National Health Interview National Health Interview Survey in TaiwanSurvey in Taiwan

Hui-Sheng (Harvey) Lin, Ph.DHui-Sheng (Harvey) Lin, Ph.DAssociate Professor, Chung-Shan Medical UniversityAssociate Professor, Chung-Shan Medical University

Consultant, Bureau of Health Promotion, Consultant, Bureau of Health Promotion,

Department of Health, TaiwanDepartment of Health, Taiwan

Roles of Survey Research on Roles of Survey Research on Health PromotionHealth Promotion

To understand current status of physical and To understand current status of physical and mental health, medical care utilization, primary mental health, medical care utilization, primary health care, KAP of health promotion, Health health care, KAP of health promotion, Health risk behaviors, etc.risk behaviors, etc.

To identify health and health promotion related To identify health and health promotion related issues and the population with the issuesissues and the population with the issues

To investigate factors relevant with the issues of To investigate factors relevant with the issues of health and health promotion.health and health promotion.

Roles of Survey Research on Roles of Survey Research on Health Promotion (Cont.)Health Promotion (Cont.)

To provide information to program To provide information to program planners on health promotionplanners on health promotion

To monitor or to assess action program To monitor or to assess action program effects on health promotion effects on health promotion

National Health Related Interview Survey National Health Related Interview Survey ever Conducted in Taiwanever Conducted in Taiwan

1992 National Health Interview Survey in Taiwan:1992 National Health Interview Survey in Taiwan: : : a pilot studya pilot study * National representative sample* National representative sample

* Sample size: 1,200 households; * Sample size: 1,200 households; about 4000 personsabout 4000 persons * Initiated by the National Department of* Initiated by the National Department of HealthHealth * Designed by the School of Public Health ,* Designed by the School of Public Health , National Taiwan UniversityNational Taiwan University * Field works conducted by the Taiwan* Field works conducted by the Taiwan Provincial Institute of Family PlanningProvincial Institute of Family Planning

1992 National Medical and Health Expenditure 1992 National Medical and Health Expenditure SurveySurvey

* * National representative sampleNational representative sample

* Sample size: 4,994 households and 21,671 cases* Sample size: 4,994 households and 21,671 cases

personspersons

* Initiated by the National Health Insurance* Initiated by the National Health Insurance

Bureau, DOHBureau, DOH

* Field works conducted by the Taiwan Provincial* Field works conducted by the Taiwan Provincial

Institute of Family PlanningInstitute of Family Planning

* Purpose: collected information for the planning* Purpose: collected information for the planning

of national health insurance programof national health insurance program

1994 National Health Interview Survey1994 National Health Interview Survey

* * National representative sampleNational representative sample

* Sample size: 3,814 households and about 15,000 * Sample size: 3,814 households and about 15,000 personspersons

* Initiated by the Department of Health, Taiwan* Initiated by the Department of Health, Taiwan

* Designed by the School of Public Health, National * Designed by the School of Public Health, National Taiwan UniversityTaiwan University

* Field works conducted by the Taiwan Provincial * Field works conducted by the Taiwan Provincial Institute of Family PlanningInstitute of Family Planning

2001 National Health Interview2001 National Health Interview Survey: Survey: a brief introductiona brief introduction

Specific Aim:Specific Aim: To establish baseline information of health status, To establish baseline information of health status,

medical service utilization, health behavior and quality medical service utilization, health behavior and quality of life of Taiwan population.of life of Taiwan population.

To provide reference information for policy making or To provide reference information for policy making or program assessmentprogram assessment

To set up feasible mechanisms for future NHISTo set up feasible mechanisms for future NHIS.. Time Period for Field OperationTime Period for Field Operation

Aug, 2001~Jan. 2002Aug, 2001~Jan. 2002 Response RateResponse Rate

6,721 households6,721 households (91.4%)(91.4%) 25,464 persons25,464 persons (93.8%)(93.8%)

2001 NHIS: about questionnaire2001 NHIS: about questionnaire QuestionnairesQuestionnaires

Household questionnaireHousehold questionnaire Questionnaire for person aged 12 and aboveQuestionnaire for person aged 12 and above Questionnaire for person aged under 12Questionnaire for person aged under 12 Self-administered questionnaire for person aged 12-19Self-administered questionnaire for person aged 12-19 (Health risk behavior, intimate behavior, drug abuse etc..)(Health risk behavior, intimate behavior, drug abuse etc..) Self-administered questionnaire for person aged Self-administered questionnaire for person aged 20-6520-65

(WHO Quality of life questions simplified version)(WHO Quality of life questions simplified version)

Design ProcedureDesign Procedure Literature reviewLiterature reviewMission of the surveyMission of the survey Health indicator Health indicator

demand demand DraftDraftReviewed by ExpertsReviewed by ExpertsPretest Pretest FinalizeFinalize

Comparison between 2001 and 2002 NHISComparison between 2001 and 2002 NHIS

SurveySurveyComp.Comp.

2001 NHIS2001 NHIS 2002 NHIS2002 NHIS(HP-KAP Survey)(HP-KAP Survey)

RepresentRepresent Taiwan, 7stratum, aboriginal Taiwan, 7stratum, aboriginal towns, off-shore islandstowns, off-shore islands

Taiwan area, City/CountyTaiwan area, City/County

PopulationPopulation Population of all agesPopulation of all ages Population aged 15+Population aged 15+

SampleSample Base on householdBase on householdTaiwan area: 6,592 householdTaiwan area: 6,592 householdaboriginal area: 608aboriginal area: 608 householdhouseholdOff-shore islands: 432 householdOff-shore islands: 432 household(Interviewed:25,464 persons: 93.8%)(Interviewed:25,464 persons: 93.8%)

Base on individualBase on individual32,656 persons32,656 persons

ContentsContents Fewer questions on knowledge of Fewer questions on knowledge of and attitude toward healthand attitude toward health

More questions on More questions on knowledge, attitude and knowledge, attitude and practicepractice

Some Preliminary ResultsSome Preliminary Results -2001 National Health Interview Survey--2001 National Health Interview Survey-

Center for Population and Health Survey ResearchCenter for Population and Health Survey Research

Bureau of Health PromotionBureau of Health Promotion

Department of Health, TaiwanDepartment of Health, Taiwan

Health Status and Self-Health Status and Self-Care of PatientsCare of Patients

Question to AnswerQuestion to Answer

Do hypertension patients, diabetic Do hypertension patients, diabetic patients or high blood lipid patients patients or high blood lipid patients have behaviors that will be harmful have behaviors that will be harmful to their diseases control?to their diseases control?

Self-care behaviors of patients aged 20 and Self-care behaviors of patients aged 20 and above who were diagnosed with chronic above who were diagnosed with chronic

diseases, NHIS 2001diseases, NHIS 2001

0% 20% 40% 60% 80% 100%

Overweight but notcontrol body weight

Smoke almost everday

No regular exercise

Not control diet HBL

HT

DM

Question to AnswerQuestion to Answer

Do known hypertension patients have their Do known hypertension patients have their blood pressure measured regularly?blood pressure measured regularly?

Percentage of known hypertension patients Percentage of known hypertension patients who had their blood pressure measured less who had their blood pressure measured less

than once a month, NHIS 2001than once a month, NHIS 2001

41.0%

60.5%

43.7% 34.9%

0%

20%

40%

60%

80%

100%

ALL 20-39 40-64 65+ AGE

Question to AnswerQuestion to Answer

Are diabetic patients monitoring progress Are diabetic patients monitoring progress of their diseases by having some required of their diseases by having some required checks or examinations?checks or examinations?

Blood sugarBlood sugarRetina checkRetina checkUrine albumin checkUrine albumin check

Percentage of diabetic patients aged 20 and Percentage of diabetic patients aged 20 and above who above who nevernever had some required checks, had some required checks,

NHIS 2001NHIS 2001

18.0%

38.4%

52.9%

59.1%

0% 20% 40% 60% 80% 100%

Never have retinachecked

Never have urinealbumin examined

No blood sugar checkduring past 1 year

No fasting blood sugarcheck in past 1 year

Utilization of Medical Utilization of Medical and Preventive Careand Preventive Care

Question to AnswerQuestion to Answer

What will Taiwanese people do when What will Taiwanese people do when they don’t feel well?they don’t feel well?

Percentage of different treatments Taiwanese Percentage of different treatments Taiwanese people seek for when they don’t feel well, people seek for when they don’t feel well,

NHIS 2001NHIS 2001

82.4

17.6

0.9

11.1

84.6

21.214.4

1.3

10.716.0

0

10

20

30

40

50

60

70

80

90

100%

男(N=9,007)

女(N=9,135)

See a westerndoctor

See a Chinesedoctor

Buydrugs

Use traditional orreligious methods

Ignore it or donothing

MaleFemale

Question to AnswerQuestion to Answer

How prevalent are preventive health care How prevalent are preventive health care services used by people aged 12 and services used by people aged 12 and above?above?

Percentage of people aged 12 and above whoPercentage of people aged 12 and above who nevernever used preventive health care services, used preventive health care services,

NHIS 2001NHIS 2001

92.4

96.295.3

49.4

69.2

72.9

82.1

72.4

45.5

93.7

97.196.4

71.273.3

81.6

70.9

0

20

40

60

80

100

Bloodpressure

Fastingbloodsugar

Bloodsugar

Blood lipid Liverfunction

Faecaloccultblood

Rectum-scope

Oral cancerscreen

%

MaleFemale

Percentage of women aged 30 and above whoPercentage of women aged 30 and above who never never used preventive healthused preventive health care services care services

NHIS 2001NHIS 2001

83.2%74.5%90.4% 92.1%

86.7%

44.6%

0%

20%

40%

60%

80%

100%

Breas

t ca.

self-

chec

k

(in pa

st month

)

Breas

t ca.

palpa

te

(in pa

st ye

ar)

Breas

t ca.

sonar

chec

k

(in pa

st ye

ar)

Mammog

raphy

(in pa

st 3 y

ears)

Bone de

nsity

(in pa

st ye

ar)

Pep's

smea

r

(in pa

st 3 y

ears)

Question to AnswerQuestion to Answer

How much proportion of children never How much proportion of children never used preventive health care services used preventive health care services provided by National Health Insurance.provided by National Health Insurance.

Why never used? Why never used?

Percentage of children aged 4 and less whoPercentage of children aged 4 and less who nevernever used preventive health care services used preventive health care services

provided by NHI, NHIS 2001provided by NHI, NHIS 2001

39.6%

20.8%

23.4% 28.0%

0%

20%

40%

60%

0 1 2 3 AGE

Reasons of not using children preventive Reasons of not using children preventive health care service, NHIS 2001health care service, NHIS 2001

29.8

15.0

12.2

9.9

8.3

1.5

1.0

36.4

0 20 40

Don't know the service is available

Don't feel ill or unhealthy

Forget to use the service

Too busy

Items are too simple

Have had other checks

Too far or inconvenient

Not insured

(%)

Health Promotion or Health Promotion or Health Risk BehaviorsHealth Risk Behaviors

Question to AnswerQuestion to Answer

Are health risk behaviors common in Are health risk behaviors common in Taiwan?Taiwan?

Percentage of people aged 12 and above Percentage of people aged 12 and above with health risk behaviors, NHIS 2001with health risk behaviors, NHIS 2001

4.5 3.57.8

39.2

6.55.5 3.90.8

3.3 1.00

10

20

30

40

50%

男

女

Not fasten seatbelt when drive

Not use helmentwhen ride

Drink and oftenget drunk

Smoke everyday Chewing betelnut everyday

MF

Question to AnswerQuestion to Answer

Have labels on pack been read when Have labels on pack been read when people buy foods in packs ?.people buy foods in packs ?.

Percentage of people who Percentage of people who never or seldomnever or seldom read the label on pack of food, NHIS 2001read the label on pack of food, NHIS 2001

19.7%

30.1%

36.9%

0% 10% 20% 30% 40% 50%

expiration date

low salt, low sugar ,low fat etc.

ingredients

Question to AnswerQuestion to Answer

When will children aged 6 and less When will children aged 6 and less brush teeth?brush teeth?

Time of brushing teeth (cleaning oral Time of brushing teeth (cleaning oral cavity) for children aged 6 and less, NHIS cavity) for children aged 6 and less, NHIS

20022002

70.5%59.2%

12.4% 2.5%2.6%3.2%

0%10%20%30%40%50%60%70%80%

Healthy Environment in Healthy Environment in HouseholdHousehold

Question to AnswerQuestion to Answer

Are people smoking passively at home?Are people smoking passively at home?

Percentage of household having family or Percentage of household having family or non-family members smoking indoors, non-family members smoking indoors,

NHIS 2001NHIS 2001

YES56%

NO43.5%

Question to AnswerQuestion to Answer

Have anti-slippery installations been Have anti-slippery installations been set up in bathroom at home?set up in bathroom at home?

Percentage of anti-slippery installations Percentage of anti-slippery installations being set up in bath room, NHIS 2001being set up in bath room, NHIS 2001

NO73.7%

YES26.3%

Dissemination of Analytical ResultsDissemination of Analytical Results

Research briefResearch brief (2002,6~2002,7(2002,6~2002,7)) ((http://ww.bhp.doh.gov.tw)http://ww.bhp.doh.gov.tw) Research reportResearch report (2003.10)(2003.10) (http://nhis.nhri.org.tw)(http://nhis.nhri.org.tw) News release and press Conference (2003.10)News release and press Conference (2003.10) Taiwan PHA annual meeting (2002.10)Taiwan PHA annual meeting (2002.10) Taiwan PHA journal (Special issue) (2004~)Taiwan PHA journal (Special issue) (2004~) Health issue related conference (2002,7~)Health issue related conference (2002,7~) Data release for public useData release for public use (2003.10) (2003.10)

Current Focus on Data AnalysisCurrent Focus on Data Analysis Define target population for health promotion Define target population for health promotion

programprogramWho are the high priority target population in Who are the high priority target population in

health promotion?health promotion?What are the major issues in health promotion?What are the major issues in health promotion?

Provide information for health promotion Provide information for health promotion program planningprogram planning

Establish baseline indicators for surveillanceEstablish baseline indicators for surveillance

2002 National Survey on Health Promotion 2002 National Survey on Health Promotion Knowledge, Attitude and Practice( HPKAP)Knowledge, Attitude and Practice( HPKAP)

Specific AimSpecific Aim

1.1. To provide basic information for BHP and To provide basic information for BHP and city/county health bureau to plan for health city/county health bureau to plan for health promotion strategiespromotion strategies

2.2. To establish city and county level baseline To establish city and county level baseline information for sequential assessment on information for sequential assessment on efficacy of intervention program and future efficacy of intervention program and future monitoring on health indicatorsmonitoring on health indicators

3.3. To provide basis for resources allocationTo provide basis for resources allocation ..

2002 Health Promotion KAP Survey2002 Health Promotion KAP Survey:: QuestionnaireQuestionnaire

Contents of Questionnaire:Contents of Questionnaire:Background informationBackground information Age, sex, height, weight, education, working, marital status, ethnicity, Age, sex, height, weight, education, working, marital status, ethnicity,

religious, family structure, economic statusreligious, family structure, economic status

Health status and morbidityHealth status and morbidity Self-rating health, prevalence of important chronic disease, knowledge of Self-rating health, prevalence of important chronic disease, knowledge of

important chronic disease, self-care of patients, hearing and sight important chronic disease, self-care of patients, hearing and sight impairment, physical function, depressive symptoms, menopause of impairment, physical function, depressive symptoms, menopause of womenwomen

Medical care UtilizationMedical care Utilization Use of Chinese, western and dental clinics, emergent and in-patient care, Use of Chinese, western and dental clinics, emergent and in-patient care,

traditional treatment, preventive health care, screen of breast cancer and traditional treatment, preventive health care, screen of breast cancer and cervical cancercervical cancer

Health behaviorHealth behavior Transportation safety, exercise, body weight control, diet habit, oral health, Transportation safety, exercise, body weight control, diet habit, oral health,

and risk behaviors(e.g. smoking, drinking, betel nuts chewing)and risk behaviors(e.g. smoking, drinking, betel nuts chewing)

Fertility, contraception and induced abortionFertility, contraception and induced abortion Fertility, contraception and attitude toward induced abortionFertility, contraception and attitude toward induced abortion

Comparison between 2001 and 2002 NHISComparison between 2001 and 2002 NHIS

SurveySurveyComp.Comp.

2001 NHIS2001 NHIS 2002 NHIS2002 NHIS(HP-KAP Survey)(HP-KAP Survey)

RepresentRepresent Taiwan, 7stratum, aboriginal Taiwan, 7stratum, aboriginal towns, off-shore islandstowns, off-shore islands

Taiwan area, City/CountyTaiwan area, City/County

PopulationPopulation Population of all agesPopulation of all ages Population aged 15+Population aged 15+

SampleSample Base on householdBase on householdTaiwan area: 6,592 householdTaiwan area: 6,592 householdaboriginal area: 608aboriginal area: 608 householdhouseholdOff-shore islands: 432 householdOff-shore islands: 432 household((interviewed:25,464 persons; 93.8%)interviewed:25,464 persons; 93.8%)

Base on individualBase on individual32,656 persons32,656 persons

ContentsContents Fewer questions on knowledge of Fewer questions on knowledge of and attitude toward healthand attitude toward health

More questions on More questions on knowledge, attitude and knowledge, attitude and practicepractice

2002 HAKAP: 2002 HAKAP: Survey ResultsSurvey Results

Survey ResultsSurvey Results

* Response rate :* Response rate :

((1) Vary by county/city ranging from 1) Vary by county/city ranging from

74.5 % to 89.9 %74.5 % to 89.9 %

(2) For the whole nation:(2) For the whole nation:

26,755 cases (81.9 %)26,755 cases (81.9 %)

2002 HPKAP: Data Use2002 HPKAP: Data Use 1. Publish1. Publish 3 Volumes of research report3 Volumes of research report Vol. 1: Health promotion indicators by Vol. 1: Health promotion indicators by

county/city and sexcounty/city and sex Vol. 2: Reasons of not using medical and Vol. 2: Reasons of not using medical and

preventive health care services as well as preventive health care services as well as reasons of doing health risk behaviors and not reasons of doing health risk behaviors and not doing health promotion behaviors by doing health promotion behaviors by county/city and sexcounty/city and sex

Vol. 3: Age-sex-specific healthVol. 3: Age-sex-specific health indicators indicators by county/city (by county/city (upcoming soonupcoming soon))

2002 HPKAP: Data Use (2002 HPKAP: Data Use (contcont.).) 2. Press Release2. Press Release 3. Provide information for program planning :3. Provide information for program planning : Discussed with program planners to transfer surveyDiscussed with program planners to transfer survey research findings research findings 4. Invite university faculty and researchers to work with4. Invite university faculty and researchers to work with county/city Health Bureau to analyze county/city datacounty/city Health Bureau to analyze county/city data and to produce county/city reportand to produce county/city report 5. Set up baseline data for the assessment or5. Set up baseline data for the assessment or evaluation of county/cityevaluation of county/city achievement and programachievement and program achievementachievement

Future Plan on NHISFuture Plan on NHIS 1.Conduct National Health Interview Survey in 20051.Conduct National Health Interview Survey in 2005 *Combine 2001 NHIS and 2002 HPKAP Survey*Combine 2001 NHIS and 2002 HPKAP Survey * Needs to be county/city representative sample* Needs to be county/city representative sample

2. Encourage county/city Health Bureau to use data 2. Encourage county/city Health Bureau to use data

for program planning for program planning 3. Conduct international comparison of NHIS results3. Conduct international comparison of NHIS results 4. Develop Computer Assisted Personal Interview for4. Develop Computer Assisted Personal Interview for NHISNHIS 5. Incorporate biological marker examination by using5. Incorporate biological marker examination by using NHIS sample casesNHIS sample cases