Collecting Valid and Reliable Data: Fieldwork Monitoring Strategies in a Health Examination Survey

Introduction: Health surveys constitute a relevant information source to access the population’s health status. Given that survey errors can significantly influence estimates and invalidate study findings, it is crucial that the fieldwork progress is closely monitored to ensure data quality. The objective of this study was to describe the fieldwork monitoring conducted during the first Portuguese National Health Examination Survey (INSEF) regarding protocol deviations and key performance indicators (KPI). Methods: Data derived from interviewer observation and from the statistical quality control of selected KPI were used to monitor the four components of the INSEF survey (recruitment, physical examination, blood collection and health questionnaire). Survey KPI included response rate, average time distribution for procedures, distribution of the last digit in a specific measure, proportion of haemolysed blood samples and missing values. Results: Interviewer observation identified deviations from the established protocols, which were promptly corrected. During fieldwork monitoring through KPI, upon implementation of corrective measures, the participation rate increased 2.5-fold, and a 4.4-fold decrease in non-adherence to standardized survey procedures was observed in the average time distribution for blood pressure measurement. The proportion of measurements with the terminal digit of 0 or 5 decreased to 19.6 and 16.5%, respectively, after the pilot study. The proportion of haemolysed samples was at baseline level, below 2.5%. Missing data issues were minimized by promptly communicating them to the interviewer, who could recontact the participant and fill in the missing information. Discussion/Conclusion: Although the majority of the deviations from the established protocol occurred during the first weeks of the fieldwork, our results emphasize the importance of continuous monitoring of survey KPI to ensure data quality throughout the survey.

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The first Portuguese National Health Examination Survey (2015): design, planning and implementation

Journal of Public Health ◽

10.1093/pubmed/fdy150 ◽

2019 ◽

Vol 41 (3) ◽

pp. 511-517 ◽

Cited By ~ 4

Author(s):

Baltazar Nunes ◽

Marta Barreto ◽

Ana P Gil ◽

Irina Kislaya ◽

Sónia Namorado ◽

...

Keyword(s):

National Health ◽

General Health Questionnaire ◽

National Level ◽

Participation Rate ◽

Epidemiological Data ◽

Blood Collection ◽

Health Examination ◽

Cross Sectional ◽

Health Examination Survey ◽

Design Planning

Abstract Background In Health Examination Surveys interview information is complemented with objective information, providing more accurate indicators than self-reported data. We report the study design, planning and implementation of the first Portuguese Health Examination Survey (INSEF). Methods INSEF was a cross-sectional population-based study representative at regional and national level. Individuals aged between 25 and 74 years old, residing in Portugal were selected from the national health users’ registry through multi-stage stratified probabilistic sampling. Sample size was set at 4200 individuals. Data was collected in primary care units and included blood pressure, height, weight, hip and waist measurements, blood collection for lipid profile, HbA1c and blood count and a general health questionnaire. European HES procedures were followed. Results A total of 4911 individuals agreed to participate (43.9% participation rate). Participation rate varied by region, sex and age group, being lower in Lisbon and Tagus Valley (32.8%), for men (41.8%) and for those aged 25–34 years old (36%). Conclusions INSEF has set up an experienced national and regional structure for HES implementation. Nationally representative quality epidemiological data is now available for public health monitoring, planning and research.

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Creating a Scientific Solution: Local Problem Solving in the Portuguese Health Examination Survey: A Mixed Method Study

10.21203/rs.3.rs-574316/v2 ◽

2022 ◽

Author(s):

Heidi Lyshol ◽

Ana Paula Gil ◽

Hanna Tolonen ◽

Sónia Namorado ◽

Irina Kislaya ◽

...

Keyword(s):

Participation Rate ◽

Local Context ◽

Health Examination ◽

Local Health ◽

Central Research ◽

Participation Rates ◽

Local Staff ◽

Staff Members ◽

Health Examination Survey ◽

Scientific Standards

Abstract BackgroundParticipation rates in health surveys, recognized as an important quality dimension, have been declining over the years, which may affect representativeness and confidence in results. The Portuguese national health examination survey INSEF (2015) achieved a participation rate of 43.9%, which is in line with participation rates from other similar health examination surveys. The objective of this article is to describe strategies used by the local teams to increase participation rates and to solve practical survey problems.MethodsAfter a literature search, informal interviews were conducted with 14 public health officials from local health examination teams, regional and central authorities. 41 of the local staff members also filled in a short questionnaire anonymously. The interviews and self-administered questionnaires were analysed using mixed methods, informed by thematic analysis.ResultsThe local teams believed that the detailed manual, described as a "cookbook for making a health examination survey", made it possible to maintain high scientific standards while allowing for improvising solutions to problems in the local context. The quality of the manual, supported by a series of training workshops with the central research and support team, gave the teams the confidence and knowledge to implement local solutions. Motivation and cohesion within the local teams were among the goals of the training process. Local teams felt empowered by being given large responsibilities and worked hard to incite people to attend the examination through a close and persuasive approach.Local teams praised their INSA contacts for being available for assistance throughout the survey, and said they were inspired to try harder to reach participants to please their contacts for interpersonal reasons.ConclusionsThe theory of organizational improvisation or bricolage, which means using limited resources to solve problems, was useful to discuss and understand what took place during INSEF.A detailed manual covering standard procedures, continuous monitoring of the data collection and face-to-face workshops, including role-play, were vital to assure high scientific standards and high participation rates in this health examination survey. Close contacts between the central team and local focal points in all regions and all survey sites were key to accommodating unexpected challenges and innovative solutions.

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The health of asylum seekers in Finland: a total population health examination survey (TERTTU)

European Journal of Public Health ◽

10.1093/eurpub/ckz185.577 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

N Skogberg ◽

P Koponen ◽

E Lilja ◽

K-L Mustonen ◽

F Garoff ◽

...

Keyword(s):

Asylum Seekers ◽

National Level ◽

Circulatory System ◽

Participation Rate ◽

Evidence Base ◽

Population Based ◽

Health Examination ◽

Assessment Protocol ◽

Health And Wellbeing ◽

Health Examination Survey

Abstract Background There is scarcity of representative population-based data on the health and wellbeing of asylum seekers in Europe. The Asylum Seekers Health and Wellbeing Survey (TERTTU) was launched to provide the evidence-base for developing services for asylum seekers as well as for planning and allocation of healthcare resources at a national level. Methods A sample of all first-time asylum applicants between 19.2-30.11.2018 was drawn from the Finnish Immigration Services electronic asylum database. Altogether 784 adults aged 18 years and older took part in the standardised health examination and face-to-face interview with participation rate of 79%. Interviewed health measures included the Minimum European Health Module, conditions previously diagnosed by a physician, permanent injury due to violence or accident and somatization. Results Self-rated health was good among 66% (95% CI 62,5-69,1) and 42% (95% CI 38,5-45,4) reported having some self-reported long-term illness or health problem. The most common previously diagnosed conditions were diseases of the circulatory system (19%, 95% CI 16,5-22,0), musculoskeletal system (18%, 95% CI 15,6-21,1), mental and behavioural disorders (13%, 95% CI 10,9-15,6) and diseases of the respiratory system (10%, 95% CI 8,0-12,2 ). Nearly half (47%, 95% CI 43,7-50,8) reported having a permanent injury due to violence or accident. Somatisation was common: 23% (95% CI 20,3-26,2) reported having headache, 23% (95% CI 19,9-25,8) back ache and 13% (95% CI 10,8-15,6) other pains at least several times a week. Conclusions The overall health of newly-arrived asylum seekers was poorer compared with the general Finnish population and migrant origin populations from similar countries of origin permanently living in Finland. Significant differences in asylum seekers health were found by sex and region of origin. Survey data will be used for developing the national initial health assessment protocol for asylum seekers during 2019. Key messages The TERTTU Survey is the largest population-based health examination survey among newly-arrived asylum seekers in Europe to date. The extensive data gathered over the course of the survey will be used for developing services for asylum seekers at a national level and is of high relevance also to other European countries.

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Estimates of prediabetes and undiagnosed type 2 diabetes in Denmark: The end of an epidemic or a diagnostic artefact?

Scandinavian Journal of Public Health ◽

10.1177/1403494818799606 ◽

2018 ◽

Vol 48 (1) ◽

pp. 106-112 ◽

Cited By ~ 6

Author(s):

Marit Eika Jørgensen ◽

Christina Ellervik ◽

Ola Ekholm ◽

Nanna Borup Johansen ◽

Bendix Carstensen

Keyword(s):

Type 2 Diabetes ◽

Diagnostic Criteria ◽

Population Study ◽

Participation Rate ◽

Population Level ◽

Population Based ◽

Health Examination ◽

Health Examination Survey ◽

Danish Health

Background: Up-to-date information on undiagnosed type 2 diabetes and prediabetes based on current diagnostic criteria is lacking. The study aimed to model the total numbers of people with undiagnosed type 2 diabetes and prediabetes in Denmark based on existing population-based surveys. Methods: Two population-based Danish studies with information on HbA1c, date of examination, gender, age and known type 2 diabetes were identified: the Danish General Suburban Population Study, n = 21,205, and the Danish Health Examination Survey, n = 18,065. The prevalence of known, undiagnosed and pre-diabetes were estimated in the Danish General Suburban Population Study, and population-level age-specific prevalence of known type 2 diabetes was estimated from national registers. The Danish Health Examination Survey was included for sensitivity analysis. Combining estimates of the survey participation rate among known type 2 diabetes patients with known overall participation rates from the studies allowed for the correction of survey prevalence to plausible population-level estimates of age- and gender-specific prevalence. Results: The prevalence of known, undiagnosed and pre-diabetes was highest among men, increasing with age with a peak at age 70. Applying the survey-based prevalence to the entire Danish population, the estimated number (May 2011) with undiagnosed type 2 diabetes was 60,681, corresponding to 24% of all type 2 diabetes cases, and 292,715 had prediabetes, about 50% more than the total type 2 diabetes population. Conclusions: Estimates of undiagnosed type 2 diabetes and prediabetes are dramatically lower than reported in previous studies (60,681 vs 200,000 and 292,715 vs 750,000); however, whether this reflects a true decrease in incidence or the change to HbA1c-based diagnostic criteria is not clear.

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Cardiovascular health of the elderly

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2015.725 ◽

2016 ◽

Vol 84 (1-2) ◽

Author(s):

Simona Giampaoli ◽

Diego Vanuzzo

Keyword(s):

Cardiovascular Health ◽

Participation Rate ◽

The Elderly ◽

High Serum ◽

Health Examination ◽

High Cholesterol ◽

High Serum Cholesterol ◽

Health Examination Survey ◽

Preventive Actions ◽

Age Range

Within the Osservatorio Epidemiologico Cardiovascolare/Health Examination Survey 426 men and 376 women, ages 75-79 years, randomly selected from the general population were examined. Participation rate was 50%; within men 78% were hypertensives, 36% had high serum cholesterol, 28% were diabetics, 25% were obese; within women 81% were hypertensives, 55% had high cholesterol, 19% were diabetics, 37% were obese. Preventive actions at individual and community level are urgent, also at this age range.RiassuntoNell’ambito dell’Osservatorio Epidemiologico Cardiovascolare/Health Examination Survey sono stati esaminati 426 uomini e 376 donne di età compresa fra 75-79 anni, estratti casualmente dalla popolazione generale. Il tasso di partecipazione è stato del 50%; fra gli uomini il 78% era iperteso, il 36% ipercolesterolemico, il 28% diabetico e il 25% obeso; fra le donne l’81% era ipertesa, il 55% ipercolesterolemica, il 19% diabetica, il 37% obesa. Azioni di prevenzione a livello individuale e collettivo sono urgenti sulla popolazione generale, anche in questa fascia di età.

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Creating a scientific solution: local problem solving in the Portuguese Health Examination Survey: a mixed method study

10.21203/rs.3.rs-574316/v1 ◽

2021 ◽

Author(s):

Heidi Lyshol ◽

Ana P. Gil ◽

Hanna Tolonen ◽

Sónia Namorado ◽

Irina Kislaya ◽

...

Keyword(s):

Participation Rate ◽

Local Context ◽

Health Examination ◽

Local Health ◽

Central Research ◽

Participation Rates ◽

Local Staff ◽

Staff Members ◽

Health Examination Survey ◽

Scientific Standards

Abstract Background Participation rates in health surveys, recognized as an important quality dimension, have been declining over the years, which may affect representativeness and confidence in results. The Portuguese national health examination survey INSEF (2015) achieved a participation rate of 43.9%, which is in line with participation rates from other similar health examination surveys. The objective of this article is to describe strategies used by the local teams to increase participation rates and to solve practical survey problems.Methods After a literature search, informal interviews were conducted with 14 public health officials from local health examination teams, regional and central authorities. 41 of the local staff members also filled in a short questionnaire anonymously. The interviews and self-administered questionnaires were analysed using mixed methods, informed by thematic analysis.Results The local teams believed that the detailed manual, described as a "cookbook for making a health examination survey", made it possible to maintain high scientific standards while allowing for improvising solutions to problems in the local context. The quality of the manual, supported by a series of training workshops with the central research and support team, gave the teams the confidence and knowledge to implement local solutions. Motivation and cohesion within the local teams were among the goals of the training process. Local teams felt empowered by being given large responsibilities and worked hard to incite people to attend the examination through a close and persuasive approach.Local teams praised their INSA contacts for being available for assistance throughout the survey, and said they were inspired to try harder to reach participants to please their contacts for interpersonal reasons.Conclusions The theory of organizational improvisation or bricolage, which means using limited resources to solve problems, was useful to discuss and understand what took place during INSEF.A detailed manual covering standard procedures and face-to-face workshops, including role-play, were vital to assure high scientific standards and high participation rates in this health examination survey. Close contacts between the central team and local focal points in all regions and all survey sites were key to accommodating unexpected challenges and innovative solutions.

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Work absence and multimorbidity in Portugal: results from the 1st National Health Examination Survey

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1390 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

J Matos ◽

C Matias Dias ◽

A Félix

Keyword(s):

Logistic Regression ◽

Regression Model ◽

Chronic Diseases ◽

National Health ◽

Logistic Regression Model ◽

Health Examination ◽

Work Absence ◽

Health Examination Survey ◽

Absence From Work ◽

The Impact

Abstract Background Studies on the impact of patients with multimorbidity in the absence of work indicate that the number and type of chronic diseases may increase absenteeism and that the risk of absence from work is higher in people with two or more chronic diseases. This study analyzed the association between multimorbidity and greater frequency and duration of work absence in the portuguese population between the ages of 25 and 65 during 2015. Methods This is an epidemiological, observational, cross-sectional study with an analytical component that has its source of information from the 1st National Health Examination Survey. The study analyzed univariate, bivariate and multivariate variables under study. A multivariate logistic regression model was constructed. Results The prevalence of absenteeism was 55,1%. Education showed an association with absence of work (p = 0,0157), as well as professional activity (p = 0,0086). It wasn't possible to verify association between the presence of chronic diseases (p = 0,9358) or the presence of multimorbidity (p = 0,4309) with absence of work. The prevalence of multimorbidity was 31,8%. There was association between age (p < 0,0001), education (p < 0,001) and yield (p = 0,0009) and multimorbidity. There is no increase in the number of days of absence from work due to the increase in the number of chronic diseases. In the optimized logistic regression model the only variables that demonstrated association with the variable labor absence were age (p = 0,0391) and education (0,0089). Conclusions The scientific evidence generated will contribute to the current discussion on the need for the health and social security system to develop policies to patients with multimorbidity. Key messages The prevalence of absenteeism and multimorbidity in Portugal was respectively 55,1% and 31,8%. In the optimized model age and education demonstrated association with the variable labor absence.

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Implementing an automated monitoring process in a digital, longitudinal observational cohort study

Arthritis Research & Therapy ◽

10.1186/s13075-021-02563-2 ◽

2021 ◽

Vol 23 (1) ◽

Author(s):

Lisa Lindner ◽

Anja Weiß ◽

Andreas Reich ◽

Siegfried Kindler ◽

Frank Behrens ◽

...

Keyword(s):

Cohort Studies ◽

Data Quality ◽

Missing Values ◽

Randomized Clinical Trials ◽

Cost Effective ◽

Observational Research ◽

Research Centre ◽

Automated Monitoring ◽

Monitoring Process ◽

Observational Cohort

Abstract Background Clinical data collection requires correct and complete data sets in order to perform correct statistical analysis and draw valid conclusions. While in randomized clinical trials much effort concentrates on data monitoring, this is rarely the case in observational studies- due to high numbers of cases and often-restricted resources. We have developed a valid and cost-effective monitoring tool, which can substantially contribute to an increased data quality in observational research. Methods An automated digital monitoring system for cohort studies developed by the German Rheumatism Research Centre (DRFZ) was tested within the disease register RABBIT-SpA, a longitudinal observational study including patients with axial spondyloarthritis and psoriatic arthritis. Physicians and patients complete electronic case report forms (eCRF) twice a year for up to 10 years. Automatic plausibility checks were implemented to verify all data after entry into the eCRF. To identify conflicts that cannot be found by this approach, all possible conflicts were compiled into a catalog. This “conflict catalog” was used to create queries, which are displayed as part of the eCRF. The proportion of queried eCRFs and responses were analyzed by descriptive methods. For the analysis of responses, the type of conflict was assigned to either a single conflict only (affecting individual items) or a conflict that required the entire eCRF to be queried. Results Data from 1883 patients was analyzed. A total of n = 3145 eCRFs submitted between baseline (T0) and T3 (12 months) had conflicts (40–64%). Fifty-six to 100% of the queries regarding eCRFs that were completely missing were answered. A mean of 1.4 to 2.4 single conflicts occurred per eCRF, of which 59–69% were answered. The most common missing values were CRP, ESR, Schober’s test, data on systemic glucocorticoid therapy, and presence of enthesitis. Conclusion Providing high data quality in large observational cohort studies is a major challenge, which requires careful monitoring. An automated monitoring process was successfully implemented and well accepted by the study centers. Two thirds of the queries were answered with new data. While conventional manual monitoring is resource-intensive and may itself create new sources of errors, automated processes are a convenient way to augment data quality.

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