Percorrer por autor "Lyshol, Heidi"
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- Collecting Valid and Reliable Data: Fieldwork Monitoring Strategies in a Health Examination SurveyPublication . Kislaya, Irina; Santos, Ana João; Lyshol, Heidi; Antunes, Liliana; Barreto, Marta; Gaio, Vânia; Gil, Ana Paula; Namorado, Sónia; Matias Dias, Carlos ; Tolonen, Hanna; Nunes, BaltazarIntroduction: Health surveys constitute a relevant information source to access the population’s health status. Given that survey errors can significantly influence estimates and invalidate study findings, it is crucial that the fieldwork progress is closely monitored to ensure data quality. The objective of this study was to describe the fieldwork monitoring conducted during the first Portuguese National Health Examination Survey (INSEF) regarding protocol deviations and key performance indicators (KPI). Methods: Data derived from interviewer observation and from the statistical quality control of selected KPI were used to monitor the four components of the INSEF survey (recruitment, physical examination, blood collection and health questionnaire). Survey KPI included response rate, average time distribution for procedures, distribution of the last digit in a specific measure, proportion of haemolysed blood samples and missing values. Results: Interviewer observation identified deviations from the established protocols, which were promptly corrected. During fieldwork monitoring through KPI, upon implementation of corrective measures, the participation rate increased 2.5-fold, and a 4.4-fold decrease in non-adherence to standardized survey procedures was observed in the average time distribution for blood pressure measurement. The proportion of measurements with the terminal digit of 0 or 5 decreased to 19.6 and 16.5%, respectively, after the pilot study. The proportion of haemolysed samples was at baseline level, below 2.5%. Missing data issues were minimized by promptly communicating them to the interviewer, who could recontact the participant and fill in the missing information. Discussion/Conclusion: Although the majority of the deviations from the established protocol occurred during the first weeks of the fieldwork, our results emphasize the importance of continuous monitoring of survey KPI to ensure data quality throughout the survey.
- Inequalities in oral health: results from the First Portuguese National Health Examination SurveyPublication . Antunes, Liliana; Kislaya, Irina; Santos, Joana; Rodrigues, Ana Paula; Santos, Ana João; Gil, Ana Paula; Braz, Paula; Gaio, Vânia; Barreto, Marta; Namorado, Sónia; Lyshol, Heidi; Nunes, Baltazar; Dias, Carlos MatiasOral health is a state of being free from a range of diseases and disorders that affect oral cavity. Dental cavities and gum diseases are among the most prevalent diseases worldwide. However, they can be prevented as risk factors include poor diets and hygiene. Also, social determinants play a key role as it is well established that poor health is higher among the most disadvantaged. Thus this study aimed to describe oral preventive care of the Portuguese population and assess socioeconomic inequalities.
- Inquérito Nacional de Saúde com Exame Físico 2013-2016: protocolo científicoPublication . Nunes, Baltazar; Barreto, Marta; Gil, Ana Paula; Kislaya, Irina; Namorado, Sónia; Antunes, Liliana; Gaio, Vânia; Santos, Ana João; Rodrigues, Ana Paula; Santos, Joana; Roquette, Rita; Alves-Alves, Clara; Castilho, Emília; Cordeiro, Eugénio; Dinis, Ana; Prokopenko, Tamara; Silva, Ana Clara; Vargas, Patrícia; Lyshol, Heidi; Matias Dias, CarlosTrata-se do protocolo científico do pojecto Inquérito Nacional de Saúde com Exame Físico (INSEF) 2013-2016. O INSEF é parte integrante do projeto “Improvement of epidemiological health information to support public health decision and management in Portugal. Towards reduced inequalities, improved health, and bilateral cooperation” que tem como parceiro o Instituto Norueguês de Saúde Pública (FHI) e conta com a colaboração das Administrações Regionais de Saúde (ARS) e das Secretarias Regionais de Saúde e dos Assuntos Socias (SRAS) das Regiões Autónomas dos Açores e Madeira. Este projeto é financiado a 85% pelo Mecanismo Financeiro do Espaço Económico Europeu 2009-2014 através das EEA Grants e será desenvolvido entre 2014 e 2016. Tem como finalidade criar e implementar um Inquérito Nacional de Saúde com Exame Físico (INSEF) que que contribua para a melhoria da saúde dos portugueses apoiando a observação em saúde, a monitorização, a avaliação dos programas nacionais de saúde e a investigação em Saúde Pública em Portugal, sendo seu objetivo geral o de contribuir para melhorar a Saúde Pública e reduzir as desigualdades em saúde na população residente em Portugal, através da disponibilização e comunicação de informação epidemiológica de elevada qualidade sobre o estado de saúde, determinantes e utilização de cuidados de saúde.
- Local problem solving in the Portuguese health examination survey: a mixed method studyPublication . Lyshol, Heidi; Gil, Ana Paula; Tolonen, Hanna; Namorado, Sónia; Kislaya, Irina; Barreto, Marta; Antunes, Liliana; Gaio, Vânia; Santos, Ana João; Rodrigues, Ana Paula; Matias Dias, CarlosBackground: Participation rates in health surveys, recognized as an important quality dimension, have been declining over the years, which may affect representativeness and confidence in results. The Portuguese national health examination survey INSEF (2015) achieved a participation rate of 43.9%, which is in line with participation rates from other similar health examination surveys. The objective of this article is to describe how local teams of survey personnel conducted the survey, describing strategies used to solve practical survey problems and to try to increase the participation rate. Methods: After a literature search, informal interviews were conducted with 14 public health officials from local health examination teams, regional and central authorities. Forty-one of the local staff members (survey personnel) also filled in a short questionnaire anonymously. The interviews and self-administered questionnaires were analysed using mixed methods, informed by thematic analysis. Results: The local teams believed that the detailed manual, described as a “cookbook for making a health examination survey”, made it possible to maintain high scientific standards while allowing for improvising solutions to problems in the local context. The quality of the manual, supported by a series of training workshops with the central research and support team, gave the teams the confidence and knowledge to implement local solutions. Motivation and cohesion within the local teams were among the goals of the training process. Local teams felt empowered by being given large responsibilities and worked hard to incite people to attend the examination through a close and persuasive approach. Local teams praised their INSA contacts for being available for assistance throughout the survey, and said they were inspired to try harder to reach participants to please their contacts for interpersonal reasons. Conclusions: The theory of organizational improvisation or bricolage, which means using limited resources to solve problems, was useful to discuss and understand what took place during INSEF. A detailed manual covering standard procedures, continuous monitoring of the data collection and face-to-face workshops, including role-play, were vital to assure high scientific standards and high participation rates in this health examination survey. Close contacts between the central team and local focal points in all regions and all survey sites were key to accommodating unexpected challenges and innovative solutions.
- Oral hygiene habits in Portugal: results from the first Health Examination Survey (INSEF 2015)Publication . Santos, Joana; Antunes, Liliana; Namorado, Sónia; Kislaya, Irina; João Santos, Ana; Rodrigues, Ana Paula; Braz, Paula; Gaio, Vânia; Barreto, Marta; Lyshol, Heidi; Nunes, Baltazar; Matias Dias, CarlosINTRODUCTION: Oral health is a determinant for quality of life and preventive behaviours such as regular tooth brushing can reduce the risk of a wide spectrum of oral diseases. Adopting preventive behaviours increases the likelihood of being healthy and can be conditioned by demographic and socio-economic factors. OBJECTIVE: This study aims to describe preventive oral hygiene behaviours in the Portuguese population and assess their association with sociodemographic and socioeconomic factors. MATERIAL AND METHODS: A cross-sectional epidemiologic study was developed using data from the first Portuguese National Health Examination Survey. The target population comprised Portuguese community-dwelling residents aged between 25 and 74 years old. The percentage of individuals who brushed their teeth at least twice a day, provided that once was before sleeping, was considered the indicator showing a preventive behaviour, as this is recommended by the General Directorate of Health in Portugal. Poisson regression was used to identify factors independently associated with this behaviour. RESULTS: Sixty-five per cent of the participants reported tooth brushing as recommended. The prevalence of adoption of this preventive behaviour was higher among those living in urban areas and those who have higher educational level. Results show an association between being male and having low educational level with lesser adoption of preventive oral health behaviours. CONCLUSION: These findings suggest a need for integrated approaches, from measures tackling social inequalities to actions focused on improving health literacy. It is also important to expand dental healthcare services and improve effective coverage to increase access for rural population.
- Participants’ recruitment: preliminary results of Portuguese National Health Examination SurveyPublication . Namorado, Sónia; Kislaya, Irina; Gaio, Vânia; Santos, Ana João; Gil, Ana Paula; Barreto, Marta; Santos, Joana; Lyshol, Heidi; Nunes, Baltazar; Dias, Carlos MatiasRecruitment of participants in health surveys is recognised as the most challenging step of fieldwork. This work presents preliminary results of recruitment in the first Portuguese National Health Examination Survey (INSEF) comparing participants and non participants. INSEF is a cross-sectional prevalence study targeting 4200 individuals aged 25–74 years, living in Portugal for more than 12 months, non-institutionalized and able to follow an interview in Portuguese. Fieldwork started in February 2015 and to date 9/49 examination sites are completed. Selected individuals received an invitation letter and later were contacted by phone to schedule the appointment. Individuals were then classified in participants, refusals and of unknown eligibility. Participation rates were calculated according to European Health Examination Survey guidelines. Reasons for refusals were recorded and non participant’s characteristics analysed. Chi square and Fisher exact tests were used to compare participants and non participants regarding age, sex, education level, marital status, smoking, use of medication and of healthcare services. 1467 of the 2161 selected individuals were successfully contacted. Overall participation rate was 42%(n = 882), ranging between 27–54% by examination site. 49% of the 512 refusals accepted to respond to a short questionnaire for non participants. The main reasons for non participation were lack of time (27.6%) and professional reasons (22.4%). No significant differences were found for the majority of the analysed variables. Participants were found to be more frequently users of medication (p < 0.001) and to have between 45–54 years old (p = 0.023). To date the planed participation rate of 40% was successfully achieved at national level. Results obtained showed the need to implement strategies to engage in participation specific target groups. To mitigate selection bias adjustment of sampling weights for non response should be done.
- Population's adherence to the Portuguese Health Examination Survey: the perspective of fieldwork teamsPublication . Gil, Ana Paula; Santos, Ana João; Santos, Joana; Kislaya, Irina; Rodrigues, Ana Paula; Namorado, Sónia; Gaio, Vânia; Barreto, Marta; Lyshol, Heidi; Nunes, Baltazar; Dias, Carlos MatiasThe participation of fieldwork teams is key to successful surveys implementation. Thus, the Portuguese National Health Examination Survey (INSEF) is involving fieldwork teams in survey quality control processes. The aim of this presentation is to report a midterm evaluation's results of the internal quality control concerning participants' recruitment strategies and how these influence participation rate. A focus group discussion was carried out with fieldwork teams (nurses, laboratory technicians and administrative staff) and regional coordinators in the North, Center and Algarve regions. Each focus group had between 8 to 14 participants with an average age of 47 years and a long professional experience with an average of 22 years. A slideshow presentation fostered the discussion of the survey process: strengths and weaknesses of training, recruitment, informed consent, physical exam, blood collection, interview and logistical issues. It also explored the teams' perceptions of local cultural attitudes and the strategies used within the fieldwork. A thematic content analysis was performed. According to fieldwork teams, higher participation rates depend on: invitation letter signed by personal General Practitioner; free clinical analysis; pride in being selected in a scientific study; study conducted by experienced health professionals; data collection in local health center, schedule flexibility, invitation and confirmatory telephone calls. Also important: population's size, cultural factors and fieldwork teams' years of experience. In two focus groups, opinions on invitation letters' legibility differed between socio-professional categories: nurses and administrative staff. Participation rate depends on fieldwork teams' credibility and local community. The use of qualitative methods such as focus group is important to improve survey processes and these can also give valuable input on fieldwork teams' engagement and motivation.
- Portuguese National Health Examination Survey: Lessons from data collection monitoringPublication . Kislaya, Irina; Rodrigues, Ana Paula; Santos, Joana; Gaio, Vânia; Gil, Ana Paula; Santos, Ana João; Namorado, Sónia; Barreto, Marta; Lyshol, Heidi; Nunes, Baltazar; Dias, Carlos MatiasThis work addresses practices related to quality assurance in the first Portuguese National Health Examination Survey (INSEF). INSEF is a cross-sectional population-based study that combines face-to-face interview, physical examination and blood collection and aims to obtain data on 4200 participants from all 7 regions of Portugal. To ensure accurate and high quality data, a monitoring system was implemented as part of internal quality assessment. It includes participant recruitment, physical examination, blood collection and interview and consists of: daily check of recruitment and participation; monitoring of blood pressure and anthropometric measurements by interviewer and collection site; monitoring blood draw, sample haemolyses and laboratory processing; evaluation of average time spent on each survey component by interviewer; daily validation of collected interview data to verify completeness and identify duplicates; regular contact with fieldwork teams to clarify issues raised in questionnaire administration. For each region we carried out survey quality assessment at the end of the second week of fieldwork (N=230 participants). Regional meetings took place to discuss assessment results and propose recommendations for improvement. Monitoring allowed identifying items in higher risk of missing data and challenging issues such as employing exclusion criteria. Proper registry of measurements and time spent were difficult for 3 out of 6 interviewers. We observed junior laboratory technicians to have higher rates of haemolysed samples, 11% compared to 2% from the most experienced. Monitoring of each fieldwork procedure allowed to provide on time feedback so fieldwork teams are able to implement correction actions aimed at reducing total survey error and improving survey quality.
- Portuguese National Health Examination Survey: questionnaire developmentPublication . Santos, Ana João; Gil, Ana Paula; Barreto, Marta; Gaio, Vânia; Namorado, Sónia; Kislaya, Irina; Lyshol, Heidi; Nunes, Baltazar; Dias, Carlos MatiasThis 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.
- Prevalence of Elevated Cholesterol in Portugal: National Health Examination Survey (2015) resultsPublication . Rodrigues, Ana Paula; Kislaya, Irina; Antunes, Liliana; Gaio, Vânia; Barreto, Marta; Santos, Ana João; Gil, Ana Paula; Namorado, Sónia; Lyshol, Heidi; Nunes, Baltazar; Dias, Carlos MatiasBackground: High cholesterol level is a major and modifiable cardiovascular (CV) risk factor. This study aims to estimate the prevalence of elevated cholesterol in the Portuguese population based in the direct measurement of total serum cholesterol. Methods: The First National Health Examination Survey (INSEF) is a cross-sectional epidemiological study representative of the Portuguese population using a random sample (N = 4,911) aged between 25 and 74 years. Data collection included physical examination, blood collection and personal interview. Serum from participants’ blood samples was used for total cholesterol measuring, using the enzymatic method in accordance with international quality standards. Elevated cholesterol (EC) was defined as having a total serum cholesterol concentration ≥ 190 mg/dL or reporting taking lipid-lowering medication. EC estimated prevalence was stratified by sex, age, educational level and employment status. Adjusted prevalence ratios (aPR) were estimated using Poisson regression. Results: The overall prevalence of EC was 63.3 % [95 %CI:61.2-65.4]. Significant differences in EC prevalence between age groups were found: prevalence was twice higher among groups aged 55-64 (80.1 % aPR =2 [1.8-2.3]) and 65-74 (79.2 % aPR= 2 [1.7-2.3]) when compared to 25-34 (38.4 %). No significant differences were observed according sex, level of education, and employment status. 43.3 % [38.9-47.8] of the individuals taking lipid-lowering medication showed EC. Conclusions: INSEF results showed that 63.3 % of the Portuguese population aged between 25-74 years had total cholesterol above the desirable level. Among those under treatment, almost half was also EC. Although total cholesterol level should be evaluated considering other CV risk factors, lowering total cholesterol levels may contribute for reducing the burden of CV diseases in Portugal. Main messages: In Portugal 2/3 of adult population (25-74 years) has total cholesterol above desirable levels. Lowering total cholesterol levels may contribute for reducing the burden of cardiovascular diseases.