The reliability of the Minimum European Health Module TF-HE 3/12/2007 Bianca Cox Herman van Oyen

Overview ●Introduction ●Data ●Analyses ●Results ●Discussion

Introduction ●The Minimum European Health Module (MEHM) is adopted as an essential part of the European Health Survey System (EHSS) ● The annual MEHM should be included in all health and health- related surveys: e.g. the inclusion of the MEHM in the social survey on Statistics on Income and Living Conditions (SILC) from 2004/2005 onwards ● The inclusion of the MEHM in the European Health Interview Survey (EHIS), to be held every 5 years and planned to be undertaken in all EU Member States in the period 2008/2009

Introduction ●The MEHM is a short instrument (3 global questions) to obtain information on 3 health domains: ● Self-perceived health (SPH): appears to be an effective summary of health and has been shown to be a strong predictor of future functional limitations, cognitive impairment and mortality ● Chronic (long-standing) conditions: affect the health-related quality of life and are one of the major causes of utilisation of the health services ● Long-term activity limitation (GALI): most sensitive to personal care activity restrictions and less sensitive to functional limitations that are not associated with activity restrictions. The new structural indicator of the European community, Healthy Life Years (HLY) will be calculated yearly based on the GALI question from SILC data

Introduction ●Contrary to the prominent position of the MEHM within the European Health Survey System, there are only a few papers describing an assessment of the MEHM  Objective of this study: to evaluate the reliability of the MEHM, one concept of validity, by means of a test-retest procedure

Data ●Belgian Food Consumption Survey 2004: ● Twice repeated 24-h recall to obtain information on food consumption ● Time span of 2 to 8 weeks between the 2 interviews ● MEHM administered as part of a self completion questionnaire to a subsample of 170 individuals (in French or Dutch) ●Equal representation of individuals according to factors which might influence reliability: gender, age, education, language, time span between the interviews

Data Sample composition:

Analyses ●2 Measures of agreement: ● Pearson correlation coefficients: values between 0.7 and 0.8: acceptable reliability ● Kappa coefficients: values < 0.40: poor agreement values between 0.40 and 0.74: good agreement values > 0.74: excellent agreement  WEIGHTED Kappa for health indicators with >2 response categories since agreement between e.g. replies “ 1 ” and “ 2 ” is higher than agreement between replies “ 1 ” and “ 3 ” * 5-category indicator SPH: weights 1.00, 0.75, 0.50, 0.25, 0.00 * 3-category indicator GALI: weights 1.00, 0.50, 0.25

Results: Raw data

Results: Measures of agreement

Results ●Total sample: ● All Pearson correlation coefficients > 0.70: acceptable reliability ● All Kappa coefficients > 0.65: good to excellent agreement ●Stratified: ● All Pearson correlation coefficients > 0.70, except for GALI in 3 strata: females, age 15-64, time span <=20 days ● All Kappa coefficients > 0.60, except for GALI in 2 strata: females, age ●Significant differences in Kappa between: ● Dutch and French language for SPH (difference in Kappa = 0.21, p = 0.05) ● Males and females for GALI (difference in Kappa = 0.28, p = 0.03)

Discussion ●Acceptable reliability for the 3 global health questions according to both Pearson correlations and Kappa coefficients ●Highest reliability for SPH according to Pearson ●Highest reliability for chronic conditions according to Kappa ●Higher agreement for males than for females (although only significant for GALI) Analyses on French data: women more inclined to report activity limitation than men, lower levels of limitation are subject to greater variability than more severe levels ●Higher agreement for time span >20 days between the interviews than for time span <=20 days (although not significant)

Discussion ●Given the importance of the MEHM within the European Health Survey System and the cultural and language differences within Europe  important that these and other indicators of the quality of the MEHM are documented within other populations.