2 nd training seminar on measurements of the health examination surveys
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2nd Training seminar on measurements of
the health examination surveys
Ana Paula Gil
Carlos Matias Dias
Instituto Nacional de Saúde, Dr Ricardo Jorge
2nd Training seminar – Helsinki, 20-22 September 2010
Introduction
First steps towards a Health Examination Survey in Portugal
Preliminary results of the pilot phase
EHES PORTUGUESE PILOT
STEP 1 of the survey: planning
The 1st phase of the survey consisted in translation and adaptation to
Portuguese of procedures defined by FEHES (2008), regarding blood
collection, physical examination and construction of questionnaires.
INPUTS for the questionnaires construction
oCore questions proposed by FEHES
oInputs by Regional Health Administrations (ARS)
oInputs from researchers with ongoing projects funded by the Portuguese Science and Technology Foundation at INSA
2nd Training seminar – Helsinki, 20-22 September 2010
EHES PORTUGUESE PILOT
Items in questionnaire
Questionnaire 1 Administered by a health
professional
• Health status; chronic/acute
diseases
• Functional evaluation
• Use of medications
• Woman Health
• Mental health (MHI-5)-
psychological stress
• Use of Healthcare services
Questionnaire 2
Self- administered
•Socio-demographic and household
•Physical activity
•Tobacco consumption
•Alcohol Consumption
•Eating habits
•Sun exposure and protection habits
•Quality of life
•Social Support / social relations
•Health services evaluation
2nd Training seminar – Helsinki, 20-22 September 2010
EHES PORTUGUESE PILOT
Health survey with physical
examination
Technical specifications Recording instruments
Blood collection Definition of procedures: Blood Processing and storage samples blood
Record sheet of blood collection.
Physical examination Definition of procedures : Height Weight Waist/hip circumference Blood pressure
Registration sheets for use during physical examination.
Interview Survey Manual: 1. Questions and answers about health surveys with physical examination 2. Basic rules of health survey o Rules for approach to participants (informed consent) o Fill rules 3. Questionnaire I and II:
oObjectives oStructure and questionsoFill rules for each question
Questionnaire 1 – administered by a health professional.
Questionnaire 2 – self administered.
STEP 2 of the survey: process definition and data collection instruments
2nd Training seminar – Helsinki, 20-22 September 2010
EHES PORTUGUESE PILOT
STEP 3 OF THE SURVEY: training program The overall process of training included 4 days, along two consecutive weeks.
1. Session
Introduction
(3 hours)
EHES: objectives, relevance, methods and core
measures, standardization of procedures (training and
quality control)
Survey
process
(3 hours)
The general description of the survey process:
oSelection of participants;
oBehavioral strategies to adopt towards non-
participants
oDaily work tasks namely preparation of materials and
equipments;
oReception of participants (general information and the
informed consent)2nd Training seminar – Helsinki,
20-22 September 2010EHES PORTUGUESE PILOT
STEP 3 OF THE SURVEY: training program
2ºSession
Blood
Collection(3h)
Safety: Practical measuresDescription of procedures:• Blood collection • Storage and packages• Transport preparation
Practical exercises (role play)Register of printed sheetsMaterial: Procedures manual
3º Session
Physical Examination
(3h)
Procedures descriptionoHeight oWeight oWaist/hip circumference oBlood pressure
Practical exercises (role play)Register of printed sheetsManual: Procedures manual
2nd Training seminar – Helsinki, 20-22 September 2010
EHES PORTUGUESE PILOT
STEP 3 OF THE SURVEY: training program
4º Session(6h)
Interview
o Basic rules of health survey o Composition of two questionnaires I and II:objectives, composition and fill rules.
Each questionnaire was preceded by a descriptive component, succeeded by practical exercises.
Material: Survey manual
5º Session
Role play
oTest all survey process (since the reception of the participant until carrying out of examinations, interview by questionnaire)
oThis essay was videotaped and discussed interactively by the group of trainees in order to identify difficulties, questions and points to be improved to implement during the pilot phase
2nd Training seminar – Helsinki, 20-22 September 2010
EHES PORTUGUESE PILOT
Time: The field work took place from 24th May to 2 July 2010 (6 weeks, on working days). Activities began at 8.00 am and ran until 12.00 am.
2nd Training seminar – Helsinki, 20-22 September 2010
EHES PORTUGUESE PILOT
STEP 4 OF THE SURVEY: fieldwork
Survey sites: Health centre of São Brás de Alportel
(Regional Health Administrations (ARS) The Health centre is 18 Km from Faro
Field team was composed of 7 professionals, all from the staff of the São Brás
de Alportel Health Centre:
•2 nurses working (health centre of São Brás de Alportel)
•Local staff (1 receptionist, 1 telephonist, 1 administrative)
•1 Blood technician (Regional Public Health Laboratory)
•1 element to support at breakfast
2nd Training seminar – Helsinki, 20-22 September 2010
Participants by sex
EHES PORTUGUESE PILOT
Participants: 221
Participants according to age groups
Planned
Times
Average
times/minutes
Informed consent 10 5,11
Measurement of body height 3 3,1
Measurement of body weight 3 3,1
Measurement of waist and hip
circumferences 5 3,19
Measurement of Blood Pressure 15 6,25
Blood collection 15 15
Questionnaire administered by
professional _ 10,24
Self administered Questionnaire
(without help) _ 29,86
Self administered Questionnaire (with
help) _ 21,52
Times shown for each stage of the survey
2nd Training seminar – Helsinki, 20-22 September 2010
EHES PORTUGUESE PILOT
2nd Training seminar – Helsinki, 20-22 September 2010
Questionnaire 1
Administered by a health professional
Strengths:
oGood preparation of the survey manual, as well as the instruments to apply;
o Simple and objective language;
oDifferent strategies depending on the participant profile (illiterate, foreigners)
EHES PORTUGUESE PILOT
Problems:
oQuestions about chronic diseases - It is very exhausting reading all the
diseases. Generally, people don´t know the technical name of the diseases.
Recommendations:
o Review some questions/ (confirm with the data analyses);
oIncrease the numbers of training hours (interview);
o More time to role play, practices and group discussion.
Questionnaire 2 – self administered
Problems:
o Very detail;
o Very long;
o Difficulty in understanding some questions
Recommendations:
o Review some questions/ (data analyses)
2nd Training seminar – Helsinki, 20-22 September 2010
EHES PORTUGUESE PILOT
o If it opts for the same structure and content of questions, their use will require more human resources available that may assist in administration.
o It is recommended that the support of this questionnaire is administered in another room prepared for this purpose, and not in the waiting room, so as to respect the privacy of the participants; oAcoustics of the rooms, even with the door closed, sometimes, it is possible to understand the type of questions and answers of the participants.
Synthesis conclusive: "Teachings" pilot and improvement plan
1. Announcement of the health survey with physical examination
2. Autonomous health team
3. Suitable areas for survey (examination and interview)
4. Review part of instruments
5. Improvements in the some procedures (blood collection and physical exam)
2nd Training seminar – Helsinki, 20-22 September 2010
EHES PORTUGUESE PILOT
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