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Participation rates and recruitment methods for health examination surveys |
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| Convenor | Dr Hanna Tolonen (National Institute for Health and Welfare) |
Health examination surveys, which include both questionnaires and physical measurements, and often also collection of biological samples like blood and urine, are challenging for the survey participants. These surveys require more time than questionnaire based surveys and they can cause some uncomfort for survey participant through blood sample collection etc. Examinations are also in many surveys conducted in health clinics, assuming that survey participants are physically fit to travel there and have sufficient time and form of transportation to do that.
The participation rates of health examination surveys have declined in past decades in similar pattern than for other surveys. What is known about non-participants to the health examination surveys and their effect on survey representativeness of the results is still limited. Some studies have shown that non-participants have at least twice as high mortality risk than participants, implying that non-participants are less healthy and have worse lifestyle than survey participants. More studies on characteristics of health examination survey non-participants are needed to better understand which population groups are not participating. This information could also help to target recruitment methods and to develop new ways to recruit survey participants.
Background: Survey response rates are important for representativeness, with anecdotal evidence of problems internationally.
Methods: Standardised definitions for numerators and denominators for participation rates were applied to data from the Health Survey for England 2010 and Scottish Health Survey 2010 (household-based surveys), and OEC/HES 2008-2012 in Italy and 'Measuring the Netherlands' (NLdeMaat) 2010 (using population registers). Data collection in England and Scotland was by an interviewer (interview, weight/height measured) then nurse (blood pressure (BP), blood sampling) visiting participants' homes, and by examination centre attendance for OEC/HES and NLdeMaat. In SLAN 2007, Ireland, home interviewees aged 45+ were invited to an examination centre.
Results: Household surveys had higher interview rates but a marked reduction in response rate for each successive phase of the household surveys: participation rates aged 35-64y for interview, BP and blood sampling were 88%, 59% and 51% in England and 87%, 55% and 45% in Scotland in co-operating households. Where participants attended an examination centre, virtually all those attending agreed to BP measurement and a blood sample but initial attendance rates can be considerably lower: 54%, 54% and 53% in Italy; 47%, 47%, 47% in the Netherlands, but 25% of those interviewed in Ireland (aged 45-64). Participation rates increased with age and were higher in women (except in Italy); they were lower by 10-15 percentage points in primate cities.
Conclusion: Home visits have higher interview rates but larger attrition with respect to measurements than attendance at an examination centre.
This paper analyzes continuing and on-time participation in a 2.5-year weekly interview study focused on teen pregnancy. The same individual-level characteristics that typify attrition in less frequent longitudinal data collection also predict attrition in this intensive longitudinal study (e.g., SES, race, personality). These characteristics also influence on-time participation. In addition, pregnancy and related experiences during the study (e.g., new sexual partners) increased the time until the next completed survey, but did not affect timeliness after the first week or permanent attrition from the study.
Background: General population health examination surveys (HES) provide a reliable source of information to monitor the health of populations. A number of countries across Europe are currently planning their first HES, or the first after a significant gap, and some of these intend offering appointments only during office hours and/or weekdays, raising concerns about representativeness of survey participants. It is important to ascertain whether personal characteristics of participants vary by time of day and day of week of data collection, in order to determine the association between time and day of interview and physical examination on the results of data collected in a health examination survey.
Methods: Multivariable regression models were applied to a national health examination survey in England to examine socio-demographic and health variations in three combined day-time periods of interview and physical examination: weekday daytime; weekday evening; and weekend.
Results: The characteristics of participants interviewed or visited by a nurse varied by both time of day and day of the week for age, ethnicity, marital status, income, socio-economic group, economic activity, and deprivation. People seen during weekday working hours had higher rates of poor self-reported health, limiting longstanding illness, and obesity, and higher alcohol consumption, BMI and systolic blood pressure; adjustment for socio-demographic characteristics eliminated or substantially reduced these differences.
Conclusion: People responsible for planning surveys should be aware of participant preference for the timing of data collection and ensure flexibility and choice in times and days offered to optimise participation
Anna Aistrich1, Katja Borodulin1, Satu Mannisto, Hanna Tolonen1
Declining participation rates are a common challenge in conducting surveys. There is very limited information on survey participants' preferences regarding the examination scheduling and how specific components of the invitation process affect their decision to participate.
A pilot survey of the European Health Examination Survey was organized in Finland in 2011 in the city of Kuusamo. A random sample of 250 persons age 25-74 years was selected. Survey participants were asked to fill-in a feedback questionnaire at the end of the examination.
The participation rate was 54% for men and 71% for women and most of them filled in the feedback questionnaire. For 62% of participants, any day of the week was acceptable as an examination day. Of those who specified only certain days, the majority (26%) felt that either Monday or Tuesday were most suitable. Only 6% responded that they would prefer coming to survey examinations during the weekend. The majority of survey participants (71%) preferred an appointment during morning hours (07.00-11.00).
Regarding the recruitment process (invitations, media coverage, etc.), survey participants responded that the invitation letter (96%) and the measurements taken during the physical examination (94%) were important factors affecting their decision to participate. Those who received an SMS reminder about their examination time had a higher participation rate than those who did not.
To maximize participation rates, more attention to the examination scheduling and invitation processes should be given.
In Östergötland and Jönköping County Councils, situated in east Sweden, there have been several closely related activities addressing the health and lifestyle of the population. These activities include a research project combining biological samples and questionnaires, a health dialogue project and routine follow up of population health by questionnaires. An idea was born to combine these activities to achieve both research, routine monitoring of public health and preventive health work. Offering participants a health examination and a health dialogue while they contribute with their data to routine monitoring and to research may gain high participation and a high engagement among participants. Also, instead of using similar questionnaires in three separate activities the overall burden of questionnaires in the population is reduced. The primary health care centres get some extra workload but in return get possibilities for preventive work and an opportunity to develop new skills in for example motivational interviewing.
In the autumn of 2012 the project started. The participants report high satisfaction with the health examination. But who are the participants? Are they healthy persons who just want a confirmation that their health is good or do we also reach people with poor health and lifestyle? Is survey participation and representativeness better or worse compared to the traditional public health questionnaires? What are the advantages and disadvantages of combining activities with different purposes?