Health for All indicators in health interview surveys

The World Health Organization's strategy of health for all 2000 (HFA 2000) has, among other things, attempted to reduce the actual differences in health status between and within countries. In order to evaluate the progress made towards the attainment of the HFA strategy, each country reports their status of achievement to the World Health Organization every 3 years. This study investigates the extensiveness and the methodology of interview surveys which measure health as a source of information for HFA in the European Region. This study focuses on the comparability of data which derive from the interview survey. The study shows that the different questions (related to the same indicator) in interview surveys mostly lead to incomparable information because there is a lack of uniformity both in phrasing and in the standards and methods used.     

Influence of proxy respondents in children''s health interview surveys

STUDY OBJECTIVES: To study the influence of the proxy respondent on health interview surveys in children. DESIGN: Cross sectional study. SETTING: Children under the age of 15 years drawn from the general population of Catalonia, Spain. PARTICIPANTS: The Catalan Health Interview Survey consisted of a multistage probability sample representative to the population of Catalonia. The sample size was 2433 children younger than 15 years of age. The interviews were answered by proxy respondents (the mother, father, or other carer), with the questionnaire adapted for the proxy respondent. Logistic regression models were used to analyse the relation between the proxy respondent's characteristics and health status and health care utilisation, controlling for the effect of sociodemographic factors. MAIN RESULTS: Proxy respondent's characteristics influenced the reports of chronic conditions and accidents within the last year. Proxy respondents over 55 years (OR = 0.47; 95% CI = 0.26, 0.82), men (OR = 0.69; 95% CI = 0.53, 0.89), the father (OR = 0.66; 95% CI = 0.50, 0.89), and the grandparents (OR = 0.49; 95% CI = 0.26, 0.89), reported a lower rate of chronic conditions. Age of the proxy 55 years or greater (OR = 0.41; 95% CI = 0.20, 0.82), men (OR = 0.70; 95% CI = 0.52, 0.94), fathers (OR = 0.68; 95% CI = 0.49, 0.92), and grandparents (OR = 0.40; 95% CI = 0.18, 0.85) showed a lower probability to report accidents. No variables related to the proxy were associated with physician visits or hospitalisation in the previous year. CONCLUSIONS: Selected characteristics of the proxy respondent can influence responses to health surveys involving children. A minimum set of basic data should be collected from the proxy respondent to evaluate different patterns of response.     

National health interview surveys in Europe: an overview.

In order to study the value of national health interview surveys for national and international research and policy activities, this paper examines the existence and content of recent and future health interview surveys in the 15 member states of the European Union (EU), Norway, Iceland and Switzerland. National health interview surveys are performed in most countries, but not in Greece (only regional surveys), Luxembourg, Ireland and Iceland (only multi-purpose surveys). The health interview surveys in the other 14 countries provide regular data on the main health topics. Of the 14 health topics that are examined in this inventory seven are measured in all countries. Questions on health status (e.g. self-assessed health, long-term physical disability, and height and weight) and medical consumption (e.g. consultations with the general practitioner, GP) are often included. Lifestyle topics are less often included, except smoking habits, information about which is sought in all countries. Topics like diet and drugs/narcotics are more often included in special surveys than in general health interview surveys. Despite differences in the content, frequency and methodology of national health interview surveys in different countries, these surveys are a valuable source of information on the health of Europeans.     

Trends in food intake: The 1987 and 1992 national health interview surveys

To examine food intake trends in the US population, cross‐sectional nationally representative food intake data were obtained from the 1987 and 1992 National Health Interview Survey Cancer Control Supplements. In each of these years, approximately 10,000 respondents completed methodologically consistent food frequency questionnaires containing the same 57 food items. Between 1987 and 1992, the proportion of Americans consuming high‐fat foods, including fried fish, fried chicken, bacon, eggs, whole milk, and butter, decreased. The proportion of Americans drinking alcoholic beverages also decreased: fewer drank wine and hard liquor in 1992. The proportion of fruit and vegetable consumers remained stable over time. These results are similar to those obtained from more detailed national surveys. National guidelines urge Americans to avoid intake of high‐fat foods, increase consumption of fruits and vegetables, and practice moderation when drinking alcoholic beverages to prevent cancer and other chronic diseases. The direction of Americans’ apparent changes in food usage between 1987 and 1992, evaluated using limited data from food frequency questionnaires, suggests greater behavioral changes in the direction of guidelines recommending avoidance of foods that may increase the risk of cancer than in the direction of guidelines recommending increased consumption of foods that may confer protection.     

Comparison of assessment methods for self-reported alcohol consumption in health interview surveys

OBJECTIVE: To select a simple method for assessing alcohol consumption and to compare how different reference periods and response categories influence the self-reported frequency of binge drinking. DESIGN: Four random samples of 1000 adult Danes. Data were collected via personal interview at the respondents' home. SETTING: Denmark, nationwide. PARTICIPANTS: The total number of interviewed was 2593 individuals. MEASUREMENTS: The assessment methods in the four samples were (1) the 7-day recall method, (2) intake each day in a typical week, (3) intake last weekend, and (4) intake in a typical week. Furthermore, binge drinking was assessed in the samples using different reference periods and response formats. FINDINGS: The sex- and age-adjusted mean number of drinks in the last week (the 7-day recall method) was 10.6 drinks compared to 10.4 drinks among respondents reporting their intake for each day in a typical week and 8.7 drinks among subjects reporting the average intake in a typical week. Furthermore, subjects that reported their typical intake for each day were as likely as subjects that had the 7-day recall method to report a high weekly alcohol intake. Respondents who had close-ended questions were more likely to report binge drinking compared to respondents that had open-ended questions. CONCLUSIONS: Questions concerning typical alcohol intake for each day of the week are feasible to use in epidemiological studies. Furthermore, it is more appropriate to use close-ended questions compared to open-ended questions in measuring binge-drinking when the reference period is long.     

The contribution of a gender perspective to the understanding of migrants' health

In 2005 women represented approximately half of all 190 million international migrants worldwide. This paper addresses the need to integrate a gender perspective into epidemiological studies on migration and health, outlines conceptual gaps and discusses some methodological problems. We mainly consider the international voluntary migrant. Women may emigrate as wives or as workers in a labour market in which they face double segregation, both as migrants and as women. We highlight migrant women's heightened vulnerability to situations of violence, as well as important gaps in our knowledge of the possible differential health effects of factors such as poverty, unemployment, social networks and support, discrimination, health behaviours and use of services. We provide an overview of the problems of characterising migrant populations in the health information systems, and of possible biases in the health effects caused by failure to take the triple dimension of gender, social class and ethnicity into account.     

National health surveys by mail or home interview: effects on response

STUDY OBJECTIVE: To study the effect of using a mail questionnaire or home interviews on the size and the selectivity of response to national health surveys. DESIGN: The interview survey and the mail survey were both carried out in the same country (the Netherlands) using the same sample frame, the same study period (1998) and collected partly the same data on demographic, socioeconomic and health characteristics. SETTING: The Netherlands. PARTICIPANTS: Dutch non-institutionalised inhabitants aged 25 years and over. MAIN RESULTS: Response to the mail survey was lower (46.9%, n=3664) than to the interview survey (58.5%, n=6061). The mail survey gave higher response rates for women and lower response rates for persons with lower levels of education. Respondents to the mail survey reported lower rates of smoking but a slightly worse health status and higher figures on the use of health care services. No differences by method of data collection were found for age, marital status, region, household composition, work status and categories of body mass index. CONCLUSION: Although the response of the mail survey was lower than the home interview survey, respondents showed generally small differences, with exception of level of education.     

Incorporating a gender perspective into sexual health promotion

The roles of men and women affect sexual health and often make it difficult for either sex to adopt safer behaviors. The author explains why a gender perspective is important and writes that programs can incorporate a gender perspective in their design by taking into account the differing needs and opportunities of men and women. She considers learning about sexual health needs, sexual health services, use of the media, policy and law, changing organizations, and evaluation. Education on HIV/STDs is more likely to be effective in changing behaviors if it is incorporated into a broader program of sexual health promotion which includes contraception, gender relations, sexuality, sexual pleasure, and abuse.     

Measuring gender and reproductive health in Africa using demographic and health surveys: the need for mixed-methods research

Understanding gender in Africa is essential to creating policy and designing interventions to address key reproductive-health issues such as HIV/AIDS and maternal mortality that are particularly pressing for the continent and are strongly related to gender inequality. The addition of questions to capture women's empowerment and autonomy on the MEASURE/Demographic and Health Surveys (DHS) in the late-1990s expanded opportunities to examine the relationship between gender and reproductive health. These questions provide valuable information on trends and individual-level associations between gender inequality and health. Given that women's empowerment, status and autonomy are largely dependent on contextually-specific gender systems, however, supplementary qualitative studies to validate and contextualise these data would strengthen analyses significantly. This paper provides examples of how such mixed-methods work would improve understandings of gender and reproductive health in Africa by validating survey questions, providing insights into how to analyse and interpret DHS data and illuminating the processes and mechanisms behind gendered experiences. Additionally, this work could help improve future survey research on gender and reproductive health.     

Measuring gender and reproductive health in Africa using demographic and health surveys: the need for mixed-methods research

Understanding gender in Africa is essential to creating policy and designing interventions to address key reproductive-health issues such as HIV/AIDS and maternal mortality that are particularly pressing for the continent and are strongly related to gender inequality. The addition of questions to capture women's empowerment and autonomy on the MEASURE/Demographic and Health Surveys (DHS) in the late-1990s expanded opportunities to examine the relationship between gender and reproductive health. These questions provide valuable information on trends and individual-level associations between gender inequality and health. Given that women's empowerment, status and autonomy are largely dependent on contextually-specific gender systems, however, supplementary qualitative studies to validate and contextualise these data would strengthen analyses significantly. This paper provides examples of how such mixed-methods work would improve understandings of gender and reproductive health in Africa by validating survey questions, providing insights into how to analyse and interpret DHS data and illuminating the processes and mechanisms behind gendered experiences. Additionally, this work could help improve future survey research on gender and reproductive health.     

Analysis of participation in surveys in 5 countries: the importance for public health research]

This study compares participation rates and reasons for nonresponse in surveys conducted in five countries of Latin America and the Caribbean. The objective of the surveys was to measure the prevalence of risk behaviors affecting the transmission of human immunodeficiency virus. The surveys were based on probability samples of the population of both sexes between 15 and 49 years old, except in Mexico, where only men were included. Proportions of three components of participation were estimated: residences interviewed, interviewed residences with eligible persons, and eligible persons who completed the interview. In addition, an overall index that combined the three components was calculated. The overall response rate ranged from 35.6% in Mexico to 81.4% in Chile. The component with the greatest variability was the participation of eligible persons, which ranged from 50% in Mexico to 95% in Cuba. These values were lower than what had been expected, especially among men, and will serve to guide future surveys, since rejection rates higher than the ones expected in the protocol should be considered. The results make it possible to infer the validity of the prevalence estimates for the various observed risk behaviors. The results also establish a benchmark to calculate the sample size in future surveys and to improve research methodology.