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

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 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 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. To investigate factors relevant with the issues of health and health promotion.

Roles of Survey Research on Health Promotion (Cont.) To provide information to program planners on health promotion To provide information to program planners on health promotion To monitor or to assess action program effects on health promotion To monitor or to assess action program effects on health promotion

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

 1992 National Medical and Health Expenditure Survey * National representative sample * National representative sample * Sample size: 4,994 households and 21,671 cases * Sample size: 4,994 households and 21,671 cases persons persons * Initiated by the National Health Insurance * Initiated by the National Health Insurance Bureau, DOH Bureau, DOH * Field works conducted by the Taiwan Provincial * Field works conducted by the Taiwan Provincial Institute of Family Planning Institute of Family Planning * Purpose: collected information for the planning * Purpose: collected information for the planning of national health insurance program of national health insurance program

 1994 National Health Interview Survey * National representative sample * National representative sample * Sample size: 3,814 households and about 15,000 persons * Sample size: 3,814 households and about 15,000 persons * Initiated by the Department of Health, Taiwan * Initiated by the Department of Health, Taiwan * Designed by the School of Public Health, National Taiwan University * Designed by the School of Public Health, National Taiwan University * Field works conducted by the Taiwan Provincial Institute of Family Planning * Field works conducted by the Taiwan Provincial Institute of Family Planning

2001 National Health Interview Survey: a brief introduction Specific Aim: 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 Time Period for Field Operation  Aug, 2001~Jan Response Rate Response Rate  6,721 households(91.4%)  25,464 persons(93.8%)

2001 NHIS: about questionnaire Questionnaires Questionnaires  Household questionnaire  Questionnaire for person aged 12 and above  Questionnaire for person aged under 12  Self-administered questionnaire for person aged (Health risk behavior, intimate behavior, drug abuse etc..) (Health risk behavior, intimate behavior, drug abuse etc..)  Self-administered questionnaire for person aged (WHO Quality of life questions simplified version) (WHO Quality of life questions simplified version) Design Procedure Design Procedure  Literature review  Mission of the survey  Health indicator demand  Draft  Reviewed by Experts  Pretest  Finalize

Comparison between 2001 and 2002 NHIS Survey SurveyComp 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 (Interviewed:25,464 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

Some Preliminary Results National Health Interview Survey- Center for Population and Health Survey Research Bureau of Health Promotion Department of Health, Taiwan

Health Status and Self- Care of Patients

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

Self-care behaviors of patients aged 20 and above who were diagnosed with chronic diseases, NHIS 2001

Question to Answer Do known hypertension patients have their blood pressure measured regularly?

Percentage of known hypertension patients who had their blood pressure measured less than once a month, NHIS 2001

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

Percentage of diabetic patients aged 20 and above who never had some required checks, NHIS 2001

Utilization of Medical and Preventive Care

Question to Answer What will Taiwanese people do when they don’t feel well?

Percentage of different treatments Taiwanese people seek for when they don’t feel well, NHIS 2001

Question to Answer How prevalent are preventive health care services used by people aged 12 and above?

Percentage of people aged 12 and above who never used preventive health care services, NHIS 2001

Percentage of women aged 30 and above who never used preventive health care services NHIS 2001

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

Percentage of children aged 4 and less who never used preventive health care services provided by NHI, NHIS 2001

Reasons of not using children preventive health care service, NHIS 2001

Health Promotion or Health Risk Behaviors

Question to Answer Are health risk behaviors common in Taiwan?

Percentage of people aged 12 and above with health risk behaviors, NHIS 2001

Question to Answer Have labels on pack been read when people buy foods in packs ?.

Percentage of people who never or seldom read the label on pack of food, NHIS 2001

Question to Answer When will children aged 6 and less brush teeth?

Time of brushing teeth (cleaning oral cavity) for children aged 6 and less, NHIS 2002

Healthy Environment in Household

Question to Answer Are people smoking passively at home?

Percentage of household having family or non-family members smoking indoors, NHIS 2001

Question to Answer Have anti-slippery installations been set up in bathroom at home?

Percentage of anti-slippery installations being set up in bath room, NHIS 2001

Dissemination of Analytical Results Research brief (2002,6~2002,7 ) Research brief (2002,6~2002,7 ) ( ( Research report ( ) Research report ( ) ( ( News release and press Conference ( ) News release and press Conference ( ) Taiwan PHA annual meeting ( ) Taiwan PHA annual meeting ( ) Taiwan PHA journal (Special issue) (2004~) Taiwan PHA journal (Special issue) (2004~) Health issue related conference (2002,7~) Health issue related conference (2002,7~) Data release for public use ( ) Data release for public use ( )

Current Focus on Data Analysis Define target population for health promotion program 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 Provide information for health promotion program planning Establish baseline indicators for surveillance Establish baseline indicators for surveillance

2002 National Survey on Health Promotion Knowledge, Attitude and Practice( HPKAP) Specific Aim Specific Aim 1. To provide basic information for BHP and city/county health bureau to plan for health promotion strategies 2. To establish city and county level baseline information for sequential assessment on efficacy of intervention program and future monitoring on health indicators 3. To provide basis for resources allocation.

2002 Health Promotion KAP Survey : Questionnaire Contents of 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

Comparison between 2001 and 2002 NHIS Survey SurveyComp NHIS 2002 NHIS (HP-KAP Survey) Represent Taiwan, 7stratum, aboriginal towns, off-shore islands Taiwan area, City/County Population Population of all ages 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 ( interviewed:25,464 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

2002 HAKAP: Survey Results Survey Results Survey Results * Response rate : * Response rate : ( 1) Vary by county/city ranging from ( 1) Vary by county/city ranging from 74.5 % to 89.9 % 74.5 % to 89.9 % (2) For the whole nation: (2) For the whole nation: 26,755 cases (81.9 %) 26,755 cases (81.9 %)

2002 HPKAP: Data Use 1. Publish 3 Volumes of research report 1. Publish 3 Volumes of research report Vol. 1: Health promotion indicators by county/city and sex 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. 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 ) Vol. 3: Age-sex-specific health indicators by county/city ( upcoming soon )

2002 HPKAP: Data Use ( cont.) 2. Press Release 2. Press Release 3. Provide information for program planning : 3. Provide information for program planning : Discussed with program planners to transfer survey Discussed with program planners to transfer survey research findings research findings 4. Invite university faculty and researchers to work with 4. Invite university faculty and researchers to work with county/city Health Bureau to analyze county/city data county/city Health Bureau to analyze county/city data and to produce county/city report and to produce county/city report 5. Set up baseline data for the assessment or 5. Set up baseline data for the assessment or evaluation of county/city achievement and program evaluation of county/city achievement and program achievement achievement

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