1. How to motivate participation in HES?

2. Based on EHES Manual, Part A
Based on EHES Manual, Part A. Planning and preparation of the survey, 2nd edition, Available at: and
EHES Manual, Part B. Fieldwork Procedures, 2nd edition, Available at:
These slides can be used freely, translated and adapted to national use (e.g. concerning the recruitment methods).

3. The purpose of recruitment
The goal is to achieve as high participation as possible
Ensuring that the sample represents the target population
Challenging, but necessary for reliable results
The recruitment process depends on:
National legislation
Survey budget
Cultural norms
Ethical acceptance

4. Invitation should be motivating
Invitation by a letter
Information leaflet with the invitation to raise interest
Phone call may follow the invitation letter
Important to pay attention to all written materials
Invitation letter: informative, convincing and professional, but easy to understand and not too long
Information leaflet: interesting (use colors and pictures), relevant and concise
Re-invitations should be made, if the person is not reached by the first invitation
Second invitation letter, phone calls, home visits (if feasible)

5. What motivates participation?
Importance and relevance of the survey
For public health and for the participant
Receiving personal benefits:
New information on health and health risks
Incentives (voucher, cash or gift) or compensation for travel costs
Requests for help
Social responsibility
Statements of data protection and confidentiality
Using all relevant languages
Helps recruiting also ethnic minorities

6. Practical matters and motivation
Flexibility in scheduling appointment
Availability of evening and weekend appointment times
Possibility to drop in (without appointment)
Duration of the examination visit
Not too extensive
Location for the examination
Access with public transportation
Parking space
Centrally situated
Home visits
Additional option for e.g. people who are unable or unwilling to participate otherwise

7. Survey personnel
Competent and motivated survey personnel play an important role in recruitment
Follow survey protocol
Understand the importance of high participation rate
Be ready to give answers to frequently asked questions and to motivate participants
Be flexible and act in a professional and polite way
Take into account any special needs of the participants (e.g. need of assistance)

8. Actions for increasing awareness and motivation
Promotion of the survey through media
Raising general awareness of the survey
Reaching and motivating selected persons
National media campaigns
Local media campaigns before fieldwork
Interviews in radio and TV
Newspapers
Posters and leaflets
Pre-notification before invitation
Survey website, social media

9. Improving participation through co-operation
Provide information about the survey to:
National and local health authorities and health professionals
Local government
Other places that are important for the community
Cooperate with
Regional or local hospitals, GP offices, health centres
Non-governmental organizations
Research centers and universities

10. Actions increasing participation during fieldwork
Personal contact is more effective
Phone call
Home visit
Appointment reminder (e.g. day before the appointment)
Text message, card or
Multiple contact attempts

11. Motivating participants during fieldwork
Possibility to ask questions and to reschedule appointments
Contact persons should be easy to reach
At the examination site:
Comfortable facilities and fluent examinations with short waiting times
Offering breakfast or snack after fasting blood samples are taken
Friendly atmosphere among survey personnel and towards participants
Encouraging feedback on measurements

12. After the examination Participants need to feel appreciated
Participants expect feedback on personal results

13. Questions and answers
The following slides are frequently asked questions that may come from the survey participants and which fieldwork staff should be able to answer.

14. “Is the information confidential?”
“Yes. In the survey data, no names and ID-information are used. Your data will be linked to you only for the purpose of sending you feedback on your personal results.”
“In case there are any questions/measurements which you experience as being too personal, you have no obligation to answer/take part in them.”

15. “Why have you selected me?”
“We have drawn a representative sample of people from all over the country. You have been randomly selected from the (add sampling frame). It is just chance that you have been selected. ” “After selecting the sample, it is not possible to replace the selected persons by someone else. This is why it is important that you will participate to the survey.”

16. ”Why do you select participants at random?”
We can’t ask everyone to participate so we invite a small fraction of the population. It is important for this group to be selected randomly so they reflect the population as a whole.

17. ”How can you learn about the general health for the entire country by only examining a few people?”
It’s not feasible to interview and examine everybody in the country. Instead we randomly select a group to represent the country. This is enough for us to gauge an accurate picture of the country’s health.

18. “How many people have you invited to participate in this survey?”
We have invited (add your sample size, min in countries implementing a multi-stage design for EHES) people from all over the country.

19. ”My husband/friend is participating and I would like to too
”My husband/friend is participating and I would like to too. Can I turn up?”
“It’s great that you are interested in the survey but unfortunately we can’t include you this time as we only have the resources to survey those we selected randomly to participate.”

20. “What do I get in return for participating?”
“You will receive (mention incentive and) a free health check-up.”
“The information is important for research and health monitoring purposes, which are needed to plan health services and health promotion activities for future generations.”

21. “I’m too busy”
“I can understand that you are busy, and we can schedule your visit for the time most suitable for you. How about evening or weekend times … (suggest days/times)?”
“It is really important to examine also busy people, so that we can get representative information about the entire population of this country and this region.”
In case the full appointment seems too time consuming, the questionnaire or a short version (non-respondent questionnaire) and only the core measurements should be offered.

22. “I’m too ill to participate.”
“To be able to get a good picture of the health status and health determinants in this country, it is really important to examine also those with poor health.” “If you feel that you are not well enough to come to the examination site, could we do the examination at your home? We will not carry out any measurement that would include any risk to your health. You have the right to refuse any measurements that you feel too exhausting.”

23. “I’m really healthy – I don’t need to participate”
“We are interested in obtaining information from healthy and sick individuals and everything in between. To be able to get a good picture of the health status and health determinants in this country, it is really important to examine also those with good health.”
“You may still receive new information on your health” (mention measurements and/or blood tests that may be interesting)

24. “I see my doctor all the time – I just had a health check up”
“The survey is not just about health but also about lifestyles and other factors affecting health.”
“We cannot obtain/use health information from your doctor (medical records).”
“Even though there is not much personal benefit for you, the information is important to the research and health monitoring purposes. The information is needed to plan health services and health promotion activities for future generations.”

25. ”I don’t mind answering some health questions but I’m not prepared to give a blood sample so I don’t think I should participate at all.”
“It is very important for the survey that you participate in any way you can. We can start with the questionnaire and measurements and if you want to stop there that’s fine. You can stop at any time during the survey.”
Note: It is better to get information from an interview and some measurements than nothing at all from the participant. It may be possible to convince the participant through the beginning part of the survey to continue with other parts with a good interaction with the interviewer.

26. Further questions…
The answers depend on your survey protocol
Can I take companion/assistant with me to the appointment?
Can I participate while pregnant? Are the examinations safe for me or my baby?
What is this study really about? What is the meaning of it?
What happens during the appointment?
I cannot follow the fasting instructions, should I just cancel the appointment?
Can I take my medicines during the fast?

27. Acknowledgements
Slides prepared by: Susie Jentoft and Johan Heldal, Sanna Ahonen, Päivikki Koponen, Hanna Tolonen Photographs: Hanna Tolonen, photo bank images Experiences and feedback from the EHES network have been utilized in the preparation of these slides Funding: Preparation of the slides is part of the activities of the EHES Coordinating Centre which has received funding from the EC/DG SANTÉ in through SANCO/2008/C2/02-SI EHES and Grand Agreement number , and in through Grand Agreement number /BRIDGE Health

28. Disclaimer
The views expressed here are those of the authors and they do not represent the Commission’s official position.