1. TASK 1.10.DOCUMENTATION OF THE PROBLEMS FACED DURING EHIS WAVE 1 BRIEF SUMMARY OF PROBLEMS OCCURED DURING EHIS WAVE 1 EHIS WORKSHOP, BERLIN SEPTEMBER 30 – OCTOBER 1, 2010

2. TASK 1.10.DOCUMENTATION OF THE PROBLEMS FACED DURING EHIS WAVE 1  One of the stages of work programme under Agreement European Statistical System Network Project on Public Health Statistics, 10501.2009.003-2009.405 was HIS Task 1.10 aimed on elaboration of the report on “Documentation of the problems faced during EHIS wave 1”. The report elaborated within the Task 1.10. was prepared on the basis of available submitted papers - questions and comments posted in the EHIS newsgroup on CIRCA, emails received in Eurostat, national interim and final reports and quality reports - prepared by countries involved in EHIS implementation project, in order to document the most important problems faced at the national level during the EHIS wave 1 and to identify potential solutions.  The report elaborated within the Task 1.10. was prepared on the basis of available submitted papers - questions and comments posted in the EHIS newsgroup on CIRCA, emails received in Eurostat, national interim and final reports and quality reports - prepared by countries involved in EHIS implementation project, in order to document the most important problems faced at the national level during the EHIS wave 1 and to identify potential solutions.

3. TASK 1.10.DOCUMENTATION OF THE PROBLEMS FACED DURING EHIS WAVE 1  Presented brief summary is based on mentioned report and focuses only on the most important national problems occured during EHIS wave 1.

4. TASK 1.10.DOCUMENTATION OF THE PROBLEMS FACED DURING EHIS WAVE 1 GENERAL PROBLEMS Design of the national version  Design of the national version  Lack of final verified conceptual cards and guidelines during the preparation of the national version of the modules  Some countries faced a lot of problems and difficulties when final version of documents (questionnaire, guidelines) was not available Questionnaire  Questionnaire  Complicated and full of skips, which resulted in difficulties and mistakes  It was hard for interviewers (even well trained) to orientate in the questionnaire and ask the questions should be asked and not to ask some which should be skipped

5. TASK 1.10.DOCUMENTATION OF THE PROBLEMS FACED DURING EHIS WAVE 1 GENERAL PROBLEMS  Reference periods  Too many various reference periods applied in one questionnaire made the interviewers and respondents confused  Self-completion forms  The application of two separated self-completion forms broke the continuity of the interview

6. TASK 1.10.DOCUMENTATION OF THE PROBLEMS FACED DURING EHIS WAVE 1 GENERAL PROBLEMS  I nterview  Too long  Tiring and exhausting for elderly people and people with health problems  Time consuming and irritating for young and healthy persons Lack of comparability  Lack of comparability  Some questions in their present form could not be compared due to e.g. linguistic differences, different health care systems, types of paramedics, types of home care services, classification of accidents, etc.

7. TASK 1.10.DOCUMENTATION OF THE PROBLEMS FACED DURING EHIS WAVE 1 GENERAL PROBLEMS Proxy interview  Proxy interview  Lack of unified and consequent guidelines  In a part of questions concerning the same issue or topic proxy answers were allowed, while in the other part they were not allowed  One part of countries did not allow proxy interview at all, while other allowed it in certain cases such as for people who were hospitalized at the moment of the interview, people with severe health problems (like dementia, mental or physical disability, etc.).

8. TASK 1.10.DOCUMENTATION OF THE PROBLEMS FACED DURING EHIS WAVE 1 THE MOST PROBLEMATIC AND DIFFICULT QUESTIONS  Marital status  Incomes  Physical and sensory functional limitation  Physical pain and discomfort  Mental health  Health care payments  Assessment of health care services providers  Physical activity  Alcohol consumption

9. TASK 1.10.DOCUMENTATION OF THE PROBLEMS FACED DURING EHIS WAVE 1 EUROPEAN BACKGROUND MODULE  The implementation of this module was difficult and complicated in view of the differences between countries and their specific national law and needs  Too long and complicated  Too more difficult, sensitive questions  The guidelines were too complicated for interviewers and respondents  The most problematic questions: legal and de facto marital status, current labour status, employment, incomes (HH5, HH6, HH8, HH10- HH14, IN)  The most sensitive question: HH5, HH6, IN.

10. TASK 1.10.DOCUMENTATION OF THE PROBLEMS FACED DURING EHIS WAVE 1 EUROPEAN HEALTH STATUS MODULE  Questions PL, PC, HA  Too long sections  Too many questions concerning functional level, use of aids and assistance  Difficult and complicated design of questions PC and HA  Lack of one principle determined for compound activities - in one case (question) the easier activity was proposed to taking under the respondent consideration, while in other case the more difficult  Questions irritating and confusing both for respondents without limitations and for visibly disabled ones

11. TASK 1.10.DOCUMENTATION OF THE PROBLEMS FACED DURING EHIS WAVE 1 EUROPEAN HEALTH STATUS MODULE  Question SF1.  The wordings “physical pain/discomfort” were difficult to translate  The response categories were difficult to understand and distinguish for the respondents  For people suffered from several pains/discomforts it was impossible to choose one of given answer categories.  Respondents could not estimate an average degree during the reference period.  Lack of pain grading scale

12. TASK 1.10.DOCUMENTATION OF THE PROBLEMS FACED DURING EHIS WAVE 1 EUROPEAN HEALTH STATUS MODULE  Question SF2-10.  Lack of more detailed guidelines and explanation of response categories  Questions were difficult to answer due to very similar wording  The reference period was problematic to determine precisely self- perceived mental health  The five answers categories perplexed the respondents  The older respondents could not answer with precision - it was hard to them to make a distinction between different answer categories

13. TASK 1.10.DOCUMENTATION OF THE PROBLEMS FACED DURING EHIS WAVE 1 EUROPEAN HEALTH CARE MODULE Questions OP1-OP3.  Questions OP1-OP3.  Lack of possibility of separation the expenditures on private and public health care due to one combined question  Lack of information on what kind of expenses should be included – spent for health care used in the given period or paid in the given period  Lack of information in the case of expenses on health care covered by someone else for the services used by the respondent  The self-completing form was not a good solution – respondents preferred questions asked by interviewer to self-completion

14. TASK 1.10.DOCUMENTATION OF THE PROBLEMS FACED DURING EHIS WAVE 1 EUROPEAN HEALTH CARE MODULE  Questions PA12 and PA15.  Some inconsistency in response categories of the same pattern  Lack of possibility of multiple answers in PA15 on reason of cervical smear test while it was allowed in the corresponding question PA12 on reason for mammography

15. TASK 1.10.DOCUMENTATION OF THE PROBLEMS FACED DURING EHIS WAVE 1 EUROPEAN HEALTH CARE MODULE Question SA1.  Question SA1.  The intention of the question was incomprehensible - was it level of respondents’ satisfaction or evaluation of the health care facilities  Health care services providers were not distinguished by the private and the public sectors while it is a well known fact that the quality of these services vary significantly  The interviewed persons were supposed to give only one common answer assessing both - the quality of services provided within the range of health insurance as well as the paid ones

16. TASK 1.10.DOCUMENTATION OF THE PROBLEMS FACED DURING EHIS WAVE 1 EUROPEAN HEALTH CARE MODULE Question SA1. (continued)  Question SA1. (continued) t was difficult for respondents to make an overall assessment of health care providers if they personally not used these services and had not such experience  It was difficult for respondents to make an overall assessment of health care providers if they personally not used these services and had not such experience  Persons who did not participate in a particular service could not assess its quality and had to based on the opinions of other people  The question about level of satisfaction was not a good solution – it would be better to ask respondents on opinion on health service providers in their country of residence such experience

17. TASK 1.10.DOCUMENTATION OF THE PROBLEMS FACED DURING EHIS WAVE 1 EUROPEAN HEALTH DETERMINATS MODULE  Questions PE1-PE3.  Questions posed the most problems during the interview for a large group of respondents and interviewers  Difficult to understand and answer, stirred the respondents’ impatience and irritation  Too complicated regardless of extensive and complex explanations (or because of them)  Lack of a list of larger number of activities, particularly performed at work  Unclear division (and the given examples) of the activities into moderate and vigorous

18. TASK 1.10.DOCUMENTATION OF THE PROBLEMS FACED DURING EHIS WAVE 1 EUROPEAN HEALTH DETERMINATS MODULE  Questions PE1-PE3. (continued)  Respondents were unable to distinguish the different types of activities, even following the guidelines and the examples given by the interviewers  Respondents had serious problems with reminding themselves not only the number of days, but also with assessment of the amount of time  The amount of time spent on walking was very difficult to assess, because respondents usually did not count the time they spend walking (in non recreation purpose)

19. TASK 1.10.DOCUMENTATION OF THE PROBLEMS FACED DURING EHIS WAVE 1 EUROPEAN HEALTH DETERMINATS MODULE  Questions PE1-PE3. (continued)  Counting the duration of all examined activities posed a very significant problem  Almost nobody of the surveyed persons had not paid an attention how much time per week he/she used for any kind of physical activities, except the cases when was engaged in active sport  In many cases the respondents overestimated the duration of their activities, since they included the whole time spent at work  Moderate physical activities and vigorous physical activities were often confused, especially for people living in rural areas and performing daily activities in agriculture, for people employed in industry, construction, etc.

20. TASK 1.10.DOCUMENTATION OF THE PROBLEMS FACED DURING EHIS WAVE 1 EUROPEAN HEALTH DETERMINATS MODULE  Questions AL1-AL3.  Questions were recognized as most sensitive, too long, detailed and complicated  The wording “drink” was not a phrase in current use in some countries and there it was difficult to understand  The response categories for questions AL1. and AL2. have started from the answer “Never” at the top to “Every day”at the bottom. The respondents chose the first alternative answer suitable for them. It could result in primacy effect bias.

21. TASK 1.10.DOCUMENTATION OF THE PROBLEMS FACED DURING EHIS WAVE 1 EUROPEAN HEALTH DETERMINATS MODULE  Question AL2.  The respondents found very difficult and confusing to report their daily consumption of alcohol by type and quantity  Question was extremely difficult for respondents to answer and might give a truncated picture of real consumption  Complicated for irregular drinkers

22. TASK 1.10.DOCUMENTATION OF THE PROBLEMS FACED DURING EHIS WAVE 1 EUROPEAN HEALTH DETERMINATS MODULE  Question AL2. (continued)  Many people were not able to specify exactly what type of alcohol and in what amount they usually drinking each day of a normal, typical week. The difficulty focused especially on persons who used to drink a variety of drinks during the week  Too complicated bands of frequency of drinking

23. TASK 1.10.DOCUMENTATION OF THE PROBLEMS FACED DURING EHIS WAVE 1 CONCLUSIONS  Harmonization of the questionnaires between countries is a key issue  All possible procedures for preparing the survey should be closely align for all countries to create the most uniform basis for comparisons  All the problems encountered during the implementation should be taken into consideration in order to obtain the best practice for future implementation

24. TASK 1.10.DOCUMENTATION OF THE PROBLEMS FACED DURING EHIS WAVE 1 I would like to thank all representatives of countries participated in the EHIS project for their really hard work without which there would not be the report and this brief summary. Thank you for your attention! Małgorzata Piekarzewska m.piekarzewska@stat.gov.pl