2018 community health survey...summers of 2016, 2017, and 2018, few question changes •...

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2018 Jefferson,

Lewis, and St.

Lawrence Counties ‒ Community Health

Adult Survey

Presentation of

Findings

August 28, 2018

Today’s Agenda:1. What was this study?

2. How was the study completed?

3. How to best use survey results.

4. The findings for this study.

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What? Three-County - Adult

Health-Related Survey

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• Survey completed in

summers of 2016, 2017,

and 2018, few question

changes

• Three-county target

sample size of n≈1,500

(J=550; L=402; SL=552)

• Residents age 18+

• Telephone & Intercept at

Fort Drum methodology

(Cells+LL’s)

• Weighted toward

population demographic

parameters within each

of 3 counties, as well as

regionally combined

• Questions related to

regional health-planning

goals

What? Survey ItemsThe interviews included three primary sections of health-related survey questions (total of ≈50 questions) listed below, all which are related to NC Health Compass and FDRHPO goals and workplans; as well as demographic characteristics of participants.

Survey Sections:1 – Participant’s Experiences with Healthcare (13 survey questions)2 – Participant’s Personal Health (14 survey questions)3 – Participant’s Lifestyle (9 survey questions)4 – Demographics (13 survey questions)

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How? Methodology→ Telephone survey, instrument developed by NCHC, FDRHPO,

and JL.

→ ≈50 survey questions (≈40 health-related, ≈10 demographics)

→ Calls made between 3:00-9:00 p.m., M-F; June 2018

→ Random residential landline and cellular numbers

→ After weighting: 41% cellular, 28% are “cell-only”

→ Intercept of Fort Drum (June 2018): 25% in Jefferson

→ Design Effect ≈ 1.9

→ All calls made by FDRHPO employees trained in Human Subject

Research laws and effective interviewing techniques, from a

call center in Watertown, NY

→ adult participants (18+ years of age)

→ ≈30% response rate, depending upon county and modality

→ Margin of Error: → approximately ±2.8% for the three-county region

→ Margin of Error is larger than ±2.8% when investigating smaller

subgroups (such as only one county, or only males,…)

→ Telephone interviewing selected as the sampling protocol since

it is far less susceptible to bias, and often-times less expensive,

than: Mail surveys; Intercept (face-to-face) surveys; Focus groups; Online surveying

Sample Size

(n=…)

Approximate

Margin of

Error

50 ±15.2%

75 ±12.4%

100 ±10.7%

125 ±9.6%

150 ±8.8%

175 ±8.1%

200 ±7.6%

250 ±6.8%

300 ±6.2%

350 ±5.7%

400 ±5.4%

450 ±5.1%

500 ±4.8%

550 ±4.6%750 ±3.9%

1000 ±3.4%

1500 ±2.8%

Margins of Error for

Varying Sample Sizes

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How? Margin of Error→ The following graph more easily illustrates the relationship between sample size and

the margin of error.

→ Diminishing returns

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How? So, was this methodology

effective? The nature of our sample,

combined in the region:

→ Gender: Raw: 61% female Weighted: 48% female

→ Age: Raw: 39% age 65+ Weighted: 18% 65+

→ Education: Raw: 27% Bach+ Weighted: 21% Bach+

→ Race: Raw: 94% White Weighted: 88% White

→ Income: Raw: 31% $75,000+ Weighted: 31% $75,000+

→ Military Affiliation Raw: 28% AM+Vet in HH Weighted: 31% AM+Vet in HH(Jefferson=41%) (Jefferson=46%)

→ Insuredness: Raw: 11% Medicaid Weighted: 15% Medicaid

Raw: 36% Medicare Weighted: 22% Medicare

Raw: 2% Uninsured Weighted: 3% Uninsured7

How? Preceding slides have

addressed minimizing three of the four

common types/sources of error in

survey research.

→ Sampling Error

→ Measurement Error

→ Random Error

→ Interpretation Error (addressed later in the “Best Uses” section of this presentation)

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The standard professional survey research analyses:

1. Within response scale interpretation.

2. Trend Analyses Comparison to past studies.

3. Comparison to the current regional average

prevalence for each question.

4. Comparison to some target or benchmark.

5. Correlation Analyses – potential demographic

key drivers (independent variables).

6. Relative standing among like-variables

measured on common scale.

Best uses? “Framing a Statistic”

Best uses?

25.310

Best uses?

25.3%(“At least once” in three-county region combined)

“How many times in the past 12 months have

you received care in an emergency room

(because you were sick or injured)?”

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Best uses?– “Framing” the Statistics

1. One-in-four “at least once”, therefore, three-in-four did not visit ER!

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2. Regionally: “2+” decreased significantly between

2016-2018 … notice the “a” and “b” (county-specific

trends below):

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3. Compare any county to the

regional average, or to one

another.

4. Comparisons to targets or

benchmarks not possible … yet.

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5. 35 tables (survey questions)*30 independent variables*4

geographic levels ≈ 4,000 unique cross-tabulations tables have

been included in this study

(not counting trend XTABS, or county-comparison XTABS).

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Here are a few of them (from Appendix II)…..

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5. Report includes XTAB

summaries graphically

portrayed:

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6. There are three “frequency-of-acquiring-healthcare” survey items

included … framing by comparing frequency:

Best uses?

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Available today:

• Survey Instrument

• Data File in SPSS

• Final Study Report

• County

Comparisons

• Regional Aggregate

for Comparison

• Both Within-County,

and Regional,

Cross-tabulations

20 pages

of survey

Pause to collect:1. What was this survey?

2. How was the survey completed?

3. How to best use survey results.

KEVIN: What are the findings for this

study? – “Let’s explore”

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2018 Community Health Survey Results

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New Questions for 2018

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• Going beyond a follow-up appointment: Do doctors do more to help patients improve their health?

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• How do patients prefer to communicate with their source of primary care?

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• Do adults know what community health workers do?

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• How do patients with chronic conditions rate their treatment options?

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• How do patients with chronic conditions rate their treatment options?

• What is the community’s opinion on the role of schools in student health?

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New Questions for 2018 (continued)

• How many adults are aware of drug disposal locations?

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• How common is chronic pain?

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• How often do adults visit their source of primary care?

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• How do adults rate their families’ access to exercise opportunities and healthy foods?

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• How do adults rate their families’ access to exercise opportunities and healthy foods?

• How many adults have difficulty getting around when they need to travel by car?

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“This could include opportunities like peer support groups, educational programs, exercise routines, counseling, or any other activity meant to improve your health.”

Note: This question was asked only of the 83% of respondents who said that they had a primary care provider.

“More than scheduling a follow-up…”

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Which of the following would you like to use to communicate with your doctor or medical office? (Choose all that apply.)

Communicating with Source of Primary Care

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Which of the following would you like to use to communicate with your doctor or medical office? (Choose all that apply.)


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Community Health Workers

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Note: This question was asked only of the 23% of respondents who said that they understand what Community Health Workers do.


Rating Treatment for Chronic Conditions

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4%9%

4% 5%

22%

8%

64%

0%

20%

40%

60%

80%

100%

Pre-diabetes Diabetes COPD Heart disease High blood pressure Any mental healthcondition

None

Chronic Conditions Diagnosed by a Health Professional


• Asked only of those who report a diagnosis

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• Pre-diabetes: 89% excellent/good

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• Diabetes: 90% excellent/good

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• COPD: 85% excellent/good

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• Heart disease: 85% excellent/good

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• High blood pressure: 90% excellent/good

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• High blood pressure: 90% excellent/good

• Mental health: 64% excellent/good

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36%45%

39% 41%49%

22%

53%45%

46% 43%

41%

42%

7% 6%

2% 4%2%

8%

3% 5%13% 12% 8%

28%

0%

20%

40%

60%

80%

100%

Pre-diabetes Diabetes COPD Heart disease High blood pressure Any mental healthcondition

Treatment Rating by Chronic Condition

Excellent Good Don't know Fair/Poor

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Chronic Pain

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Chronic Pain

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Primary Care Visits

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Primary Care Visits

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25%

21%

54%

24%

21%

55%

22%23%

55%

26%

20%

54%

0%

10%

20%

30%

40%

50%

60%

No visit 1 visit 2 or more visits

Primary Care Visits (Past 12 Months)

Region Jefferson Lewis St. Lawrence

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75%

17%

8%

76%

17%

8%

81%

14%

5%

72%

19%

9%

0%

20%

40%

60%

80%

100%

No visit 1 visit 2 or more visits

Emergency Department Visits (Past 12 Months)


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86%

11%

3%

85%

11%

5%

87%

11%

2%

87%

11%

2%

0%

20%

40%

60%

80%

100%

None 1 admission 2 or more admissions

Hospitalizations (Past 12 Months)


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Schools & Student Health

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Schools & Student Health

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Drug Disposal Use & Awareness

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Drug Disposal Use & Awareness

Tobacco Use Status

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Tobacco Use Status

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Using Tobacco "Some Days" or "Every Day"

All Participants = 24%

Fewer Users More Users

Women (14%) Men (32%)

Age 55-74 (17%) Age 18-34 (34%)

Age 75+ (5%)

4+ Year Degree (12%) No College (31%)

Non-military households (21%) Active Military Households (36%)

Non-Medicaid (21%) Medicaid (40%)

Active Transportation

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Active Transportation

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Access to Exercise Opportunities

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Access to Exercise Opportunities

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Access to Healthy Foods

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Access to Healthy Foods

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Accessibility of Auto Transportation

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Accessibility of Auto Transportation

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Trends

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Trends: Fewer Seeking Care in ER

• “When you or a family member has a fever of 101, where do you generally go for medical attention?”

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Trends: Fewer Seeking Care in ER

• “When you or a family member has a fever of 101, where do you generally go for medical attention?”

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Trends: More Have Usual Source of Primary Care• “Do you have one person or medical office that you think of as your

personal doctor or health care provider?”

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Trends: More Have Usual Source of Primary Care• “Do you have one person or medical office that you think of as your

personal doctor or health care provider?”

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Trends: More Have a Recent Dentist Visit

• “How long has it been since you last visited a dentist or a dental clinic for a routine cleaning?”

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Trends: More Have a Recent Dentist Visit

• “How long has it been since you last visited a dentist or a dental clinic for a routine cleaning?”

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Trends: Reduced Hospital Use

• “How many times in the past 12 months have you received care in an emergency room?”

• “How many times in the past 12 months have you been admitted to a hospital?”

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• “How many times in the past 12 months have you received care in an emergency room?”

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• “How many times in the past 12 months have you been admitted to a hospital?”

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Trends: More Physical Activity (Walking)

• “How much time do you spend walking as a part of your normal routine on a typical day?”

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Trends: More Physical Activity (Walking)

• “How much time do you spend walking as a part of your normal routine on a typical day?”

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Other Highlights

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Who isn’t getting to the doctor?

• “Was there a time in the past 12 months when you needed to see a doctor but did not?”• 23% say “yes,” including 18% in St. Lawrence County, 19% in Lewis County,

and 28% in Jefferson County

• Most likely to say so: 31% of adults age 18-34 and 43% of adults in active military households

• Least likely to say so: 55 or older (13%)

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Screenings: Breast Cancer

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Note: Includes women ages 50 to 75.

Screenings: Colorectal Cancer

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Note: Includes adults ages 50-75.

Questions & Discussion

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2018 community health survey...summers of 2016, 2017, and 2018, few question changes •...

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