Comparison of MEHM questions in Estonian 2004 surveys

1. Comparison of MEHM questions in Estonian 2004 surveys Mall Leinsalu, National Institute for Health Development, Luule Sakkeus, Ministry of Social Affairs Tallinn, September 8-9, 2005, Expert mission on pilot project Health and Disabiltity

2. Aim of the analysis The aim of the analysis was to • Evaluate the implementation of mini-European health module questions in three population surveys in the same year (2004) in order to understand the impact of • wording of questions • survey method (face-to-face interview, postal questionnaire) • different methodological approach (cross-sectional, event history, panel approach)

3. Surveys under evaluation • Estonian Health Behaviour Survey of Adult Population (HBAP) • Coordinated: Finbalt Health Monitor Survey since 1990 • Coordinator: since 2004: NIHD • Sampling frame: population register • Target population: Individual person, 16-64 • Result: 3074 (males 1319, females1755), response rate 61,5% • Comparative sample: 20-64, 2763 (1174, 1589) • Method: postal • Methodology: cross-sectional, every 2 years

4. Surveys under evaluation • Estonian Social Survey * (ESS) • Coordinated by EUROSTAT in the frame of EU-SILC • Coordinator: Estonian Statistical Office • Sampling frame: population-based address register • Target population: Households,main person, >14+ • Result: 9209 (males 4195, females 5014), response rate 67,7% • Method: face-to-face interview • Methodology: 1 year in a 4-year panel (until 2008) • Comparative sample: 20-64, 6336 (2966, 3370) • *by the time of analysis raw data was availabale

5. Surveys under evaluation • Estonian Family and Fertility Survey** (ESTONIAN FFS) • Coordinated: UN ECE 1990s European FFS, 2000s Gender and Generation Survey • Coordinator: Estonian Demographic Association, Estonian Demographic Institute • Sampling frame: population-based address register • Target population: Individual person, 20-80 • Comparative sample: 20-64, 2709 (933, 1776) • Method: face-to-face interview • Methodology: event-history **By the time of analysis fieldwork not carried out yet

6. Surveys under evaluation • Estonian Health Interview Survey 1996 • Coordinated: Working Group, WHO • Coordinator: Institute for Epidemiological and Clinical Research • Sampling frame: population census 1989 • Target population: Individual person, 15-75 • Comparative sample: age-based 20-64, 3034 (1468,1566);cohort-based 30-64 2903 (1403,1500) • Method: face-to-face interview • Methodology: event-history

7. Survey population representativeness at 1.01.2004

8. MEHM: How is your health in general? • MEHM answer categories: very good, good, average/neither good nor bad, bad, very bad • How do you evaluate currently your health in general? • Good, rather good, average, rather bad, bad (HBAP) • How do you evaluate your health in general? • Very good, good, neither good nor bad, bad, very bad (ESS) • How do you evaluate your health in general? • Very good, good, satisfactory, bad, very bad (EstFFS) • How do you evaluate your health status in general? (Overall, how do you evaluate your health status?) • Very good, good, average, satisfactory, bad, very bad (EHIS96)

9. Males, very good versus good health

10. MEHM: total good health

11. Standardised very good health

12. MEHM: conclusion of self-perceived health • Usage of wordings like evaluate, describe and characterise does not make a difference • Usage of health status and health does not make a difference • Timing of the survey makes a difference (impact of the general atmosphere of the society and environment of the time at survey –age versus cohort) • Cohortvalues persist over time (however not standardised for mortality) • Meaning of the categories makes a huge difference: assumption that Nordic population seldom expresses itself in extreme terms does not hold in this very case (vice versa good and rather good in HBAP). However, the vice versa effect does not compensate in the total indicator • Survey method might play a role – in written form people tend to complain more

13. MEHM –Do you have any longstanding illness or health problem? • MEHM answer categories: Yes/No • Do you have any longstanding(chronical) illness or health problem? • Yes/No – HBAP • Do you have any longstanding (chronical) illness or health problem? NB! Seasonal (allergic cold) or recurrent health problems state as long-standing health problems. • Yes/No - ESS • (Have you ever had injuries which for more than 3 months have limited your daily activities;) Are you having or have had any longstanding health problems or illness which for 3 months has limited your educational, working or daily activities? • Yes/No –EFFS

14. MEHM –Do you have any longstanding illness or health problem? • MEHM answer categories: Yes/No • Beside traumas and injuries, but sometimes as a result of them, there are other long-term health problems. Let us talk about the most substantial long-term health problems that you have ever had in your life. To make it easier for you, try to recall by the areas of your body. Have you ever in your life had ... • Yes/No – EHIS96 • 1) recurred (rec)- in PHARE 2001 chron • 2) also last year (ly) – in PHARE 2001 chronA

15. MEHM- long-standing illness recurrent versus has occurred also last year (limited for 3 months), male population

16. Standardised long-standing illness

17. MEHM: conclusion of long-standing illness • The wider the wording of the question the higher proportion of complaints the population indicates (at least chronical should be added) –ever had+more complaints • Definition of recurrent gives similar responses even in case of very different response formation (in EHIS96 from 2 questions) • Specification about the occurrence last year as well differentiates the population with real long-standing problems nowadays from those ever had • What do we measure? – the aim needs clarification

18. MEHM -For at least the past 6 months, to what extent have you been limited because of a health problem in activities people usually do? • MEHM answers: Would you say you have been severely limited, limited but not severelyor not limited at all? • Has any health problem limited your daily activities during the last 6 months? • Yes, severely limited, Yes, somewhat limited, No –HBAP • Has any health problem limited your daily activities for a long time (for at least last 6 months)? NB! Take into account also Seasonal (allergic cold) or recurring health problems. Think about the last year, if the health problem has recently started think about the next year. State for the following activities: • School and work activities • Getting out and about outdoors as well as at home • Leisure and social activities (attending clubs, meetings etc.) • Yes, very much, Yes, somewhat, No, not at all -ESS

19. MEHM -For at least the past 6 months, to what extent have you been limited because of a health problem in activities people usually do? • MEHM answers: Would you say you have been severely limited, limited but not severelyor not limited at all? • (If a person had an injury or health problem which limited its school, work or daily activities for at least 3 months until nowadays, then ask) To which extent your health status limits your (possibilities,capability) at different activities? • Asked for school and work, coomunication with official instituions, communication with friends ,relatives, getting out and about, household activities, going up and down from the stairs, dressing, eating, sitting and standing up, usage of toilet, reading/TV watching, hearing radio/doorbell, speaking • Does not enable, severely limits, somewhat limits, does not limit at all- EFFS

20. MEHM -For at least the past 6 months, to what extent have you been limited because of a health problem in activities people usually do? • MEHM answers: Would you say you have been severely limited, limited but not severelyor not limited at all? • Do you feel healthy enough to do what you want each day • Almost always, Rather frequently, Rarely, Almost never –EHIS96 – in PHARE 2001 limact • Having asked all limitations (school and work, communication with official instituions, communication with friends ,relatives, getting out and about, household activities, personal care activities, seeing in 4 m a person, hearing radio/TV, speaking) Does the respondent have any limitations in managing daily activities ( if any answer was Yes, count in) • Yes, severely limited, Somewhat limited, No –EHIS96 in PHARE 2001 limactb

21. Male population Female population MEHM: overall limited versus limited in case of certain activities+frequency scale

22. Standardised activity limitation

23. MEHM: conclusion from activity limitations • Question worded in MEHM very clumsily, brings about different wordings in translations, needs clarification • No specification leads for overstatement at younger ages in particular (postal survey specifically) • Specifications decrease the population under risk for more than 2 times (despite that 6 months is more than 3 months, 3 months gives smaller proportion because a person can better count for the time) • Best specification is to account for real limitations in whatever daily life area- most objective (3 months specification does not make any difference if objective restrictions are counted) • Frequency scale appears to work better than scale of severity, however do not know the effect of want in the wording of the question • What do we want to measure? – aim has to be clarified