Sample selection, recruitment and participation rates in health examination surveys in Europe – experience from seven national surveys
Creators: name: Mindell, Jennifer S.
name: Giampaoli, Simona
name: Gößwald, Antje
name: Kamtsiuris, Panagiotis
name: Mann, Charlotte
name: Männistö, Satu
name: Morgan, Karen
name: Shelton, Nicola J.
name: Verschuren, WM Monique
name: Tolonen, Hanna
Publisher: name: Robert Koch-Institut, Epidemiologie und Gesundheitsberichterstattung
Year: 2015
Subjects: subject: Europe
subject: Response
subject: Recruitment
subject: Health examination survey
subject: Sampling frame
subject: Sample size
subject: Eligibility
subject: Incentives
subject: Participation rates
subject: 610 Medizin

description: Background: Health examination surveys (HESs), carried out in Europe since the 1950’s, provide valuable information about the general population’s health for health monitoring, policy making, and research. Survey participation rates, important for representativeness, have been falling. International comparisons are hampered by differing exclusion criteria and definitions for non-response. Method: Information was collected about seven national HESs in Europe conducted in 2007–2012. These surveys can be classified into household and individual-based surveys, depending on the sampling frames used. Participation rates of randomly selected adult samples were calculated for four survey modules using standardised definitions and compared by sex, age-group, geographical areas within countries, and over time, where possible. Results: All surveys covered residents not just citizens; three countries excluded those in institutions. In two surveys, physical examinations and blood sample collection were conducted at the participants’ home; the others occurred at examination clinics. Recruitment processes varied considerably between surveys. Monetary incentives were used in four surveys. Initial participation rates aged 35–64 were 45 % in the Netherlands (phase II), 54 % in Germany (new and previous participants combined), 55 % in Italy, and 65 % in Finland. In Ireland, England and Scotland, household participation rates were 66 %, 66 % and 63 % respectively. Participation rates were generally higher in women and increased with age. Almost all participants attending an examination centre agreed to all modules but surveys conducted in the participants’ home had falling responses to each stage. Participation rates in most primate cities were substantially lower than the national average. Age-standardized response rates to blood pressure measurement among those aged 35–64 in Finland, Germany and England fell by 0.7-1.5 percentage points p.a. between 1998–2002 and 2010–2012. Longer trends in some countries show a more marked fall. Conclusions: The coverage of the general population in these seven national HESs was good, based on the sampling frames used and the sample sizes. Pre-notification and reminders were used effectively in those with highest participation rates. Participation rates varied by age, sex, geographical area, and survey design. They have fallen in most countries; the Netherlands data shows that they can be maintained at higher levels but at much higher cost.