TASK 1.10.DOCUMENTATION OF THE PROBLEMS FACED DURING EHIS WAVE 1 BRIEF SUMMARY OF PROBLEMS OCCURED DURING EHIS WAVE 1 EHIS WORKSHOP, BERLIN SEPTEMBER 30

TASK 1.10.DOCUMENTATION OF THE PROBLEMS FACED DURING EHIS WAVE 1

BRIEF SUMMARY BRIEF SUMMARY OF PROBLEMS OCCURED OF PROBLEMS OCCURED

DURING EHIS WAVE 1DURING EHIS WAVE 1

EHIS WORKSHOP, BERLINEHIS WORKSHOP, BERLINSEPTEMBER 30 – OCTOBER 1, 2010SEPTEMBER 30 – OCTOBER 1, 2010


One of the stages of work programme under Agreement One of the stages of work programme under Agreement European European Statistical System Network Project on Public Health Statistics, Statistical System Network Project on Public Health Statistics, 10501.2009.003-2009.405 was HIS Task 1.10 aimed on elaboration of 10501.2009.003-2009.405 was HIS Task 1.10 aimed on elaboration of the report on “Documentation of the problems faced during EHIS wave the report on “Documentation of the problems faced during EHIS wave 11”.”.

The report elaborated within the Task 1.10. The report elaborated within the Task 1.10. was was prepared prepared on the on the basis of available submitted papers - questions and comments posted basis of available submitted papers - questions and comments posted in the EHIS newsgroup on CIRCA, emails received in Eurostat, national in the EHIS newsgroup on CIRCA, emails received in Eurostat, national interim and final reports and quality reports - prepared by countries interim and final reports and quality reports - prepared by countries involved in EHIS implementation project, in order to document the involved in EHIS implementation project, in order to document the most important problems faced at the national level during the EHIS most important problems faced at the national level during the EHIS wave wave 11 and to identify potential solutions and to identify potential solutions..


Presented Presented brief summarybrief summary is based on mentioned report and is based on mentioned report and focuses only on focuses only on the the most important most important national problems national problems occured during occured during EHIS wave 1.EHIS wave 1.


GENERAL PROBLEMSGENERAL PROBLEMS

DesignDesign of the of the national versionnational version

Lack of final verified conceptual cards and guidelines duringLack of final verified conceptual cards and guidelines during the the preparation preparation of the national version of the modules of the national version of the modules

Some countries faced a lot of problems and difficulties when final Some countries faced a lot of problems and difficulties when final version of documents (questionnaire, guidelines) was version of documents (questionnaire, guidelines) was not not availableavailable

Questionnaire Questionnaire

Complicated and full of skips, which resulted in difficulties and Complicated and full of skips, which resulted in difficulties and mistakesmistakes It was hard for interviewers (even well trained) to orientate in the questionnaire and ask the questions should be asked and not to ask some which should be skipped



Reference periodsReference periods

Too many various reference periods applied in one questionnaire Too many various reference periods applied in one questionnaire made the interviewers and respondents confusedmade the interviewers and respondents confused

Self-completion formsSelf-completion forms The application of two separated self-completion forms broke the The application of two separated self-completion forms broke the continuity of the interviewcontinuity of the interview



IInterviewnterview

TToo longoo long

TTiring and exhaustingiring and exhausting f for elderly people and people with health or elderly people and people with health problemsproblems TTime consuming and irritating for young and healthyime consuming and irritating for young and healthy persons persons

Lack of comparabilityLack of comparability

Some questions in their present form could not be compared due to Some questions in their present form could not be compared due to e.g. linguistic differences, different health care systems, types of e.g. linguistic differences, different health care systems, types of paramedics, types of home care services, classification of accidents, paramedics, types of home care services, classification of accidents, etc. etc.



Proxy interviewProxy interview

Lack of unified Lack of unified and consequent and consequent guidelines guidelines

IIn a part of questions concerning the same issue or topic proxy n a part of questions concerning the same issue or topic proxy answers were allowed, while in the other part they were not allowedanswers were allowed, while in the other part they were not allowed

One part of countries did not allow proxy interview at all, while other One part of countries did not allow proxy interview at all, while other allowed it in certain cases such as for people who were hospitalized at allowed it in certain cases such as for people who were hospitalized at the moment of the interview, people with severe health problems (like the moment of the interview, people with severe health problems (like dementia, mental or physical disability, etc.). dementia, mental or physical disability, etc.).


THE MOST PROBLEMATIC AND DIFFICULT QUESTIONSTHE MOST PROBLEMATIC AND DIFFICULT QUESTIONS

Marital statusMarital status

IncomesIncomes

PPhysical and sensory functional limitationhysical and sensory functional limitation

PPhysical painhysical pain and and discomfortdiscomfort

MMental healthental health

HHealth care paymentealth care paymentss

AAssessment of health care services providersssessment of health care services providers

PPhysical activityhysical activity

AAlcohol consumptionlcohol consumption


EUROPEAN BACKGROUND MODULEEUROPEAN BACKGROUND MODULE

The implementation of this module was difficult and complicated in The implementation of this module was difficult and complicated in view of the differences between countries and their specific national view of the differences between countries and their specific national law and needs law and needs

TToo long and complicated oo long and complicated

TToo more difficult, sensitive questionsoo more difficult, sensitive questions

The guidelines were too complicated for interviewers and The guidelines were too complicated for interviewers and respondentsrespondents

The most problematic questions: legal and de facto marital status, The most problematic questions: legal and de facto marital status, current labour status, employment, incomes (HH5, HH6, HH8, HH10-current labour status, employment, incomes (HH5, HH6, HH8, HH10-HH14, IN)HH14, IN)

The most sensitive question: HH5, HH6, IN.The most sensitive question: HH5, HH6, IN.


EUROPEAN HEALTH STATUS MODULEEUROPEAN HEALTH STATUS MODULE

Questions PL, PC, HAQuestions PL, PC, HA

TToo longoo long sections sections

Too many questions concerning functional level, use of aids and Too many questions concerning functional level, use of aids and assistance assistance

Difficult and complicated design of questions PC and HADifficult and complicated design of questions PC and HA

Lack of one principle determined Lack of one principle determined for compound activitiesfor compound activities - - in one in one casecase (question) (question) the easier activity was proposed the easier activity was proposed to taking under the to taking under the respondent consideration , while in other respondent consideration , while in other case case the more difficultthe more difficult

Questions irritating and confusing both for respondents without Questions irritating and confusing both for respondents without limitations and for visibly disabled oneslimitations and for visibly disabled ones



Question SF1.Question SF1.

The wordings “physical pain/discomfort” were difficult to translate The wordings “physical pain/discomfort” were difficult to translate The The response categories response categories were were difficult to difficult to understand and distinguish understand and distinguish for for the respondents the respondents

For pFor people suffered from several pains/discomforts eople suffered from several pains/discomforts iit was impossible to t was impossible to choose one of given answer categorieschoose one of given answer categories. .

RespondentsRespondents could not estimate an average degree during the could not estimate an average degree during the reference period. reference period.

Lack of Lack of pain grading scale pain grading scale



Question SF2-10.Question SF2-10.

Lack of mLack of more detailed guidelines and explanation of ore detailed guidelines and explanation of responseresponse categories categories

QQuestions wuestions wereere difficult to answer difficult to answer due to due to very similar wordingvery similar wording

The reference period was problematic to determine precisely self-The reference period was problematic to determine precisely self-perceived mental healthperceived mental health

The five answers categories perplexed the respondents The five answers categories perplexed the respondents

TThe older respondents could not answer with precision he older respondents could not answer with precision - i- it was hard t was hard to to them them to make a distinction between different answer categories to make a distinction between different answer categories


EUROPEAN HEALTH CARE MODULEEUROPEAN HEALTH CARE MODULE

Questions OP1-OP3.Questions OP1-OP3.

Lack of possibility of separation the expenditures on private and Lack of possibility of separation the expenditures on private and public healthpublic health care care due to onedue to one combined question combined question

Lack of information on what kind of expenses should be included – Lack of information on what kind of expenses should be included – spent for health care used in the given period or paid in the given spent for health care used in the given period or paid in the given periodperiod

Lack of information in the case of expenses on health care covered Lack of information in the case of expenses on health care covered by someone else for the services used by the respondentby someone else for the services used by the respondent

TThe self-completing form was not a good solutionhe self-completing form was not a good solution – respondents – respondents preferred questions asked by interviewer to self-completion preferred questions asked by interviewer to self-completion



Questions PA12 and PA15.Questions PA12 and PA15.

Some inconsistency Some inconsistency in response categories of the same patternin response categories of the same pattern

LLack of possibility of multiple answers in PA15 on reason of cervical ack of possibility of multiple answers in PA15 on reason of cervical smear test while it was allowed in the corresponding question PA12 on smear test while it was allowed in the corresponding question PA12 on reason for mammographyreason for mammography



Question SA1. Question SA1.

The The intentionintention of the questionof the question was i was incomprehensiblencomprehensible - was it level of - was it level of respondents’ satisfaction respondents’ satisfaction or or evaluation of the health care facilitiesevaluation of the health care facilities

Health care services providers Health care services providers were not were not distinguished by the private distinguished by the private and the public sectors and the public sectors while iwhile it is a well known fact that the quality of t is a well known fact that the quality of these services vary significantlythese services vary significantly

The iThe interviewed persons were supposed to give only one common nterviewed persons were supposed to give only one common answer assessing bothanswer assessing both - - the quality of services provided within the the quality of services provided within the range of health insurance as well as the paid ones range of health insurance as well as the paid ones



Question SA1.Question SA1. (continued) (continued) It was difficult for respondents to make an overall assessment of t was difficult for respondents to make an overall assessment of health care providers if they personally not used these serviceshealth care providers if they personally not used these services and and had not had not such experience such experience

Persons who did not participate in a particular service Persons who did not participate in a particular service could could not not assess itassess its quality and had to based s quality and had to based on the opinions of other peopleon the opinions of other people

The question about level of satisfaction was not a good solution –The question about level of satisfaction was not a good solution –it would be better to ask it would be better to ask respondentrespondents on s on opinion on health service opinion on health service providers in providers in their their country of residence such experience country of residence such experience


EUROPEAN HEALTH DETERMINATS MODULEEUROPEAN HEALTH DETERMINATS MODULE

Questions PE1-PE3.Questions PE1-PE3.

QQuestions posed the most problems during the interviewuestions posed the most problems during the interview for a large for a large group of respondents and interviewersgroup of respondents and interviewers

Difficult to understand and answerDifficult to understand and answer,, stirred the respondent stirred the respondents’s’ impatience and irritationimpatience and irritation

TToo complicated regardless of extensive oo complicated regardless of extensive and and complexcomplex explanations explanations (or because of them) (or because of them)

LLack of a list of larger number of activities, particularly performed at ack of a list of larger number of activities, particularly performed at work work

UnclearUnclear division division ((and the given examplesand the given examples)) of the activities into of the activities into moderate and vigorous moderate and vigorous



Questions PE1-PE3. Questions PE1-PE3. (continued)(continued)

RRespondents were unable to distinguish the different types of espondents were unable to distinguish the different types of activities, even following the guidelines and the examples given by the activities, even following the guidelines and the examples given by the interviewers interviewers

RRespondents had serious problems with reminding themselves not espondents had serious problems with reminding themselves not only the number of days, but also with assessment of the amount of only the number of days, but also with assessment of the amount of time time

TThe amount of time spent he amount of time spent on on walking was very difficult to assesswalking was very difficult to assess, , becausebecause rrespondents usually did not count the time they spend espondents usually did not count the time they spend walking (in non recreation purpose)walking (in non recreation purpose)



Questions PE1-PE3. Questions PE1-PE3. (continued)(continued)

Counting the duration of all examined activities posed a Counting the duration of all examined activities posed a very very significant significant problemproblem

Almost nobody of the surveyed persons had not paid an attention Almost nobody of the surveyed persons had not paid an attention how much time per week he/she used for any kind of physical how much time per week he/she used for any kind of physical activities, except the cases when was engaged in active sportactivities, except the cases when was engaged in active sport

IIn many cases the respondents overestimated the duration of their n many cases the respondents overestimated the duration of their activities, since they included the whole time spent at workactivities, since they included the whole time spent at work

Moderate physical activities and vigorous physical activities Moderate physical activities and vigorous physical activities were were often confused, especially for people living in rural areas often confused, especially for people living in rural areas and and performing daily activities in agricultureperforming daily activities in agriculture, for, for people people employed employed in in industry, construction, etc.industry, construction, etc.



Questions AL1-AL3.Questions AL1-AL3.

Questions wereQuestions were recognized as mostrecognized as most sensitive, too long, detailed and sensitive, too long, detailed and complicatedcomplicated

The wording “drink” was not a phrase in current use in some The wording “drink” was not a phrase in current use in some countries and countries and there there it was difficult to understandit was difficult to understand

The The response categories for questions AL1. and AL2. response categories for questions AL1. and AL2. have startedhave started from the answer “Never” from the answer “Never” at the top at the top to “Every day”to “Every day”at the bottomat the bottom. The . The respondents chose the first alternativerespondents chose the first alternative answer answer suitablesuitable for them. for them. It It could result in primacy effect bias.could result in primacy effect bias.



Question AL2. Question AL2.

The respondents found very difficult and confusing to report their The respondents found very difficult and confusing to report their daily consumption of alcohol by type and quantitydaily consumption of alcohol by type and quantity

Question was extremely difficult for respondents to answer and Question was extremely difficult for respondents to answer and might give a truncated picture of real consumptionmight give a truncated picture of real consumption

Complicated for irregular drinkersComplicated for irregular drinkers



Question AL2. Question AL2. (continued)(continued)

Many people were not able to specify exactly what type of alcohol Many people were not able to specify exactly what type of alcohol and in what amount they usually drinking each day of a normal, typical and in what amount they usually drinking each day of a normal, typical weekweek. . The difficulty focused especially The difficulty focused especially on on persons persons who who used to drink a used to drink a variety of drinks during the weekvariety of drinks during the week

Too complicated bands of frequency of drinkingToo complicated bands of frequency of drinking


CONCLUSIONSCONCLUSIONS

Harmonization of the questionnaires between countries is a key Harmonization of the questionnaires between countries is a key issueissue

All possible procedures for preparing the survey should be closely All possible procedures for preparing the survey should be closely align for all countries to create the most uniform basis for align for all countries to create the most uniform basis for comparisonscomparisons

All the problems encountered during the implementation should be All the problems encountered during the implementation should be taken into consideration in order to obtain the best practice for future taken into consideration in order to obtain the best practice for future implementationimplementation


I would like to thank all I would like to thank all representatives of representatives of countries participated in countries participated in the the EHISEHIS project project for their really hard work without which there would not for their really hard work without which there would not be be thethe report and this brief summary. report and this brief summary.

Thank you for your attention!Thank you for your attention!

Małgorzata PiekarzewskaMałgorzata Piekarzewska

[email protected]@stat.gov.pl

Documents

TASK 1.10.DOCUMENTATION OF THE PROBLEMS FACED DURING EHIS WAVE 1 BRIEF SUMMARY OF PROBLEMS OCCURED DURING EHIS WAVE 1 EHIS WORKSHOP, BERLIN SEPTEMBER 30