4363.0.55.001 - National Health Survey: Users' Guide, 2001
ARCHIVED ISSUE Released at 11:30 AM (CANBERRA TIME) 27/05/2003
Page tools:
 Print Page
 Print All
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CONTENTS
Further details such as recent medication use or other recent action taken for the condition were only collected for those NHPA conditions determined to be both current and long-term conditions. In some cases persons with these conditions may not have reported the conditions in response to these particular questions but may have instead have reported the condition in response to subsequent, more general, questions covering all conditions. Where this occurred the condition was recorded and is counted in survey results as a current and long-term condition, but the supplementary information about actions taken or medication used is not available. These cases are identified in survey output as condition status 4: Not known if ever told, but condition current and long-term. Data from the 2001 NHS(G) show there were 40 cases for heart and circulatory conditions, and less than 10 for cancer and diabetes. Similarly the NHS(I) data had very few of these cases. Conversely, in some cases respondents reported non-NHPA conditions in response to the questions about NHPA conditions, which were not those conditions. While all conditions reported are recorded and are available for output, counts may differ according to the particular item or population used and some care should be taken in using the data to ensure the items and populations used are appropriate to the purposes intended. Implications for particular NHPA data are discussed under the separate condition sections below. For each of the NHPA conditions listed above, a condition 'status' item has been derived. These items bring together the concepts of :
regardless of how and where in the questionnaire the condition was reported, into the following categories:
Counts of persons with a specific long-term NHPA condition will agree with the sum of current and long-term status categories (i.e. categories 1 and 4) above. The methodology used for all conditions (NHPA and others) is illustrated below: DIAGRAM 3.1 The approach of screening respondents through 'ever told' questions for NHPAs was introduced because those previously diagnosed with the conditions, but who no longer consider they had the particular condition, may be at special risk, and were therefore a key group of interest to users of the data. One outcome of this methodology is that most of those with NHPA conditions which are included in general long-term conditions data from the survey have been medically diagnosed with the condition. This differs from the approach used for data collected in the survey about all other long-term conditions, which required only that a condition is current and long-term before it is recorded, irrespective of whether it had been medically diagnosed. For general output from the survey all conditions are combined to provide an overall picture of current long-term conditions in the population. However, the conceptual differences in the coverage of particular conditions should be considered when interpreting those data. The different conceptual bases of the conditions data available from the survey are summarised below. The scope of published results about long-term conditions is those conditions identified (by the respondent or assumed under the survey methodology) as current and long-term. TABLE 3.1: Long term conditions
Despite the different methodologies used for obtaining information about medical conditions, all conditions data from the survey are ultimately 'as reported' by respondents. While the survey questionnaire was designed to prompt respondents and give them opportunity to report all NHPA conditions and all other long-term conditions they had, whether or not they chose to report a condition to the ABS interviewer, and how they chose to identify or describe that condition, were at the respondent's discretion. As far as was possible (and with the exception of the health priority area 'condition status' items described above) the conditions recorded and classified in the survey were those currently experienced by the respondents at the time of the interview, although not necessarily manifest in terms of current symptoms; for example, a person may suffer from hayfever or sinusitis but experience infrequent attacks. The 2001 NHS(G) and the non-sparse NHS(I) questionnaire design enabled a theoretical maximum of 90 conditions per person to be reported; there was no limit on the data file to the number of conditions an individual respondent could have but no respondents reported more than 30 conditions. INFORMATION ABOUT MEDICAL CONDITIONS Classification of conditions Provision was made on the survey questionnaire for interviewers to record condition information in two ways;
Information from both sources was combined and classified to a single list of approximately 1000 specific condition and condition group categories; referred to as the "1000 input code list" in this publication. This list covered the more common types of long-term conditions experienced in the Australian community. The list was developed by the Family Medicine Research Centre at the University of Sydney, in consultation with the ABS. A computer assisted coding system was developed by the ABS based on this list, and all 'write in' condition information was office coded using this system. The ABS employed a team of specially trained coders for this work. Predefined response categories in the questionnaire were allocated unique codes within the 1000 input code list. Data are not generally available from the survey classified to the full 1000 code level. As the data are from a sample survey there are simply not enough observations to support reliable estimates at that level of detail. While some data at this level may be made available on request for more commonly occurring conditions to meet special needs, for general output purposes long-term conditions are classified in three ways:
While the ICD10 and ICPC-based output classifications were developed by ABS, they were based on mappings between the 1000 input code list and ICD10 and ICPC provided by the Family Medicine Research Centre. These output classifications take account of :
Efforts were made to ensure that the description of each condition which was recorded at interview was as precise and informative as possible to enable detailed, accurate and consistent coding of conditions. However, provision was made in the coding system and classifications for the general and imprecise terms often used by respondents. Copies of the three standard classifications of medical conditions available from this survey are contained in Appendixes 3, 4 and 5. The process of mapping the 1000 input codes to the ICD and ICPC-based output classifications was a complex one, and in some cases the classification of the input codes was based on 'best fit' rather than 'exact match'. Further information about this process, including the placement of specific medical conditions in the classification, can be obtained by contacting the ABS. Interpretation of conditions data In addition to the self-reported nature of the all the conditions data recorded, and the conceptual differences (outlined above) between the data recorded for the NHPA conditions and other long-term conditions, there are a number of other points to be considered in interpreting the information about medical conditions available from this survey;
Other conditions specifically shown in prompt cards (in the order in which they were shown) were:
Back - slipped disc/ other disc problems Back pain or back problems Behavioural or emotional problems Deformity or disfigurement from birth Other deformity or disfigurement Dependence on drugs or alcohol Difficulties in learning or understanding Feeling anxious or nervous Feeling depressed Gallstones Incontinence Paraplegia or other paralysis Speech impediment
ASTHMA Information was collected on two separate aspects of asthma:
Respiratory symptoms Definition This topic refers to the presence of particular respiratory problems/symptoms, at times other than when the respondent had a cough, cold or other infection. Methodology Adult respondents aged less than 45 years were asked whether they had ever had a whistly or wheezy chest, and whether woken at night coughing due to shortness of breath, and how long ago this had last occurred. Respondents were further asked if they had a wheezy chest or coughing during physical exertion in the last 12 months, and how often this occurred. See Q350 to Q358 in 2001 NHS(G) Adult form. Population All persons aged 18 to 44 years. This was the age group for which these particular problems/symptoms were regarded as most relevant; different questions, more appropriate to younger and older age groups, were not included in this survey. This information was not collected in sparse NHS(I). Data items
Items have been kept separate and not joined together into a composite item because to do so would imply some known or predetermined relative importance of symptoms and their frequency as asthma risk factors. While this may be appropriate in terms of individuals, taking account of individual health, co-morbidity, environment, etc this was not considered appropriate at the population level. Output categories for the 2001 NHS(G) and 2001 NHS(I) are available from the ABS web site, through links provided in the Health and Indigenous theme pages to the respective output data item lists. Interpretation Points to consider when interpreting results for this topic include:
Comparability with 1995 Similar information was collected in the 1995 NHS to that obtained in the 2001 survey, although information was collected for selected ages only in 2001. In addition there are a number of differences in the questions used which should be considered in comparing data between the surveys.
Asthma Definition This topic refers primarily to those ever told by a doctor or a nurse that they have asthma, and who still regard their asthma as a current condition. This topic is independent of the questions on respiratory symptoms; for example, respondents may have reported respiratory problems/symptoms but not report asthma, or may report asthma without reporting any of the respiratory symptoms above. Persons who reported they had been told they had asthma, but not told by a doctor or nurse, were recorded as not having been told. As a result they were sequenced around the detailed asthma questions, but did have the opportunity to report current asthma (if appropriate) through later sections of the questionnaire covering 'other' long-term conditions. Information recorded about whether or not asthma was still current was 'as reported' by the respondent. Many people may consider they still get asthma even though it may have been some time since they last had an asthma attack or since they last used medication to prevent an attack. However if an adult indicated they were unsure how to answer because they have not had an attack since childhood, interviewers were instructed to record that asthma was not still current. All persons recorded as still having asthma were considered to have asthma as a long-term condition. Methodology All respondents were asked whether they had ever been told by a doctor or nurse that they have asthma, and whether they still got asthma. For 2001 NHS(G) and non-sparse NHS(I), those who answered yes to both these questions were asked questions about asthma action plans, use of medications for asthma in the last 2 weeks, and other actions taken for asthma in that period. See Q359 to Q376 in 2001 NHS(G) Adult form. Respondents in sparse NHS(I) were not asked questions relating to written action plans. As noted above, persons sequenced around these questions may have reported current long-term asthma in response to later general questions about medical conditions. These are included and contribute to estimates of the prevalence of asthma, but the information about action plans, medication use and other actions taken, was not collected in these cases. Written asthma action plans included management plans developed in consultation with a doctor, cards associated with peak flow meters and medication cards distributed through chemists. Respondents who reported having a written plan were shown a prompt card of the asthma action plan recommended by the National Asthma Campaign (which is available through doctors) and asked if their plan was similar to this; it is this plan which is referred to as the 'standard plan' in the output data items. Respondents were encouraged to gather up and refer to their medication packets, bottles, etc when answering questions about medications used for asthma. The brand or generic name of the medications reported by respondents as used for asthma in the last 2 weeks was recorded by interviewers; these were office coded during processing - see Chapter 2: Survey Design and Operation. Provision was made to record the names of up to three medications. If more that three medications were reported, only three which the respondent considered were their main asthma medications were recorded. In sparse NHS(I), respondents were asked only if they had used a puffer or taken tablets for their asthma in the last 2 weeks. Information regarding specific medication was not collected. Population Information was obtained for all persons. Data items
Output categories for the 2001 NHS(G) and 2001 NHS(I) are available from the ABS web site, through links provided in the Health and Indigenous theme pages to the respective output data items lists. The Indigenous output data items list indicates whether each item is available for non-remote only or both non-remote and remote. Interpretation Points to be considered in interpreting data for this topic include:
Comparability with 1995 Although both the 2001 and 1995 surveys provide estimates of the prevalence of long-term asthma, and information about medication use and other actions taken for asthma in the previous two weeks, results from the two surveys are not considered directly comparable. This is due to the differences in the methodology for identifying asthma, the conceptual differences noted above in the cases of asthma identified, and the different methodologies for identifying medication use and other actions taken. These are summarised in the table below. TABLE 3.4: Asthma comparability - 1995 and 2001
The comparability issues outlined above for NHS(G) also apply to non-remote NHS(I). Data are not available for remote areas in the 1995 NHS so time series comparisons are only possible for non-remote areas. For other general comparability issues between 1995 NHS and the 2001 NHS(I) refer to Chapter 7. CANCER Definition This topic refers primarily to those ever told by a doctor or nurse they have cancer, and who consider they currently have cancer (including cancer in remission). For the purposes of this survey all cancer reported as current was regarded as being a long-term condition. Given the potential sensitivity of the topic, this was considered the most appropriate approach, although it was recognised that some cases of cancer may not meet the 6 months threshold (e.g. a person diagnosed for skin cancer who has surgery to remove it, all within a six month period). Methodology Respondents were asked if they had ever been told by a doctor or nurse that they had cancer, and the type of cancer, including type of skin cancer, they had. Respondents in sparse NHS(I) were first asked about whether they had ever had a test for cancer, then whether they had ever been told by a doctor or nurse that they had cancer, followed by the type of cancer. They were not asked for details about type of skin cancer. Predefined 'type of cancer' categories were included on the questionnaire, with provision for interviewers to record one additional write-in type of cancer if required. The type of cancer categories used were: Skin Colon/rectum/bowel Breast Prostate Lung (incl. trachea, pleura, bronchus) Female reproductive organs (incl. cervix, uterus, ovary) Bladder/Kidney Stomach Leukaemia Lymphoma (incl. Non-Hodgkins lymphoma) Unknown (primary site) The use of these types in the questionnaire effectively established this list as the most detailed level of information on type of cancer available from the survey. If breast cancer was reported, age when first diagnosed with breast cancer was asked. Respondents were then asked if they currently had cancer, the type of cancer (including type of skin cancer), and whether they had taken vitamins/minerals, natural/herbal medicines or other medications (pharmaceuticals) for their cancer in the last two weeks. For the purposes of this survey, persons in remission were regarded as still having cancer, irrespective of the period of remission, and this was specifically mentioned in the question regarding currency (ie. "including cancer which is in remission, do you currently have cancer?"). The sparse NHS(I) made no specific reference to cancer in remission in the wording of the question, however in the interviewer instructions interviewers are told to include cancer in remission. Respondents were encouraged to gather up and refer to their medication packets, bottles, etc when answering questions about medications used for cancer. The brand or generic name of the medications reported by respondents as used for cancer in the last 2 weeks was recorded by interviewers; these were office coded during processing - see Chapter 2: Survey Design and Operation. Provision was made to record the names of up to three medications. If more than three medications were reported, only the three which the respondent considered were their main cancer medications were recorded. See Q400 to Q418 in 2001 NHS(G) Adult form. The sparse NHS(I) collected information only on whether the respondents had taken any medicine or tablets for their condition. Specific information regarding type of medication was not collected. It should be noted that medication use was not linked in the questionnaire to a particular type of cancer. Therefore, if a person reported they currently had several types of cancer and used medication for cancer, that usage cannot be linked with a particular cancer type (although users may be able to draw inferences in some cases from the medication type used). Only those medications specifically used for cancer were included. Other medications, used for example to treat symptoms or side effects of treatment, were excluded. As noted in the introduction, persons sequenced around these questions may have reported current long-term cancer in response to later general questions about medical conditions. These are included and contribute to estimates of the prevalence of cancer, but the information about medication use was not collected in these cases. Population Information was obtained for all persons. Data items
Output categories for the 2001 NHS(G) and 2001 NHS(I) are available from the ABS web site, through links provided in the Health and Indigenous theme pages to the respective output data items lists. The Indigenous output data items list indicates whether each item is available for non-remote only or both non-remote and remote. Interpretation Points to be considered in interpreting data for this topic include:
Comparability with 1995 Both the 2001 and 1995 surveys provide estimates of the prevalence of cancer, and information about medication use for cancer in the previous two weeks. However, results from the two surveys are not considered directly comparable. This is due to the differences in the methodology for identifying cancer, the conceptual differences noted above in the cases of cancer identified, and the different methodologies for identifying medication use. The comparability issues outlined above for NHS(G) also apply to non-remote NHS(I). Data are not available for remote areas in the 1995 NHS so time series comparisons are only possible for non-remote areas. For other general comparability issues between 1995 NHS and the 2001 NHS(I) refer to Chapter 7. HEART AND CIRCULATORY CONDITIONS Definition This topic refers primarily to those persons ever told by a doctor or nurse that they have one or more heart or circulatory conditions, and who consider they currently have one or more such conditions. The scope of this topic differs according to the particular data aspect being considered:
Some care should be taken in using the data to ensure the scope of the topic is appropriate to the data use intended. For the purposes of this survey rheumatic heart disease, heart attack and stroke were assumed to be long-term conditions i.e. of 6 months or more duration, if the respondent reported them as current conditions. Although unlikely in some cases, all other heart and circulatory conditions could be reported by the respondent as current conditions, but in the respondent's perception, not be of 6 months or more duration and hence not be defined as a long-term condition in this survey. Methodology Respondents were asked if they had ever been told by a doctor or nurse that they had a heart or circulatory condition. A prompt card showing examples of conditions was provided to respondents (a prompt card was not used in sparse NHS(I)). The following predefined condition categories were included on the questionnaire, with provision for interviewers to record three additional write-in conditions if required: Rheumatic heart disease Heart attack Stroke (including after effects) Angina High blood pressure/hypertension Hardening of the arteries/atherosclerosis/arteriosclerosis Fluid problems/fluid retention/oedema High cholesterol Rapid or irregular heartbeat/tachycardia/palpitations Heart murmur/heart valve disorder Haemorrhoids Varicose veins In sparse NHS(I) the following categories were used instead: High blood pressure/hypertension High cholesterol or fat in blood Rheumatic heart disease Heart attack Stroke (including after effects) Fast or irregular heartbeats The use of these categories in the questionnaire effectively established this as the most detailed level of information on those conditions available from the survey. Respondents were then asked if they currently had any heart or circulatory conditions, including conditions currently controlled by medications, and whether any/which of these conditions had lasted or were expected to last for 6 months or more. In the sparse NHS(I), respondents were not asked whether they expected their condition to last for 6 months or more. If the respondent's condition was current it was considered to be long-term. The list of predefined conditions was again used for these questions in NHS(G) and NHS(I), with provision for interviewers to record up to three additional conditions if required. If in response to either of these questions a respondent mentioned a heart or circulatory condition they hadn't previously mentioned, the earlier questions in this section were re-asked as appropriate. Information was then obtained about medication use for up to three current and long-term heart and circulatory conditions reported. Respondents were asked whether they had taken vitamins/minerals, natural/herbal medicines or other medications (pharmaceuticals) for the condition in the last two weeks. Respondents were encouraged to refer to their medication packets, bottles, etc when answering questions about medications used for heart and circulatory conditions. The brand or generic name of the medications reported by respondents were recorded by interviewers; these were office coded during processing - see Chapter 2: Survey Design and Operation. Provision was made to record the names of up to three medications for each (up to a maximum of 3) heart and circulatory condition reported. If more that three medications were reported, only three which the respondent considered were the main medication they used for that condition were recorded. This was simplified for sparse NHS(I) as respondents were only asked whether they had used or taken any tablets for up to three heart and circulatory conditions in the last 2 weeks. Specific information regarding type of medication was not collected in sparse NHS(I). Testing had shown that in some cases people who had several heart and circulatory conditions were unable to link a particular medication they had used with a particular condition. Provision was made to record up to three additional medication names in these cases. Sparse NHS(I) did not collect specific information on additional medication, other than asking whether other medication had been taken. Only those medications specifically used for (the particular) heart and circulatory condition are conceptually included. Other medications, used for example to treat symptoms or side effects of treatment were excluded where the purpose for use was identified. Persons sequenced around these questions because they reported they had never been told by a doctor or nurse that they had a heart or circulatory condition may have reported a current and long-term heart and circulatory condition in response to later general questions about medical conditions. These cases are included and contribute to estimates of the prevalence of heart and circulatory conditions, but the information about medication use was not collected in these cases. Population Information was obtained for all persons. Data items
Interpretation Points to be considered in interpreting data for this topic include:
Comparability with 1995 Both the 2001 and 1995 surveys provide estimates of the prevalence of heart/circulatory conditions, and information about medication use for these conditions in the previous two weeks. However results from the two surveys are not considered directly comparable. This is due to the differences in the methodology for identifying the conditions, the conceptual differences noted above in the cases of heart and circulatory conditions identified, and the different methodologies for identifying medication use. In addition, the adoption of a new classification system in the 2001 survey has resulted in some loss of comparability at the more detailed levels, and some aggregation of conditions may be necessary to obtain more comparable condition groups. For further information see Chapter 7: Data Quality and interpretation of results. The comparability issues outlined above for NHS(G) also apply to non-remote NHS(I). Data are not available for remote areas in the 1995 NHS so time series comparisons are only possible for non-remote areas. For other general comparability issues between 1995 NHS and the 2001 NHS(I) refer to Chapter 7. DIABETES Definition This topic refers primarily to those ever told by a doctor or nurse they have diabetes mellitus or high sugar levels in their blood or urine, and who consider they currently have this condition. Although diabetes insipidus is included in some items within this topic, most items relate to diabetes mellitus and/or high sugar levels only. The topic uses a hierarchy of conditions in cases where several types of diabetes mellitus were reported by a respondent or where high sugar levels were reported in association with diabetes. All types reported were recorded for the item about whether ever told by a doctor or nurse, but all other items refer only to the type appearing first on the list below: Diabetes; Type 1 Diabetes; Type 2 Diabetes; Gestational Diabetes; Type unknown High sugar levels Methodology Respondents were asked if they had ever been told by a doctor or nurse that they had diabetes and/or high sugar levels in blood or urine, the age at which they were first diagnosed, and the type of diabetes they were told they had. Persons reporting only diabetes insipidus were sequenced out at this point. Those remaining were asked whether the diabetes or high sugar level was still current. Where the respondent had reported they currently had Type 1 or Type 2 diabetes those conditions were assumed to be of 6 months or more duration; if the respondent reported they currently had diabetes but didn't know the type, or currently had high sugar levels they were asked if their condition had or was expected to last for 6 months or more. Type of diabetes was not collected in sparse NHS(I), and diabetes reported as current was assumed to be long term. For the purposes of sequencing respondents through the questionnaire, gestational diabetes was treated as a long-term condition. However, for purposes of data output, gestational diabetes is assumed to be of less than 6 months duration, and therefore is excluded from long-term conditions data available from the survey. Additional information outlined below was obtained only for those people reporting conditions determined or assumed to be both current and long-term (but including gestational diabetes). Information was then obtained about whether the respondent had daily insulin injections and the age they started having daily injections, and about the use of pharmaceutical medications in the last two weeks. Respondents were encouraged to gather up and refer to their medication packets, bottles, etc when answering questions about medications used for diabetes. The brand or generic name of the medications reported by respondents were recorded by interviewers; these were office coded during processing - see Chapter 2: Survey Design and Operation. Provision was made to record the names of up to three medications for each condition. If more than three medications were reported, only three which the respondent considered were the main medication they used for that condition were recorded. Use of vitamins/minerals and natural/herbal medications were identified through questions about other recent actions; see below. In the sparse NHS(I) details on whether the respondent had daily insulin injections or sugar needles was collected but the age started injections was not obtained. Also, sparse NHS(I) respondents were only asked whether they took tablets for their diabetes or sugar problems, specific information regarding type of medication was not collected. Only those medications specifically used for diabetes or high sugar levels were conceptually included. Other medications, used for example to treat symptoms or side effects of treatment were excluded where the purpose for use was identified. Respondents who reported they had current and long-term diabetes or high sugar levels were also asked about changes to diet, recent actions taken to manage their condition, and whether in the last 12 months their condition had interfered with their work, study and/or other day to day activities. Further information was obtained about whether these people had a diabetes-related sight problem, the type of sight problem, and the time since they had last consulted an eye specialist or optometrist. See Q500 to Q521, and Q522 to Q541 in 2001 NHS(G) Adult form. Respondents sequenced around these questions because they reported they had never been told by a doctor or nurse that they had diabetes or high sugar levels may have reported these conditions in response to later general questions about long-term medical conditions. These cases are included and contribute to estimates of the prevalence of diabetes mellitus and high blood sugar as appropriate, but the information about medication use, recent actions, eye/sight problems, etc was not collected in these cases. Population Information was obtained for all persons. Data items
Interpretation Points to be considered in interpreting data for this topic include:
Comparability with 1995 Although both the 2001 and 1995 surveys provide estimates of the prevalence of diabetes and high sugar levels and have collected some apparently similar data about insulin and other medication use, lifestyle changes, etc, the methodologies used and the populations covered differ between surveys. As a result, the only items common to both surveys which are considered comparable are:
Some other items, such as those relating to daily insulin injections are similar, except that the scope of the population differs; in 1995 it was those 'ever told' they have diabetes, whereas in 2001 it is those 'ever told, who currently have the condition and have reported it is a long-term condition'. This difference may have minimal impact on the data in practice, but users of the data should be mindful of it when making comparisons. Also in making comparisons users should be aware of the different concepts which may underly the particular data they are using - reported or derived, current or ever told, current or long-term, etc. The different concepts effect the overall estimates of prevalence as shown below, and hence direct comparability between 1995 and 2001 data. Note: the estimates in this table exclude gestational diabetes, and high sugar levels. In some published estimates these may be included. TABLE 3.5: Diabetes comparability - 1995 and 2001
(b) Except cases reported as a reason for action only, all diabetes reported as current in the 1995 survey were assumed to be long-term. In the 1995 NHS only one type of diabetes 'ever told' was recorded; in 2001 NHS(G) multiple types could be recorded, but only one type was used for current conditions and subsequent questions. As a result comparisons of type of diabetes 'ever told' can be made, but need to be interpreted with care. The comparability issues outlined above for NHS(G) also apply to non-remote NHS(I). Data are not available for remote areas in the 1995 NHS so time series comparisons are only possible for non-remote areas. For other general comparability issues between 1995 NHS and the 2001 NHS(I) refer to Chapter 7. RECENT INJURIES Definition This topic refers to selected events occurring in the 4 weeks prior to interview which resulted in injury, and which in turn resulted in medical consultation or treatment, or a reduction in usual activities. The types of events included were:
The topic aimed to cover all injuries, from minor scrapes and cuts through to serious injuries such as broken bones and burns, and included birth injuries if these occurred in the previous 4 weeks. Detailed information was collected about those events resulting in injury for which some action was taken. Food poisoning and minor insect bites were not regarded as an injury for the purposes of this survey. The data items included in the NHS module on recent injuries are based on the National Minimum Data Set for Injury Surveillance in the National Health Data Dictionary. They include items describing the event, the type of injury and its bodily location, the place of occurrence and the activity when injured. Methodology Respondents were asked (with the aid of prompt cards) whether any of the events listed above had happened to them in the previous 4 weeks and if so, whether those events had resulted in the respondent taking one or more of the following actions:
For sparse NHS(I), actions collected were:
For those who reported an event for which one or more of those actions was taken, information was collected to establish the number and types of event(s) which had occurred in that period. Further information was then collected about each of the three most recent events in that 4 week period. This information covered details of the event (activity at the time of the injury, and location of event) and consequences of the event (type and bodily location of injury, medical treatment and days of reduced activity resulting from the injury). Prompt cards were used to assist respondents in reporting type of injury, activity at time of event, location of event, and medical consultation arising from the event. These prompt cards were not used in sparse NHS(I). Respondents reporting an injury while working for an income were asked if this was in the same occupation as previously reported in the interview; that is, occupation in the main job the respondent had at the time of the survey. For those not in the labour force, not currently employed, or who have changed occupation since their injury, details of the occupation at the time of the injury were not recorded. A small number of cases were recorded in the survey where after the initial screening questions, it was found that no injury had resulted from the reported event. In these cases no further information about the event or consequences of the event were recorded. These are included in counts of events, but not in counts of injuries or injury events; see diagram later in this section. In the sparse NHS(I), the initial screening question required an injury to have resulted in order to record an event. See Q600 to Q675 in 2001 NHS(G) Adult form. Population Information was collected for all persons in scope of the survey. Data items Items available for reported events:
Items available for reported injury events: Separately for each of most recent/second most recent/ and third most recent event which resulted in injury -
Interpretation Points to be considered in interpreting data for this topic include:
DIAGRAM 3.2
Comparability with 1995 The methodology used to collect data about recent injuries in the 2001 NHS was new, and reflected a change in the basic aims of the injury section, compared with that in the 1995 survey.
Although the two surveys share some apparently similar data items, the differences noted above, which effect the scope and coverage of the data, mean the data are not considered directly comparable for any items. The comparability issues outlined above for NHS(G) also apply to non-remote NHS(I). Data are not available for remote areas in the 1995 NHS so time series comparisons are only possible for non-remote areas. For other general comparability issues between 1995 NHS and the 2001 NHS(I) refer to Chapter 7. LONG TERM CONDITIONS: TYPE OF CONDITION Definition Long-term conditions were defined as medical conditions (illness, injury or disability) which were current at the time of the survey and which have lasted at least six months, or which the respondent expects to last for six months or more, including:
In the 2001 NHS long-term conditions are made up of two conceptually different sets of data;
For output from this survey relating to long-term conditions or persons with long-term conditions, data from these two groups are combined. Methodology Information about the collection of data for the specific NHPA conditions is contained in the previous sections of this publication. Information about the collection of data about all other long-term conditions is provided below. Long-term conditions were addressed in two ways:
In sparse NHS(I), reported NHPA conditions were assumed to be long-term and respondents were not asked if the condition had lasted or was expected to last for 6 months or more. Population Information was collected in respect of all persons in scope of the survey. Data items
Interpretation Points to be borne in mind in interpreting data from the survey relating to long-term conditions:
Comparability with 1995 Data on long-term conditions from the 2001 NHS are broadly comparable with long-term condition data from the 1995 survey. However, direct comparisons should be made with care:
The comparability issues outlined above for NHS(G) also apply to non-remote NHS(I). Data are not available for remote areas in the 1995 NHS so time series comparisons are only possible for non-remote areas. For other general comparability issues between 1995 NHS and the 2001 NHS(I) refer to Chapter 7. LONG TERM CONDITIONS: REPORTED CAUSE Definition This topic refers to the cause; work related or as a result of an injury (including injury at work) of current long-term conditions, as reported by respondents. Methodology Respondents who earlier in the survey had reported one or more current long-term conditions were asked whether that/any of the condition(s) was work related , and whether that/any of the condition(s) was the result of an injury. The type of condition was recorded in either case; provision was made to record up to 5 conditions as work related and 5 conditions as due to an injury. The same condition may have been reported and recorded as both work related and due to an injury. Respondents who reported one or more conditions as due to an injury were asked, in respect of each condition, whether the injury was received while at work/school, in a motor vehicle accident or during exercise or sport. In the sparse NHS(I), information regarding work related long-term conditions was not collected. However, information on long-term injuries was collected. Population Information was collected in respect of all persons for whom one or more current long-term condition had been reported. Data items
Interpretation Points to be borne in mind in interpreting data from the survey relating to the reported cause of long-term conditions:
Comparability with 1995 In the 1995 NHS the questions for this topic were asked in respect of recent and long-term conditions previously reported. Published results were compiled on this basis. However, results can be compiled for long-term conditions only, consistent with the 2001 survey on request. In addition to the different scopes of the topic in each survey, data for this topic are not directly comparable between surveys for methodological reasons, as outlined below:
Work-related conditions were therefore much more narrowly defined in 1995 than 2001, and while the injuries were conceptually the same, the specific reference in 1995 to the accident, incident or exposure coverage of the question could be expected to have elicited a different response to that obtained by the more generic "injury" terminology used in 2001. The comparability issues outlined above for NHS(G) also apply to non-remote NHS(I). Data are not available for remote areas in the 1995 NHS so time series comparisons are only possible for non-remote areas. For other general comparability issues between 1995 NHS and the 2001 NHS(I) refer to Chapter 7. MENTAL WELL-BEING Definition Mental health relates to emotions, thoughts and behaviours. A person with good mental health is generally able to handle day-to-day events and obstacles, work towards important goals, and function effectively in society. However, even minor mental health problems may affect everyday activities to the extent that individuals cannot function as they would wish, or are expected to, within their family and community. Consultation with a health professional may lead to the diagnosis of a mental disorder. Mental health data was not collected in the 2001 NHS(I) as the mental health measures used for the 2001 NHS(G) were considered to be culturally inappropriate to the Indigenous population (for more information see Chapter 2). Data is therefore not available for the NHS(I) sample and the information below relates only to the 2001 NHS(G) sample. In the 2001 NHS(G), information was collected on mental well-being via:
These are outlined below. Kessler Psychological Distress Scale - 10 The Kessler Psychological Distress Scale - 10 (K10) is a scale of non-specific psychological distress. It was developed by Professors Ron Kessler and Dan Mroczek, as a short dimensional measure of non-specific psychological distress in the anxiety-depression spectrum, for use in the US National Health Interview Survey. It was asked of adults aged 18 years and over in the 2001 NHS(G). The K10 is a ten item questionnaire, yielding a measure of psychological distress based on questions about negative emotional states experienced in the four weeks prior to interview. It contains low through to high-threshold items. For each item there is a five-level response scale based on the amount of time that a respondent experienced the particular problem. The response options are: none of the time; a little of the time; some of the time; most of the time; all of the time. Each of the items is scored from 1 for none to 5 for all of the time. Scores for the ten items are summed, yielding a minimum possible score of 10 and a maximum possible score of 50, with low scores indicating low levels of psychological distress and high scores indicating high levels of psychological distress. In the ABS publication National Health Survey, Summary of Results, 2001 (Catalogue Number 4364.0), K10 results are grouped into four categories:
Based on research from other population studies, a very high level of psychological distress, as shown by the K10, may indicate a need for professional help. In Australia, national level information on psychological distress using the K10 was first collected in the Survey of Mental Health and Well-being of Adults (SMHWB) conducted by the ABS in 1997. The SMHWB was an initiative of, and funded by, the (then) Commonwealth Department Of Health and Family Services as part of the National Mental Health Strategy. The K10 was included in the 2001 NHS(G) as it proved to be a better predictor of depression and anxiety disorders than the other short, general measures used in the 1997 SMHWB. Role limitations due to mental health In context of mental well-being, role limitations refer to having accomplished less than desired, or having worked or performed other regular daily activities less carefully than usual, because of emotional problems. Adult respondents were asked two questions from the SF12, a standard international instrument that provides a generic measure of health status and addresses limitations due to physical and mental health. The two questions on role limitations from the mental health dimension of the SF12 were applied to the four weeks prior to interview. Type of medication used for mental well-being Information was collected on whether adult respondents had taken any vitamin or mineral supplements, herbal or natural treatments or remedies, or medications for aspects of their mental well-being in the two weeks prior to interview. The types of pharmaceutical medications recorded were:
Information was also collected on the duration and frequency of use for up to three medication types. If respondents reported using more than three types of medication for mental well-being, they were asked to nominate three main medications. Long-term mental and behavioural problems Information on long-term conditions, i.e. conditions that had lasted or were expected to last for six months or more, was collected in the 2001 NHS(G) for people of all ages. Mental health and behavioural problems were identified through the self-reported information on long-term conditions obtained by the survey. However, unlike other NHPAs such as cancer, cardiovascular conditions, diabetes and asthma, respondents in the survey were not specifically asked whether they had been diagnosed with any mental disorders, so the information provided by respondents could be based on self-diagnosis rather than diagnosis by a health professional. Hence, self-reported survey data on long-term mental and behavioural problems are considered to be less reliable than other self-reported long-term condition data. Some conditions, such as behavioural or emotional disorders, dependence on drugs or alcohol, feeling anxious or nervous and feeling depressed, were identified on prompt cards, while others were collected by asking respondents to identify any other long-term conditions they had. Quality of life measure: the Delighted - Terrible Scale The Delighted-Terrible Scale is a quality of life measure that was developed by Frank M. Andrews and Stephen B. Withey. It is a seven point scale that provides a general indicator of satisfaction with life. Adult respondents to the 2001 NHS(G) were asked, "How do you feel about your life as a whole, taking into account what has happened in the last year, and what you expect to happen in the future?". Respondents were shown the scale on a printed prompt card and asked by the interviewer, "Please tell me the number that most corresponds to how you feel". The options were: 1 - Delighted; 2 - Pleased; 3 - Mostly satisfied; 4 - Mixed (about equally satisfied and dissatisfied); 5 - Mostly dissatisfied; 6 - Unhappy; 7 - Terrible. Population For long-term mental and behavioural problems, information was collected for all persons in scope of the survey. Information on persons under 18 years of age was provided by a proxy (see Chapter 2 - Data collection). Other mental health information was collected for persons in scope of the survey and aged 18 years and over. Data items
Output categories for the 2001 NHS(G) are available from the ABS web site, through a link provided in the Health theme pages to the output data items list. Comparability with 1995
In the 1995 NHS these two questions were asked in context of the SF36. Prior to administration of the main NHS questionnaire by personal interview, the General Health and Well-being Form (SF 36) was given to adults (aged 18 years and over), in selected households, for self-completion. Instructions to respondents on how to complete the form were printed on it and a brief demonstration of how to correctly fill out the Optical Mark Reader readable boxes was also given. The two questions constituted parts b and c of a three part question and took the form: "During the past four weeks, have you had any of the following problems with your work or other regular activities as a result of any emotional problems (such as feeling depressed or anxious)? a. Cut down the amount of time you spent on work or other activities b. Accomplished less than you would like c. Didn't do work or other activities as carefully as usual", with two possible responses to each part: Yes or No. Changes in community perceptions of illness and disability and changes in the identification and treatment (e.g. institutional versus community care) of conditions may have affected the degree to which certain conditions were identified in the survey.
SELF ASSESSED HEALTH STATUS Definition This topic covers two separate but related indicators; the respondent’s perception of their current general health status, and how they consider their overall health to have changed in the previous 12 months. Methodology Respondents were asked directly how they rated their health in general against a 5 point scale; excellent, very good, good, fair and poor. Following this, respondents were asked how they rated their health now compared to one year ago; a 5 point scale was used covering ratings from much better than one year ago, to much worse. Both questions are from the Short Form 36 (SF36) 1. See Q202 and Q203 in 2001 NHS(G) Adult form. Both questions were asked, in association with a general question on how respondents feel about their life (see Mental Wellbeing), before any other illness-related questions to avoid the possible influence of those questions on the respondent’s perception of his/her health. In sparse NHS(I) the questions regarding health ratings were asked, however the general question on how respondents feel about their life was not asked. Population Information was obtained for all persons aged 15 years and over. Data items
Output categories for the 2001 NHS(G) and 2001 NHS(I) are available from the ABS web site, through links provided in the Health and Indigenous theme pages to the respective output data items lists. The Indigenous output data items list indicates whether each item is available for non-remote only or both non-remote and remote. Interpretation Points to be considered in interpreting these data items include:
Comparability with 1995 Self-assessed health status is considered directly comparable between the 2001 and 1995 surveys. Although the health transition item is available from the 1995 NHS for adults, it was collected via the self-completion SF36 questionnaire. The different methodology used to collect the item should be considered in comparing data for this item between surveys. The comparability issues outlined above for NHS(G) also apply to non-remote NHS(I). Data are not available for remote areas in the 1995 NHS so time series comparisons are only possible for non-remote areas. For other general comparability issues between 1995 NHS and the 2001 NHS(I) refer to Chapter 7.
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
