2 nd training seminar on measurements of the health examination surveys

2nd Training seminar on measurements of

the health examination surveys

Ana Paula Gil

Carlos Matias Dias

Instituto Nacional de Saúde, Dr Ricardo Jorge

2nd Training seminar – Helsinki, 20-22 September 2010

Introduction

First steps towards a Health Examination Survey in Portugal

Preliminary results of the pilot phase

EHES PORTUGUESE PILOT

STEP 1 of the survey: planning

The 1st phase of the survey consisted in translation and adaptation to

Portuguese of procedures defined by FEHES (2008), regarding blood

collection, physical examination and construction of questionnaires.

INPUTS for the questionnaires construction

oCore questions proposed by FEHES

oInputs by Regional Health Administrations (ARS)

oInputs from researchers with ongoing projects funded by the Portuguese Science and Technology Foundation at INSA



Items in questionnaire

Questionnaire 1 Administered by a health

professional

• Health status; chronic/acute

diseases

• Functional evaluation

• Use of medications

• Woman Health

• Mental health (MHI-5)-

psychological stress

• Use of Healthcare services

Questionnaire 2

Self- administered

•Socio-demographic and household

•Physical activity

•Tobacco consumption

•Alcohol Consumption

•Eating habits

•Sun exposure and protection habits

•Quality of life

•Social Support / social relations

•Health services evaluation



Health survey with physical

examination

Technical specifications Recording instruments

Blood collection Definition of procedures: Blood Processing and storage samples blood

Record sheet of blood collection.

Physical examination Definition of procedures : Height Weight Waist/hip circumference Blood pressure

Registration sheets for use during physical examination.

Interview Survey Manual: 1. Questions and answers about health surveys with physical examination 2. Basic rules of health survey o Rules for approach to participants (informed consent) o Fill rules 3. Questionnaire I and II:

oObjectives oStructure and questionsoFill rules for each question

Questionnaire 1 – administered by a health professional.

Questionnaire 2 – self administered.

STEP 2 of the survey: process definition and data collection instruments



STEP 3 OF THE SURVEY: training program The overall process of training included 4 days, along two consecutive weeks.

1. Session

Introduction

(3 hours)

EHES: objectives, relevance, methods and core

measures, standardization of procedures (training and

quality control)

Survey

process

(3 hours)

The general description of the survey process:

oSelection of participants;

oBehavioral strategies to adopt towards non-

participants

oDaily work tasks namely preparation of materials and

equipments;

oReception of participants (general information and the

informed consent)2nd Training seminar – Helsinki,

20-22 September 2010EHES PORTUGUESE PILOT

STEP 3 OF THE SURVEY: training program

2ºSession

Blood

Collection(3h)

Safety: Practical measuresDescription of procedures:• Blood collection • Storage and packages• Transport preparation

Practical exercises (role play)Register of printed sheetsMaterial: Procedures manual

3º Session

Physical Examination

(3h)

Procedures descriptionoHeight oWeight oWaist/hip circumference oBlood pressure

Practical exercises (role play)Register of printed sheetsManual: Procedures manual



STEP 3 OF THE SURVEY: training program

4º Session(6h)

Interview

o Basic rules of health survey o Composition of two questionnaires I and II:objectives, composition and fill rules.

Each questionnaire was preceded by a descriptive component, succeeded by practical exercises.

Material: Survey manual

5º Session

Role play

oTest all survey process (since the reception of the participant until carrying out of examinations, interview by questionnaire)

oThis essay was videotaped and discussed interactively by the group of trainees in order to identify difficulties, questions and points to be improved to implement during the pilot phase



Time: The field work took place from 24th May to 2 July 2010 (6 weeks, on working days). Activities began at 8.00 am and ran until 12.00 am.



STEP 4 OF THE SURVEY: fieldwork

Survey sites: Health centre of São Brás de Alportel

(Regional Health Administrations (ARS) The Health centre is 18 Km from Faro

Field team was composed of 7 professionals, all from the staff of the São Brás

de Alportel Health Centre:

•2 nurses working (health centre of São Brás de Alportel)

•Local staff (1 receptionist, 1 telephonist, 1 administrative)

•1 Blood technician (Regional Public Health Laboratory)

•1 element to support at breakfast

EHES PORTUGUESE PILOT2nd Training seminar – Helsinki,

20-22 September 2010


Participants by sex


Participants: 221

Participants according to age groups

Planned

Times

Average

times/minutes

Informed consent 10 5,11

Measurement of body height 3 3,1

Measurement of body weight 3 3,1

Measurement of waist and hip

circumferences 5 3,19

Measurement of Blood Pressure 15 6,25

Blood collection 15 15

Questionnaire administered by

professional _ 10,24

Self administered Questionnaire

(without help) _ 29,86

Self administered Questionnaire (with

help) _ 21,52

Times shown for each stage of the survey




Questionnaire 1

Administered by a health professional

Strengths:

oGood preparation of the survey manual, as well as the instruments to apply;

o Simple and objective language;

oDifferent strategies depending on the participant profile (illiterate, foreigners)


Problems:

oQuestions about chronic diseases - It is very exhausting reading all the

diseases. Generally, people don´t know the technical name of the diseases.

Recommendations:

o Review some questions/ (confirm with the data analyses);

oIncrease the numbers of training hours (interview);

o More time to role play, practices and group discussion.

Questionnaire 2 – self administered

Problems:

o Very detail;

o Very long;

o Difficulty in understanding some questions

Recommendations:

o Review some questions/ (data analyses)



o If it opts for the same structure and content of questions, their use will require more human resources available that may assist in administration.

o It is recommended that the support of this questionnaire is administered in another room prepared for this purpose, and not in the waiting room, so as to respect the privacy of the participants; oAcoustics of the rooms, even with the door closed, sometimes, it is possible to understand the type of questions and answers of the participants.

Synthesis conclusive: "Teachings" pilot and improvement plan

1. Announcement of the health survey with physical examination

2. Autonomous health team

3. Suitable areas for survey (examination and interview)

4. Review part of instruments

5. Improvements in the some procedures (blood collection and physical exam)



2 nd training seminar on measurements of the health examination surveys

Documents

training program

overall process of training

portuguese of procedures

health surveys

portuguese science

interview survey manual

blood processing

process definition