Recruitment: Who will participate?

1. Recruitment:Who will participate? Presentation on workshop in Luxembourg 10. April 2008 Sidsel Graff-Iversen

2. A challenge: • Participation rates in HES and HIS have declined during the last decades • Rates: 25-85% in European HES 1994-2003 • Not at random: Those interested in their own health are the easiest to recruit • Substitution of selected persons with neighbours etc is not accepted

3. Low participation: a critical point • Non-participants’ mortality is elevated • Health related habits, substance use and health differ by participation. • Low participation does not necessarily bias the results, based on control for relevant factors from registers. • But register information has limitations. • Some HES variables are more vulnerable for selection bias than others • In conclusion, at least 70% of selected persons should participate.

4. A survey within the FEHES network: • We sent an e-request on sampling and recruitment to national experts in 2007. • Answers for 26 of 32 countries: 17 countries answered for a recent HES and 9 countries for a recent HIS

5. Results of the request Answers could be grouped in 3 categories: • Repeated contact (by letter, phone or visit) • Participant service and information • Appeal to public gain

6. Repeated contact • Re-contacts done in all 17 countries with HES • And re-contacts was considered the most effective recruitment method in 8 of these 17 countries.

7. Repeated contact • Phone for re-contact in 13/17 countries. • Cell phone/SMS not specified, but we know it was used. • Up to 25 contact attempts. • Who called? Could be junior staff, senior staff, physician or head of project. • Home visit was part of the strategy in 10/17 countries.

8. Participant service Mentioned by most experts and ranked as the best method for 5/17 countries • Gain for own health (“Include an ethically approved test that really attracts people”) • High quality, user-friendly written materials in relevant languages • Flexible opening hours • Possibility of examination by home visit

9. Participant service • Local partners (like work-sites, hospitals, universities) • Skilled, polite and interested field personell • Mass communication • Internet site • Reimbursement of travel expenses • Small gift (pen, lottery ticket, voucher - if considered effective)

10. Appeal to public gain • ”Invitation signed by Health Director General”. • “Used the authority of the National Institute of Public Health”. • “A physician made the first (or last) phone call to non-participants”. • General appeal to public gain.

11. Conclusion of the request • Countries with recent HES recognise the need for several recruitment strategies - which have to comply with cultural norms.

12. Recommendations Prior to invitation: • Inform health authorities and other relevant actors • Mass media, survey website, a free contact telephone, ways to change appointment time • Written materials: appealing and easy to understand. • Training of field personnel for service • If possible, plan to collect some information from non-participants Prepare for record keeping about each invitee

13. Recommendations In any information, public or personal: • Explain why it is so important that each selected person joins the HES. – None of them can be replaced. • Appeal to personal and public gain by joining the national HES. • Consider who should front the information and who should sign the invitation letter.

14. Recommendations Flexibility and tailored appointments: • Flexible opening hours, including evenings and week-ends. • Possible for invitees to “drop in”? • Examination by mobile survey teams and home visits? • Other solutions, such as transporting the participant to the survey clinic?

15. Recommendations After the first invitation: • At least one re-invitation in all countries • At least two re-invitations if participation is lower than 70 % after the first invitation