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COMMON METHODS AND
INSTRUMENTS FOR HEALTH
INTERVIEW SURVEYS IN
EUROPE
Report of the WHO EUROHIS Mid-term Review
Copenhagen, Denmark 2–4 November 2000
2001
international comparisons of the results. The WHO Regional Office for Europe, working with 54 organizations in 35 countries in the WHO European Region, is tackling this problem through the project on common health interview surveys in Europe (EUROHIS). Within the current phase of the project, planned to end in December 2001, and co-sponsored by the BIOMED2 programme of the European Commission (EC), the EUROHIS Mid-term Review was held to examine the progress made in developing common instruments for seven indicators and decide on the action to take to complete the project. The participants discussed the draft instruments and agreed on the changes required. They recommended further field-testing for these instruments, along with those of the previous phases of the project, and their implementation, preferably as a group, in countries’ health surveys.
Finally, they asked WHO to urge all European Member States to use the final package of instruments in their health surveys.
Keywords
HEALTH SURVEYS
DATA COLLECTION – methods – standards INTERVIEWS – methods
PROGRAM EVALUATION EUROPE
©World Health Organization – 2001
All rights in this document are reserved by the WHO Regional Office for Europe. The document may nevertheless be freely reviewed, abstracted, reproduced or translated into any other language (but not for sale or for use in conjunction with commercial purposes) provided that full acknowledgement is given to the source. For the use of the WHO emblem, permission must be sought from the WHO Regional Office. Any translation should include the words: The translator of this document is responsible for the accuracy of the translation. The Regional Office would appreciate receiving three copies of any translation. Any views expressed by named authors are solely the responsibility of those authors.
WHO Regional Office for Europe, Copenhagen
Project on common health interview surveys in Europe ...1
EUROHIS Mid-term Review ...2
Progress on the draft instruments and changes needed...2
Pre-testing of the draft instruments ...3
Indicator 1. Chronic physical conditions ...4
Indicator 3. Alcohol consumption...4
Indicator 4. Physical activity...5
Indicator 5. Use of curative medical services...6
Indicator 6. Use of medicines...7
Indicator 7. Use of preventive health care ...8
Indicator 8. Health-related quality of life ...8
Stage B of the EUROHIS project...9
Conclusions ... 10
Recommendations ... 10
Annex 1. Principal investigators and active participants in EUROHIS indicator networks ... 11
Annex 2. Working papers and background documents... 13
Annex 3. Participants ... 14
Annex 4. Other participants in EUROHIS project... 23
Project on common health interview surveys in Europe
The availability of internationally comparable health data is important for national discussions on health policies. Such data can highlight real variations in health status and the factors
affecting health across countries, and can then guide policy-related discussions on best practices to improve the health of populations. As the importance of health information systems for
decision-making has increased, health interview surveys remain a unique source of data for some essential indicators. At present, however, making valid international comparisons of survey results in Europe is virtually impossible, because of the large variations in design and techniques used. The WHO Regional Office for Europe is tackling this problem through the project on common health interview surveys in Europe (EUROHIS). The current phase of the project is co- sponsored by the BIOMED2 programme of the European Commission (EC). The overall objective of EUROHIS is to develop and promote the use of common instruments in health interview surveys in European countries. The specific objectives are:
• to develop recommended common survey instruments and to promote their use in national health interview surveys; and
• to collate and adjust data already collected by countries and to determine their potential for international comparison.
EUROHIS aims at developing recommended common instruments for eight indicators:
1. chronic physical conditions 2. mental disability
3. alcohol consumption 4. physical activity
5. use of curative medical services 6. use of medicines
7. use of preventive health care 8. health-related quality of life.
The WHO Regional Office for Europe coordinates the project and works with organizations in 35 countries in the WHO European Region. For each indicator, a network of interested institutions with specific expertise in the area (active participants) has been formed, and is managed by a principal investigator (see Annex 1). The principal investigators, along with WHO staff as project coordinators and EC staff as observers, make up the project’s scientific and management board. The board makes the main decisions about the implementation of the project.
EUROHIS began as a cooperative initiative of the Regional Office and Statistics Netherlands in 1987; since 1998 it has continued as an EC-supported concerted action, with a work plan and funding for three years. The current phase will end in December 2001.
The networks have done considerable work in developing draft instruments for the indicators. For 7 of the 8 indicators, the following tasks have been completed:
1. preparatory exploration and definition of the relevant concept(s) to be measured, indicator by indicator;
2. a wide-ranging review (by means of a written consultation) of existing methods and instruments used in national surveys (including specialized surveys) to measure each indicator (the so-called 'survey of surveys')
3. definitive clarification of the concepts to be included in the draft EUROHIS instruments;
4. formulation of cross-national questionnaire items for the common instruments; and 5. preliminary field-testing of the instruments (so-called pre-testing).
Five of the eight indicators were combined into a single instrument and pre-tested in
September/October 2000 on small samples (typically n=20) in 17 countries: mostly countries of central and eastern Europe (CCEE) and newly independent states of the former USSR (NIS).
Some of the instruments were also tested on larger samples as part of other international research projects. (For indicator 2, mental disability, no further work had been carried out after the completion of the survey of surveys, due to staff changes at the principal investigating institution.)
EUROHIS Mid-term Review
At the midpoint of the current phase of the project, the Regional Office held the EUROHIS Mid- term Review in November 2000. The objectives were to examine the progress made in
developing common instruments for seven of the eight project indicators, to decide on means for their further refinement and testing and to agree on the action to take to complete the project.
Annex 2 lists the working papers for the Review. Annex 3 lists the Review participants, who represented 27 countries in the WHO European Region, and included the EUROHIS active participants and principal investigators, as well as survey managers from CCEE and NIS who had pre-tested the draft EUROHIS instruments, and staff of WHO and the Organisation for Economic Co-operation and Development (OECD). Annex 4 lists the remaining EUROHIS participants, who were not able to attend the Review.
Dr Anca Dumitrescu, Director of the Evidence, Information and Communication Division at the Regional Office, welcomed the participants on behalf of the WHO Regional Director for Europe. She stressed the importance of the EUROHIS project in the context of the current reforms in the Regional Office. EUROHIS could help countries collect data that would be useful both to monitor health and health determinants at the national level and to enable countries to take advantage of international comparisons and best practices in the development of their health policies.
An additional purpose for the Review was for the participants to consider opportunities for cooperation with information-gathering initiatives by WHO headquarters and OECD. The former has a large programme to obtain comparable health data worldwide through the promotion of a common framework for reporting, which would be considered by the WHO Executive Board and the World Health Assembly in 2001. The latter has a similar goal for its member countries
through the further development of OECD Health Data.
Progress on the draft instruments and changes needed
The first scientific session consisted of a review of the methodology used in the pre-testing of the draft instruments and the main results. After this, for each indicator in turn, the principal
investigator reviewed the development of the instrument and the main findings from pre-testing, and then a workshop was held to allow a smaller group of participants more detailed discussion of the items within the instrument and the need for any changes. The resulting conclusions and recommendations were then reported and discussed in plenary sessions.
Pre-testing of the draft instruments
The pre-testing sought to detect any problems in the interview process or any factors that might lead to measurement error (in sampling, data processing or analysis), as well as indicate the relevance and practical feasibility of the draft instruments. Results of pre-testing in 15 countries were reviewed: Bosnia and Herzegovina, Bulgaria, the Czech Republic, Estonia, Finland, Hungary, Latvia, Lithuania, the Netherlands, Romania, the Russian Federation, Slovakia, Slovenia, Spain and Ukraine. (Pre-testing was also carried out in Italy and the former Yugoslav Republic of Macedonia; these reports became available later.)
The methods used in the joint pre-test exercise varied, including differences in the place and mode of interviewing, the way of recruiting respondents, and the level and structure of follow-up or check questions. The number of respondents ranged from 10 in the Russian Federation to 133 in Bulgaria; most countries used about 20, which proved to be sufficient to identify the main issues. As much as possible, the instruments were tested as a group; different numbers of
countries, however, tested different combinations of instruments (Table 1). The pre-testing raised several issues for discussion by the Review participants. The general conclusions that could be drawn for most countries were that:
• translation of the instruments required special care;
• the more general the level of measurement, the fewer the errors of detail; and
• the instruments should be considered together as one questionnaire, which should be as short and as balanced as possible and required adaptation to the interview mode.
Table 1. Pre -testing of draft instruments:
numbers of countries and combinations of instruments Indicators covered
Number of
countries Total Names
7 5 1. Chronic physical conditions
5. Use of curative medical services 6. Use of medicines
7. Use of preventive health care 8. Health-related quality of life
5 6 1. Chronic physical conditions
4. Physical activity
5. Use of curative medical services 6. Use of medicines
7. Use of preventive health care 8. Health-related quality of life
1 4 1. Chronic physical conditions
5. Use of curative medical services 7. Use of preventive health care 8. Health-related quality of life
1 3 1. Chronic physical conditions
7. Use of preventive health care 8. Health-related quality of life
Indicator 1. Chronic physical conditions
The survey of surveys showed 18 surveys in 17 countries using 15 check-lists of chronic conditions. Countries generally agreed on the definition of chronic physical conditions; most used hospital statistics and some used registers andad hoc epidemiological surveys to gather data. In general, however, data from different sources were not comparable.
The network drafted the instrument in two parts: first, a general question to elicit
respondents' perceptions as to whether they had a chronic condition and second, a section with five questions about whether the respondents had specific conditions, which had been diagnosed and treated within the past 12 months. The conditions listed were chosen for their high
prevalence and social relevance, as well as being well defined conditions or diseases.
Pre-testing took place as part of the joint exercise, and focused on question sequence and wording, structure level, memory problems and filters. The results in general were good, but indicated the need for some revisions to the second section. The network members suggested a change in the order of the conditions, and further questions about asthma and skin diseases. Of the disease-specific questions, the one asking about diagnosis by a physician worked well, but the question on drugs and/or therapy was considered to need revision, and the 12-month reference period was questioned.
Discussion and next steps
In discussing the draft instrument, the workshop participants agreed on the relationship of the two sections: the first was not a filter for the second; the former was more subjective and the latter more objective. They agreed to retain the general question as it was, and noted the effectiveness of its use of the term longstanding illness or health problem, rather than chronic condition. For the next stage of the work, the participants agreed that the network should make several changes to section two: shortening the list of conditions to 7–8 items and revising the sub-questions. Some of these could perhaps be optional.
The recommended next step for this indicator would be further field-testing, but the network also expressed an interest in extending the survey of surveys to create a database of survey methods and instruments and to identify the data existing in countries for this indicator.
Indicator 3. Alcohol consumption
The survey of surveys revealed a huge difference in the topics and content of instruments on alcohol consumption, In addition, the survey of surveys and a compilation of other research showed that most surveys ignored the three most important factors in alcohol-related health risks: volume of consumption in particular periods, the prevalence of binge drinking on
particular occasions and the occurrence of drinking in high-risk contexts, such as road traffic, the workplace and certain leisure activities. The survey of surveys also highlighted the wide
differences in drinking cultures in Europe and the consequent difficulties in adjusting existing data for comparison.
The instrument on alcohol consumption was developed differently from those for most of the other EUROHIS indicators. The network devised the instrument, and then revised, translated and tested it in collaboration with the European Comparative Alcohol Study (ECAS). The draft instrument was available in six languages. Field-testing included a qualitative element (protocol analysis) and inclusion of the instrument in the ECAS questionnaire, used in France, Germany, Finland, Italy, Sweden and the United Kingdom. The protocol analysis showed the differences between countries in cultural interpretation and the use of cognitive strategies. ECAS revealed a
serious and nearly universal problem with respondents’ under-reporting their drinking. Self- reports, however, can be validated by comparison with statistics on consumption.
The network’s proposed instrument covered the three main health-related aspects of drinking (volume of consumption, binge drinking and drinking in different contexts), preceded by a question as to whether respondents drink at all, and followed by a possible alternative section. This allowed adjustments to cope with country differences in beverage types and units of measurement. The reference periods used varied between questions: 12 months, 1 month and 7 days.
Discussion and next steps
As the alcohol instrument was not available for pre-testing, most of the workshop participants had not seen the proposed instrument before. There was concern, however, about the length of the instrument (with five multi-part questions) and the variations in reference period. The participants suggested simpler wording for each question. They also raised questions about the definitions of such terms as alcoholic beverage and occasions of binge drinking.
It was suggested that the instrument could form a useful part of the WHO headquarters initiative. This currently included 14 questions on alcohol, of which 4 related to drinking patterns and alcohol consumption. On the basis of previous testing in Finland, Germany and the
Netherlands, the principal investigator felt that the instrument was ready for implementation in country health interview surveys. Some changes could be made, however, in wording of the questions.
Indicator 4. Physical activity
Physical activity was a new concept as a health indicator; this raised the question of what to measure. The network decided to measure both vigorous and moderate activity because both benefit health.
The network adapted a model instrument developed by an initiative begun at WHO headquarters but now being carried out by 17 institutes worldwide: the International Physical Activity Questionnaire (IPAQ). IPAQ measures moderate and vigorous activity in daily life (at work and educational institutions, in transport, at home and in leisure time), its frequency per week and its duration per time. It has eight forms, according to length (long or short), reference period (a usual week or the last seven days) and administration method (telephone interview or self-completed by respondents).
The instrument’s reliability and validity was tested in eight countries (Finland, Italy, the Netherlands, Portugal, Slovenia and the United Kingdom (England)), using from 50 to 150 subjects varying in sex, age and other structures. Each participating institute chose the IPAQ form it preferred to use, and the results had become available just in time for the Mid-term Review. The results were promising: IPAQ’s reliability was good and its validity equivalent to that of other instruments. In addition, the EUROHIS network would examine the results of tests done by the global network, which would soon be available. The EUROHIS network wanted more time to analyse and explore the data before making final proposals.
Pre-testing the instrument for feasibility as part of the EUROHIS project was carried out in a further 5 countries: Bulgaria, the Czech Republic, Hungary, Spain and Ukraine (see Table 1).
Bulgaria and the Czech Republic were critical of the instrument; Hungary, Spain and Ukraine made some suggestions for change. All countries preferred the short forms of the instrument.
Discussion and next steps
The workshop participants preferred the short, last-seven-days version of IPAQ; the long forms were too complex. They noted some problems with classifying gardening as an activity and the need to avoid the phrase paid work. Some participants suggested adding measures of time spent sitting and walking.
The participants agreed, however, that the recommended next step for IPAQ would be to implement it in countries, preferably with a common protocol. Chances appeared to be good for such implementation in the next few years in the Czech Republic, Denmark, Finland, Germany, Hungary, Norway, Sweden and Slovenia.
Indicator 5. Use of curative medical services
Health interview surveys on curative medical services can add value to the data available from medical registers, integrate data on services with those on the demographic and socioeconomic characteristics of service users, and fill gaps with data on non-users and services not covered in registers. The EUROHIS survey of surveys showed a great variability in the instruments used in countries, their wording and their reference periods (ranging from 2 weeks to 12 months). The four most commonly covered domains were: hospitalization, consultation with medical doctors and with dentists, and the use of other health care providers and services, such as physiotherapy, dietetics, mental health and nursing. The network developed an instrument covering all of these domains, with priority being given to the first three. The criteria used to make this decision comprised: the importance of services (volume and costs), feasibility of measurement and presence in health interview surveys, prospects for comparison and availability of register data.
The instrument contained a number of core and optional questions on each of the domains (Table 2). It was pre-tested as part of the common EUROHIS exercise. This gave the network an overview of problems and the differences between countries. There were few problems with translation. The complexity of the instrument, however, meant that self-administration could be difficult, and more text was needed to instruct interviewers. The network members agreed that the introductory texts and the order and wording of questions needed more work. In addition, the list of core items was too long; the network requested advice on reducing it.
Table 2. Elements selected for each domain the of the instrument on use of curative services
Domain Core elements Optional elements
Hospitalization Frequency and duration of inpatient hospitalization Frequency and duration of day-patient
hospitalization
Reason for hospitalization
Duration of
hospitalization by reason Operations
Consultation with medical doctors (general practitioners, first-aid doctors, occupational health doctors, paediatricians, specialists)
Frequency
Percentage of persons consulting in last 12 months Reason for consultation
Place of consultation (with general practitioner) Type of specialist
Illness or health complaint that led to consultation
Consultation with dentist Frequency
Percentage of persons consulting in last 12 months Reason for consultation
Presence of own teeth
Regularity of dentist consultations
Consultation with other health services
Percentage of persons consulting in last 12 months –
Discussion and next steps
The workshop participants agreed that, while countries found the instrument too long, cutting items would be difficult. It was suggested to transfer to the optional elements the open answer category of the question on reason for hospitalization, and the questions on place of general practitioner consultation and type of specialist. Further, it was advised to start the medical doctor section with 1–2 general questions on consultations. To make a core of the core list, the
workshop participants urged the network to try to identify only 1–2 core questions for each priority domain. The principal investigator agreed to do this and to review the other adjustments suggested. After that, the recommended next step for this indicator would be wider field-testing;
the prospects for this were good in several countries.
Indicator 6. Use of medicines
The use of medicines is an important indicator because medicines are widely used, have great potential for good or ill effects and impose rising costs to society; in addition, information on medicine use helps to describe the prevalence of diseases and symptoms. In measuring medicine use, the network wanted to reveal the proportion of the population exposed to medicines (with and without prescription), the role of medicines in disease treatment, the extent and purpose of self-medication, and medicine use to maintain or even improve good health. The network definedmedicine in practical terms: a product that is used to alleviate symptoms, to prevent illness and to improve health and that is ordinarily purchased from a pharmacy. This definition includes, for example, contraceptive pills, vitamins and minerals.
The survey of surveys collected 20 questionnaires from 18 countries; the surveys used 1–14 questions and/or groups of questions, and mentioned 44 groups of medicines; 14 groups were mentioned in at least 5 questionnaires. The most common reference period was two weeks.
The network created an instrument with four questions: two each on prescribed and over- the-counter medicines. Each section began by asking whether the respondent had taken any medicines in the last two weeks, and then enquired about the condition it had been taken for and the type of medicine taken. In listing the conditions, the network had worked in coordination with the network on chronic physical conditions.
Pre-testing took place as part of the common exercise. In general, the results were good. One change in wording was suggested, however, and the testing revealed problems with
comparability arising from differences between countries in the division between prescription and over-the-counter medicines and whether doctors prescribed the latter as well as the former.
Discussion and next steps
The workshop participants noted some problems related to the definition of medicines. First, translating the term was rather easy in northern Europe, but very difficult in southern countries.
Second, some found the term too broad in its inclusion of products. Third, older respondents might not know for what conditions they took medicines; perhaps the questions could be reformulated using proprietary names. The participants agreed, however, that the two-week reference period was the optimum choice.
As the next step, it was recommended that the network revise the wording of the questions to make them more useful for southern Europe. After that, wider field-testing should be done, preferably in combination with the other EUROHIS instruments.
Indicator 7. Use of preventive health care
The network defined preventive health care to include both services provided by health professionals and actions taken by respondents themselves. The survey of surveys, which
reviewed questionnaires on prevention used in 19 countries, showed that countries differed in the content of preventive health care services as well as who providers of these services.
The network used four criteria – importance to public health and prevention, prevalence, possibility to form questions and relevance – to create an instrument covering the following domains:
• immunization of populations against influenza and diphtheria, of children against poliomyelitis and of women against rubella;
• health promotion (nutrition and weight change);
• hormone replacement;
• screening for breast and cervical cancer, hypertension and hypercholesterolaemia; and
• rehabilitation and occupational health programmes.
The network used questions from the survey of surveys – 14 with the original wording and 19 with adjusted wording – and composed 12 new items. As far as possible, questions on each domain sought information on whether the respondent had ever/never participated, the last time of participation, the reason and on whose initiative participation took place.
The instrument was pre-tested as part of the joint EUROHIS exercise. The first results were useful, particularly in indicating respondents’ difficulties in remembering their immunizations.
The network members recognized that the list of questions was too long and suggested limitations on domains and elements. For immunization, they suggested measuring only
influenza. While retaining the health promotion domain, they thought further work was needed on the reasons for change and their links with health promotion. The question on hormone therapy needed to consider other purposes than replacement. Perhaps hypercholesterolaemia screening should be dropped. As no questions for rehabilitation and occupational health could be found, the network would try to formulate them.
Discussion and next steps
The workshop participants agreed that the instrument was too long. They recommended that the immunization questions be deleted and suggested that more of the other questions be made optional, such as those on the reasons for participation in screening programmes. After these changes had been made, the participants agreed that the next step for this instrument should be wider field-testing.
Indicator 8. Health-related quality of life
The survey of surveys revealed 11 surveys with elements covering quality of life (QOL), although they differed widely in definitions of the concept and thus in the questions asked. As a result, the network members could not harmonize existing questions to compose its instrument.
They identified elements of three different, widely known instruments in country surveys: SF-36 in seven and WHOQOL and EuroQoL in three each. To choose among them, the network held a meeting in 1999 at which representatives of each made presentations. The network chose to work with WHOQOL, which treats QOL as subjective, considers both positive and negative aspects and has been developed in different cultures simultaneously. Using WHOQOL offered the
additional advantage of providing access to a substantial data set from many different European countries.
The network began with the short form of the instrument, the 26-item WHOQOL-BREF.
From this the members developed an even shorter EUROHIS-QOL instrument, with eight items on: overall QOL; sufficiency of energy for everyday life; satisfaction with oneself, with own health, with ability to perform daily living activities, with personal relationships and with living conditions; and sufficiency of money to meet needs.
The instrument was pre-tested as part of the common EUROHIS exercise. In general, the feedback was positive, although three points were made. Careful translation was required to seek semantic equivalents of the terms used. The QOL concept was not readily understood in at least one culture. As many official translations of WHOQOL already existed, they should be used to help ensure comparability.
Discussion and next steps
The workshop participants agreed that it would be useful if an overall summary score could be calculated from the various QOL dimensions. As the meaning of responses varied between cultures, wording should be carefully chosen.
As the next steps, the participants recommended that the instrument should undergo both further field-testing as well as implementation in country health interview surveys. Testing of an even smaller subset of a few items, possibly alongside the current 8 EUROHIS questions and the 26-item WHOQOL-BREF, would also be worth while.
Stage B of the EUROHIS project
The EUROHIS Mid-term Review showed that the project was well advanced towards its first goal (stage A): developing recommended common survey instruments on important health indicators. The participants agreed, however, that the second goal (stage B) – to collate and adjust existing data on the indicators for international comparison – would be extremely difficult to fulfil. The draft EUROHIS instruments contained many new elements on which data had not previously been collected. In addition, existing country data were too variable in content and quality to enable the harmonization exercise to yield results that would justify the effort and difficulty of the task. This being so, the participants recognized three options for stage B of the project: extending the survey of surveys, extending field-testing of the instruments and urging Member States to implement the instruments ready for use.
Extension of the survey of surveys would comprise further qualitative descriptions of existing surveys and their perceived problems. It would result in the compilation of an international database of survey methods and instruments. It would not create a set of comparable data, but would identify what data exist in countries for the various indicators.
Field-testing could be conducted using a standard protocol on larger samples, to allow further revision of the current instruments and to extend the empirical justification for their implementation; 300–700 subjects in each centre would be required to make statistical evaluations and to compile evidence for the usefulness of the instruments. The exercise could also focus on cross-cultural applicability.
Moving towards implementation would include not only urging Member States to use the instruments but also supporting countries in the task.
The three options were not mutually exclusive and several networks were interested in pursuing more than one. The networks on chronic physical conditions and the use of medicines preferred the second option, but were willing to take the first as well. Two networks each favoured field-testing (use of medical services and use of preventive health services) and implementation (physical activity and alcohol consumption), while one (QOL) was interested in both options.
The participants reviewed the opportunities for each option, and drew several conclusions and made several recommendations for the remainder of the current phase of the EUROHIS project.
Conclusions
Field-testing and implementation should be the main lines of action for Stage B of the EUROHIS project. Some effort could also be devoted to extending the survey of surveys, however, with EUROHIS coordinating its efforts with other initiatives, such as those of WHO headquarters and OECD.
Seven to eight countries were committed to field-testing; coordination between networks was important to combine the instruments into a large module. Due attention had to be paid to ensuring the balance between different indicators and settling the questions of mode of
administration and differing reference periods.
While 26 countries expressed strong interest in or intentions towards implementation of the EUROHIS recommended instruments by 2005 at the latest, 5–6 were prepared to use the instruments in 2001. They would need support in this task, however, and it was hoped that the EUROHIS project could commit some resources to this.
Recommendations
1. The EUROHIS indicator networks should further revise the draft instruments in the light of the pre-testing results, and finalize the instruments as far as possible.
2. A common recommended protocol for field-testing should be developed, including guidelines for implementation, and taking note of the recommendations from WHO headquarters on comparability. The guidelines should cover translation, sampling and administration methods. The protocol should be available by the end of January 2001 and distributed as a basis for field-testing in as many European countries as possible.
3. When the instruments are finalized, the project participants and WHO should urge all Member States to consider their implementation in national health interview surveys.
Annex 1
Principal investigators and active participants in EUROHIS indicator networks
Chronic physical conditions
V. Egidi, National Institute of Statistics (ISTAT), Rome, Italy (principal investigator), V. Buratta, P. Baroncini, National Institute of Statistics (ISTAT), Rome, Italy
A. Aromaa, National Public Health Institute (KTL), Helsinki, Finland A. de Bruin, Statistics Netherlands, Voorburg, Netherlands
R. Gispert, Institute of Health Studies, Barcelona, Spain
J.-M. Robine, REVES Network on Health Expectancy, Montpellier, France Mental disability
(network to be re-established) Alcohol consumption
J. Simpura, National Research and Development Centre for Welfare and Health (STAKES), Helsinki, Finland (principal investigator)
G. Badéyan, Ministère de l’emploi et de la solidarité, Paris, France F. Cipriani, Local Health Unit of Florence, Italy
R. Knibbe, University of Limburg, Netherlands
L. Kraus, Institut für Therapieforschung, Munich, Germany Physical activity
P. Oja, UKK Institute for Health Promotion Research, Tampere, Finland (principal investigator) P. Fentem, Great Chesterford, United Kingdom
J.A.R. Maia, Faculdade de Ciencas do Desporto, Porto, Portugal G. Mensink, Robert Koch-Institut, Berlin, Germany
Use of curative medical services
A. de Bruin, Statistics Netherlands, Voorburg, Netherlands (principal investigator) S. Arinen, Social Insurance Institution (KELA), Helsinki, Finland
V. Buratta, National Institute of Statistics (ISTAT), Rome, Italy
M. Garcia-Barbero, WHO Regional Office for Europe, Copenhagen, Denmark H. van Oyen, Institut scientifique de santé publique – Louis Pasteur, Brussels, Belgium Use of medicines
E. Kalimo, Social Insurance Institution (KELA), Helsinki, Finland (principal investigator) M.S. Green, Gertner Institute, Tel-Hashomer, Israel
E. Holme Hansen, Royal Danish School of Pharmacy, Copenhagen, Denmark T. Klaukka, Social Insurance Institution (KELA), Helsinki, Finland
J. Martikainen, Social Insurance Institution (KELA), Helsinki, Finland J. Yfantopoulos, National and Capodistrian University of Athens, Greece
Use of preventive health care
M. de Kleijn-de Vrankrijker, TNO Prevention and Health, Leiden, Netherlands (principal investigator)
P. Baroncini, National Institute of Statistics (ISTAT), Rome, Italy W. Davidse, TNO Prevention and Health, Netherlands
V. Egidi, National Institute of Statistics (ISTAT), Rome, Italy
E. Greiser, Bremer Institut für Präventionsforschung und Sozialmedizin (BIPS), Bremen, Germany
O. Impivaara, Social Insurance Institution (KELA), Helsinki, Finland
J. Tafforeau, Institut scientifique de la santé publique – Louis Pasteur, Brussles, Belgium Quality of life
M. Power, University of Edinburgh (principal investigator) P. Bech, Frederiksborg General Hospital, Hillerød, Denmark
D.R. Billington, WHO Regional Office for Europe, Copenhagen, Denmark J.B. Bjørner, University of Copenhagen, Denmark
M. Bullinger, Universitätskrankenhaus Eppendorf, Hamburg, Germany G. de Girolamo, Istituto Superiore di Sanità, Rome, Italy
J. Holub, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
R. Lucas Carrasco, Barcelona, Spain
A. Nossikov, WHO Regional Office for Europe, Copenhagen, Denmark S.M. Skevington, University of Bath, United Kingdom
Annex 2
Working papers and background documents
Working papers
EUR/00/5018706/6 MT Overview of the implementation of EUROHIS EUR/00/5018706/7 BM5 & MT Report of the network “chronic physical conditions”
(revised December 2000)
EUR/00/5018706/8 BM5 & MT Report of the network “alcohol consumption”
(revised December 2000)
EUR/00/5018706/9 BM5 & MT Report of the network “physical activity”
(revised January 2001)
EUR/00/5018706/10 BM5 & MT Report of the network “use of curative medical services”
(revised December 2000)
EUR/00/5018706/11 BM5 & MT Report of the network “use of medicines”
(revised December 2000)
EUR/00/5018706/12 BM5 & MT Report of the network “use of preventive health care”
(revised January 2001)
EUR/00/5018706/13 BM5 & MT Report of the network “quality of life”
(revised December 2000)
Background documents
Compendium of country reports on national HIS from the countries of central and eastern Europe (CCEE) and newly independent states (NIS)
Compendium of pre-testing reports from EUROHIS participants outside of the indicator working groups
The EUROHIS project: common instruments for health interview surveys in Europe. Synopsis of 1st and 2nd annual reports sent to the European Commission covering the period 01 July 1998 – 30 June 2000
Annex 3
Participants
Belgium
Dr J. Van der Heyden Tel. No.: +32 2 642 57 90
Scientific Institute for Public Health – Louis Pasteur Fax No.: +32 2-642 54 10
Rue Juliette Wytsman 14 E-mail: johan.vanderheyden@ihe.be
B-1050 Brussels
Bosnia and Herzegovina
Dr A. Pilav Tel. No.: +387 33 444 710
Federal Public Health Institute Fax No.: +387 33 618 433
Titova 9 E-mail: idanap@hotmail.com
71000 Sarajevo Bulgaria
Ms F.K. Denkova Tel. No.: +359 2 9857 2459
National Statistical Institute Fax No.: +359 2 946 0109
2, P. Volov str. E-mail: fdenkova@nsi.bg
1504 Sofia Croatia
Dr M. Kuzman Tel. No.: +385 1 46 83 012
Head, Social Medicine Department Fax No.: +385 1 46 83 011 Croatian National Institute of Public Health E-mail: marina.kuzman@zg.tel.hr Rockefellerova 7
10000 Zagreb Czech Republic
Dr J. Holub Tel. No.: +4202 2497 5993
Vice-Director Fax No.: +4202 2497 2659
Institute of Health Information E-mail: holub@uzis.cz and Statistics of the Czech Republic
PO Box 60, Palackého nam. 2 128 01 Prague 2
Denmark
Professor P. Bech Tel. No.: +45 48293253
Director Fax No.: +45 48263877
WHO Collaborating Centre in Mental Health E-mail: pebe@fa.dk Psychiatric Research Unit
Frederiksborg General Hospital Dyrehavevej 48
DK-3400 Hillerød
Ms J. Nygaard Jensen Tel. No.: +45 39 20 77 77 National Institute of Public Health Fax No.: +45 39 20 80 10 Statens Institut for Folkesundhed E-mail: jnj@dike.dk 25 Svanemøllevej
DK-2100 Copenhagen Ø
Dr N.K. Rasmussen Tel. No.: +45 39 20 77 77
Deputy Director Fax No.: +45 39 20 80 10
National Institute of Public Health E-mail: nkr@dike.dk Statens Institut for Folkesundhed
25 Svanemøllevej DK-2100 Copenhagen Ø Estonia
Ms M. Ruuge Tel. No.: +372 6269 846
Department of Statistics and Social Analysis Fax No.: +372 6269 845 Ministry of Social Affairs of Estonia E-mail: mare.ruuge@sm.ee Gonsiori 29
15027 Tallinn Finland
Dr S. Arinen Tel. No.: +358 9 4744 8792
National Public Health Institute (KTL) Fax No.: +358 9 4744 8924 Department of Health and Disability E-mail: sisko.arinen@ktl.fi Mannerheimintie 166
FIN-00300 Helsinki
Professor A. Aromaa Tel. No.: +358 29 4744 8770
Research Professor Fax No.: +358 29 4744 8760
National Public Health Institute E-mail: arpo.aromaa@ktl.fi Mannerheimintie l66
FIN-00300 Helsinki
Dr T. Klaukka Tel. No.: +358 20 434 1969
The Social Insurance Institution (KELA) Fax No.: +358 20 434 1700
Research and Development Centre E-mail: timo.klaukka@kela.memonet.fi P.O. Box 450. Nordenskioldinkatu l2
SF-00101 Helsinki
Ms J. Martikainen Tel. No.: +358 20 43 41953
Research and Dev. Centre Fax No.: +358 20 43 41700
The Social Insurance Institution (KELA) Nordenskioldinkatu 12, PO Box 450 FIN-00101 Helsinki
E-mail: jaana.martikainen@kela.memonet.fi
Dr P. Oja Tel. No.: +358 3 2829111
Scientific Director Fax No.: +358 3 2829200
UKK Institute for Health Promotion Research E-mail: ukpeoj@uta.fi P.O. Box 30 - Kaupinpuistonkatu 1
FIN-33501 Tampere (Co-Chair)
Professor J. Simpura Tel. No.: +358 20 3967 2022
Research Professor Fax No.: +358 20 3967 2170
Social Research Unit for Alcohol Studies E-mail: jussi.simpura@stakes.fi STAKES-National Research and
Development Centre for Welfare & Health P.O. Box 220 - Siltasaarenkatu 18
FIN-00531 Helsinki (Co-Chair) France
Mr J.-M. Robine Tel. No.: +33 467 61 30 43
Equipe INSERM Démographie et Santé Fax No.: +33 467 61 30 47 REVES Network on Health Expectancy E-mail: robine@valdorel.fnclcc.fr Centre Val d'Aurelle
Parc Euromédecine
F-34298 Montpellier, Cédex 5 Germany
Professor M. Bullinger Tel. No.: +49 40 42803 2977 /sec. 6430
Abteilung für Medizinische Fax No.: +49 40 42803 4940
Psychologie E-mail: bullinger@uke.uni-hamburg.de
Universitätskrankenhaus Eppendorf Martinistr. 52 – Pav. 69
D-20246 Hamburg
Professor E. Greiser Tel. No.: +49421595960
Bremer Institut für Präventionsforschung Fax No.: +494215959665
und Sozialmedizin (BIPS) E-mail: greiser@bips.uni-bremen.de
Linzerstr. 8-10 D-28359 Bremen
Dr G. Mensink Tel. No.: +49 30 4547 3216
Robert Koch-Institut Fax No.: +49 30 4547 3203
Nordufer 20 E-mail: mensinkg@rki.de
D-13353 Berlin Hungary
Dr E. Gardos Tel. No.: +36 1 345 6890
Director Fax No.: +36 1 345 6678
Div. for Population Health and Social Statistics E-mail: eva.gardos@office.ksh.hu Hungarian Central Statistical Office
PO Box 51 H-1525 Budapest
Dr Z. Voko Tel. No.: +36 1 331 3327
Head Fax No.: +36 1 302 2964
Epidemiology Unit E-mail: vokoz@elender.hu
Ministry of Health Arany J. u. 6-8 1051 Budapest
Ireland
Mr H. Magee Tel. No.: +353 1 635 4300
Statistician Fax No.: +353 1 635 4378
Information Management Unit E-mail: hugh_magee@health.irlgov.ie Department of Health and Children
Hawkins House Hawkins Street IRE-Dublin 2 Italy
Dr V. Buratta Tel. No.: +39 06 8541 059
National Unit for Epidemiology and Health Fax No.: +39 06 8535 4401
Indicator Studies E-mail: buratta@istat.it
National Institute of Statistics - ISTAT Viale Liegi l3
I-00135 Rome (Co-Chair)
Dr F. Cipriani Tel. No.: +39 (0) 55 6577300
Epidemiologist Fax No.: +39 (0) 55 6577533
Local Health Unit of Florence E-mail: epicip@ats.it Operational Unit for Epidemiology
Villa Margherita Viale Michelangelo 41 I-50125 Florence
Ms L. Frova Tel. No.: +39 06 8541 059
National Institute of Statistics, ISTAT Fax No.: +39 06 8535 4401
Viale Liegi, 13 E-mail: frova@istat.it
I-00198 Rome
Ms L. Gargiulo Tel. No.: +39 06 8541 059
National Institute of Statistics, ISTAT Fax No.: +39 06 8535 4401
Viale Liegi, 13 E-mail: gargiulo@istat.it
I-00198 Rome
Ms L. Quattrociocchi Tel. No.: +39 06 8541 059
National Institute of Statistics, ISTAT Fax No.: +39 06 8535 4401
Viale Liegi, 13 E-mail: quattrociocchi@istat.it
I-00198 Rome
Ms S. Prati Tel. No.: +39 06 8541 059
National Institute of Statistic s, ISTAT Fax No.: +39 06 8535 4401
Viale Liegi, 13 E-mail: prati@istat.it
I-00198 Rome Latvia
Ms I. Pudule Tel. No.: +371 724 0446
Head of Health Education Division Fax No.: +371 724 0447
Health Promotion Centre E-mail: iveta.vvc@parks.lv
Skolas 3 LV-1010 Riga
Lithuania
Professor V. Grabauskas Tel. No.: +370 7 22 61 10
Rector, Kaunas University of Medicine Fax No.: +370 7 22 07 33
Mickevicius str. 9 E-mail: vilgra@kmu.lt
LT-3000 Kaunas
Dr A. Tamosiunas Tel. No.: +370 7 734618
Kaunas University of Medicine Fax No.: +370 7 732286
Sukileliu Str. 17 E-mail: atamos@kmu.lt
LT-3000 Kaunas Malta
Dr R. Pace Asciak Tel. No.: +356 234915
Consultant Health Information Fax No.: +356 235910
A/Director, Department of Health Information E-mail: renzo.pace-asciak@magnet.mt Ministry of Health
95, Guardamangia Hill Guardamangia MS D08 Netherlands
Dr D.J. Beukenhorst Tel. No.: +31 45 570 7320
Statistics Netherlands Fax No.: +31 45 570 6266
P.O. Box 4481 E-mail: dbkt@cbs.nl
NL-6401 CZ Heerlen
Ms A. de Bruin Tel. No.: +31 70 3375 299
Division Sociocultural Statistics Fax No.: +31 70 3877 429
Statistics Netherlands E-mail: abun@cbs.nl
P.O. Box 4000
NL-2270 YM Voorburg (Co-Chair)
Dr M.W. de Kleijn-deVrankrijker Tel. No.: +31 71 518 1696 Head, Department of Public Health Fax No.: +31 71 518 1903
TNO Prevention and Health E-mail: mw.dekleijn@pg.tno.nl
Wassenaarseweg 56, PO Box 2215 NL 2301 CE Leiden (Co-Chair)
Dr R. Knibbe Tel. No.: +31 43 882 286
University of Limburg Fax No.: +31 43 671 048
Medical Sociology E-mail: r.knibbe@zw.unimaas.nl
PO Box 616
6200 MD Maastricht Dr W. van Mechelen Professor of Social Medicine Dept. of Social Medicine
Faculty of Medicine Tel. No.: +31 20 444 8206/10
Van der Boechorststraat 7 Fax No.: +3120 444 881/8387
1081 BT Amsterdam E-mail: w.van_mechelen.emgo@med.vu.nl
Norway
Ms J. Ramm Tel. No.: +47 22 00 4492
Senior Executive Officer Fax No.: +47 22 00 44 04
Statistics Norway E-mail: jrm@ssb.no
Kongensgt. 10 N-0033 Oslo Portugal
Ms M. de Jesus A. Charrua Graca Tel. No.: +351 21 7510536 National Institute of Health (INSA) Fax No.: +351 21 7573671
Av. Padre Cruz E-mail: ceb.onsa@insarj.pt
1649-016 Lisboa
Dr Carlos M. Matias Dias Tel. No.: +351 21 7510 535
Instituto National de Saude (INSA) Fax No.: +351 21 75 73 671
Av. Padre Cruz E-mail: ceb.onsa@insarj.pt
1649-016 Lisboa Romania
Dr D. Ursuleanu Tel. No.: +40 1 314 08 90
Deputy Director Fax No.: +40 1 311 2998
National Centre for Health Statistics E-mail: dursulea@ms.ro Ministry of Health of Romania
Str George Vraca No. 9 Sector 1 - 70706 Bucharest Russian Federation
Professor T. Maximova Tel. No.: +7 095 916 2452
Head Fax No.: +7 095 916 0398
Division of Complex Studies of Population Morbidity E-mail: tmaximova@mail.ru N.A. Semashko Research Institute of Social Hygiene
Vorontsovo Pole St. 12 103064 Moscow Slovakia
Dr G. Gulis Tel. No.: +421 7 52923537
National Health Promotion Centre Fax No.: +421 7 52961146
Lazarebska 26 E-mail: gulis@ncpz.sk
820 07 Bratislava Slovenia
Dr M. Macarol-Hiti Tel. No.: +386 1 4327 142
Director Fax No.: +386 61 2323 955
Institute of Public Health of the E-mail: metka.hiti@ivz-rs.si Republic of Slovenia
Trubarjeva 2 Ljubljana 1000
Spain
Dr L. Biglino Tel. No.: +34 91 59 64 410
Head, Servic io de Estadistica de Salud Fax No.: +34 91 59 61 547 Subd. Gral. de Epidemiologia, Promocion y Educacion E-mail: lbiglino@msc.es para la Salud
Ministry of Health and Consumer Affairs Paseo del Prado 18-20, 9th floor
E-28071 Madrid
Dr R. Lucas Carrasco Tel. No.: +34 93 428 22 97
Armonia 5, 2-3 Fax No.: +34 93 428 25 59
E-08035 Barcelona E-mail: 18350rlc@comb.es
The former Yugoslav Republic of Macedonia
Professor R. Isjanovska Tel. No.: +389 91 11 4825
Institute of Epidemiology, Biostatistics with Medical Fax No.: +389 91 11 1828
Informatics E-mail:
Medical Faculty – Skopje
University “St. Kiril and Metodij”
Vodnjanska no. 31 91000 Skopje Turkey
Dr A. Toros Tel. No.: +90 312 3119987
Director Fax No.: +90 312 3118141
Institute of Population Studies E-mail: atoros@hacettepe.edu.tr NEE Haceteppe University
06100 Ankara United Kingdom
Dr H. Meltzer Tel. No.: +44 20 7533 5391
Office for National Statistics Fax No.: +44 20 7533 5300
1, Drummond Gate E-mail: howard.meltzer@ons.gov.uk
London SW1V 2QQ
Professor M. Power Tel. No.: +44 131 537 6578
The University of Edinburgh Fax No.: +44 131 537 6760
Department of Psychiatry E-mail: mj@srv1.med.ed.ac.uk
Kennedy Tower
Royal Edinburgh Hospital Morningside Park
Edinburgh EH10 5HF (Co-Chair)
Professor S. Skevington Tel. No.:+44 12 25 82 68 30
University of Bath Fax No.: +44 12 25 82 67 52
Department of Psychology E-mail: S.M.Skevington@bath.ac.uk
Claverton Down Bath BA2 7AY
OTHER ORGANIZATIONS
Mr G. Lafortune Tel. No.: +33 1 45 24 92 67
Health Policy Unit Fax No.: +33 1 45 24 91 12
OECD E-mail: gaetan.lafortune@oecd.org
2 rue André-Pascal 75775 Paris Cédex 16 France
OBSERVERS
Dr Judit Juhasz Tel. No.: +45 38 81 46 43
Hüvösvölgyi ut 42 Fax No.:
H-1021 Budapest E-mail: juhasz.j@.freemail.hu
Hungary
Mr S.E. Skovlund, MSc., Drg Tel. No.: +45 35 37 8810 (private) Psychobiology and Psychology +45 26 15 1414 (mobile)
Læssøgade 18B, 2. th. Fax No.:
2200 Copenhagen N. E-mail: skovlund@post1.tele.dk
Denmark
WORLD HEALTH ORGANIZATION Headquarters
Dr B. Üstün Tel. No.: +41 22 791 3609
World Health Organization Fax No.: +41 22 791 4328/4885
20, Avenue Appia E-mail: ustunb@who.int
CH-1211 Geneva 27 Switzerland
Regional Office for Europe
Dr R. Alderslade Tel. No.: +45 39 17 14 55
Regional Advisor Fax No.: +45 39 17 18 85
Evidence on Health Needs and Interventions E-mail: ral@who.dk Dr A. Brandrup-Lukanow
Regional Adviser
Tel. No.: +45 3917 1426 Fax No.: +45 39 17 1818 Gender Mainstreaming / Reproductive Health E-mail: abr@who.dk
Ms M.S. Burgher Tel. No.: +45 39 17 14 48
Editor Fax No.: +45 39 17 18 52
Publications (Rapporteur) E-mail: msb@who.dk
Dr A. Dumitrescu Tel. No.: +45 39 17 1352
Director, Division of Information, Evidence Fax No.: +45 39 17 1818
and Communication E-mail: adu@who.dk
Dr C. Gudex Tel. No.: +45 39 17 1459
Short-term Professional Fax No.: +45 39 17 1895
Evidence on Health Needs and Interventions E-mail: cgu@who.dk
Professor Isuf Kalo Tel. No.: +45 39 17 12 65
Regional Advisor Fax No.: +45 39 17 18 64
Quality of Health Systems E-mail: ika@who.dk
Mr A. Nanda Tel. No.: +45 39 17 1895
Regional Adviser Fax No.: +45 39 17 1895
Health Information Unit E-mail: arn@who.dk
Ms B. Nielsen Tel. No.: +45 39 17 14 98
Secretary Fax No.: +45 39 17 18 95
Evidence on Health Needs and Interventions E-mail: bni@who.dk
Dr A. Nossikov Tel. No.: +45 39 17 1267
Epidemiologist Fax No.: +45 39 17 1895
Evidence on Health Needs and Interventions (Co- Chair)
E-mail: ano@who.dk
Annex 4
Other participants in EUROHIS project
Bosnia and Herzegovina
Dr Milorad Balaban Contact through WHO Liaison Officer
Minister of Health Ministry of Health Republika Srpska Zdrave Korde 4 78000 Banja Luka Bosnia and Herzegovina Ukraine
Prof Antonina Nahorna Tel. No.: +380 44 216 30 35
Deputy Director Fax No.: +380 44 216 71 00
Ukrainian Institute of Public Health E-mail: nahorna@health.freenet.viaduk.net
65 O. Honchara Street health@uiph.kiev.ua
252 054 Kiev Ukraine
