Slovenian Experience on Measuring Health Status

1. Slovenian Experience on Measuring Health Status Darja Lavtar National Institute of Public Health, Slovenia Work Session of the Budapest Initiative on Measuring Health Status, Geneve, 20-22 January 2010

2. Outline Surveys measuring health status in Slovenia: • Pilot EHSM in 2005 (supported by Phare 2003) • Pilot EHIS in 2007 (supported by TF 2004) • First national EHIS in 2007 (supported by Eurostat grant for 2006 and Eurostat grant for 2007)

3. Administrative data sources vs. survey data in Slovenia • Importance of national administrative data sources used for health statistics (causes of death, perinatal data, hospital data, out-patient data, accidents at work, etc.) • Only a few surveys with health topic: • Public opinion survey 1997,1999, 2001 (life style) • CINDI 2001, 2004, 2008 (life style and chronic diseases) • SILC from 2005 on (MEHM, unmet needs)

4. Pilot EHSM in 2005: questionnaire • Questionnaire: European Health Status Module, English version 16-01-2005: • Mini European Health Module • Chronic Diseases • Physical and sensory functional limitations • Personal Care Activities • Household Care Activities • Other daily activities • Psychological distress and well-being

5. Pilot EHSM in 2005: methodology • Area covered: the capital city of Ljubljana and neighbouring settlements • Age range: 18 to 84 years of age • Sample size: 200 • Respondents selecting procedure: two-stage sample design • Data collection procedure: face-to-face interviewing (paper questionnaire) • Response rate: 80% • Average time required for completing the questionnaire: 19 minutes

6. Pilot EHSM in 2005: experiences • Youth found many of the questions redundant. • Some people have an aid, but do not need it. Is this the same as “has no aid”?

7. Pilot EHIS in 2007: questionnaire • Questionnaire: European Health Interview Survey, 1st round (adopted in November 2006): • European Health Status Module • European Health Care Module • European Health Determinants Module • European Background Variables Module

8. Pilot EHIS in 2007: methodology (1) • Target population:Persons aged 15 years and more, non-institutionalized • Sampling frame:The list of persons living in the capital city of Ljubljana and neighbouring settlements from the Central Population Register • Sample design:Two-stage sample design (25 PSUs, 8 units in each PSU) • Sample size:200 persons • Mode of administration:Face-to-face interview (PAPI); Sections with sensitive questions to be completed by respondent alone and sent back to the National Institute of Public Health in a pre-paid and addressed envelope

9. Pilot EHIS in 2007: methodology (2) • Interviewers:8 persons (mostly students) • Proxy respondents:Allowed in case of severe health problems and permanent absence of the selected person • Response rate: 69%; for self-completion questionnaires: 70% of respondents • Average time required for completing the questionnaire:37 minutes

10. Pilot EHIS in 2007: experiences • The major problem encountered in the translation process was that no conceptual translation cardswere provided. • Showcards were very useful for the younger respondents and less useful (sometimes even confusing) for the older respondents. • Final decision was made that the EHIS will be an independent survey.

11. National EHIS in 2007: questionnaire • Questionnaire: European Health Interview Survey, 1st round: • European Health Status Module • European Health Care Module • European Health Determinants Module • European Background Variables Module • When implementing EHIS questionnaire in Slovenia, we strictly hold on European Health Interview Survey questionnaire for the 1st Round.

12. National EHIS in 2007: methodology • Target population:Persons aged 15 years and more, non-institutionalized • Sampling frame:Central Population Register • Sample design:Two-stage sample design (425 PSUs, 8 units in each PSU) • Sample size:3400 persons • Mode of administration:Face-to-face interview (PAPI) for most of the questions and two self-completion questionnaires • Response rate: 68%

13. National EHIS in 2007: health status - question specific remark • In the case of EHIS 1st round question HS.7 answer “Not applicable” should be possible at least in case of Accident at work and Accident at school, for people that do not work and do not attend school, as these two questions are unnecessary for them.

14. National EHIS in 2007: results • Wearing a hearing aid: a hearing aid was used by 5,2% of respondents aged 15 years or more, theshare for men being 5,5% and for women 4,8%. • Conversation with several people:In a conversation among several people the uttered words could be heard: • without difficulty by 85,7% of respondents (84,8% men and 86,6% women), • with some difficulty by 10,5% of respondents (11,8% men and 9,3% women), • with considerable difficulty by 3,1% of respondents (2,7% men and 3,3% women).

15. National EHIS in 2007: experiences • The interviewers’ recruitment presented the biggest problem and no permanent base of the interviewers’ could be established, as even very serious and experienced students are not permanent staff for interviewing. • Based upon pilot study which was conducted in the beginning of 2007we decided not to allow proxy, as it is not suitable to be used especially in case of subjective questions. • A larger sample should be drown in the 2nd round of EHIS in order to allow more detailed analyses.

16. Conclusion • Survey data analyses with health topic have not been (yet) widely done (because of the good administrative sources?) • Promotion of the health survey data • Survey materials (questionnaires, conceptual cards, indicators, etc.) should be available – very important for countries with less experience in gathering the health information with survey data