National Health Interview Survey in Taiwan

1
National Health Interview Survey in Taiwan

• Hui-Sheng (Harvey) Lin, Ph.D
• Associate Professor, Chung-Shan Medical
  University
• Consultant, Bureau of Health Promotion,
• Department of Health, Taiwan

2
Roles of Survey Research on Health Promotion

• To understand current status of physical and
  mental health, medical care utilization, primary
  health care, KAP of health promotion, Health risk
  behaviors, etc.
• To identify health and health promotion related
  issues and the population with the issues
• To investigate factors relevant with the issues
  of health and health promotion.

3
Roles of Survey Research on Health Promotion
(Cont.)

• To provide information to program planners on
  health promotion
• To monitor or to assess action program effects on
  health promotion

4
National Health Related Interview Survey ever
Conducted in Taiwan

• 1992 National Health Interview Survey in Taiwan
• a pilot study
• National representative
  sample
• Sample size 1,200
  households
• about
  4000 persons
• Initiated by the National
  Department of
• Health
• Designed by the School of
  Public Health ,
• National Taiwan University
• Field works conducted by the
  Taiwan
• Provincial Institute of
  Family Planning

5
1992 National Medical and Health Expenditure
Survey

• National representative sample
• Sample size 4,994 households and
  21,671 cases
• persons
• Initiated by the National Health
  Insurance
• Bureau, DOH
• Field works conducted by the
  Taiwan Provincial
• Institute of Family Planning
• Purpose collected information for
  the planning
• of national
  health insurance program

6
1994 National Health Interview Survey

• National representative sample
• Sample size 3,814 households and about 15,000
  persons
• Initiated by the Department of Health, Taiwan
• Designed by the School of Public Health,
  National Taiwan University
• Field works conducted by the Taiwan Provincial
  Institute of Family Planning

7
2001 National Health Interview Survey a brief
introduction

• Specific Aim
• To establish baseline information of health
  status, medical service utilization, health
  behavior and quality of life of Taiwan
  population.
• To provide reference information for policy
  making or program assessment
• To set up feasible mechanisms for future NHIS.
• Time Period for Field Operation
• Aug, 2001Jan. 2002
• Response Rate
• 6,721 households (91.4)
• 25,464 persons (93.8)

8
2001 NHIS about questionnaire

• Questionnaires
• Household questionnaire
• Questionnaire for person aged 12 and above
• Questionnaire for person aged under 12
• Self-administered questionnaire for person aged
  12-19
• (Health risk behavior, intimate
  behavior, drug abuse etc..)
• Self-administered questionnaire for person aged
  20-65
• (WHO Quality of life questions
  simplified version)
• Design Procedure
• Literature review?Mission of the survey ?Health
  indicator demand ? Draft?Reviewed by
  Experts?Pretest ?Finalize

9
Comparison between 2001 and 2002 NHIS
Survey Comp. 2001 NHIS 2002 NHIS (HP-KAP Survey)
Represent Taiwan, 7stratum, aboriginal towns, off-shore islands Taiwan area, City/County
Population Population of all ages Population aged 15
Sample Base on household Taiwan area 6,592 household aboriginal area 608 household Off-shore islands 432 household (Interviewed25,464 persons 93.8) Base on individual 32,656 persons
Contents Fewer questions on knowledge of and attitude toward health More questions on knowledge, attitude and practice
10
Some Preliminary Results -2001 National Health
Interview Survey-

• Center for Population and Health Survey Research
• Bureau of Health Promotion
• Department of Health, Taiwan

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Health Status and Self-Care of Patients
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Question to Answer

• Do hypertension patients, diabetic patients or
  high blood lipid patients have behaviors that
  will be harmful to their diseases control?

13
Self-care behaviors of patients aged 20 and above
who were diagnosed with chronic diseases, NHIS
2001
14
Question to Answer

• Do known hypertension patients have their blood
  pressure measured regularly?

15
Percentage of known hypertension patients who had
their blood pressure measured less than once a
month, NHIS 2001
16
Question to Answer

• Are diabetic patients monitoring progress of
  their diseases by having some required checks or
  examinations?
• Blood sugar
• Retina check
• Urine albumin check

17
Percentage of diabetic patients aged 20 and above
who never had some required checks,NHIS 2001
18
Utilization of Medical and Preventive Care
19
Question to Answer

• What will Taiwanese people do when they dont
  feel well?

20
Percentage of different treatments Taiwanese
people seek for when they dont feel well, NHIS
2001
21
Question to Answer

• How prevalent are preventive health care services
  used by people aged 12 and above?

22
Percentage of people aged 12 and above who never
used preventive health care services, NHIS 2001
23
Percentage of women aged 30 and above who never
used preventive health care services NHIS 2001
24
Question to Answer

• How much proportion of children never used
  preventive health care services provided by
  National Health Insurance.
• Why never used?

25
Percentage of children aged 4 and less who never
used preventive health care services provided by
NHI, NHIS 2001
26
Reasons of not using children preventive health
care service, NHIS 2001
27
Health Promotion or Health Risk Behaviors
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Question to Answer

• Are health risk behaviors common in Taiwan?

29
Percentage of people aged 12 and above with
health risk behaviors, NHIS 2001
30
Question to Answer

• Have labels on pack been read when people buy
  foods in packs ?.

31
Percentage of people who never or seldom read the
label on pack of food, NHIS 2001
32
Question to Answer

• When will children aged 6 and less brush teeth?

33
Time of brushing teeth (cleaning oral cavity) for
children aged 6 and less, NHIS 2002
34
Healthy Environment in Household
35
Question to Answer

• Are people smoking passively at home?

36
Percentage of household having family or
non-family members smoking indoors, NHIS 2001
37
Question to Answer

• Have anti-slippery installations been set up in
  bathroom at home?

38
Percentage of anti-slippery installations being
set up in bath room, NHIS 2001
39
Dissemination of Analytical Results

• Research brief
  (2002,62002,7)
• (http//ww.bhp.doh.gov.tw)
• Research report
  (2003.10)
• (http//nhis.nhri.org.tw)
• News release and press Conference (2003.10)
• Taiwan PHA annual meeting (2002.10)
• Taiwan PHA journal (Special issue) (2004)
• Health issue related conference (2002,7)
• Data release for public use
  (2003.10)

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(No Transcript)
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Current Focus on Data Analysis

• Define target population for health promotion
  program
• Who are the high priority target population in
  health promotion?
• What are the major issues in health promotion?
• Provide information for health promotion program
  planning
• Establish baseline indicators for surveillance

42
2002 National Survey on Health Promotion
Knowledge, Attitude and Practice( HPKAP)

• Specific Aim
• To provide basic information for BHP and
  city/county health bureau to plan for health
  promotion strategies
• To establish city and county level baseline
  information for sequential assessment on efficacy
  of intervention program and future monitoring on
  health indicators
• To provide basis for resources allocation.

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2002 Health Promotion KAP Survey Questionnaire

• Contents of Questionnaire
• Background information
• Age, sex, height, weight, education, working,
  marital status, ethnicity, religious, family
  structure, economic status
• Health status and morbidity
• Self-rating health, prevalence of important
  chronic disease, knowledge of important chronic
  disease, self-care of patients, hearing and sight
  impairment, physical function, depressive
  symptoms, menopause of women
• Medical care Utilization
• Use of Chinese, western and dental clinics,
  emergent and in-patient care, traditional
  treatment, preventive health care, screen of
  breast cancer and cervical cancer
• Health behavior
• Transportation safety, exercise, body weight
  control, diet habit, oral health, and risk
  behaviors(e.g. smoking, drinking, betel nuts
  chewing)
• Fertility, contraception and induced abortion
• Fertility, contraception and attitude toward
  induced abortion

44
Comparison between 2001 and 2002 NHIS
Survey Comp. 2001 NHIS 2002 NHIS (HP-KAP Survey)
Represent Taiwan, 7stratum, aboriginal towns, off-shore islands Taiwan area, City/County
Population Population of all ages Population aged 15
Sample Base on household Taiwan area 6,592 household aboriginal area 608 household Off-shore islands 432 household (interviewed25,464 persons 93.8) Base on individual 32,656 persons
Contents Fewer questions on knowledge of and attitude toward health More questions on knowledge, attitude and practice
45
2002 HAKAP Survey Results

• Survey Results
• Response rate
• (1) Vary by county/city ranging
  from
• 74.5 to 89.9
• (2) For the whole nation
• 26,755 cases (81.9 )

46
2002 HPKAP Data Use

• 1. Publish 3 Volumes of research report
• Vol. 1 Health promotion indicators by
  county/city and sex
• Vol. 2 Reasons of not using medical
  and preventive health care services as well as
  reasons of doing health risk behaviors and not
  doing health promotion behaviors by county/city
  and sex
• Vol. 3 Age-sex-specific health
  indicators by county/city (upcoming soon)

47
2002 HPKAP Data Use (cont.)

• 2. Press Release
• 3. Provide information for program planning
• Discussed with program planners to
  transfer survey
• research findings
• 4. Invite university faculty and researchers to
  work with
• county/city Health Bureau to analyze
  county/city data
• and to produce county/city report
• 5. Set up baseline data for the assessment or
• evaluation of county/city achievement and
  program
• achievement

48
Future Plan on NHIS

• ? 1.Conduct National Health Interview Survey in
  2005
• Combine 2001 NHIS and 2002 HPKAP
  Survey
• Needs to be county/city
  representative sample
• ? 2. Encourage county/city Health Bureau to use
  data
• for program planning
• ? 3. Conduct international comparison of NHIS
  results
• ? 4. Develop Computer Assisted Personal Interview
  for
• NHIS
• ? 5. Incorporate biological marker examination by
  using
• NHIS sample cases