cindi health monitor: a study of feasibility of a health ... · a health behaviour monitoring...

CINDI Health Monitor: A Study of feasibility of

a health behaviour monitoring survey

across CINDI countries

Data Book

ABSTRACT

To better monitor health-related behaviour at community level in countries which are implementing an integrated approach towards noncommunicable disease prevention and control, a CINDI Health Monitor survey was introduced in the CINDI (Countrywide Integrated Noncommunicable Diseases Intervention) Programme. In 2000–2002, 32 surveys were carried out in 26 countries of the CINDI network. In order to assess the process of the implementation of the surveys and to study feasibility of such surveys, a survey on the methodological aspects of the CINDI Health Monitor survey was conducted. A database on the results was established and a data book prepared, which will be used to study the experience of the implementation of the CINDI Health Monitor survey at country level and elaborate strategies for the development of a regular health behaviour monitoring system.

Keywords HEALTH SURVEYS – methods ATTITUDE TO HEALTH BEHAVIOR FEASIBILITY STUDIES CHRONIC DISEASE – prevention and control EUROPE

© World Health Organization – 2003 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 WHORegional 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 aresolely the responsibility of those authors.

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CONTENTS

Page

Preface...........................................................................................................................................................1

Acknowledgments .........................................................................................................................................2

Contributors...................................................................................................................................................3

Introduction ...................................................................................................................................................8

CINDI Health Monitor ..................................................................................................................................9

A survey to assess the process of conducting a CINDI Health Monitor survey..........................................10

Methodology ...........................................................................................................................................10 Survey response ......................................................................................................................................10

Implementation of the CINDI Health Monitor survey ................................................................................11

The questionnaire ........................................................................................................................................11

Management and use of survey data ...........................................................................................................12

Conclusions .................................................................................................................................................13

Recommendations .......................................................................................................................................13

Table i, ii, and iii .........................................................................................................................................15

Databook Tables 1–40.................................................................................................................................19

Annex 1. List of persons responsible for the latest CINDI Health Monitor Survey in the country and for data management and analysis of the survey ..................................................................................70

Annex 2. Questionnaire on methodological aspects of the CINDI Health Monitor Survey ......................74

Annex 3. The CINDI Health Monitor Questionnaire ..................................................................................86

EUR/03/5040781 page 1

Preface

The WHO Countrywide Integrated Noncommunicable Diseases Intervention (CINDI) Programme has a standardized methodology and comprehensive system for monitoring and evaluating the programme, at both national and demonstration-area levels. Monitoring and evaluation are carried out at regular intervals using agreed indicators and applying an agreed methodology for epidemiological surveys. The CINDI Health Monitor is a survey to reflect health behaviour and lifestyle related risk factors to carry out at the CINDI demonstration area, at regional or national level. This activity is supported by the National Public Health Institute, Finland, and the Centers for Disease Control and Prevention, United States. The methodology of the survey is based on the experience of the Finbalt Health Monitor project on health behaviour monitoring in which Finland, Estonia, Latvia and Lithuania participated. In 2000–2002 (the pilot phase of the project), 32 surveys were conducted in 26 CINDI participating countries. Information covered smoking, food habits, physical activity, alcohol intake, personal assessment of health, and use of health services in 25–64 years age population groups. In order to assess if it is feasible to establish a health behaviour monitoring system at community level across CINDI countries using the proposed methodology, a survey on the methodology of carrying out such a survey in CINDI participating countries was conducted. When the survey was completed, the WHO Regional Office, in collaboration with participating countries, prepared a database on findings. This document is a data book that contains responses from countries. The findings are presented in a format of tables for every question of the questionnaire on survey implementation methodology. A preliminary analysis of the pilot phase of the project indicates that it is feasible to implement such a survey across CINDI participating countries and that international comparison of information on health behaviour is possible. The data book will be used by CINDI Programme Directors for various analyses according to their needs. A report on experience of the pilot phase of the CINDI Health Monitor will be prepared and the results of this survey will be used for national CINDI participating countries capacity building in health information system. Professor V. Grabauskas Aushra Shatchkute, M.D. Chairman Regional Adviser CINDI Management Committee Chronic Disease Prevention

EUR/03/5040781 page 2 Acknowledgments

The pilot phase of the CINDI Health Monitor and the survey on the methodological aspects of CINDI Health Monitor surveys conducted in countries during the pilot phase were supported by the National Public Health Institute, Finland, Centers for Disease Control and Prevention, United States, the Kaunas University of Medicine, Lithuania, the National Centre of Preventive Medicine, Russian Federation. Technical guidance regarding the CINDI Health Monitor survey and the survey on methodological aspects provided by Dr A. Nossikov, and Dr R. Prochorskas, WHO Regional Office for Europe, is highly appreciated.

EUR/03/5040781 page 3

Contributors

Austria Dr Günter Diem, CINDI Director

Director, Arbeitskreis für Vorsorge-und Sozialmedizin, Bregenz Belarus Dr Alexander A. Grakovich, CINDI Director

Director, Belarusian Centre for New Medical Technologies, Computer Systems, Administration and Management of Health, Minsk

Dr Igor Kozlov

Head, Cardiology Prevention Laboratory, the Republican Scientific and Practical Centre of Cardiology, Minsk

Bosnia and Herzegovina Professor Milorad Balaban

Institute of Public Health, Republika Srpska Dr Jasna Omanic

Institute of Public Health Federation, Federation of Bosnia & Herzegovina Bulgaria Dr Nikola I. Vassilevsky, CINDI Director

Director, Department of Health Promotion and Disease Prevention, The National Centre of Public Health, Sofia

Dr Ivan Stelianov Peshev

Department of Health Promotion and Disease Prevention, The National Centre of Public Health, Sofia

Canada Professor Sylvie Stachenko, CINDI Director

Director General, Disease Intervention Division, Centre for Chronic Diseases Prevention and Control, Population and Public Health Branch, Health Canada, Ottawa

Dr Yang Mao

Centre for Chronic Diseases Prevention and Control, Population and Public Health Branch, Health Canada, Ottawa

Croatia Professor Zeljko Metelko, CINDI Director

“Vuk Vrhovac” Institute, Clinic for Diabetes Endocrinology and Metabolic Diseases, University of Zagreb, Zagreb

Dr Gordana Pavlekovic

Andrija Stampar School of Public Health, Medical School, University of Zagreb, Zagreb

EUR/03/5040781 page 4 Czech Republic Associate Professor Lumir Komarek, CINDI Director

National Institute of Public Health, Center of Health and Environment, Prague Dr Ludmila Skalova

National Institute of Public Health, Centre of Health and Environment, Prague Finland Dr Ritva Prättälä,

National Public Health Institute, Department of Epidemiology and Health Promotion, Helsinki

Ms Kati Vähäsarja National Public Health Institute, Department of Epidemiology and Health Promotion, Helsinki

Georgia Associate Professor Revaz Tataradze

Vice-President, Georgian Medical Association, State Medical University, Tbilisi

Dr Constantine Liluashvili Researcher, Department of Coronary Heart Disease, National Centre of International Medicine, Tbilisi

Hungary Professor Endre Morava, CINDI Director

Director, Department of Public Health, Semmelweis University, Medical Faculty, Budapest Dr Katalin Antmann

Department of Public Health, Semmelweis University, Medical Faculty, Budapest Italy Professor Maria Teresa Tenconi, CINDI Director

Hygiene Section, Department of Preventive Medicine, University of Pavia, Pavia Dr Anna Maria Gianti

Department of Preventive Medicine, University of Pavia, Pavia Kazakhstan Professor Aikan Akanov, CINDI Director

Director General, National Centre for Problems of Healthy Lifestyle Development, Ministry of Health, Almaty

Dr Azslan Indershiyev

National Centre for Problems of Healthy Lifestyle Development Ministry of Health, Almaty

Kyrgyzstan Professor Tilek S. Meimanaliev, CINDI Director

Ministry of Health, Bishkek

EUR/03/5040781 page 5

Dr Chinara Bekbasarova MANAS Health Care Reform Programme, Ministry of Health, Bishkek

Latvia Dr Vilnis Dzerve, CINDI Director

Latvian Institute of Cardiology, Riga Dr Iveta Pudule

Health Promotion Centre, Riga Lithuania Professor Vilius Grabauskas, CINDI Director

Chancellor, Kaunas University of Medicine, Kaunas Associate Professor Jurate Klumbiene

Kaunas University of Medicine, Institute for Biomedical Research, Kaunas Malta Dr Maria Ellul, CINDI Director

Director, Health Promotion Department, Floriana Republic of Moldova Professor Mihail Popovici, CINDI Director

Director, Institute of Cardiology, Chisinau Poland Professor Wojciech K. Drygas. CINDI Director

Department of Preventive and Social Medicine, University of Medicine, Lodz Dr B. Wojciech

Department of Preventive and Social Medicine, University of Medicine, Lodz Portugal Professor Fernando de Padua, CINDI Director

Director, National Institute of Preventive Cardiology, Lisbon Romania Dr Aura Marcu, CINDI Director

Institute of Public Health, Bucharest Dr Carmen Ungurean, CINDI Director’s Assistant

Institute of Public Health, Bucharest Russian Federation Professor Igor Glasunov, CINDI Executive Director

State Research Centre for Preventive Medicine, Moscow Dr Rimma Potemkina

Deputy Head, Senior Researcher, State Research Centre for Preventive Medicine, Moscow

EUR/03/5040781 page 6 Slovakia Dr Maria Avdicova, CINDI Director

Head, Department of Epidemiology, State Institute of Public Health, Banska Bystrica Slovenia Dr Jozica Maucec Zakotnik, CINDI Director

State Secretary, Ministry of Health, Ljubljana Dr Lijana Zaletel-Kragelj

Chair of Public Health, University of Ljubljana, Faculty of Medicine, Ljubljana Spain Professor Helios Pardell, CINDI Executive Director

General Direction of Public Health, Department of Health and Social Security, Barcelona

Dr Riccard Tresseras Deputy Director for Health Planning, General Director of Public Health, Department of Health and Social Security, Barcelona

Turkmenistan Dr Rustam Kazimov, CINDI Director

Director, Educational and Informational Centre –“Health Promotion and Prevention”, Turkmenian Research Institute of Preventive and Clinical Medicine, Ashgabat

Mr Valeriy V. Polma

Mathematics, Statistics and programme’s assistant, Turkmenian Research Institute of Preventive and Clinical Medicine, Ashgabat

Ukraine Professor Iryna P. Smyrnova, CINDI Executive Director

Institute of Cardiology, Kyiv

Dr Iryna Gorbas Institute of Cardiology, Kyiv

United Kingdom Dr Brian Gaffney, CINDI Director

Head, The Health Promotion Agency for Northern Ireland, Belfast United States of America Ms Virginia S. Bales

Director, Division of Adult and Community Health, Centers for Disease Control & Prevention, Atlanta

Dr Gary Hogelin

Director of Research, Centre for Health Promotion and Education, Centers for Disease Control & Prevention, Atlanta

EUR/03/5040781 page 7

World Health Organization Headquarters Dr Kathy Douglas

Scientist, Noncommunicable Disease Prevention and Health Promotion Dr Pekka Puska

Director, Health Promotion/NCD Prevention and Surveillance Regional Office for Europe Ms Lise Højbjerre

Short Term Professional, Chronic Disease Prevention Dr Aushra Shatchkute

Regional Adviser, Chronic Disease Prevention

EUR/03/5040781 page 8 Introduction

The WHO CINDI (Countrywide Integrated Noncommunicable Disease Intervention) Programme focuses its action on the reduction of levels of major noncommunicable diseases (cardiovascular diseases, cancer, chronic respiratory diseases, diabetes) through coordinated comprehensive health promotion and disease prevention measures. The measures are aimed to favourably influence health related lifestyles in communities and to prevent and control common risk factors (such as hypertension, hyperlipidemia, obesity, smoking, alcohol abuse, sedentary lifestyle). The programme is based on the concept of an integrated approach towards the prevention and control of noncommunicable diseases. The approach implies recognition that a number of risk factors are common to major noncommunicable diseases (NCD) and are related to lifestyle. There are 28 countries (26 WHO European Member States, Canada and Cyprus) participating in CINDI. When establishing a CINDI programme, each country prepares its own detailed protocol (based on the international CINDI Protocol and Guidelines), with national objectives and plan of action for implementing the programme that reflects local circumstances, the importance of major health problems, available resources and priorities, cultural aspects. The protocol also defines health information systems to support the planning, monitoring and evaluation of interventions. CINDI has a standardized methodology and comprehensive system of programme monitoring and evaluation. Monitoring and evaluation are carried out at regular intervals using agreed indicators and applying an agreed methodology for epidemiological surveys. Information comes from statistics (such as those on mortality) and from carefully standardized random population sample surveys on health behaviour and risk factors. The CINDI Health Monitor is a survey to monitor health-related behaviour and NCD risk factors in adult populations.

EUR/03/5040781 page 9

CINDI Health Monitor

The CINDI Health Monitor survey was introduced in CINDI participating countries in 2000. It was agreed that the first round of surveys would be conducted in 2001–2002 (pilot phase), in as many countries as possible, to assess the feasibility of the survey. In 2001, a training seminar in Helsinki was hosted by the National Public Health Institute, Finland for countries that planned to carry out such a survey. Aims of the CINDI Health Monitor:

�� To monitor health behaviour and lifestyle related risk factors in order to evaluate and promote favourable health behaviour in populations;

�� To make international comparisons. The survey is based on the questionnaire and experience of the FINBALT Health Monitor project. The survey has the following principle requirements: Implementation: The survey is an obligatory CINDI monitoring and evaluation component that should be carried out on a regular basis. It is recommended to carry out the survey in the same period of the year (preferably March-May). In order to be able to assess the trends, countries should use the same survey methodology in every survey. Sampling: Since the ultimate goal of CINDI is to implement the programme at national level, it was agreed that the survey would be conducted at national level as a random sample survey. If it is not feasible to conduct the survey at national level, it could be carried out in the demonstration area(s) only. It was also recommended that an independent additional sample survey be conducted in the same demonstration area(s) as the CINDI risk factor surveys. Sample size: At least 3000 subjects. Age group: The sample should be of at least 3000 persons and the core age group between 25 and 64 years. Each country will be free to have additional samples from younger or older age groups. Survey methods: Countries can choose their own methods of data collection according to their possibilities and situation. A posted questionnaire is recommended. However, if this is not possible, telephone interviews or face-to-face interviews might be used. Questionnaire: The survey questionnaire includes two categories of questions: 1) obligatory survey questions; 2) highly recommended survey questions. It was noted that when countries conducted the survey, additional questions could be added to serve local needs. Data archive: To have comparable data and establish a data archive of good quality, the description of every survey should contain details on the survey area and method of data collection, as well as contacting information in respect of those in charge of the study.

EUR/03/5040781 page 10 A survey to assess the process of conducting a CINDI Health Monitor survey

In order to document the process of the first CINDI Health Monitor Survey across CINDI countries, analyse the methodology used and assess feasibility of such a survey, a survey was carried out in CINDI participating countries by the WHO Regional Office for Europe, August 2002–February 2003.

Methodology

A questionnaire (Annex 1) was elaborated for an analysis of the process of the first CINDI Health Monitor survey and assessment of the feasibility of such a health behaviour monitoring survey across CINDI countries, which vary in socioeconomic conditions and lifestyle culture. To this end the questionnaire was focused on the following issues: how the survey was organized (e.g. did the survey meet the agreed principles of the CINDI Health Monitor; how was the training of the personnel organized) and implemented (e.g. sampling procedure, data collection method, questionnaire used); what were main obstacles and problems; how comparable and reliable is the data; how the results of the survey have been utilized.

Survey response

The questionnaire was distributed to 30 countries (28 CINDI participating countries and two CINDI candidate countries). Response was received from 29 countries (Table i) indicating that almost all countries conducted a CINDI Health Monitor survey and that data on health behaviour was already available in 26 CINDI Programme participating countries. Among those countries (23), which conducted the CINDI Health Monitor survey in 2000–2002, 17 countries conducted such a survey for the first time. The agreed principles of the CINDI Health Monitor require that the survey be conducted at national or, if this is not feasible or possible, at CINDI demonstration area level. The survey was conducted in 13 countries at national level, in 13 countries – at the level of the CINDI demonstration area. National surveys were more typical for countries with a smaller number of inhabitants. It should be noted that a number of countries (Bulgaria, Canada, Italy, the Russian Federation, Slovenia) conducted surveys in several regions or at national and regional level (Canada, Kyrgyzstan, Slovenia). The variation of the level at which the survey was conducted is reflected also in the responses of countries on the methodological aspects of surveys. In fact, some countries (Italy) have sent information on all their regional surveys. It should be noted that since the survey did not request regional data, other countries did not supply such information. Therefore in the data book the analysis unit is a survey but not a country. In this version of the data book only the data about regional surveys in Italy is presented. Information about regional surveys from countries with several surveys will be added in the future development of the data book.

EUR/03/5040781 page 11

Implementation of the CINDI Health Monitor survey

The period of data collection in surveys varied widely in terms of the length (from 14 days to 15 months) as well as the season of the year (for example, the month of starting data collection varied from January to October). In most cases (75%) the CINDI Health Monitor survey was carried out as an independent survey. In four countries (Austria, Canada, Romania and Turkmenistan) it was carried out in parallel with a CINDI Risk Factor survey. It was run as part of a large survey in six countries. Since it was envisaged that in a number of countries the CINDI Health Monitor survey would be the first survey of such a type, our interest regarding the preparatory work was focused on training of the staff. Only five countries did not provide any training. An analysis of the number of staff involved and their training demonstrated that the number of staff involved varied very significantly (from 2 to 450 persons) as well as the duration of training (from two hours to six weeks). Training topics also varied. Aims of the survey, survey procedures, interviewing, data coding, and the content of the questionnaire were the topics mentioned frequently. The population register was the most frequently used sampling frame. Cluster sampling, lists of electors, telephone lists, household area frame, lists of family physicians, the latest census of the population and the whole population of a town were used in some surveys as a sample frame. Some action to motivate the population to participate in the survey was taken in approximately 50% of surveys. Promotion of the survey through the mass media, offering a free of charge medical examination or blood sample analysis, and lottery tickets were reported as examples of motivation methods used. According to the agreed principles of the CINDI Health Monitor, simple random sampling was the procedure to select a study sample. This procedure was followed in 72% of surveys. The recommended sample size was 3000 subjects. This requirement was met by 16 (50%) surveys. The results of the survey demonstrated that the sample size of a survey varied from 401 to 130 880 subjects. The CINDI Health Monitor recommends posted questionnaire as the first choice method for data collection. However, this method of data collection was used only in 11 of 32 surveys. In 15 surveys, in person interview was used (Table ii). The response rate varied from 23% to 99%. In most surveys the response rate was higher than 60%. The age of surveyed subjects varied from 12 to 81 years. However, all surveys covered the recommended 25–64 years age group.

The questionnaire

The questionnaire (Annex 2) included highly recommended questions and obligatory questions. All questions of both categories were included in the questionnaire in 53% of surveys. Approximately 25% of surveys did not include all obligatory questions. Regarding highly recommended questions, approximately 30% of surveys did not include some of them. Obligatory questions most often (three surveys) not included were about physical activity.

EUR/03/5040781 page 12 Almost every second survey used additional questions. Smoking habits, the use of alcohol, educational level, traffic safety, food habits, and health services were areas where additional questions were added. A number of surveys modified answer categories. Answers to the questions regarding fat intake were modified most often. Other questions with often-modified answer categories were questions about alcohol consumption and health services, including preventive services. It should be noted that only six surveys (four Italian surveys, the surveys in Belarus and Croatia) included exclusively all obligatory and highly recommended questions and did not add any questions or modify answer categories (Table iii). Since the questionnaire was used in countries with different socioeconomic and cultural conditions, it was important to learn how the questions functioned. In general, there were no major problems. However, almost every second survey had certain problems with some questions. The questions most often defined as poorly functioning were questions regarding physical activity, food habits and alcohol use.

Management and use of survey data

In most surveys CINDI teams were responsible for data processing. The software most often used for data processing and analyses were Excel and/or SPSS (26 surveys). In 63% of surveys, certain steps were taken to ensure the quality of data. Data has already been analysed in approximately 47% of surveys and the results were used for the elaboration of preventive strategies, development of regional or national health policy or establishment of community health programmes.

EUR/03/5040781 page 13

Conclusions

1. The response from countries regarding the implementation of the CINDI Health Monitor survey has been very high.

2. It is feasible to monitor health-related behaviour at community level in CINDI participating countries using the proposed methodology.

3. Although countries attempt to follow the agreed principles of the implementation principles, the methodology varies and depends on local conditions and possibilities.

4. Comparison of data between countries requires further analysis/elaboration of indicators.

Recommendations

1. To verify and collect additional information regarding certain aspects of surveys in some surveys.

2. To analyse the data book in detail and prepare a report.

3. To prepare a manual for further surveys.

4. To incorporate findings of the survey in the process of capacity building on health promotion and disease prevention.

EUR/03/5040781 page 15

Table i

Participation in the survey on methodological aspects of the CINDI Health Monitor survey

CINDI participating country

Year of the CINDI Health

Monitor Survey

Survey was carried out

at national (N), regional (R),

CINDI demo area (D)or other (O) level

Comments

Austria 1998–1999 D Although it was reported that the CINDI Health Monitor survey was conducted, it is very likely that this was a CINDI Process Evaluation survey

Belarus 2002 D

Bosnia and Herzegovina 2001–2002 N (Republic Srpska) D (Federation of Bosnia & Herzegovina)

Bulgaria 2002 D

Canada 2000 N and R

Croatia 2002 D

Cyprus Survey not yet conducted

Czech Republic 2002 N

Estonia 2001–2002 Survey conducted, however information not available at the moment

Finland 2002 N

Germany No response

Georgia 2001 D

Hungary 2001–2002 N

Italy 2001–2002 D and O

Kazakhstan 2002 D

Kyrgyzstan 2002 N and R

Latvia 2002 N

Lithuania 2002 N

Malta 2002 N

Republic of Moldova 2001 D

Poland 2001–2002 D

Portugal Survey not yet conducted

Romania 2001 D

Russian Federation 2000–2001 R

Slovakia 2002 N

Slovenia 2001 N and R

Spain (Catalonia) D The CINDI Health Monitor survey not yet conducted; relevant information related to the previous CINDI Process evaluation survey is provided.

Turkmenistan 1998–1999 D

Although it was reported that the CINDI Health Monitor survey was conducted, it is very likely that this was a CINDI Process Evaluation survey

Ukraine 2002 D

United Kingdom (Northern Ireland)

A similar survey to the CINDI Health Monitor was conducted 2002

EUR/03/5040781 page 16

Table ii

Characteristics of Surveys which used In-person interview to collect Data Survey Type of survey Sample

Size Training Provided

Training lasted

Number of Interviewers

Length of survey (months)

Austria Population Risk factor Survey 2400 X 2 weeks 450 12

Belarus CINDI H.M.S.* 3174 X 1 day 13 5 Bosnia and

Herzegovina Republika Srpska

CINDI H.M.S.* 2200 X 2 days 15 1

Bosnia and Herzegovina CINDI H.M.S.* 2000 X 1 day 20 1

Bulgaria CINDI H.M.S.* 2400 X 1 day 60 3

Canada Canadian Community Health Survey (CCHS) 130 880 X 6 weeks 60 15

Croatia CINDI H.M.S.* 2615 X 3 days 8 4 Czech Republic CINDI H.M.S.* 3050 X 2 days 287 0.5

Georgia CINDI H.M.S.* 1000 X 5 days 20 1 Italy Mercato San

Severino CINDI H.M.S.* 401 2 10

Kazakhstan CINDI H.M.S.* 3777 12 1.5

Malta CINDI H.M.S.* 5510 X 3 days, 3 hours each 50 3.5

Republic of Moldova CINDI H.M.S.* 3088 X 1 month 20 5

Poland CINDI H.M.S.* 5000 X 2 hours 5 5 Romania CINDI H.M.S.* 600 X 2 days - 4

Turkmenistan CINDI Risk Factor Survey 2830 X 2 days 5 13.5

Characteristics of Surveys which used Postal Questionnaire to collect Data

Survey Type of survey Sample Size

Training Provided

Training lasted



Finland CINDI H.M.S.* 5000 3 3 Hungary CINDI H.M.S.* 6000 X 2 days 7 4

Italy Bologna CINDI H.M.S.* 453 - - - 3 Italy Cagliari CINDI H.M.S.* 1095 X 2 weeks 15 3 Italy Latina CINDI H.M.S.* 504 X 2 days 2 2.5 Italy Pavia CINDI H.M.S.* 526 X 2 hours 6 4 Kyrgyzstan CINDI H.M.S.* 8000 X 1 day 120 6

Latvia CINDI H.M.S.* 3000 X 2 weeks 3 3 Lithuania CINDI H.M.S.* 3000 X 2 days 6 3 Slovakia CINDI H.M.S.* 3000 X 4 hours 50 6 Slovenia CINDI H.M.S.* 15 379 X 25 hours 23 1.5 Ukraine CINDI H.M.S.* 3223 X 5 days 8 3

United Kingdom Nothern Ireland

NI Health and Lifestyle Survey 6000 5 ?

Characteristics of Surveys which used Telephone interview to collect data


Training Provided

Training lasted



Russian Federation

CINDI Risk Factor Survey 2449 X 3 days 14 10

Italy Udine CINDI H.M.S.* 512 X 1 week 35 4

Characteristics of Surveys where data collection method is unknown


Training Provided

Training lasted



Estonia CINDI H.M.S.* - - - - 12

EUR/03/5040781 page 17

* CINDI Health Monitor Survey

Table iii The degree of surveys meeting the principle recommendations of the CINDI Health

Monitor

CINDI participating

country

National survey

Started in

March-May

Simple random sampling

At least 3000

subjects

Response rate

>70 %

Age group 25–64

Postal question

-naire

All obligatory questions included

Austria x x Belarus x x x x x x Bosnia and Herzegovina x x x

Bulgaria x x x x x Canada x x x x x Croatia x x Cyprus Czech Republic x x x x x x Estonia Finland x x x x x x Germany Georgia x x x Hungary x x x Italy Varied x Varied x x x Kazakhstan x x x x x x Kyrgyzstan x x x x x x x Latvia x x x x x x x Lithuania x x x x x x x Malta x x x x Republic of Moldova x x x

Poland x x x x Portugal Romania x x x x Russian Federation x x x

Slovakia x x x x x x x Slovenia x x x x x x Spain (Catalonia) Turkmenistan x x x x Ukraine x x x x x x United Kingdom (Northern Ireland)

x x x x

EUR/03/5040781 page 19

Databook

Tables

No 1–40

EUR/03/5040781 page 20

Table 1. Has the CINDI Health Monitor Survey been conducted in your country?

Survey Yes No

How often

Data collection for the latest survey

started on

Data collection for the latest survey was completed on

We expect to conduct

the CINDI Health Monitor starting

Will not conduct the CINDI Health Monitor Survey

but have conducted a

similar survey and are able to

provide data Austria 3 June 1998 June 1999

Belarus 1 5 March 2002 10 August 2002 Bosnia and Herzegovina Banja Luka

2 8 July 2002 13 August 2002

Bosnia and Herzegovina Sarajevo

2 1 July 2001 1 August 2001

Bulgaria 1 April 2002 June 2002 Canada 1 September 2000 November 2001 Croatia 1 February 2002 May 2002 Cyprus 2003

Czech Republic 1 23 May 2002 7 June 2002 Estonia* 6 2000 2001 Finland 24 4 April 2002 30 June 2002 Georgia 1 14 September 2001 10 October 2001

Germany - - - - - Hungary 1 10 September 2001 11 January 2002 Italy Mercato San Severino 1 1 September 2001 30 June 2002

Italy Cagliari 1 1 April 2002 30 June 2002 Italy Latina 1 1 July 2002 14 September 2002 Italy Bologna 1 June 2002 September 2002 Italy Udine 1 June 2002 September 2002

Italy Pavia 1 March 2001 June 2001 Kyrgyzstan 1 2 February 2002 30 March 2002 Kazakhstan 1 9 April 2002 1 October 2002 Latvia 2 9 April 2002 15 July 2002

Lithuania 6 2 April 2002 24 June 2002 Malta 1 14 January 2002 April 2002

Republic of Moldova 1 1 January 2001 30 May 2001 Poland 2 1 October 2001 28 February 2002

Portugal January 2003 Romania 1 September 2001 December 2001 Russian Federation 1 24 May 2000 18 March 2001 Slovakia 1 5 May 2002 October 2002 Slovenia 1 16 May 2001 27 June 2001 Spain Catalonia 2003–2004

Turkmenistan 2003–2004 Ukraine 3 1 February 2002 30 April 2002 United Kingdom Northern Ireland X

*Estonia has conducted the Finbalt Health Monitor Survey from the year 1990. The CINDI Health Monitor applies the methodology in the Finbalt project

EUR/03/5040781 page 21

Table 2. Number of staff involved in the data collection

Survey Number Austria 450 Belarus 13 Bosnia and Herzegovina Banja Luka 15 Bosnia and Herzegovina Sarajevo 20

Bulgaria 60 interviewers (10 per each 6 CINDI Areas)

Canada 60 Croatia 8 Cyprus - Czech Republic 287 interviewers Estonia* - Finland 3 Georgia 20 Germany** Hungary 6–8 Italy Mercato San Severino 2 Italy Cagliari 15 Italy Latina 2 Italy Bologna* - Italy Udine 35 Italy Pavia 6 Kazakhstan 12 Kyrgyzstan 136 Latvia 3 Lithuania 6 Malta 50 Republic of Moldova 20

Poland 5 Portugal* - Romania* - Russian Federation 14 Slovakia 50 Slovenia 23 Spain Catalonia*** 3 Turkmenistan*** 5 Ukraine 8 United Kingdom Northern Ireland**** 5

*Data not available from this source **Did not conduct a CINDI Health Monitor Survey Note Kyrgyzstan: including 120 postmen, 8 regional coordinators, 4 employees of the National Statistic Committee (NSC) (including Chief of the Sampling Survey Department) and 4 members of CINDI team. ***Did not conduct a CINDI Health Monitor Survey yet, but have provided information from the latest CINDI Process Evaluation Survey. ****Did not conduct a CINCI Health Monitor Survey, but have provided information from a similar survey.

EUR/03/5040781 page 22

Table 3

Was local training provided to the staff? How long did the training last?

Survey No Yes Austria X 2 weeks Belarus X 1 day Bosnia and Herzegovina Banja Luka X 2 days Bosnia and Herzegovina Sarajevo X 1 day Bulgaria X 1 day Canada X 6 weeks Croatia X 3 days Cyprus** - - - Czech Republic X 2 days Estonia* - - - Finland X Georgia X 5 days Germany*** Hungary X 2 days Italy Mercato San Severino X Italy Cagliari X 2 weeks Italy Latina X 2 days Italy Bologna* - - - Italy Udine X 1 week Italy Pavia X 2 hours Kazakhstan X Kyrgyzstan X 1 day Latvia X 2 weeks Lithuania X 2 days Malta X 3 days, 3 hours each Republic of Moldova X 1 month Poland X 2 hours Portugal** - - - Romania X 2 days Russian Federation X 3 days Slovakia X 4 hours Slovenia X Varied Spain Catalonia X Turkmenistan X 2 days Ukraine X 5 days United Kingdom Northern Ireland X

TOTAL 5 16%

26 81%

*Data not available from this source **Data not available because the country has not yet conducted the survey Note Canada: Approximately 6 weeks depending on the responsibility of the staff ***Did not conduct a CINDI Health Monitor Survey

EUR/03/5040781 page 23

Table 4. What topics were included in the training?

Survey Topics Austria Interviewing

Belarus

Knowledge of the questionnaire and instructions on its completion Creation of database Formation of random sampling Invitations to participate in the survey Adherence to confidentiality during interview

Bosnia and Herzegovina Banja Luka

Protocol Questionnaire and guidelines


Importance of health promotion programmes Monitoring of healthy lifestyles Targets Implementation and evaluation Interviewers training for data collection in questionnaire Administrative duties in projects implementation

Bulgaria

Survey essence, aim, objectives Sample design Questionnaire content Interview approach Measurement procedures Data checking Possible errors, verification

Canada

Survey procedures Question contents Interview skills Follow-up non response Computer-based interview Telephone interview techniques Privacy and confidentiality policy

Croatia

Introduction to CINDI (goals and objectives) Communication skills Methodology CINDI Health Monitor questionnaire content

Cyprus –

Czech Republic The Agency has permanent team of interviewers, the training included topics listed in the questionnaire

Estonia* – Finland** –

Georgia

Main aspects of lifestyle measures Role of integrated risk factors Observation of questionnaire and technique of data collection Technique and methodology of interview; ethical aspects of the survey (confidentiality of interview) Data collection process

Germany*** –

Hungary

Organization of the survey Data coding Evaluation Individual data protection

Italy Mercato San Severino** _

Italy Cagliari Aims of the survey Sample population Administration methods

Italy Latina Training for MATISS Project (old MONICA project) Italy Bologna –

EUR/03/5040781 page 24

Survey Topics

Italy Udine

Aims of the survey Characteristics of the questionnaire Administration methods Local Authorities involvement General practitioners and nurses involvement

Italy Pavia Aims of the survey Characteristics of the questionnaire Administration methods

Kazakhstan** –

Kyrgyzstan

Sampling Questionnaire Mailing Respondent feedback Data entry Analysis (at national level)

Latvia

Questionnaire coding Data sampling Data entry Data analysis

Lithuania The standardized coding and entering of the data Malta Briefing, discussion on questionnaire layout and conducting of interview

Republic of Moldova

Performing correct questioning Collection and storage of blood Recording an ECG Detection and registration of risk factors Arterial pressure measurement Physical characteristics measurement

Poland Methodological rules (how to formulate questions, problems with receiving answers, etc.) Portugal –

Romania Methodological issues: sampling Interview techniques Standard blood pressure, height, weight measurement

Russian Federation

Random sample creation Telephone interviewing Supervision Putting the data in the computer database

Slovakia Importance of study Contents of questionnaire Preparation of staff on answering or talks on the possible questions of respondents

Slovenia Before and during the data collection there were several short-term training sessions regarding methodology of data collection, also online instructions were available. Training sessions regarding data analysis are ongoing, dedicated to actual topics

Spain Catalonia** –

Turkmenistan

Essential and recommended indicators Implementing a risk factor survey Quality control Implementing of process control

Ukraine

Goals of CINDI Health Monitor Sampling Data collection Items in the questionnaire

United Kingdom Northern Ireland** –

*Data not available from this source **Data not available because the country answered no in the previous question ***Did not conduct a CINDI Health Monitor Survey

EUR/03/5040781 page 25

Table 5. At what level was the survey conducted?

Survey National level Regional Is the region a CINDI demonstration area? Other

Yes No Yes No No Yes No Yes Austria X X X - -

Belarus X X X - - Bosnia and Herzegovina Banja Luka*** X - - - - -

Bosnia and Herzegovina Sarajevo*** - - X X - -

Bulgaria*** - - X X - - Canada X X X X

Croatia X X X X Cyprus** - - - - - - - - Czech Republic*** X - - - Estonia* - - - - - - - - Finland*** X - - - - - - Georgia*** - X X - -

Germany**** - - - - - - - - Hungary X - - - - Italy Mercato San Severino*** - - - - Hospital Italy Cagliari - - X X X

Italy Latina X - - Demonstration area during another local survey of the population

Italy Bologna - - - - Demonstration area

Italy Udine - - - - Demonstration area

Italy Pavia - - - - Demonstration area during another local survey of the population

Kazakhstan X X X X Kyrgyzstan X X X-in Bishkek

Latvia X - - - Lithuania*** X - - - -

Malta*** X - - - - Republic of Moldova - - X X - -

EUR/03/5040781 page 26

Survey National level Regional Is the region a CINDI demonstration area? Other

Yes No Yes No No Yes No Yes Poland - - X X - - Portugal**

Romania*** X X X - Demonstration area/parallel with CINDI Risk Factor Survey Russian Federation X X X -

Slovakia X X - - Slovenia X X - -

Spain Catalonia X X - Demonstration area (Girona) Turkmenistan X X X - -

Ukraine X X X - - United Kingdom Northern Ireland*** X - - - - -

TOTAL 13 41%

9 28%

17 53%

2 6%

3 (of 17) 18%

13 (of 17) 77%

3 9%

8 25%

*Data not available from this source **Data not available because the country has not yet conducted the survey ***Data partly not available from this source ****Did not conduct a CINDI Health Monitor Survey Croatia wrote a note: 4 demonstration areas, 2 with intervention and 2 without intervention Kyrgyzstan wrote a note: X All Regions of Kyrgyzstan were covered, including Bishkek city, with the total of 8 regions of the country Slovenia wrote a note: The CINDI Health Monitor Survey 2001 was conducted at both national and regional levels (stratified random sample – strata presenting nine health regions of Slovenia)

EUR/03/5040781 page 27

Table 6. Which sampling frame was used?

Survey Population register Cluster Other If other, please specify

Austria X Belarus X Bosnia and Herzegovina Banja Luka X

Bosnia and Herzegovina Sarajevo X

Bulgaria X

Canada X Household area frame and a minor part from telephone list

Croatia X Cyprus** - - - - Czech Republic X Electoral list Estonia* - - Finland X Georgia X Germany*** - - - - Hungary X Italy Mercato San Severino X

Italy Cagliari X Italy Latina X Italy Bologna X Population of Brisighella Italy Udine X Italy Pavia X Kazakhstan X Kyrgyzstan X Census of Population of the year 1999 Latvia X Lithuania X Malta X Electoral register Republic of Moldova X Poland X Portugal** - - Romania X List of family physicians Russian Federation X Telephone list Slovakia X Slovenia X Spain Catalonia X Turkmenistan X Ukraine X United Kingdom Northern Ireland X

TOTAL 22 69%

3 9%

7 22%

*Data not available from this source **Data not available because the country has not yet conducted the survey ***Did not conduct a CINDI Health Monitor Survey

EUR/03/5040781 page 28

Table 7: Has any action being taken regarding protection of individual data?

Survey No Yes Austria X Belarus X Bosnia and Herzegovina Banja Luka X


Bulgaria X Canada X Croatia X Cyprus** - - Czech Republic X Estonia* - - Finland X Georgia X Germany*** - - Hungary X Italy Mercato San Severino X Italy Cagliari X Italy Latina X Italy Bologna X Italy Udine X Italy Pavia X Kazakhstan X Kyrgyzstan X Latvia X Lithuania X Malta X Republic of Moldova X Poland X Portugal** - - Romania X Russian Federation X Slovakia X Slovenia X Spain Catalonia X Turkmenistan X Ukraine X United Kingdom Northern Ireland X

TOTAL 4 13%

28 88%


EUR/03/5040781 page 29

Table 8. Was the CINDI Health Monitor Survey conducted as an independent survey or as part of a larger survey?

Survey Independent survey

Part of a larger survey

Which survey was the present survey a part of?

Austria X Belarus X Bosnia and Herzegovina Banja Luka X Bosnia and Herzegovina Sarajevo X Bulgaria X

Canada X Canadian Community Health Survey (CCHS)

Croatia X Cyprus** - - - Czech Republic X Estonia* - - -

Finland X Health behaviour and health among Finnish adult population 2002

Georgia X Germany*** - - - Hungary X Italy Mercato San Severino X

Italy Cagliari X Regional project for CVD, NIDDM, IDDM (EDIPS Study) Prevention

Italy Latina X MATISS project (old MONICA) Italy Bologna X Italy Udine X

Italy Pavia X About a health status of the rural population (on respiratory function)

Kazakhstan X Kyrgyzstan X

Latvia X Health Behaviour Monitoring Survey of Latvian Adult Population, 2002

Lithuania X Malta X 1st National Interview Survey Republic of Moldova X Poland X Portugal** - - - Romania X Russian Federation X Slovakia X Slovenia X

Spain Catalonia X A sub sample of an epidemiological study carried out in Girona

Turkmenistan X Ukraine X United Kingdom Northern Ireland X

TOTAL 24 75%

8 25%


EUR/03/5040781 page 30

Table 9. Was the CINDI Health Monitor Survey conducted in parallel with a CINDI risk factor survey?

Survey No Yes Austria X Belarus X Bosnia and Herzegovina Banja Luka X

Bosnia and Herzegovina Sarajevo X Bulgaria X Canada X Croatia X Cyprus** - - Czech Republic X Estonia* - - Finland X Georgia X Germany*** - - Hungary X Italy Mercato San Severino X Italy Cagliari X Italy Latina X Italy Bologna X Italy Udine X Italy Pavia X Kazakhstan X Kyrgyzstan X Latvia X Lithuania X Malta X Republic of Moldova X Poland X Portugal** - - Romania X Russian Federation X Slovakia X Slovenia X Spain Catalonia X Turkmenistan X Ukraine X United Kingdom Northern Ireland X

TOTAL

28 88%

4 13%


EUR/03/5040781 page 31

Table 10. Which method did you use to select a sample?

Survey Simple random sampling Other If other please specify

Austria X Double stage random sampling Belarus X Bosnia and Herzegovina Banja Luka X Three stage stratified quota sample


Bulgaria X

Canada X Household survey-multistage stratified cluster design

Croatia X All people living in defined areas Cyprus** - - - Czech Republic X Estonia* - - - Finland X Georgia X Germany*** - - - Hungary X - Italy Mercato San Severino X

Italy Cagliari X Italy Latina X Italy Bologna X Italy Udine X

Italy Pavia X All the subjects of the village of Rovescala, age 20–64 years

Kazakhstan X Kyrgyzstan X Latvia X Lithuania X Malta X Stratified random sample Republic of Moldova X Poland X Portugal** - - - Romania X Russian Federation X Slovakia X Slovenia X Stratified random sample

Spain Catalonia X A self-administered questionnaire was sent to 50% of participants in the epidemiologicalstudy

Turkmenistan X Ukraine X United Kingdom Northern Ireland X

TOTAL 23 72%

9 28%


EUR/03/5040781 page 32

Table 11. What was the size of the sample?

Survey Total Females Males Austria 2400 1200 1200 Belarus 3174 1905 1269 Bosnia and Herzegovina Banja Luka 2200 1100 1100

Bosnia and Herzegovina Sarajevo 2000 1000 1000 Bulgaria***** 2400 per area 1200 per area 1200 per area Canada 130 880 70 366 60 514 Croatia 2615 1494 1121 Cyprus - - - Czech Republic 3050 1537 1513 Estonia* - - - Finland 5000 2540 2460 Georgia 1000 596 404 Germany**** - - - Hungary 6000 3091 2909 Italy Mercato San Severino 401 198 203 Italy Cagliari 1095 - - Italy Latina 504 255 249 Italy Bologna 453 241 212 Italy Udine 512 256 256 Italy Pavia 526 246 280 Kazakhstan 3777 2389 1388 Kyrgyzstan 8000 4160 3840 Latvia 3000 1562 1436 Lithuania 3000 1504 1496 Malta** 5510 - - Republic of Moldova 3088 1596 1495 Poland 5000 2000 3000 Portugal*** - - - Romania 600 300 300 Russian Federation 2449 Slovakia 3000 1500 1500 Slovenia 15 379 7765 7614 Spain Catalonia** 1700 - - Turkmenistan 2830 1520 1310 Ukraine 3223 1633 1593 United Kingdom Northern Ireland 6000 3000 3000

*Data not available from this source **Data partly not available from this source ***Data not available because the country has not yet conducted the survey ****Did not conduct a CINDI Health Monitor Survey *****Bulgaria has 6 CINDI areas

EUR/03/5040781 page 33

Table 12. Which age group did the survey cover?

Survey Austria 25–64 years Belarus 18–81 years Bosnia and Herzegovina Banja Luka 25–74 years

Bosnia and Herzegovina Sarajevo 19–65 years

Bulgaria 25–64 years Canada ≥ 12 years Croatia 18–64 years Cyprus – Czech Republic 25–65 years Estonia* – Finland 15–64 years Georgia 18–64 years Germany*** – Hungary 20–69 years Italy Mercato San Severino 25–64 years Italy Cagliari 25–64 years Italy Latina 25–64 years Italy Bologna 25–64 years Italy Udine 25–64 years Italy Pavia 20–64 years Kazakhstan 25–64 years Kyrgyzstan >18 years (25–64 years separately) Latvia 15–64 years Lithuania 20–64 years Malta > 16 years Republic of Moldova 25–64 years Poland 18–64 years Portugal** – Romania 20–64 years Russian Federation 25–64 years Slovakia 25–64 years Slovenia 25–64 years Spain Catalonia > 24 years Turkmenistan 18–64 years Ukraine 25–64 years United Kingdom Northern Ireland 16–74 years

*Data not available from this source **Data not available because the country has not yet conducted the survey *** Did not conduct a CINDI Health Monitor Survey

EUR/03/5040781 page 34

Table 13

Number of reminders sent to non-responders? Overall rate of response in the

survey Method used to collect data

Survey Number Percent Austria 3 35% In person interview Belarus 3 72 % In person interview Bosnia and Herzegovina Banja Luka At least 1 93% In person interview

Bosnia and Herzegovina Sarajevo 1 99% In person interview

Bulgaria 1–3 75% In person interview

Canada 2 85% Computer-assisted in person interview Computer-assisted telephone interview

Croatia 0 68% In person interview Cyprus*** – - -

Czech Republic 0 66% In person interview Estonia* – - - Finland 3 65% Postal questionnaire Georgia 0 94% In person interview

Germany**** – - - Hungary 1 54% Postal questionnaire

Italy Mercato San Severino At least 1 85% In person interview Italy Cagliari 1 65% Self-administrated questionnaire

Italy Latina 0 50% Home to home distribution of self self-administrated questionnaire, recollection in the local post office

Italy Bologna 2 23% Postal questionnaire Italy Udine 2–3 53% Telephone interview

Italy Pavia** – 61% Postal questionnaire Kazakhstan At least 1 72% In person interview Kyrgyzstan 1 96% Postal questionnaire Latvia 2 67% Postal questionnaire

Lithuania 1 60% Postal questionnaire Malta 2 (by phone) 79% In person interview Republic of Moldova 1–3 79% In person interview Poland At least 1 59% In person interview

Portugal*** – - - Romania At least 1 88% In person interview

Russian Federation Up to 15 telephone calls 69% Telephone interview Slovakia 1 56% Postal questionnaire

Slovenia 2 64 % Postal questionnaire Spain Catalonia 0 58% -

Turkmenistan At least 1 90% In person interview Ukraine 2 61% Postal questionnaire United Kingdom Northern Ireland 2 - Postal questionnaire

*Data not available from this source **Data partly not available from this source ***Data not available because the country has not yet conducted the survey ****Did not conduct a CINDI Health Monitor Survey

EUR/03/5040781 page 35

Table 14. Method used to collect the data

Survey Postal questionnaire

In person interview

Computer assistedinterview in person

Telephone interview

Computer assisted telephone interview Other

Austria X

Belarus X Bosnia and HerzegovinaBanja Luka X

Bosnia and HerzegovinaSarajevo X

Bulgaria X

Canada X X

Croatia X

Cyprus*** – – – – – –

Czech Republic X

Estonia* – – – – – –

Finland X

Georgia X

Germany**** – – – – – –

Hungary X Italy Mercato San Severino X

Italy Cagliari Self administration

Italy Latina

Home to home distribution of self administrated questionnaire, recollection in the local Post Offices

Italy Bologna X X

Italy Udine X

Italy Pavia X

Kazakhstan X

Kyrgyzstan X

Latvia X

Lithuania X

Malta X Self administered questionnaire was used for some of the questions

Republic of Moldova X

Poland X

Portugal*** – – – – – –

Romania X

Russian Federation X

Slovakia X

Slovenia X

Spain Catalonia** – – – – – –

Turkmenistan X

Ukraine X United Kingdom Northern Ireland X

TOTAL

11 34%

15 47%

1 3%

3 9%

1 3%

*Data not available from this source **Spain wrote a note: have not completed the following questions as they used the process evaluation questionnaire ***Data not available because the country has not yet conducted the survey ****Did not conduct a CINDI Health Monitor Survey Note Kyrgyzstan: Mail questionnaire was used for data collection, but 120 Regional employees of the National Statistic Committee (NSC) worked as postmen to distribute and collect questionnaires.

EUR/03/5040781 page 36

Table 15. Was the questionnaire translated into the national language and retranslated back to conduct the survey?

Survey No Yes Problems encountered regarding translation Austria X No problems Belarus X No problems Bosnia and Herzegovina Banja Luka

X No problems

Bosnia and Herzegovina Sarajevo X No problems

Bulgaria X Canada X Croatia X No problems Cyprus** - - - Czech Republic X No Problems Estonia* - - - Finland X Georgia X No problems Germany**** - - - Hungary X Italy Mercato San Severino X No problems

Italy Cagliari X Italy Latina X Italy Bologna X No problems Italy Udine X Italy Pavia X

Kazakhstan X Doubt about the accuracy of the translation of some of the variables

Kyrgyzstan X

There were no major problems. But 56% of questionnaires were translated from the Russian language into Kyrgyz. But there was no need for retranslation, except for 3–4 open questions

Latvia X

Lithuania X There were problems with the translation of questions about physical activity

Malta X Republic of Moldova X No problems encountered Poland X Portugal** - - - Romania* X, not retranslated back No problems Russian Federation X No problems Slovakia X No problems Slovenia X No serious problems Spain Catalonia*** - - Turkmenistan X Ukraine X No problems United Kingdom Northern Ireland X

TOTAL 11 34%

20 63%

*Data not available from this source **Data not available because the country has not yet conducted the survey ***Data not available because the country has not conducted the CINDI Health Monitor Survey, but another survey ****Did not conduct a CINDI Health Monitor Survey

EUR/03/5040781 page 37

Table 16. Were all the obligatory questions included in the survey?

Survey No Yes Obligatory questions not included


Bosnia and Herzegovina Sarajevo X Bulgaria X Canada X Croatia X Cyprus** - - - Czech Republic X Estonia* - - - Finland X IPAQ

Georgia X 6.4, 6.5, 6.6, 6.7, 6.8, 6.9, 6.10 (These questions were not available when the survey in Georgia was conducted)

Germany - - - Hungary X 6.4–6.10 Italy Mercato San Severino X Italy Cagliari X Italy Latina X Italy Bologna X Italy Udine X Italy Pavia X Kazakhstan X Kyrgyzstan X Latvia X 8.2 was included in 1998 and 2000 but not in 2002 survey Lithuania X Malta X 2.2; 2.14; 5.7; 6.14, 7.1 Republic of Moldova X 2.12 2.13 2.14 Poland X Portugal** - - - Romania X

Russian Federation X 2.2, 2.6, 2.8 (only for high blood pressure) 2.10, 2.11, 4.6, 7.1, 7.3, 8.2

Slovakia X

Slovenia X Some of them (3.5, 3.7) were slightly changed but the transformation to original is mostly possible

Spain Catalonia*** - - -

Turkmenistan X 2.1–2.14, 3.1, 3.2, 3.4, 3.5, 3.7, 3.9, 3.10, 3.11, 5.3, 5.5, 5.6, 5.7, 6.4–6.10, 7.1–7.3, 8.2

Ukraine X United Kingdom Northern Ireland*** - - -

TOTAL 8 25%

22 69%

*Data not available from this source **Data not available because the country has not yet conducted the survey ***Data not available because the country has not conducted the CINDI Health Monitor Survey, but another survey ****Did not conduct a CINDI Health Monitor Survey

EUR/03/5040781 page 38

Table 17: Were all the highly recommended questions included in the survey?

Survey No Yes Highly recommended questions not included


Bosnia and Herzegovina Sarajevo X 4.3 in our living conditions people usually prepare food at home every day

Bulgaria X Canada X Croatia X Cyprus*** - - - Czech Republic X Estonia* - - - Finland X Georgia X Germany***** - - - Hungary X 7.4 Italy Mercato San Severino X Italy Cagliari X Italy Latina X Italy Bologna** X - Italy Udine X Italy Pavia X

Kazakhstan X 1.6, 2.3, 2.4, 2.5, 3.8, 4.3, 4.5, 4.7, 4.8, 4.9, 4.10, 5.1, 5.4, 6.3, 6.11, 6.12, 6.13, 7.4, 8.3

Kyrgyzstan X Latvia X 2.5 and 4.3. Question 2.5 was included in survey 1998 Lithuania X Malta X Republic of Moldova X 1.4 2.3 2.4 2.5 6.7 7.4 Poland X Portugal*** - - - Romania X Russian Federation X 1.4, 1.6, 2.4, 2.5, 4.1, 4.3, 4.7, 4.8, 4.9, 4.10, 6.3, 7.4, 8.3

Slovakia X We excluded (by mistake) question 4.3 – How often do you prepare food at home

Slovenia X Some of them (1.4, 2.5, 4.3, 4.7, 4.8, 8.3) were slightly changed but the translation to original is mostly possible

Spain Catalonia**** - - -

Turkmenistan X 1.4, 2.3, 2.4, 2.5, 3.8, 4.1, 4.3, 5.4, 6.3, 7.4, 8.3. In question 5.0 family condition is excluded

Ukraine X 1.4, 1.6, 2.3, 2.5, 4.1, 4.3, 4.5, 4.8, 4.9, 6.11, 6.12, 6.13, 7.4, 8.3 United Kingdom Northern Ireland**** - - -

TOTAL 10 31%

20 63%

*Data not available from this source **Data partly not available from this country ***Data not available because the country has not yet conducted the survey ****Data not available because the country has not conducted the CINDI Health Monitor Survey, but another survey *****Did not conduct a CINDI Health Monitor Survey

EUR/03/5040781 page 39

Table 18. Were questions included in addition to the obligatory and highly recommended questions?

Survey No Yes How many additional questions? Topics of the additional questions

Austria X 5 Frequency of health examinations Belarus X


X 4

Age when you had alcohol for the first time Place where you had your first alcohol beverage Age when you were drunk for the first time The largest quantity of alcohol during one day


X 4 Oral health care

Bulgaria X 2

Health self-assessment Health information sources Biological risk factors (body mass index, blood pressure, blood lipids profile)

Canada X 100

Social demographics Health status Health care utilization Disease specific etc. Injury and use of protective equipment Lifestyles

Croatia X Cyprus*** - - - -

Czech Republic X 17 Risk factors for cancer (reproductive history, family history, preventive medical examination)

Estonia* - - – -

Finland X 20–30

Background, health services and health Smoking Food habits Alcohol consumption Traffic safety Opinions on health promotion Use of illegal drugs

Georgia X Germany***** - - – - Hungary X 7 Smoking habits, smoking history, tobacco advertisement, allergy Italy Mercato San Severino

X

Italy Cagliari X Italy Latina X

Italy Bologna X Italy Udine X 6 Physical activity

Italy Pavia X Kazakhstan X

Kyrgyzstan X 5

Education Nationality Seeking medical care (When do you seek medical care?) Opinion on the Kyrgyz Republic Laws (on advertisements, taxation of tobacco products) Opinion on signing the Framework Convention on Tobacco Control by the Kyrgyz Government The Follow-up Survey of Quit and Win 2000 Consumption of salt (Do you add salt to a tea with milk?)

EUR/03/5040781 page 40

Survey No Yes How many additional questions? Topics of the additional questions

Latvia X 57

Attitudes and knowledge (23) Immunization (3), Quit and Win smoking cessation campaign (4) Traffic safety (8) Advice to reduce weight (1) Alcohol consumption (1) Smoking (8) X-rays (1) Cholesterol (2) Depression (1)

Lithuania X 30 Preventive examination among women Questions on usage of primary health care

Malta** X - EUROHIS questionnaire

Republic of Moldova X 64 Management of hypertension Coronary heart disease (the Rose questionnaire) Knowledge of risk factors in the population

Poland X 5 Quality of life (Standardized EuroQuol 5D questionnaire) Portugal*** - - - - Romania X Russian Federation X 2 Awareness of blood pressure

Slovakia X 1 Deeper specification of education: 1) elementary, 2) apprentice, 3) high school with graduation, 4) university

Slovenia X 17 Food habits Alcohol consumption

Spain Catalonia**** - - - -

Turkmenistan X 8

Two questions regarding oral tobacco use Marital status Place of birth The origin (clan) for the local nationalities Main hand (right handed, left handed) If they wear hats If they use sunglasses

Ukraine X 5

Education Reason for stopping smoking Frequency of food consumption Observance of any diets Frequency of consumption of fresh fruit and vegetables

United Kingdom Northern Ireland****

- - - -

TOTAL

10 31%

20 63%

*Data not available from this source **Data partly missing ***Data not available because the country has not yet conducted the survey ****Data not available because the country has not conducted the CINDI Health Monitor Survey, but another survey *****Did not conduct a CINDI Health Monitor Survey

EUR/03/5040781 page 41

Table 19. Inclusion of obligatory or highly recommended questions where the answer categories were modified

Survey No Yes Specify modification Austria X Belarus X Bosnia and Herzegovina Banja Luka

X


X

Bulgaria X

Question 4.4(1) about fat types and 4.5(2) about milk fat content. In both instances there was adjustment in compliance with the products consumed in Bulgaria

Canada X

Nutrition and dietary questions Physical activity Work stress/self-esteem/mastery Others

Croatia X Cyprus*** - - - Czech Republic X Estonia* Finland** X - Georgia X Germany***** - - -

Hungary X 4.2 there was an added answer option: I don’t cook at home 4.5 about milk fat%, adjustment of categories as to fat content %

Italy Mercato San Severino X

Italy Cagliari X Italy Latina X Italy Bologna X Italy Udine X Italy Pavia X Kazakhstan X

Kyrgyzstan X

In section 3 on smoking, tobacco for chewing and nasal use was added 4.2 added: natural (homemade, melted) butter, mixed (vegetable oil and animal fat), I do not know, usually I do not prepare/cook food at home 4.3 Natural sour cream. 4.5 Changing fat content and adding: I drink milk only with tea 4.6 Tea with milk (or cream) 4.7 Number of teaspoonfuls in a cup of tea with milk 4.11 Do you add salt to tea with milk? 7.1 5th category of the answer was added – “I do not have a reflector, but I use a lantern flash-light” and the following question was added “do you use a lantern flash light, when walking on streets without lights when it is dark?

Latvia X 2.1, 2.2, 2.4, 2.6, 2.8, 2.10, 3.1, 4.1, 3.12, 4.2, 4.4, 4.5, 4.8

Lithuania X Kind of fat used for food preparation Kind of fat on bread Kind of alcohol consumed during the last week

EUR/03/5040781 page 42

Survey No Yes Specify modification Malta X Diet and food questions Republic of Moldova X 4.5 (the percentage of fat in milk was changed) Poland X Portugal*** - - -

Romania X

Lard use added Categories of fat content of milk according to local availability Type of alcohol and alcohol portions explicitated by local customs

Russian Federation X 2.3, 2.7, 2.8 (only blood pressure), 2.10, 2.11, 3.1, 3.2, 3.5.1, 3.7, 3.8.1, 3.9, 4.2, 4.4, 4.5, 4.9.11, 4.9.12, 5.1, 5.3, 5.4, 5.5, 6.11, 6.12

Slovakia X 4.5 – If you drink milk do you usually use (See specification)

Slovenia X

Regarding the physical activity questions: last-7-days-short-self-administrated questions were used instead of the original ones on physical activity. For some other questions (3.8, 4.9, 5.2) the categories were slightly changed but the transformation to original is possible

Spain Catalonia**** - - - Turkmenistan X Ukraine X United Kingdom Northern Ireland**** - - -

TOTAL 17 53%

13 41%

*Data not available from this source **Data partly not available ***Data not available because the country has not yet conducted the survey ****Data not available because the country has not conducted the CINDI Health Monitor Survey, but another survey *****Did not conduct a CINDI Health Monitor Survey

EUR/03/5040781 page 43

Table 20. Did you find any of the questions functioned poorly?

Survey No Yes Why did the question(s) function poorly? Austria X Belarus X Bosnia and Herzegovina Banja Luka

X


X

Bulgaria X

Maybe the section on smoking is appropriate for some countries, however for us it was difficult. It would have been better if from the very beginning it became clear whether the individual is smoking or not, and then to extract the additional information. The respondents were confused and time was lost

Canada X Croatia X Cyprus** - - - Czech Republic X Estonia* - - - Finland X

Georgia X

1.6 (2) Traditionally from the Soviet period a lot of the respondents consider that a job is only that which is paid by an official governmental organization. As such jobs are limited today, the part of respondents, who marked that they are unemployed, are in fact occupied in individual business activities. Similar to that, because of lack of pension security, part of pensioners also is occupied in individual business activities, but they marked themselves as pensioners, and the other part of them marked that they are unemployed 2.1 (1) As the response to this question respondents marked only “official” visits to a doctor within health care organizations, but they did not imply visits to a “family doctor”, “relative doctor” or “neighbour doctor” and other unpaid visits 2.3 (2) Because of occupational peculiarities of the population only part of respondents have so-called “permanent jobs”. Only such respondents answered this question correctly. Others who have not so-called “permanent jobs”, answered this question incorrectly. 4.9 (2) Since food products listed in this question as the answer categories are inaccessible for the part of respondents, this question provoked unnatural protest among them

Germany**** - - -

Hungary X Many people marked more than one answer 2.4, 2.6, 2.8, 3.12, 4.11, 5.7, 6.14 – it is difficult to verify answers to these questions because a lot of responders marked only 1 and forgot to mark 2


Italy Cagliari X Italy Latina X Italy Bologna* - - - Italy Udine X Question 4.9 and 6.4–6.10 Italy Pavia X Question 4.9 and 6.4–6.10 Kazakhstan X

Kyrgyzstan X

Question 4.6 – Kyrgyz people have national traditions both for pouring and drinking tea (the size/volume of the cup varies throughout the country. Question 4.8 – Some problems with description of the number of bread pieces/slices were encountered due to different weight of bread slices available in Kyrgyzstan Some problems were encountered with the number of beer bottles (due to different volume of bottles)

Latvia X 6.4–6.10 questions on physical activity. They seem for respondents difficult to understand and calculate

Lithuania X Questions on physical activity (6.4–6.10)

EUR/03/5040781 page 44

Survey No Yes Why did the question(s) function poorly? Malta X Republic of Moldova X Poland X Portugal** - -

Romania X Food habits and physical activity questions are the most difficult to adapt to local customs


2.1 There were answers of 100 or more. Need clarification. We’ve recommended in this case putting 98 Question 4.4, in cases when somebody uses two kinds of fat equally we’ve recommended to mark the product containing more saturated fat Question 5.6 – where should be answered 2–3 times in a month, or 2–3 times in a week? Questions 6.4–6.10 on physical activity

Slovakia X Slovenia X The questions 6.4–6.10 Spain Catalonia*** - - - Turkmenistan X

Ukraine X 7.1–there are no reflectors in Ukraine 6.4 to 6.10 are very difficult for understanding and self-evaluation

United Kingdom Northern Ireland*** - - -

TOTAL 17 53%

12 38%

*Data not available from this country **Data not available because the country has not yet conducted the survey ***Data not available because the country has not conducted the CINDI Health Monitor Survey but another survey ****Did not conduct a CINDI Health Monitor Survey

EUR/03/5040781 page 45

Table 21. Problems encountered in adapting the questionnaire

Survey Problems

Austria No problems Belarus We had no problems Bosnia and Herzegovina Banja Luka No problems

Bosnia and Herzegovina Sarajevo No problems

Bulgaria No problems

Canada

Survey had to be translated for non-English speaking immigrants Survey (terminology) had to be explained to younger groups since age 12 and over were included Difficulty in getting mailed responses from seniors

Cyprus** - Czech Republic No problems Estonia* - Finland No problems Georgia No other problems other than the ones mentioned in the above table Germany**** - Hungary No problems Italy Mercato San Severino No problems

Italy Cagliari No problems Italy Latina No problems Italy Bologna No problems Italy Udine No problems Italy Pavia No problems

Kazakhstan Discrepancy of approaches to statement of questions in the questionnaire. The big volume of questions

Kyrgyzstan No other problems than the ones mentioned in the above table Latvia No problems Lithuania No problems Malta No problems Republic of Moldova No problems Poland No problems Portugal** - Romania No problems Russian Federation No problems Slovakia No problems Slovenia No specific problems Spain Catalonia*** - Turkmenistan The problem was in defining the kinds of margarine Ukraine No problems United Kingdom Northern Ireland*** -

*Data not available from this country **Data not available because the country has not yet conducted the survey ***Data not available because the country has not conducted the CINDI Health Monitor Survey, but another survey ****Did not conduct a CINDI Health Monitor Survey

EUR/03/5040781 page 46

Table 22. Was action taken to motivate the target population to participate in the survey?

Survey No Yes What kind of action Austria X Letters of invitation by Department of Health

Belarus X Surveys were carried out in the polyclinics that provided medical services for the population involved in the initial sampling Representations by the Republican radio


X Public announcement by the Minister of Health, mass media, support of local authorities and voluntary organizations


X

Bulgaria X Radio and TV broadcast on the survey benefits, free test as an incentive for participation for every respondent

Canada X

Media coverage Prior to the first contact by an interviewer, an introductory letter and brochure were delivered to each selected dwelling. These explained the importance of the survey and provided examples of how Canadian Community Health Survey data would be used

Croatia X Information about the CINDI Health Survey on radio and TV, information to local health professionals, priests etc. (they informed and motivated personally their population to participate)

Cyprus** - - -

Czech Republic X Information concerning the importance of study for public health was printed on the front page of the questionnaire

Estonia* - - - Finland X Georgia X Germany*** - - - Hungary X Italy Mercato San Severino X

Italy Cagliari X Blood analysis Italy Latina X Italy Bologna X Italy Udine X Italy Pavia X Blood analysis, respiratory function test Kazakhstan X

Kyrgyzstan X All filled and collected/handed over questionnaires took part in the lottery for each region (8 regions). The main regional prize was 1000 soms = $21. The National Super prize was $104

Latvia X A lottery for respondents, mass media information about the survey Lithuania X

Malta X Lottery and gifts, Personal consultation by MSH, Introductory letter by Director General of Health

Republic of Moldova X Patients with cardiovascular problems were given free consultation and treatment Poland X Portugal** - - - Romania X Complete free physical examination and laboratory tests Russian Federation X Slovakia X

Slovenia X Mass media motivation (radio, TV at national and regional level), “healthy prizes” (a week in health resort, several weekends in health resort, bikes, healthy food like apples)

Spain Catalonia X

Turkmenistan X The doctor explained to the population that after survey it would be possible to elaborate individual recommendations regarding the risk factors and attend health clubs

Ukraine X Drawing of encouragement prizes United Kingdom Northern Ireland X

TOTAL 15 47%

17 53%

*Data not available from this country **Data not available because the country has not yet conducted the survey ***Did not conduct a CINDI Health Monitor Survey

EUR/03/5040781 page 47

Table 23. Was the study population representative compared with the source population as to demographic characteristics?

Survey No Yes Do not know Austria X Belarus X Bosnia and Herzegovina Banja Luka X


Bulgaria X (age range and gender) Canada X Croatia X Cyprus*** - - - Czech Republic X Estonia* - - - Finland X Georgia** X Germany**** Hungary X Italy Mercato San Severino X Italy Cagliari X Italy Latina X Italy Bologna X Italy Udine X Italy Pavia X Kazakhstan X Kyrgyzstan X Latvia X

Lithuania The analysis of data is not yet finished. This information will be available in the future

Malta X Republic of Moldova X Poland X Portugal*** - - - Romania X Russian Federation X (age range) Slovakia X

Slovenia X (only gender was a problem in some regions)

Spain Catalonia X Turkmenistan X Ukraine X United Kingdom Northern Ireland X

TOTAL 3 9%

24 75%

5 16%

*Data not available from this country **Georgia note: results of the latest census of the Georgian population are still in the process of working up; significant changes have taken place in the structure of population after the previous census. ***Data not available because the country has not yet conducted the survey ****Did not conduct a CINDI Health Monitor Survey

EUR/03/5040781 page 48

Table 24. Is there any basic information on non-responders

Survey No Yes

Austria X

Belarus X Bosnia and Herzegovina Banja Luka X


Bulgaria X (age and gender)

Canada X

Croatia X

Cyprus** - -

Czech Republic X (age and gender)

Estonia* - -

Finland X

Georgia X

Germany*** - -

Hungary X (age group, gender and settlement type)


Italy Cagliari X

Italy Latina* - -

Italy Bologna X

Italy Udine X

Italy Pavia X

Kazakhstan X

Kyrgyzstan X

Latvia X

Lithuania X

Malta X


Poland X

Portugal** - -

Romania X


Slovakia X (age, gender, district)

Slovenia X (age, gender, district, place of living)

Spain Catalonia X

Turkmenistan X

Ukraine X (age, gender, home address)

United Kingdom Northern Ireland X

TOTAL 11 34%

20 63%


EUR/03/5040781 page 49

Table 25. Have steps been taken to reflect the source population in data processing appropriately

Survey No Yes Procedures used Austria X

Belarus X Bosnia and Herzegovina Banja Luka*** X -

Bosnia and Herzegovina Sarajevo*** - - We followed instructions at original questionnaire of the

World Health Organization Bulgaria X

Canada X Editing, coding, creation of derived and grouped variables, imputation and weighing

Croatia X

Cyprus** - - -

Czech Republic X

Estonia* - - -

Finland X

Georgia X

Germany**** - - -

Hungary X Weighing in age/gender/settlement type


Italy Cagliari X

Italy Latina X

Italy Bologna X

Italy Udine X

Italy Pavia X

Kazakhstan X

Kyrgyzstan X The obtained data was weighed by individual rates/coefficients

Latvia X

Lithuania X

Malta* - -


Poland X

Portugal** - - -

Romania X The age and gender group structure of the source population was used when sampling

Russian Federation X (not yet)

Slovakia X

Slovenia X (not yet)

Spain Catalonia* - - -

Turkmenistan X

Ukraine X

United Kingdom Northern Ireland X Geographical weighing for health district

TOTAL 23 72%

6 19%

*Data not available from this source **Data not available because the country has not yet conducted the survey ***Data partially not available from this source ****Did not conduct a CINDI Health Monitor Survey

EUR/03/5040781 page 50

Table 26. Group(s) responsible for processing the data

Survey Responsible for data processing Austria CINDI Team, Innsbruck University Belarus CINDI Team Bosnia and Herzegovina Banja Luka CINDI Team

Bosnia and Herzegovina Sarajevo CINDI Team which consist of 7 doctors

Bulgaria The data were entered in the National Centre for Health Informatics. Associate. Professor conducted statistical processing from the same centre

Canada Statistics Canada Special Survey and Analysis Group Croatia CINDI Core Team (A. Stampar School of Public Health) Cyprus** - Czech Republic CINDI Team Estonia* - Finland 2 research teams in the National Public Health Institute Georgia CINDI team at the Georgian Medical Association Germany*** - Hungary CINDI Team of SE Public Health Department Italy Mercato San Severino CINDI Team: Department of Preventive Medicine, University of Pavia Italy Cagliari CINDI Team: Department of Preventive Medicine, University of Pavia Italy Latina CINDI Team: Department of Preventive Medicine, University of Pavia Italy Bologna CINDI Team: Department of Preventive Medicine, University of Pavia Italy Udine CINDI Team: Department of Preventive Medicine, University of Pavia Italy Pavia CINDI Team: Department of Preventive Medicine, University of Pavia Kazakhstan CINDI Team

Kyrgyzstan 3 employees of the Sampling Survey Department of National Statistic Committee

Latvia CINDI Team, Students Lithuania CINDI Team Malta Department of Health Information, Minister of Health Republic of Moldova CINDI Team Poland CINDI Team Portugal** - Romania CINDI Team Russian Federation CINDI Team Slovakia CINDI Team

Slovenia In the group there are several Public Health experts from the Institute of Public Health, Faculty of Medicine and from Regional Health Institutes

Spain Catalonia CINDI Team Turkmenistan CINDI Team Ukraine CINDI Team United Kingdom Northern Ireland -


EUR/03/5040781 page 51

Table 27. Software used for data processing and data analysis

Survey Software Used Austria SPSS, MS Excel Belarus Access Bosnia and Herzegovina Banja Luka SPSS

Bosnia and Herzegovina Sarajevo Access and Excel

Bulgaria SPSS Canada SAS, other typical software was used when necessary Croatia SPSS and Excel Cyprus - Czech Republic Excel, EPI 6 Estonia* - Finland SPSS for Windows

Georgia Minitab for Windows Release11. © 1996 Minitab inc.

Germany*** -

Hungary EPINFO 6 to type records Excel/SPSS to analyse data

Italy Mercato San Severino Excel Italy Cagliari Excel Italy Latina Excel Italy Bologna Excel Italy Udine Excel Italy Pavia Excel Kazakhstan SPSS Kyrgyzstan SPSS and Excel Latvia SPSS Lithuania SPSS 10. for Windows

Malta OMR Software for screening SPSS

Republic of Moldova SPSS Poland Microsoft Access, Excel, Stat graphics Portugal** - Romania Excel and Epiinfo 6 Russian Federation SAS

Slovakia EPI-INFO 2000-public domain software of CDC Atlanta and SAS

Slovenia Data entry: ACCESS, Data analysis: SPSS Spain Catalonia SPSS Turkmenistan Excel Ukraine Excel United Kingdom Northern Ireland SPSS


EUR/03/5040781 page 52

Table 28. Have steps been taken to ensure quality of data?

Survey No Yes Specification of steps taken Austria X Training of interviewers and cross matching samples

Belarus X Training of interviewers Evaluating performance of interviewers

Bosnia and Herzegovina Banja Luka X Training of interviewers, evaluation of performance of interviewers, verification

procedure (50% of respondents) Bosnia and Herzegovina Sarajevo X Training of interviewers. First and second checking of data was done by

different groups

Bulgaria X Double key punching, training of interviewers, evaluating performance of interviewers

Canada X

On screen edit Training of interviewers Rapid Conduct Logical edit Re-interview is planned but not yet completed Field test

Croatia X Training of interviewers Evaluating performance of interviewers Re-interviewing

Cyprus*** - - - Czech Republic X Double key punching of data Estonia* - - - Finland** X -

Georgia X Training of interviewers (5 days), re-interviewing of respondents to check up on main data from interviewers performance, evaluation of interviewers performance – analysing answers to related questions from questionnaire

Germany**** - - - Hungary X Italy Mercato San Severino X Italy Cagliari X Italy Latina X Italy Bologna X Italy Udine X Italy Pavia X Kazakhstan X

Kyrgyzstan X

We conducted interview by mail. Detailed and written instructions were developed, printed and distributed to the 120 postmen; Training of the staff, regional coordinators and postmen was conducted. Data was entered and tables were obtained by experienced and competent staff of the National Statistics Committee

Latvia X Lithuania X Training of staff entering and coding the data Malta X Scanning Republic of Moldova X Verification procedures to ensure accurate data Poland X Training of interviewers Portugal*** - - -

Romania X Training of interviewers Evaluation of performance of interviewers

Russian Federation X Training of interviewers, evaluating performance of interviewers, Verification procedures to ensure accurate data (re-interviewing 5% of the respondents)

Slovakia X Double key punching of data Slovenia X Data entry performed by professional staff, data check by data entry programme Spain Catalonia X Turkmenistan X Ukraine X United Kingdom Northern Ireland X Double key punching of data and verification procedures to ensure accurate data

TOTAL 12 38%

20 63%

*Data not available from this country ** Data partially not available from this source ***Data not available because the country has not yet conducted the survey **** Did not conduct a CINDI Health Monitor Survey

EUR/03/5040781 page 53

Table 29. Does the data processing include procedures to ensure consistency of responses?

Survey No Yes Specification of procedures followed Austria X Belarus X Bosnia and Herzegovina Banja Luka

X Logical editing during data entering


X

For editing data each of nominated doctors in research evaluation was responsible for one part of data evaluation. Finally, the scientific research committee in our health institution is completing the whole research evaluation before publishing

Bulgaria X Following filling in, each questionnaire has been verified by an appointed specialist- verifier

Canada X Logical edit process Croatia X (not yet) Cyprus** - - -

Czech Republic X Double key punching of data based on standardized controlled interviews

Estonia* - - - Finland X - Georgia X Germany*** - - -

Hungary X We are checking whether the answers given for different questions are consistent to each other


Italy Cagliari X Italy Latina X Italy Bologna X Italy Udine X Italy Pavia X Kazakhstan X

Kyrgyzstan X

Software for data entry had control of questions programme All extreme values by open questions were rechecked against questionnaires Logic consistency to transfer/switch to questions

Latvia X Checking internal validity and consistency of responses Lithuania X

Malta X A sample of 5 were interviewed twice and analysed for consistency of responses

Republic of Moldova X Controversial results were corrected by visiting the territory again and making the necessary adjustment

Poland X Portugal** Romania X Russian Federation X Re-interviewing 5% of respondents Slovakia X Slovenia X There were some questions posed for verifying some key data Spain Catalonia X Manual checking and search of inconsistencies Turkmenistan X Ukraine X United Kingdom Northern Ireland X

TOTAL 18 56%

14 44%


EUR/03/5040781 page 54 Table 30. The total cost (US$) of conducting the survey from the preparatory phase to the reporting phase

Survey Preparation and planning of the survey

Organization and coordination of efforts

to implement the surveyData collection

Data processing,analysis and

reporting

Staff training Other

If other, please specify the costs according to

fields of activity Austria $70 000

Belarus* - - - - - - - Bosnia & Herzegovina Banja Luka $1500 $1000 $6000 $5000 $1000 $500 Printing material, postal

expenses Bosnia & Herzegovina Sarajevo $500 $4500 $1250 $1750 $250

Bulgaria $1500 - $1.800 - $600 $20 100

Lab reagents, interviewer fee, blood pressure measurement device purchase

Canada - - - - - - -

Croatia $400 - $2000 - $2000 $2000 Translating and printing the questionnaire

Cyprus - - - - - - -

Czech Republic $1300 $980 $7830 $3270 $1640

Estonia* - - - - - - -

Finland** - - - - - Total costs: €70 000

Georgia $100 $300 $1000 $300 $100 -

Germany**** - - - - - - -

Hungary $640 $1000 $5000 $60 000 $400 $800 Helpers and co-workers Italy Mercato San Severino* - - - - - -

Italy Cagliari* - - - - - -

Italy Latina* - - - - - -

Italy Bologna* - - - - - -

Italy Udine** - -- - - - Total €2230

Italy Pavia* - - - - - -

Kazakhstan $500 $600 $800 $600 $0 $300 -

Kyrgyzstan $1000 $1000 $21000 $1600 $150 $750

Communication (mail, e-mail, trunk calls, fax) Motivation (Prizes) Total $6500

Latvia $3000 $5000 $12000 $12000 $1000 $2000

Lithuania $1000 $500 $3500 $2000 $600

Malta** Total $120 000

Republic of Moldova $11 530 $6180 $20 390 $6860 $20 960

Poland** - - - - - In Torun; ca. $30 000 In Lodz; ca.$40 000

Total costs including analytic measurement (lipids, glucose), ECG

Portugal***

Romania - - - - - -

Russian Federation $2000 $3000 $7000 $7000 $1000 $3000 Printing, communication expenses, technical personal service

Slovakia $1000 $200 $1500 $1500 $200 $500 Publication

Slovenia $8500 $29 000 $3.000 $4.200 $1800

Spain Catalonia** Total ca $15.000

Turkmenistan $100 $600 $150 $150 $10

Ukraine $250 $300 $1700 $600 - $150 Purchase of encouragement prizes

United Kingdom Northern Ireland* - - - - - -

*Data not available from this source ** Data partially not available from this source ***Data not available because the country has not yet conducted the survey ****Did not conduct the CINDI Health Monitor Survey Romania note: All listed activities were part of the professional curricula (along with other duties to fulfil) and as part of the National Programme for Health Monitoring

EUR/03/5040781 page 55

Table 31. How was the survey financed?

Survey By your own institution

By the Ministry of

Health

By a nongovernmental

organization

By a pharmaceutical

company

By other institutions in the

private sector

Other institution, organization If other, please specify

Austria X X Belarus X X WHO Regional Office for Europe Bosnia and Herzegovina Banja Luka X X WHO Regional Office for Europe

Bosnia and Herzegovina Sarajevo X X WHO Regional Office for Europe Bulgaria X X Expecting some funds from WHO for data processing, analysis and reporting Canada X Croatia X Cyprus** - - - - - - - Czech Republic X X WHO Regional Office for Europe Estonia* - - - - - - - Finland X Georgia X Survey was financed by WHO Regional Office for Europe Germany - - - - - - - Hungary X X X WHO Italy Mercato San Severino X X Autonomous way Italy Cagliari X Sardinia region Italy Latina X Italy Bologna X Italy Udine X X Udine City Italy Pavia X Kazakhstan X Kyrgyzstan X WHO/EURO and USAID funded ZDRAF/Plus Health Project Latvia X X Finnish-Latvian Cardiovascular Disease Prevention Pilot Project Lithuania X X WHO Malta X X WHO and department of health information Republic of Moldova X X X Poland X X Regional Sickness found in Lodz and Municipal Department of Public Health in Torun Portugal** - - - - - - - Romania X Russian Federation X WHO-CDC grant Slovakia X X WHO Slovenia X X X Spain Catalonia X X Turkmenistan X X Ukraine X WHO United Kingdom Northern Ireland X

TOTAL 19 59%

12 38%

2 6 %

1 3%

1 3%

18 56%

*Data not available from this source **Data not available because the country has not yet conducted the survey *** Did not conduct the CINDI Health Monitor Survey

EUR/03/5040781 page 56

Table 32. How many person months in total were used to conduct the survey?

Survey Preparation and

planning of the survey

Organisation and coordination of

efforts Data collection Data processing,

analysis and reporting Staff training Other If other please specify field(s) of activity as to persons months

Austria 3 3 35 3 2 6

Belarus 4 1 5 2 0 Bosnia and Herzegovina Banja Luka

2 2 30 3 1

Bosnia and Herzegovina Sarajevo 4 2 20 4 2

Bulgaria 6 3 30 6 0.06

Canada - - - - - - -

Croatia* - - - - - - -

Cyprus*** - - - - - - -

Czech Republic 4 3 287 3 5

Estonia*

Finland - - 6 18 - - -

Georgia 2 6 20 6 2

Germany**** - - - - - - -

Hungary***** 2 1 2 24 0.3 1 Assistants and co-workers who helped to fill envelopes – it was only few days but very intensive work

Italy Mercato San Severino - - - - - -

Italy Cagliari 3 3 15 3 3 2 Biologist for blood analysis

Italy Latina 2 1 4 2 2 1

Italy Bologna 2 3 7 - - -

Italy Udine 5 6 20 2 3 60 General practitioners, Local Authorities

Italy Pavia 2 2 6 2 6 -

Kazakhstan 6 24 36 3 0 0

Kyrgyzstan 12 18 1 months * 130 persons 12 1 25 24 months for communication (mail, e-mail, trunk calls, fax) and 1

month for motivation (prizes for 39 persons) Latvia 3 3 3 5 0.5 1.5 Publications, meetings, conferences

Lithuania***** 1 2 4 6 0.5

Malta 1 6 3 6 0.5

Republic of Moldova 1.5 2.5 5 5 1

Poland 3 2 8 8 1 -

EUR/03/5040781 page 57

Survey Preparation and

planning of the survey

Organisation and coordination of

efforts Data collection Data processing,

analysis and reporting Staff training Other If other please specify field(s) of activity as to persons months

Portugal***

Romania 7 6 78 12 1

Russian Federation 4 8 20 12 2 -

Slovakia 6 2 12 16 0.02 2 -

Slovenia***** 5 1 7.5 6 1 -

Spain Catalonia***** 0.4 0.3 0.5 1.0 - -

Turkmenistan 2 15 3 1 0.2

Ukraine* - - - - - - United Kingdom Northern Ireland* - - - - - -

*Data not available from this source **Data partly not available from this source ***Data not available because the country has not yet conducted the survey **** Did not conduct the CINDI Health Monitor Survey ***** Notes: Spain-Catalonia: It has to be considered that our study was a part of a larger study Hungary: It is very difficult to correctly answer this question, because we worked not only on this field Lithuania: The numbers are preliminary, because we don’t use such calculations in the institute Slovenia: Note all numbers are assessed

EUR/03/5040781 page 58

Table 33. How do you assess the feasibility of the CINDI Health Monitor Survey to monitor health related behaviour?

Survey Good Reasonably good Average Rather poor Poor Austria X

Belarus X Bosnia and Herzegovina Banja Luka X


Bulgaria X

Canada X

Croatia X

Cyprus** - - - - -

Czech Republic X

Estonia* - - - - -

Finland X

Georgia X

Germany*** - - - - -

Hungary X


Italy Cagliari X

Italy Latina X

Italy Bologna X

Italy Udine X

Italy Pavia X

Kazakhstan X

Kyrgyzstan X

Latvia X

Lithuania X

Malta X


Poland X

Portugal** - - - - -

Romania X


Slovakia X

Slovenia X

Spain Catalonia X

Turkmenistan X


TOTAL 14 44%

17 53%

1 3%

0

0


EUR/03/5040781 page 59

Table 34: Obstacles encountered during the preparation and conducting of the CINDI Health Monitor Survey

Survey Austria Availability of population data (address etc.) was difficult to manage due to data protection Belarus The questionnaire is rather big. Considerable time was required to fill in, especially for patients with poor education Bosnia and Herzegovina Banja Luka

Rather complicated way to get the list of persons included in the sample. Difficulties in finding respondents


Until now, we have accent migrations of population and it takes time to collect updated census of the population. Finally we received actual census from the cabinet of presidents of all municipalities. This year there will be an official census of the population

Bulgaria Firstly, the timely financial resources. Secondly, how to avoid inconsistencies of the population registers, and thirdly to motivate people to participate taking into account hard living circumstances in some CINDI areas

Canada As health surveys are frequently implemented in Canada, well developed procedures exist to deal with obstacles Croatia Financial constraints Cyprus** - Czech Republic None Estonia* - Finland* -

Georgia

Lack of informational support of the survey (people have thought that this survey implied medical care and some respondents called for examination by physician. For evaluation of physical activity we got adapted questions (6.4–6.10) after conducting the survey and we could not use them in this survey. We could not consider modifying and adding some questions for clarification of obligatory questions for clearing up of main issues. It was our first try to conduct a CINDI Health Monitor Survey. Lack of financial resources; Because of this we could not conduct the survey at national level

Germany*** -

Hungary In the planning period we awaited more advice from the central organizers: the complete final format of the questionnaire. It would be better to get coding rules before recording data The budget was very limited. We had to limit ourselves to mail questionnaires, however at that method the response rate is low

Italy Mercato San Severino The major obstacle was the length of the questionnaire

Italy Cagliari* - Italy Latina* - Italy Bologna* - Italy Udine Data storing and processing Italy Pavia* - Kazakhstan Insufficiently powerful computer equipment. Problems with data collection. No ability to conduct training for staff

Kyrgyzstan

1. Creation of sampling: 1. There is no database for the population in the State Register, as it is a new structure (established last year); 2. Population enrolment to Family Group Practices (FGP) data was not used, as many FGPs have only 90% of the population enrolled, and some - as low as 60-65%; 3. Names and addresses of people from any population census represent confidential information; 4. High migration rates within the regions of the country; 5. Many rural residents do not live at the addresses specified in the Census, as they live in urban areas seeking jobs there.

That’s why, first, the population census was used for random sampling of households, and then residents of the households were interviewed. 2.Mailing questionnaires:

��No names and addresses of the potential respondents (confidential information);

EUR/03/5040781 page 60

Survey ��Mailing service does not cover the whole country (especially in the remote areas); ��Shortage of financial resources and higher cost of mailing questionnaires (3 times higher compared to distribution and collection by postmen); ��Risk of loss of most of questionnaires before they reach respondents;

For the above reasons questionnaires were distributed and collected after they were filled out by regional employees (interviewers) of the National Statistic Committee, who served as postmen and did not interfere with the filling out the questionnaires. They were also the ones, who reminded people who did not return them on time to fill out the questionnaires

Latvia* -

Lithuania Difficulties in getting a random sample. Contradiction between the methodology of the survey and the Lithuanian law on protection on personal data. Lower response rate compared to previous surveys

Malta Pressure to limit the interview to 50–80 min duration Republic of Moldova Many people at various levels of society do not realize the importance of the problem. Difficulties with involving specialists in this programme because of low salary Poland* - Portugal** -

Romania Due to financial shortage the CINDI Team could not allocate full time staff to conduct the CINDI Health Monitor. The data collection was done by in-person interview (time consuming) and as an extra job of family physicians

Russian Federation Telephone survey was a new methodological approach for the Russian CINDI Programme and therefore the data collection period was very long. We also implemented a lot of new questions and some of them still need to be improved. Design of data analysis was not very well developed. Appropriate interviewers were involved step by step. From 14 recruited only 7 continue to work at the end of the project

Slovakia

Based on the recommendation for CINDI Health Monitor Survey, we understood that the survey was absolutely anonymous. Therefore we didn’t encode sent questionnaires. Also we were not able to control who filled in the questionnaire and who didn’t. After personal meeting with directors of the CINDI Programme and coordinators of the study we decided to request our respondents as follow: One worker from every State Institute of Public Health participated in collection of data. They were instructed and they obtained the list of respondents. They had to call the respondents and asked them if they had filled in the questionnaire. If not they had to ask them to fill in the questionnaire: respondents without a telephone had to be visited personally. Based on this we were able to find out who filled in the questionnaire and who did not

Slovenia Due to time lack we did not plan any pilot survey. Problems estimating the sample size because of problems with estimation the response rate Time limitations of conducting the survey, collaborators usually used their spare time conducting the survey

Spain Catalonia* - Turkmenistan The specialists of the Sociological and Preventive Department were made redundant and we had to pay their work Ukraine Financial problems and problems with getting the population register United Kingdom Northern Ireland* -

*Data not available from this source **Data not available because the country has not yet conducted the survey ***Did not conduct the CINDI Health Monitor Survey

EUR/03/5040781 page 61

Table 35. Successes encountered during the preparation and conducting of the CINDI Health Monitor Survey

Survey Austria* -

Belarus Data obtained on peoples’ health behaviour habits can be compared with data from other CINDI countries and then priorities for intervention can be defined

Bosnia and Herzegovina Banja Luka High level of responsibility of all staff and excellent cooperation with most of respondents


Results of the CINDI Health Monitor are important for our Ministry of Health because we have data about health and health behaviour of our population and we can plan our health policy Also after 11 years it is the first time the Federation of Bosnia and Herzegovina and Republica Srpska sent all data together to World Health Organization

Bulgaria* - Canada -

Croatia Information to the population including health care professionals about CINDI. Training of medical students

Cyprus** - Czech Republic None Estonia* - Finland* -

Georgia

We conducted the CINDI Health Monitor in Georgia for the first time. We got much information about health behaviour in Georgia (Tbilisi), which is interesting and useful for development of health policy, legislation, development of health promotion and planning of NCD prevention programmes. Conducting this survey showed possibilities for conducting other surveys in the future and elevated capacity of CINDI team in Georgia

Germany*** -

Hungary 54% response rate for a mailed questionnaire is considered in Hungary as a success. In most cases 20–30% of the subjects used to answer

Italy Mercato San Severino* -

Italy Cagliari* - Italy Latina* - Italy Bologna* - Italy Udine Fairly high rate of responders Italy Pavia Fairly high rate of responders Kazakhstan We can use the results of the data collection in our future activity Kyrgyzstan None Latvia* - Lithuania The use of computerised system for mailing envelopes Malta* -

Republic of Moldova With the help of trained physicians, we managed to change the medical and population opinion towards the importance of the studied problems We will now know the real situation (risk factors and morbidity of cardiovascular diseases)

Poland Interest of media and decision makers in Torun Portugal** - Romania* -

Russian Federation Currently 10 Russian regions are in process of conducting a survey. All of them have already completed data collection, 5 databases are submitted to the Moscow CINDI Centre

Slovakia

There are 37 State Institutes of Public Health, which are involved in primary prevention and intervention activities. There is a Health Counselling Centre in every State Institute of Public Health. Only workers from these departments were involved in the collection of the above mentioned data

Slovenia The survey was designed and planned and started in a month and a half Spain Catalonia* -

Turkmenistan We have organized 2 health clubs to correct risk factors, which met with success among population and family doctors as well

Ukraine* - United Kingdom Northern Ireland* -


EUR/03/5040781 page 62

Table 36.

Have you already analysed data collected during a CINDI Health Monitor

Survey?

Have the results been used? In which way have results been used?

Survey No Yes No Yes Austria X X Belarus X X Development of health promotion and NCD prevention programmes Bosnia & Herzegovina Banja Luka X X The results will be used for the strategy of prevention and control of noncommunicable diseases

which should be adopted by the Government by the end of the year 2002

Bosnia & Herzegovina Sarajevo X X

Results have been used as a contribution to health policy and legislation in Country Plan for Nutrition at level of the Ministry of Health and in legislation about smoking prevention at the Parliament level. Also results have been used for planning health prevention and health promotion programmes through annual report about population health conditions

Bulgaria X

Canada X X The information generated from the results have been used for policy and programme development, e.g. to help the initiative design of the Healthy Living agenda of Health Canada

Croatia X (partially) X

(partially) Partial feedback to local government and local health professionals and some preliminary results prepared for local population (radio)

Cyprus** - - - - - Czech Republic X - - Estonia* - - - - - Finland X

Georgia X X

Public Health Department of Ministry of Labour, Health and Social affairs used results for development of Cardiovascular Disease Prevention State Programme-2002; Health Policy Department – for specifying details of strategic plan for CVD Prevention and Control for years 2002–2005

Germany*** - - - - - Hungary X X Italy Mercato San Severino X

Italy Cagliari X Italy Latina X Italy Bologna X Italy Udine X Italy Pavia X

EUR/03/5040781 page 63

Have you already analysed data collected during a CINDI Health Monitor

Survey?

Have the results been used? In which way have results been used?

Survey No Yes No Yes Kazakhstan X

Kyrgyzstan X X

For drafting and lobbying in the Parliament the Law on Tobacco Control, advertisement and other legislative documents For development of health promotion and NCD prevention programmes For development of the National Tobacco Control Action Plan For development of other policy documents of the Ministry of Health For development of other recommendations of the Ministry of Health to the Parliament

Latvia X X Contribution to state health policy – results have been used in Public Health strategy 2001; in development and evaluation of Health Promotion; NCD prevention programmes and campaigns

Lithuania X The data from previous surveys has been used for health policy development, in the project on health inequity, for elaboration of the nutrition action plan and the Tobacco Control Programme in Lithuania

Malta X Republic of Moldova X

Poland X X Development of health promotion and NCD prevention programmes. Contribution to regional health policy

Portugal** - - - - - Romania X Russian Federation X X Slovakia X Slovenia X X Spain Catalonia X

Turkmenistan X, partially X The materials were used by family doctors and nurses for seminars


TOTAL 17 53%

15 47%

3(of 15) 20%

11(of 15) 73%

* Data not available from this source **Data not available because the country has not yet conducted the survey *** Did not conduct the CINDI Health Monitor Survey

EUR/03/5040781 page 64

Table 37. Have you published a basic report on your survey results?

Survey No Yes References Austria X AKS Gesundheitsbericht vol. 1 (AKS health report vol 1), 2001 Belarus X Bosnia and Herzegovina Banja Luka X The report on CINDI Health Monitor Survey has been produced and sent to the WHO

Regional Office for Europe


University book: Health Education and Health Promotion, Medical University in Sarajevo. Journal: Life and Health, Health Institute of Federation. Education materials for World Health Day. Stomatology Bulletin, Stomatology University, Sarajevo. Country plan for nutrition, Ministry of Health, Federation of Bosnia &Herzegovina

Bulgaria

Canada X A report has been published to introduce the Canadian Community Health Survey (CCHS) in which CINDI related information has been included

Croatia X Cyprus - - - Czech Republic X www.szu.cz/czzp/cindi Estonia**

Finland Report will be published as Health behaviour and health among Finnish adult population, Spring 2002. The report will also be published online at www.ktl.fi/eteo

Georgia X Germany*** - - - Hungary X Italy Mercato San Severino*

Italy Cagliari* Italy Latina* Italy Bologna* Italy Udine* Italy Pavia* Kazakhstan* Kyrgyzstan X

Latvia X Health behaviour among Latvian Adult Population, 2000, Helsinki: National Public Health Institute, 2001. Pudule I. et al. (in Latvian)

Lithuania* Malta* Republic of Moldova* - - -

Poland X

Health status, health attitudes and behaviours of Torun Citizen. Drygas et. al. 2001 (in Polish) Health status, health attitudes and behaviours of Lodz Citizen. Drygas et. al. 2001 (in Polish)

Portugal** Romania*

Russian Federation X NCD Behavioural Risk Factor Survey System Development in Russia. Moscow Survey 2000–2001. Moscow 2002. Articles in the National Journal of Disease Prevention and Health Promotion

Slovakia* Slovenia X www.javnozdravje.com (in Slovenian language) Spain Catalonia* Turkmenistan X Ukraine* United Kingdom Northern Ireland*

TOTAL 6 (of 15) 40%

9 (of 15) 60%

*Blank field because the country answered no in the previous question **Data not available because the country has not yet conducted the survey *** Did not conduct the CINDI Health Monitor Survey

EUR/03/5040781 page 65

Table 38. Have you produced any other reports using your survey results?

Survey No Yes Audience the reports were produced for? Austria X Media, policy-makers

Belarus X Decision-makers, researchers, general public, physicians and nurses (especially during training seminars on the prevention of noncommunicable diseases)

Bosnia and Herzegovina Banja Luka X


The annual report about population health condition for the Ministry of Health, Federation of Bosnia and Herzegovina Students of the Medical University for their education programme Students of the Medical University for their postgraduate education programme Legislation about smoking prevention: Ministry of Health, Federation of Bosnia & Herzegovina Presentation of Stomatology Conference in Sarajevo Press conferences for the World Health Day Celebration of World Health Day in Ministry of Health Celebration of World Health Day at the Medical University in Sarajevo Health education materials for World Health Day 7 TV and radio transmissions targeting on health education

Bulgaria*** - -

Canada X Several reports have been published for Canadian Community Health Survey and CINDI related information was used

Croatia X Local government, local health professionals, local population Cyprus - - - Czech Republic*** - - Estonia* - - - Finland*** - -

Georgia X Public Health Department, National Institute of Health, International and national conference and seminars

Germany**** - - -

Hungary X

E.Morava, K.Antmann, B.Oroszi, J.Oszlar, A.Sima, J.Forrai: “Comparative Health Monitor in the CINDI countries” J.Oszlar, K.Antmann, B.Oroszi, A.Sima, J.Forrai, E. Morava: “The health status of the Hungarian population aged 18–69” K.Antmann, B.Oroszi, J.Oszlar, A.Sima, J.Forrai, E. Morava: “Smoking habits in Hungary at the end of 2001”

Italy Mercato San Severino*** - -

Italy Cagliari*** - - Italy Latina*** - - Italy Bologna*** - - Italy Udine*** - - Italy Pavia*** - Kazakhstan*** - - Kyrgyzstan*** - - - Latvia X Decision-makers, researchers, media and general public Lithuania*** - - Malta*** - - Republic of Moldova X Poland X Portugal** - - Romania*** - - Russian Federation X International and national conferences and seminars Slovakia*** - - Slovenia X Public health experts, general public, media Spain Catalonia*** - - Turkmenistan X Ukraine*** - - United Kingdom Northern Ireland*** - -

TOTAL 5 (of 15)33%

9 (of 15) 60%

*Data not available from this source **Data not available because the country has not yet conducted the survey ***Blank because the country answered no in question 14.2 **** Did not conduct the CINDI Health Monitor Survey

EUR/03/5040781 page 66

Table 39. Issues not mentioned in the questionnaire which you would like to comment on

Survey Issues Austria No Belarus It is important that data can be compared with data from other CINDI Countries Bosnia and Herzegovina Banja Luka No

Bosnia and Herzegovina Sarajevo It will be constructive to add some guidelines for target on quality of health care

Bulgaria No Canada No

Croatia We are very glad to conduct the CINDI Health Survey. Thank you for giving us the possibility to be a member of the CINDI family

Cyprus - Czech Republic No Estonia* _ Finland No

Georgia

All issues mentioned in the questionnaire are comprehensive and correspond to requirements of countries like Georgia. In future surveys we would like to include, in addition to the obligatory and highly recommended questions, some others which will clear up the meaning of different issues mentioned in this questionnaire for local population

Germany*** -

Hungary Availability on the Internet of this Monitor – data (age-specific and standardized) would be urgent. International comparative data analysis is required

Italy Mercato San Severino No

Italy Cagliari No Italy Latina No Italy Bologna No

Italy Udine Different versions of the questionnaire, which did not allow a homogeneous data collection. Length of the questionnaire

Italy Pavia No Kazakhstan No

Kyrgyzstan

This questionnaire is a good tool to study behavioural risk factors, as well as to monitor health of people at the population level. However, to reflect a more accurate picture, some questions have to be adapted to local peculiarities. In countries with limited financial resources, it is possible to use mailing method for distribution and collection of questionnaire data through a network of postmen. To increase the efficiency and rate of response, it is possible to use the available resources of the National Statistic Committee in the regions and to conduct interviews by” face to face” method

Latvia No Lithuania No Malta No

Republic of Moldova Three obligatory questions, which refer to oral health, and six highly recommended questions, were not included in the questionnaire for technical reasons

Poland No Portugal** - Romania No Russian Federation Countries data comparison Slovakia We suggest including some basic questions regarding the social and economic status of respondents Slovenia No Spain Catalonia We used the process evaluation questionnaire Turkmenistan No Ukraine No United Kingdom Northern Ireland No -


EUR/03/5040781 page 67

Table 40. Requirements followed

Survey Providedtraining

Protected individual

data

Sampling frame was a population register

and/or the study population was representative

compared with the source population

Method to select sample was simple

random sampling

Size ofsample ≥2000

Size of sample ≥3000

Age group includes

age group 25–64

Included all obligatory questions

Reminder sent

Surveys including all

recommended issues and

having a sample size of ≥2000

Surveys including all recommended issues and having a sample size of ≥

3000

Austria X X X Double stage random sampling X X X X X

Belarus X X X X X X X X X X X Bosnia and Herzegovina Banja Luka

X X X Three stage stratified quota sample X X X X X


X X X X X X X X X

Bulgaria X X X X X X X X X X

Canada X X X Multistage stratified cluster design X X X X X X X

Croatia X X X X X X

Czech Republic X X X X X X X X

Finland X X X X X X X X

Georgia X X X X

Hungary X X X X X X Italy Mercato San Severino

X X X X X X

Italy Cagliari X X X X X X X

Italy Latina X X X X X X

Italy Bologna - X X X X

Italy Udine X X X X X X X

Italy Pavia X X X X X -

Kazakhstan X X X X X X X

EUR/03/5040781 page 68

Survey Providedtraining

Protected individual

data

Sampling frame was a population register

and/or the study population was representative

compared with the source population

Method to select sample was simple

random sampling

Size ofsample ≥2000

Size of sample ≥3000

Age group includes

age group 25–64

Included all obligatory questions

Reminder sent

Surveys including all

recommended issues and

having a sample size of ≥2000

Surveys including all recommended issues and having a sample size of ≥

3000

Kyrgyzstan X X X X X X X X X X X

Latvia X X X X X X X X

Lithuania X X X X X X X X X X X

Malta X X X Stratified random sample X X X X

Republic of Moldova X X X X X X

Poland X X X X X X X X X X X

Romania X X X X X X X

Russian Federation X X X X X X X

Slovakia X X X X X X X X

Slovenia X X X Stratified random sample X X X X X X X

Spain Catalonia X X X -

Turkmenistan X X X X X X X

Ukraine X X X X X X X X X X X

United Kingdom Northern Ireland X X X X X X X

Did a similar survey and

therefore no answers to this question

X X X

TOTAL 27 84%

28 88%

29 91%

28 88%

20 63%

18 56%

32 100%

23 72%

26 81%

12 38%

9 28%

EUR/03/5040781 page 69

Annexes 1–3

EUR/03/5040781 page 70

Annex 1

LIST OF PERSONS RESPONSIBLE FOR THE LATEST CINDI HEALTH MONITOR SURVEY IN THE COUNTRY AND FOR DATA MANAGEMENT AND ANALYSIS OF THE SURVEY

Responsible for the latest CINDI Health Monitor Survey

Responsible for the data management and analysis of the latest CINDI Health Monitor Survey

Austria Dr Günter Diem Arbeitskreis für Vorsorge-und Sozialmedizin gemainn. Bestriebs GesmbH Rheinstrasse 61 A-6900 Bregenz E-mail: [email protected]

Dr Hanno Ulmer Arbeitskreis für Vorsorge-und Sozialmedizin gemainn. Bestriebs GesmbH Rheinstrasse 61 A-6900 Bregenz E-mail: [email protected]

Bosnia and Herzegovina (Republic Srpska)

Professor Milorad Balaban Ministry of Health of Republic of Srpska, Zdrave Korde 8, 78000 Banja Luka, B&H Tel: +387 51 216 600/216 599 Fax: +387 51 216 601 E-mail: [email protected]

Mr Zoran Potic Institute for Cardiovascular Diseases, 21000 Novi Sad, Serbia and Montenegro Tel: +381 21 423 883 Fax: +381 21 622 059 E-mail: [email protected]

Bosnia and Herzegovina (Federation of Bosnia and Herzegovina)

Dr Jasna Omanic Institute of Public Health Federation B&H, Titova 9, Sarajevo Tel: + 387 33 66 3941 Fax:+ 387 33 22 0548 E-mail: [email protected]

Dr Jasna Omanic Institute of Public Health Federation B&H, Titova 9, Sarajevo Tel: + 387 33 66 3941 Fax:+ 387 33 22 0548 E-mail: [email protected]

Belarus Professor Alexander Grakovich 7a, P.Brovki Str., Minsk, 220600, Republic of Belarus Tel: +375-17 2 32 30 94 Fax: +375-17 232 30 80 E-mail: [email protected]

Professor Alexander Grakovich 7a, P.Brovki Str., Minsk, 220600, Republic of Belarus Tel: +375-17 2 32 30 94 Fax: +375-17 232 30 80 E-mail: [email protected]

Bulgaria Dr Nikola Vassilevsky Department of Health Promotion and Disease Prevention, The National Centre of Public Health 15 Dimitar Nestorov St. 1431 Sofia, Tel: + 359 2 958 1515 Fax: +359 2 591 146 E-mail: [email protected]

Dr Ivan Peshev Department of Health Promotion and Disease Prevention, The National Centre of Public Health 15 Dimitar Nestorov St. 1431 Sofia, Tel: + 359 2 958 1515 Fax: +359 2 591 146 E-mail: [email protected]

Canada Professor Sylvie Stachenko Centre for Chronic Disease Prevention and Control Jeanne Mance Bldg. Room 1543B Ottawa, Ontario, K1A 0K9, Canada Tel: 613 954-2629 Fax: 613 954-8631 E-mail: [email protected]

Dr Yang Mao Centre for Chronic Disease Prevention and Control Tunney’s Pasture, Ottawa, ON, K1A 0L2, Canada Tel: (613) 957-1765 Fax: (613) 941-2057 E-mail: [email protected]

mailto:[email protected]


EUR/03/5040781 page 71



Croatia Professor Z. Metelko Vuk Brhovac Institute Clinic for Diabetes Endocrinology and Metabolic Diseases, University of Zagreb, Dugi dol 4a, 100 00 Zagreb, Croatia Tel: +385 1 233 2222/115 Fax: +385 1 233 1515 E-mail: [email protected]

Dr Gordana Pavlekovic Andrija Stampar School of Public Health, Medical School University of Zagreb, Rockefellerova 4, 10000 Zagreb, Croatia Tel: +385 1 4590 100 Fax: +385 1 4590 182 E-mail: [email protected]

Czech Republic Dr Ludmila Skalova National Institute of Public Health, Centre of Health and Environment Srobarova 48, 10042 Praha 10 Tel: +420 2 6708 2547 Fax: +420 2 6731 0291 E-mail: [email protected]

Dr Ludmila Skalova National Institute of Public Health, Centre of Health and Environment Srobarova 48, 10042 Praha 10 Tel: +420 2 6708 2547 Fax: +420 2 6731 0291 E-mail: [email protected]

Finland Dr Ritva Prättälä (CINDI HM) and Dr Antti Uutela (National Health and Behaviour survey) National Public Health Institute, Department of Epidemiology and Health Promotion, Mannerheimintie 166, 00300 Helsinki, Finland Tel: Ritva: +358 9 4744 8631 Tel: Anti: +358 9 4744 8619 Fax: +358 9 4744 8338 E-mail: [email protected] or antti@[email protected]

Dr Ville Helasoja National Public Health Institute, Department of Epidemiology and Health Promotion, Mannerheimintie 166, 00300 Helsinki, Finland Tel: +358 9 303 145 Fax: +358 9 4744 8338 E-mail: [email protected]

Georgia Dr Revatz Tataradze Tblisi State Medical University Georgian Medical Association 7 Asatoamo St. Tblisi 380077 Tel: +995 32 372675 Fax: +995 32 988387 E-mail: [email protected]

Dr Constantine Liluashvili Department of Coronary Heart Disease National Centre for Internal Medicine 74, Iosebidze sstr. apt. 1 Tbilisi Tel: +995 32 373727/ 532279 E-mail: [email protected]

Hungary Professor Endre Morava Semmelweis University, Medical Faculty, Department of Public Health, Hungary, Budapest, PF-370.H-1145 Tel: +36 01 2102954 Fax: +36 01 2102954 E-mail: [email protected]

Dr Katalin Antmann Semmelweis University, Medical Facilty Department of Public Health, Hungary, Budapest, PF-370.H-1145 Tel: +36 01 2102954 Fax: +36 01 2102954 E-mail: [email protected]

Italy Professor Maria Teresa Tenconi Department of Preventive Medicine, viale Forlanini 2, 27100 Pavia, Italy Tel: + 0039 0382 507290 Fax: + 0039 0382 507558 E-mail: [email protected]

Dr Annamaria Gianti Department of Preventive Medicine, viale Forlanini 2, 27100 Pavia, Italy Tel: + 0039 0382 507290 Fax: + 0039 0382 507558 E-mail: [email protected]





EUR/03/5040781 page 72 Responsible for the latest CINDI Health

Monitor Survey


Kazakstan Dr Botakoz Turdalieva National Centre for Problems of Health Lifestyle Development 86, Kunaev Str. 480100 Almaty, Kazakhstan Tel.: 327 2918842, 327 2912081 Fax No.: 3272918842 E-mail: lifestyle@nur_sat.kz

Dr Botakoz Turdalieva National Centre for Problems of Health Lifestyle Development 86, Kunaev Str. 480100 Almaty, Kazakhstan Tel.: 327 2918842, 327 2912081 Fax No.: 3272918842 E-mail: lifestyle@nur_sat.kz

Kyrgyzstan Dr Chinara Bekbasarova Moscovskaya Str., # 148, Ministry of Health, Bishek, Kyrgyzstan Tel: +996 312 54 6650 62 47 14 Fax:+996 312 68 4009 66 04 93 E-mail: [email protected]

Dr Chinara Bekbasarova Moscovskaya Str., # 148, Ministry of Health, Bishek, Kyrgyzstan Tel: +996 312 54 6650 62 47 14 Fax: +996 312 68 4009 66 04 93 E-mail: [email protected]

Latvia Dr Iveta Pudule Health Promotion Centre, Skolas 3, Riga LV-1010 Latvia Tel: +371 7240446 Fax: +371 7240446 E-mail: [email protected]

Dr Iveta Pudule Health Promotion Centre, Skolas 3, Riga LV-1010 Latvia Tel: +371 7240446 Fax: +371 7240446 E-mail: [email protected]

Lithuania Associate Professor Jurate Klumbiene Eiveniu 4, Kaunas LT-3007, Tel: +370 7 731170 Fax: +370 7 796498 E-mail: [email protected]

Ms Irena Nedzelskiene and Mr Viktoras Saferis Eiveniu 4, Kaunas LT-3007, Tel: +370 7 799476 (Irena) Tel: +370 7 732051 (Viktoras) Fax: +370 7 799476 (Irena) Fax: +370 7 796498 (Viktoras) E-mail: [email protected] E-mail: [email protected]

Republic of Moldova

Professor M. Popovici Director National Institute of Cardiology N.Testemitanu street 29/1 Tel: 727511 Fax: 73 95 86 E-mail: [email protected]

Professor M. Popovici Director National Institute of Cardiology N.Testemitanu street 29/1 Tel: 727511 Fax: 73 95 86 E-mail: [email protected]

Poland Professor Wojciech Drygas Department of Preventive and Social Medicine, University of Medicine 90-647 Lodz, Plac Hallera 1 Tel: +48 42 639 3215 Fax: +48 42 639 3218 E-mail: [email protected]

Ms Malgorzata Pikala Department of Preventive and Social Medicine, University of Medicine 90-647 Lodz, Plac Hallera 1 Tel: +48 42 639 3215 Fax: +48 42 639 3218 E-mail: [email protected]

Portugal Professor Fernando de Padua Av. Antonio Serpa, No. 26-2 Dt, 1050-027 Lisboa Tel: +351 21 7910162 Fax: +351 21 7910169 E-mail: [email protected]

Romania Dr Otilia Sfetcu County Public Health Directorate; 22 december str.58, 2700 Deva Tel: +40 254 22 59 27 Fax: +40254 225 225

Mr Adriana Galan Dr Leonte Str., 1-3, 76256, Sector 5, Bucharest Tel: +40 21 224 92 28 ext. 108 Fax: +40 21 312 34 23 E-mail: [email protected]

EUR/03/5040781 page 73



Russian Federation Dr Rimma Potemkina National Centre for Preventative Medicine Petroverigsky pereulok 10, Moscow 101953 Tel: +095 928 21 37 Fax: + 095 924 89 88 E-mail: [email protected]

Dr Rimma Potemkina National Centre for Preventative Medicine Petroverigsky pereulok 10, Moscow 101953 Tel: +095 928 21 37 Fax: + 095 924 89 88 E-mail: [email protected]

Slovenia Dr Lijana Zaletel-Kragelj Institute of Public Health, Facilty of Medicine, Zaloska 4, 1000 Ljubljana, Tel: +386 1 543 75 40 Fax: +386 1 543 75 41 E-mail: [email protected]

Dr Lijana Zaletel-Kragelj Institute of Public Health, Facilty of Medicine, Zaloska 4, 1000 Ljubljana, Tel: +386 1 543 75 40 Fax: +386 1 543 75 41 E-mail: [email protected]

Slovakia Dr Maria Avdicova Banska Bystrica, Cesta k nemocnici 1, 97556 Tel: +00421 48 4153261 Fax: 00421 48 4123637 E-mail [email protected]

Dr Frantiska Hruba Banska Bystrica Cesta k nemocnici 1, 97556 Tel: + 00421 48 4335717 Fax: + 00421 48 4146045 E-mail: [email protected]

Spain (Catalonia) Dr Richard Tresserras Department of Health and Social Security, Travessera de les Corts, 131-159 08028 Barcelona Tel: +34 93 227 2949 Fax: +34 93 227 2990 E-mail:[email protected] or [email protected]

Dr Eulalia Roure Department of Health and Social Security, Travessera de les Corts, 131-159 08028 Barcelona Tel: + 34 93 556 6443 Fax: +34 93 227 2990 [email protected]

Turkmenistan Dr Rustam Kazimov Educational and Informational Centre “Health Promotion and Prevention”. Turkmenian Research Institute of Preventive and Clinical Medicine 31-5 Ostrovsky street, Ashgabat Tel: +99312 444765 Fax: +99312 444765 E-mail: [email protected]

Dr Rustam Kazimov Educational and Informational Centre “Health Promotion and Prevention”. Turkmenian Research Institute of Preventive and Clinical Medicine 31-5 Ostrovsky street, Ashgabat Tel: +99312 444765 Fax: +99312 444765 E-mail: [email protected]

Ukraine Professor Iryna Smyrnova Institute of Cardiology, Narodnogo Opolcheniya st. 5, 03151, Kyiv Tel: +38 044 249 70 36 Fax: +38 044 277 42 09 E-mail: [email protected]

Dr Iryna Gorbas Institute of Cardiology, Narodnogo Opolcheniya st. 5, 03151, Kyiv Tel: +38 044 249 70 36 Fax: +38 044 277 42 09 E-mail: [email protected]

United Kingdom (Northern Ireland)

Dr Brian Gaffney Health Promotion Agency for Northern Ireland 18 Ormeau Avenue Belfast BT2 8HS, Northern Ireland Tel: +44 2890 311 611 Fax: +44 2890 311 711 E-mail: [email protected]

Dr Brian Gaffney Health Promotion Agency for Northern Ireland 18 Ormeau Avenue Belfast BT2 8HS, Northern Ireland Tel: +44 2890 311 611 Fax: +44 2890 311 711 E-mail: [email protected]










EUR/03/5040781 page 74

Annex 2

QUESTIONNAIRE ON METHODOLOGICAL ASPECTS OF THE CINDI HEALTH MONITOR SURVEY

1. Contact information 1.1 Country 1.2 Who is completing this questionnaire? Name: Address: Telephone: Fax: E-mail: 2. Implementation of the CINDI Health Monitor Survey 2.1 Has the CINDI Health Monitor Survey been conducted in your country?

�� Yes How often: /_____/ times Data collection for the latest survey started on:

Day: _____ month: _________ year: _______ Data collection was completed on:

Day: _____ month: _________ year: _______

�� No

If no, please specify either a) or b)

a) We expect to conduct the CINDI Health Monitor Survey starting:

Month: _________year: _______

b) We will not conduct the CINDI Health Monitor Survey but we have conducted a similar survey and are able to provide data

If b), please specify which data could be provided (e.g. BMI, physical activity)

EUR/03/5040781 page 75

3. Latest survey 3.1 Who was responsible for the latest CINDI Health Monitor Survey in your country? Name: Address: Telephone: Fax: E-mail: 3.2 Who was responsible for data management and analysis of the latest CINDI Health Monitor

Survey? Name: Address: Telephone Fax: E-mail: 4. Staffing 4.1 How many staff was involved in the data collection for the latest survey?

4.2 Was local training provided to the staff?

�� No

�� Yes

If yes:

a) How long did the training last? _____________________________________________

b) What topics were included in the training?

EUR/03/5040781 page 76 5. Sampling 5.1 At what level was the survey conducted?

5.1.1 National � No � Yes

5.1.2 Regional � No � Yes

If regional, is the region a CINDI demonstration area? � No � Yes

5.1.3 Other (e.g. in an organized population such as a workplace) � No � Yes

If yes, please specify:

5.2 Which sampling frame was used?

�� Population register

�� Cluster

�� Other (e.g. telephone lists, commercial lists, telephone directories) If other, please describe which type of sampling frame:

5.3 Has any action being taken regarding protection of individual data?

�� No

�� Yes

EUR/03/5040781 page 77

5.4 Was the CINDI Health Monitor Survey conducted as an independent survey or as part of a larger survey?

�� As an independent survey

�� As part of a larger survey

If part of a larger survey, please specify which survey:

5.5 Was the CINDI Health Monitor Survey conducted in parallel with a CINDI risk factor survey?

�� No

�� Yes 5.6 Which method did you use to select a sample?

� Simple random sampling

�� Other

If other, please describe the method used:

5.7 What was the size of the sample?

Total: _____________ No. of females: ______________ No. of males:_______________ 5.8 Which age group did the survey cover?

5.9 How many reminders were sent to non-responders?

5.10 What was the overall rate of response in the survey (including responses to all reminders sent)?

EUR/03/5040781 page 78 6. CINDI Health Monitor questionnaire We refer to the questionnaire presented at the CINDI website: http://www.euro.who.int/Document/Chr/Cinheamonquest.pdf

6.1 Which method was used to collect the data?

�� Mail questionnaire

�� In person interview

�� Computer-assisted interview in person

�� Telephone interview

�� Computer-assisted telephone interview

�� Other

If other, please specify the method used:

6.2 Was the questionnaire translated into the national language and retranslated back to conduct

the survey?

�� No

� Yes

If yes, please outline any problems encountered (e.g. doubt about the accuracy of the translation of some of the variables)

6.3 Were all of the obligatory questions from the questionnaire included in the survey?

�� Yes

�� No

If no, please specify the question(s) (number(s)) that were not included:

EUR/03/5040781 page 79

6.4 Were all of the highly recommended questions from the questionnaire included in the survey?

�� Yes

�� No

If no, please specify the question(s) (number(s)) that were not included:

6.5 Were any questions included in addition to the obligatory and highly recommended questions?

�� No

�� Yes

If additional questions were included, please specify:

a) a) How many: /________/

b) The topics of the questions

6.6 Did the questionnaire include any obligatory or highly recommended questions where the

answer categories were modified (ex. modified categories as to fat content of milk)?

�� No

�� Yes

If yes, please specify

EUR/03/5040781 page 80 6.7 Did you find that any of the questions (obligatory, highly recommended and/or additional)

functioned poorly?

�� No

�� Yes

If yes, please specify the question(s) by number and explain why it/they functioned poorly:

6.8 Please outline any other problems encountered in adapting the questionnaire:

7. Motivation of respondents 7.1 Was action taken to motivate the target population to participate in the survey (e.g. payment)?

�� No

�� Yes If yes, please describe the action taken:

8. Representative study population 8.1 Was the study population representative compared with the source population as to

demographic characteristics (age range, gender, marital status, education etc)? �� No

�� Yes

�� Do not know

EUR/03/5040781 page 81

8.2 Is there any basic information (age, gender, education etc.) on non-responders?

�� No

�� Yes

8.3 Have steps been taken to reflect the source population in data processing appropriately

(e.g. weighting data)? �� No

�� Yes

If yes, please outline briefly the procedures used:

9. Data management 9.1 Please specify the group(s) responsible for processing the data (e.g. the CINDI team, an agency,

students)?

9.2 Which software was used for data processing and data analysis (e.g. SAS, SPSS,

Excel)?

10. Quality and comparability of data 10.1 Have any steps been taken to ensure the quality control of the data to be analysed (e.g. double

key punching of data, training of interviewers, evaluating performance of interviewers, verification procedures to ensure accurate data (e.g. re-interviewing 5% of the respondents)

� No

� Yes

If yes, please specify the steps taken:

EUR/03/5040781 page 82 10.2 Does the data processing include procedures to ensure consistency of responses (i.e. editing

data)?

�� No

�� Yes

If yes, please describe the procedures followed to edit data:

11. Financial resources

11.1 What is the total cost (US$) of conducting the survey from the preparatory phase to the reporting phase?

11.1.1 Preparation and planning of the survey $___________ 11.1.2 Organization and coordination of efforts to implement the survey $___________ 11.1.3 Data collection $___________ 11.1.4 Data processing, analysis and reporting $___________ 11.1.5 Staff training $___________ 11.1.6 Other $___________

If other, please specify the costs (US$) according to field(s) of activity:

11.2 How was the survey financed? (Choose as many as necessary)

11.2.1 � By your own institution 11.2.2 � By the Ministry 11.2.3 � By a nongovernmental organization 11.2.4 � By a pharmaceutical company 11.2.5 � By other institutions in the private sector 11.2.6 � Other institution, organization

If other, specify which type of institution(s)/organization(s):

EUR/03/5040781 page 83

12. Time resources 12.1 How many person months in total were used to conduct the survey? (Person months refers to one person’s full-time work for one month)

No. of person months

12.1.1 Preparation and planning of the survey /__/

12.1.2 Organization and coordination of efforts /__/

12.1.3 Data collection /__/

12.1.4 Data processing, analysis and reporting /__/

12.1.5 Staff training /__/

12.1.6 Other /__/ If other, please specify field(s) of activity as to person months

13. Feasibility of the CINDI Health Monitor Survey 13.1 In general, how do you assess the feasibility of the CINDI Health Monitor Survey to monitor

health related behaviour?

� Good � Reasonably good � Average � Rather poor � Poor

13.2 Please, describe any obstacles encountered during the preparation and conduct of the CINDI

Health Monitor Survey:

EUR/03/5040781 page 84 13.3 Please, describe any successes encountered during the preparation and conduct of the CINDI

Health Monitor Survey:

14. Results and reports 14.1 Have you already analysed data collected during a CINDI Health Monitor Survey?

�� No (go to section 15.1)

�� Yes

If yes, have the results been used (e.g. as a contribution to health policy or legislation development, development of health promotion and NCD prevention programmes, etc.)?

�� No

�� Yes

If yes, please specify in which way results have been used:

14.2 Have you published a basic report on your survey results?

� No (go to section 15.1)

�� Yes

If yes, please list the references

EUR/03/5040781 page 85

14.3 Have you produced any other reports using your survey results?

�� No

�� Yes

If yes, please specify for which audiences the report(s) were produced (e.g., decision-makers, researchers, media, general public, etc.)?

15. Other comments 15.1 Are there any issues, not mentioned in this questionnaire, on which you would like to

comment?

Thank you for your contribution

EUR/03/5040781 page 86

Annex 3

THE CINDI HEALTH MONITOR QUESTIONNAIRE

METHODOLOGY FOR A HEALTH BEHAVIOUR SURVEY

CINDI Health Monitor Questionnaire The category of importance of each question is indicated in brackets after the number of each question:

(1) = Obligatory; (2) = Highly recommended

1. BACKGROUND INFORMATION 1.1 (1) Sex?

1 male 2 female

1.2 (1) Year of birth?

19└─┴─┘ 1.3 (1) Marital status?

1 Married or living in a partnership

2 single 3 separated or divorced 4 widowed

1.4. (2) How many children under the age

of 18 are living in your home?

└─┴─┘persons 1.5 (1) Total number of years of full-time

education (including school, study)?

└─┴─┘years 1.6. (2) Occupation?

1 farming, cattle-raising, forestry 2 industrial, mining, construction

or other similar type of work 3 office work, intellectual work,

services 4 student 5 housewife 6 pensioned 7 unemployed

2. HEALTH SERVICES AND HEALTH

STATUS 2.1 (1) How many times did you visit the doctor

during the last year (12 months)? (Include hospitalisation or visits to the outpatient department; do not include visits to the dentist).

└─┴─┘times. 2.2 (1) Do you receive disability pension?

1 no 2 yes, partial pension 3 yes, for a limited period 4 yes, permanently

2.3 (2) During the last year (12 months),

how many days were you absent from work or unable to carry out normal duties because of illness? (If you do not remember exactly, please give an estimate. Do not include absence owing to a normal pregnancy).

└─┴─┴─┘ DAYS

EUR/03/5040781 page 87

2.4 (2) During the last year (12 months),

have you been diagnosed as having, or been treated for, any of the following conditions?

yes no High blood pressure, (hypertension) ...................................... 1......2 High blood cholesterol, (hypercholesterolemia)......................... 1......2 High blood sugar, (diabetes).............................................. 1......2 Myocardial infarction, (heart attack) ........................................ 1......2 Angina pectoris (chest pain during exercise).................................... 1......2 Heart failure ......................................... 1......2 Rheumatism or arthritis........................ 1......2 Back illness .......................................... 1......2 Chronic bronchitis or emphysema........................................... 1......2 Bronchial asthma.................................. 1......2 Gastritis or ulcer................................... 1......2

2.5 (2) During the last year (12 months) have

you had persistent coughs with phlegm that persist for a while and that occur almost daily?

1 no 2 yes, for less than 1 month 3 yes, for a period of 1-2 months 4 yes, for a period of 3 months or

longer 2.6 (1) Have you had any of the following

symptoms or complaints during the last month (30 days)?

yes no Chest pain during exercise ................... 1......2 Joint pain .............................................. 1......2 Back-pain ............................................. 1......2 Neck/shoulder pain............................... 1......2 Swelling of feet .................................... 1......2 Varicose veins ...................................... 1......2 Eczema................................................. 1......2 Constipation ......................................... 1......2 Headache.............................................. 1......2 Insomnia............................................... 1......2 Depression............................................ 1......2 Toothache............................................. 1......2

2.7 (1) How would you assess your present state

of health? 1 good 2 reasonably good 3 average 4 rather poor 5 poor

2.8 (1) Have you taken any tablets, pills or other

medication during the last week (7 days): yes no

for high blood pressure......................... 1......2 for high cholesterol .............................. 1......2 for headache ......................................... 1......2 for other aches and pains...................... 1......2 for cough .............................................. 1......2 sedatives ............................................... 1......2 vitamins, minerals or trace elements .... 1......2 contraceptives....................................... 1......2

2.9 (1) Have you been feeling tense, stressed or

under a lot of pressure during the last month (30 days)?

1 not at all 2 yes – somewhat but not more than is

usual for people in general 3 yes – more than is usual for people in

general 4 yes – my life is almost unbearable

2.10 (1) When was the last time your blood

pressure was measured? 1 during the previous year 2 between 1 and 5 years ago 3 more than 5 years ago 4 never 5 I do not know

2.11 (1) When was the last time your blood

cholesterol was measured? 1 during the previous year 2 between 1 and 5 years ago 3 more than 5 years ago 4 never 5 I do not know

EUR/03/5040781 page 88 2.12 (1) How many teeth are you missing?

1 none 2 between 1 and 5 3 between 6–10 4 more than 10 – but not all 5 all your teeth are missing or you have

dentures 2.13 (1) How often have you seen a dentist during

the last year (12 months)? └─┴─┘times

2.14 (1) How often do you brush your teeth?

1 more than once daily 2 once daily 3 less than once daily 4 never

3. SMOKING 3.1. (1) Do you or any family members smoke at

home? 1 No, nobody smokes 2 Yes, somebody smokes

3.2 (1) How many hours a day do you spend at

your workplace where somebody smokes? 1 more than 5 hours 2 between 1and 5 hours 3 less than one hour a day 4 almost never 5 I do not work outside the home

3.3 (1) Have you ever smoked in your life?

1 no 2 yes

3.4 (1) Have you ever smoked at least 100

cigarettes, cigars or pipefuls in your lifetime?

1 no (proceed to question 4.1) 2 yes

3.5 (1) Have you ever smoked daily (=almost

every day for at least one year)? If so, how many years altogether?

1 no 2 yes, I have smoked daily for a total of

└─┴─┘ years 3.6. (1) Do you smoke at the present time

(cigarettes, cigars, pipe)? 1 yes, daily 2 occasionally 3 not at all

3.7 (1) When did you last smoke?

If you smoke currently, please circle alternative 1.

1 yesterday or today 2 2 days – 1 month ago 3 1 month – half a year ago 4 half a year to one year ago 5 1–5 years ago 6 5–10 years ago 7 more than ten years ago

3.8 (2) How much do you smoke, or did you

smoke before you stopped, on average per day? (please give an answer to each item)

manufactured cigarettes:

└─┴─┘cigarettes per day

self-rolled cigarettes: └─┴─┘cigarettes per day

pipe:└─┴─┘ pipefuls a day

cigars:└─┴─┘cigars a day

NOTE FOR TRANSLATION: Local categories on other types of tobacco allowed! 3.9 (1) Would you like to stop smoking?

1 no 2 yes 3 I am not sure 4 I do not smoke at present

EUR/03/5040781 page 89

3.10 (1) Have you ever tried seriously to stop

smoking and been without smoking for at least 24 hours?

If so, when was the last time? 1 during the last month 2 a month to half a year ago 3 half a year to one year ago 4 more than one year ago 5 never

3.11 (1) Are you concerned about the harmful

consequences that smoking can have on your health?

1 very concerned 2 somewhat concerned 3 not much concerned 4 not at all concerned


you been advised to stop smoking by any of the following:

yes no a doctor............................................1 ..... 2 a dentist ...........................................1 ..... 2 other health care personnel ..................................1 ..... 2 a family member .............................1 ..... 2 others...............................................1 ..... 2

4. FOOD HABITS

4.1 (2) Do you eat breakfast at all? 1 no 2 yes

4.2 (1) What kind of fat do you mostly use for

food preparation at home? (please circle only one alternative)

1 vegetable oil 2 margarine 3 butter or product consisting mainly of

butter 4 lard or other animal fat 5 no fat at all 6 I do not know 7 I do not usually prepare food

4.3 (2) How often do you prepare food at home?

1 never 2 a few times a year 3 2–3 times a year 4 once a week 5 2–3 times daily 6 daily

4.4 (1) What kind of fat do you use on bread

mostly? (please circle only one alternative)

1 none 2 low fat margarine 3 ordinary margarine 4 butter product consisting mainly of

butter 5 lard or other animal fat 6 butter

4.5 (2) If you drink milk do you usually use

(please circle only one alternative)

1 whole milk (ordinary cow’s milk, about 4.3 % fat or more)

2 consumer milk (ordinary shop milk, about 3.9 % fat)

3 low-fat milk (about 1.9 % fat) 4 skim milk (about 0.05 % fat) 5 I do not drink milk

NOTE FOR TRANSLATION: please replace with local alternatives, if needed! 4.6 (1) How many cups of coffee or tea do you

usually drink a day? Please answer both items.

coffee └─┴─┘cups

tea └─┴─┘ cups

4.7 (2) How many lumps of sugar or spoonfuls

of granulated sugar do you use for one cup of coffee or tea? (Please mark 0 if you don't use sugar). └─┴─┘lumps or teaspoonfuls in a cup of coffee

└─┴─┘lumps or teaspoonfuls in a cup of tea

4.8 (2) How many slices of bread do you usually

eat per day? rye bread └─┴─┘ slices a day

white bread └─┴─┘ slices a day

other bread └─┴─┘slices a day

EUR/03/5040781 page 90 4.9 (2) How often during the last week have you consumed the following foods and drinks? never 1–2 times 3–5 times 6–7 times

boiled potatoes.......................... 1..........................2 .........................3 .........................4 fried potatoes(excl.crisps)......... 1..........................2 .........................3 .........................4 rice/pasta................................... 1..........................2 .........................3 .........................4 cereals (cornflakes, porridge) ................................... 1..........................2 .........................3 .........................4 cheese ....................................... 1..........................2 .........................3 .........................4 chicken...................................... 1..........................2 .........................3 .........................4 fish ............................................ 1..........................2 .........................3 .........................4 meat .......................................... 1..........................2 .........................3 .........................4 meat products (sausages etc.) ........................... 1..........................2 .........................3 .........................4

fresh vegetables ........................ 1..........................2 .........................3 .........................4 other vegetables ........................ 1..........................2 .........................3 .........................4 fresh fruit/berries ...................... 1..........................2 .........................3 .........................4 other fruit/berries ...................... 1..........................2 .........................3 .........................4 sweet pastries (cookies, cakes) ........................................ 1..........................2 .........................3 .........................4 sweets (candy, chocolate) ......... 1..........................2 .........................3 .........................4 soft drinks ................................. 1..........................2 .........................3 .........................4

eggs........................................... 1..........................2 .........................3 .........................4

4.10 (2) Do you add salt to your meals at the table? 1 never 2 when the food is not salty enough 3 almost always before tasting

4.11 (1) During the last year (12 months) have you

been advised to change your dietary habits for health reasons by any of the following:

yes no a doctor ........................................1 ..... 2 other health care personnel ..................................1 ..... 2 a family member .............................1 ..... 2 by others ..............………………..1 ..... 2

EUR/03/5040781 page 91

5. ALCOHOL 5.1 (2) During the last year (12 months) have

you consumed any alcoholic drinks (beer, wine or spirits)? 1 yes 2 no

5.2 (1) How many glasses (regular restaurant

portions) or bottles of the following drinks have you had during the last week (7 days)? (If you have not had any, mark 0). medium strong or strong beer └─┴─┘ bottles free-mixed highballs └─┴─┘ bottles strong alcohol, spirits └─┴─┘ restaurant portions (4 cl) wine or equivalent └─┴─┘ glasses

NOTE FOR TRANSLATION: local drinks/categories/portions allowed! 5.3 (1) How often do you usually have strong

spirits? 1 never 2 a few times a year 3 2–3 times a month 4 once a week 5 2–3 times a week 6 daily

5.4 (2) How often do you usually drink wine?

1 never 2 a few times a year 3 2–3 times a month 4 once a week 5 2–3 times a week 6 daily

5.5 (1) How often do you usually drink beer? 1 never 2 a few times a year 3 2–3 times a month 4 once a week 5 2–3 times a week 6 daily

5.6 (1) How often do you drink six glasses

(regular restaurant portions) or bottles of alcohol, or more, at once?

1 never 2 less than once a month 3 once a month 4 once a week 5 daily or almost daily


you been advised to drink less by any of the following:

yes no a doctor ........................................1 ..... 2 other health care personnel ................................1 ..... 2 a family member .............................1 ..... 2 others ........................................1 ..... 2

6. HEIGHT, WEIGHT AND PHYSICAL ACTIVITY

6.1 (1) How tall are you? └─┴─┴─┘cm 6.2 (1) How much do you weigh in light

clothing? └─┴─┴─┘kg

6.3 (2) How would you describe your weight? 1 underweight 2 normal weight 3 overweight 4 I do not know

EUR/03/5040781 page 92 The following questions aim to determine what kind of physical activity people do in their everyday lives. The questions relate to time spent on physical activities in the last 7 days including physical activities carried out at work and in connexion with housework, garden work, commuting, recreation, exercise and sport. 6.4 (1)* Vigorous physical activity: This refers to

activity that requires hard physical effort and makes you breathe much harder than normal and may include heavy lifting, digging, aerobics, or fast bicycling

During the last 7 days, on how many days did you do vigorous physical activities? Think only about physical activities that you did for at least 10 minutes at a time. (Please mark 0 if you did not do any vigorous physical activity)

On └─┘ days during the last 7 days

6.5 (1)* How much time in total did you usually

spend on one of those 7 days doing vigorous physical activities? └─┴─┘ hours └─┴─┘ minutes/day

(An average time per day is being sought.

If you can’t answer because the pattern of time spent varied widely from day to day divide by 7 the total amount of time you spent over the past 7 days doing vigorous physical activities)

6.6 (1)* Moderate physical activity: This refers

to activity that requires moderate physical effort that makes you breathe somewhat harder than normal and may include carrying light loads, bicycling at a regular pace, or playing tennis doubles. Do not include walking.

During the last 7 days, on how many days did you do moderate physical activities? Think only about physical activities that you did for at least 10 minutes at a time. (Please mark 0 if you did not do any moderate physical activity.)

On └─┘ days during the last 7 days


spend on one of those 7 days doing moderate physical activities?

└─┴─┘ hours └─┴─┘ minutes/day (An average time per day is being sought. If you can’t answer because the pattern of time spent varied widely from day to day divide by 7 the total amount of time you spent over the past 7 days doing moderate physical activities)

6.8 (1)* During the last 7 days, on how many days

did you walk for at least 10 minutes at a time? Include walking at work, at home, to commute from place to place, walking for recreation, and in connection with sport, exercise or leisure. (Please mark 0 if you did not walk at least 10 minutes at a time) On └─┘ days during the last 7 days


spend walking on one of those 7 days?

└─┴─┘ hours └─┴─┘ minutes/day (An average time per day is being sought. If you can’t answer because the pattern of time spent varied widely from day to day divide by 7 the total amount of time you spent over the past 7 days walking)

6.10 (1)* On any one weekday during the last 7 days how much time did you usually spend sitting? Include time spent sitting at work, when travelling or visiting friends, and when sitting/lying down while reading or watching television.

└─┴─┘ hours └─┴─┘ minutes/day (An average time per day is being sought. If you can’t answer because the pattern of time spent varied widely from day to day what was the total amount of time you spent sitting last Wednesday?)

EUR/03/5040781 page 93

6.11 (2) How many minutes a day do you spend walking or riding a bicycle to and from work? (Combine time spent both ways)

1 I do not work at all or I work at home 2 I go to work by car 3 less than 15 minutes a day 4 15–30 minutes a day 5 30–60 minutes a day 6 more than one hour per day

6.12 (2) In your leisure time, how often do you do

physical exercise for 30 minute, which makes you at least mildly short of breath or perspire?

1 daily 2 4–6 times a week 3 2–3 times a week 4 once a week 5 2–3 times a month 6 a few times a year or less 7 I cannot exercise because of illness 8 I cannot exercise because of disability

6.13 (2) How physically strenuous is your work?

1 very light (mainly sitting) 2 light (mainly walking) 3 medium (lifting, carrying light loads) 4 heavy manual work (climbing, carrying

heavy loads) *Taken from the WHO/EURO EUROHIS study (with permission) 6.14 (1) During the last year (12 months) have

you been advised by any of the under mentioned to increase your physical activity?

yes no

a doctor ........................................1 ..... 2 other health care personnel .....................................1 ..... 2 a family member .............................1 ..... 2 other ........................................1 ..... 2

7. TRAFFIC SAFETY 7.1 (1) Do you use a reflector when walking on

streets without lights when it is dark? 1 almost always 2 sometimes 3 never 4 I never walk on unlit streets when it is

dark 7.2 (1) Do you use a seat-belt when driving or as

a passenger in the front seat? 1 almost always 2 sometimes 3 never 4 I never use a car

7.3 (1) Do you use a seat-belt in the back seat?

1 almost always 2 sometimes 3 never 4 there is no seat-belt in the back seat 5 I never travel in the back of the car

7.4 (2) Are you aware if any of your close friends

have driven a car under the influence of alcohol during the last year (12 months)?

1 no 2 yes 3 difficult to say

8. OTHERS

8.1 (1) During the last year (12 months), have

you changed your diet or other habits for health reasons?

yes no I eat less fat .......................................... 1......2 I have changed type of fat I eat ................................................. 1......2 I eat more vegetables............................ 1......2 I eat less sugar ...................................... 1......2 I eat less salt ......................................... 1......2 I have been on a weight- reducing diet......................................... 1......2 I drink less alcohol ............................... 1......2 I do more physical exercise .................. 1......2

EUR/03/5040781 page 94 8.2 (1) In your opinion what is the most

important reason for the rather high death rate among the adult population in our country. (Please mark only one alternative).

1 wrong diet 2 stress 3 difficult living conditions 4 strenuous work 5 smoking 6 lack of physical exercise 7 lack of vitamins, minerals etc. 8 overweight 9 genetic factors

10 alcohol 11 lack of health services 12 other, please

specify________________ 8.3 (2) Do you know anyone who has tried drugs

(hashish, marihuana, amphetamine, heroin) during the last year (12 months)?

1 no 2 one person 3 2–5 persons 4 more than five persons

CINDI HEALTH MONITOR: A STUDY OF FEASIBILITY OF A HEALTH BEHAVIOUR MONITORING SURVEY ACROSS CINDI COUNTRIES

To better monitor health-related behaviour at community level in countries which are implementing an integrated approach towards noncommunicable disease prevention and control, a CINDI Health Monitor survey was introduced in the CINDI (Countrywide Integrated Noncommunicable Diseases Intervention) Programme. In 2000–2002, 32 surveys were carried out in 26 countries of the CINDI network. In order to assess the process of the implementation of the surveys and to study feasibility of such surveys, a survey on the methodological aspects of the CINDI Health Monitor survey was conducted. A database on the results was established and a data book prepared, which will be used to study the experience of the implementation of the CINDI Health Monitor survey at country level and elaborate strategies for the development of a regular health behaviour monitoring system.

The WHO Regional Office for Europe

The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves.

Member States

Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia and Montenegro Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan

5040781E79396Original: English

World Health Organization Regional Office for Europe

Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark Tel.: +45 39 17 17 17. Fax: +45 39 17 18 18. E-Mail: [email protected]

Web site: www.euro.who.int

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