Portuguese National Health Examination Survey: questionnaire development

• Main Authors: Santos, Ana João, Gil, Ana Paula, Barreto, Marta, Gaio, Vânia, Namorado, Sónia, Kislaya, Irina, Lyshol, Heidi, Nunes, Baltazar, Dias, Carlos Matias
• Format: Conference Object
• Language: English
• Published: Instituto Nacional de Saúde Doutor Ricardo Jorge, IP 2015
• Subjects: Questionário; Pré-teste; Estados de Saúde e de Doença; INSEF; Norway; Ricardo; Iceland
• Online Access: http://hdl.handle.net/10400.18/3122

This paper focuses on development and testing of the questionnaire used in the first Portuguese National Health Examination Survey (INSEF), a cross-sectional prevalence study conducted by the National Health Institute Doutor Ricardo Jorge (INSA) in cooperation with the Norwegian Institute of Public Health, five Regional Health Administrations and the Regional Health and Social Affairs Offices of the Autonomous Regions of Azores and Madeira. INSEF aims at in-depth knowledge about health status, health determinants and use of health care services. INSEF target population comprises community-dwelling individuals aged between 25 and 74. The survey encompasses a blood collection, a physical examination and a questionnaire applied by Computer Assisted face-to-face interview. The questionnaire has four thematic areas (health status; health determinants; health behaviours and health services use), following national and international guidelines, such as the European Health Examination Survey, the 4th and 5th National Health Surveys and other instruments selected by INSA. INSEF questionnaire was pre-tested to evaluate three dimensions: comprehension (clarity of questions), judgment (evaluation of recall and perceptions) and response requested format. A convenience sample of 30 individuals, users of Alcácer do Sal Health Center or employers of INSA was recruited. Participants were 26 to 60 years old and mostly female. Participants answered the questionnaire and assessed it in a face-to-face semi structured interview based in an evaluation grid: understanding of the questions and the terms; repetition of some questions and overall evaluation of the questionnaire. Combination of qualitative and quantitative methods was used for pre-test data analyses. Of the three dimensions assessed, difficulties were mostly brought up within comprehension. In particular, participants indicated the lack of knowledge on specific terminology, ambiguous questions criteria and length of questions as critical issues. Participants also pointed out difficulties in estimating time, degree or ranking. Sensitive questions within mental health and functional evaluation subsections were indicated as potentially producing response bias. Some questions were too long and overly complex. Also participants had issues in choosing from a high number of response options and in answering in the given response formats. Some individuals did not find the response options to be mutually exclusive. Solutions found to answer to the difficulties encountered by participants were developed at three levels: questionnaire, training and fieldwork manual. To improve comprehension some questions were reformulated, glossaries were developed and notes for interviewers on questions criteria and participant’s clues were included. Judgment issues were solved also by rewriting questions, changing response design from closed to open and including examples in response options. Cards with response options, to be shown to participants during the interview, were introduced to facilitate the response and approach in sensitive questions. Small introductions for sensitive subsections were provided and strategies to approach participants were developed in training sessions with interviewers. During these sessions questions criteria were clarified and highlighted and examples of coding open responses in closed format design were provided. Findings are specific to INSEF, but include suggestions for adapting the approaches as well as consider implications for other health surveys. The project “Improvement of epidemiological health information to support public health decision and management in Portugal. Towards reduced inequalities, improved health, and bilateral cooperation” benefits from a 1.300.000€ Grant from Iceland, Liechtenstein and Norway