondents accordingly, e.g., every nth person coming
out of a clinic or selecting the nth person from each
household.[7] Systematic random sampling is applicable
when the study population is relatively large (100 or
more) and a list is available of all the members, e.g.,
employees in a hospital, medical students in a class, or
even beds in a hospital. The total number of subjects
in the list is divided by the required sample size to
obtain the “skip number” e.g., to select 25 out of a list
of 200 the skip number will be every 8th person on the
list (200/25 = 8). The next step is to choose a number
randomly from between 1 and 8 which will be the first
person selected and then systematically select every 8th
person from the list till the end of the list is reached, e.g.,
3, 11, 19, 27, …, 195. It is important to remember that
the first person should be chosen randomly – arbitrarily
selecting the 1st person or the 8th person on the list will
lead to zero probability of the other persons in the list
being selected.[30] Stratified random sampling is a form
of systematic random sampling with the addition that
the list is stratified (arranged by categories) according
Table 4: List of different probability and nonprobability sampling
methods
Probability sampling methods Nonprobability sampling methods
Simple random sampling Convenience sampling
Systematic random sampling Consecutive sampling
Stratified random sampling Quota sampling
Cluster sampling Judgmental/purposive sampling
Multistage sampling Snowball sampling
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Omair: Sample size estimation and sampling techniques
to a predetermined characteristic, e.g., gender, level of
employees, class in medical college. After arranging
the list according to the specified criterion, the same
process of selecting every nth person is followed as in
systematic random sampling.[30] The stratified random
sampling technique ensures that the sample contains
approximately the same proportion of the specified
criterion as in the study population. This is important
when the outcome variable that is being studied is
directly related to that particular characteristic, e.g.,
gender and smoking, employee satisfaction, and
level of employees. The other two probably sampling
methods of cluster sampling and multistage sampling
are more appropriate for a community based or large
scale surveys and will not be described in detail in this
article. More information on these two methods can be
obtained from other detailed text on sampling.[7,9,10,15,30]
The issue of avoiding bias due to nonresponse in
sampling will be discussed in detail in the next article
on data collection methods.
CONCLUSION
The issue of sampling is of an important consideration
in all quantitative research which aims to generalize
the finding of the study to a larger population. It is
essential to have the required sample size as well as
to select a representative sample using the appropriate
sampling technique.
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How to cite this article: Omair A. Sample size estimation and sampling
techniques for selecting a representative sample. J Health Spec 2014;2:142-7.
Source of Support: Nil, Conflict of Interest: None declared.

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