WHO Multi-country Survey Study on Health and Responsiveness 2000-2001 T. Bedirhan Üstün, Somnath Chatterji, Maria Villanueva, Lydia Bendib Can Çelik, Ritu Sadana, Nicole Valentine, Juan Ortiz, Ajay Tandon, Joshua Salomon, Yang Cao, Xie Wan Jun, Emre Özaltin, Colin Mathers and Christopher J.L. Murray GPE Discussion Paper 37 30 November 2001 TABLE OF CONTENTS SUMMARY................................................................................................................................................ 1 1. INTRODUCTION ................................................................................................................................ 3 2. OVERALL GOALS OF THE SURVEY STUDY .............................................................................. 6 2.1 SPECIFIC AIMS OF THE WHO MULTI-COUNTRY SURVEY STUDY........................................................... 7 2.2 THE SPECIFIC AIM OF CROSS-POPULATION COMPARABILITY ................................................................ 7 3. DEVELOPMENT AND CONTENT OF SURVEY INSTRUMENT ............................................. 11 3.1 SELECTION OF HEALTH DOMAINS..................................................................................................... 11 3.2 FORMULATION OF QUESTIONS.......................................................................................................... 12 3.3 OPERATIONALIZATION OF CROSS-POPULATION CRITERIA .................................................................. 13 3.4 HEALTH STATE DESCRIPTIONS.......................................................................................................... 14 3.5 HEALTH STATE VALUATIONS............................................................................................................. 14 3.6 DEVELOPMENT OF THE RESPONSIVENESS MODULE ........................................................................... 15 3.7 CONTENT OF THE RESPONSIVENESS MODULE .................................................................................... 16 3.8 MENTAL HEALTH (DEPRESSION AND ALCOHOL USE)......................................................................... 17 3.9 CHRONIC HEALTH CONDITIONS ........................................................................................................ 17 3.10 ADULT MORTALITY.......................................................................................................................... 17 3.11 HEALTH RELATED AREAS: ENVIRONMENTAL FACTORS ..................................................................... 17 3.12 HEALTH FINANCING ........................................................................................................................ 17 4. MODES USED IN THE WHO MULTI-COUNTRY SURVEY STUDY....................................... 19 4.1 HOUSEHOLD INDIVIDUAL INTERVIEWS ............................................................................................. 19 4.2 HOUSEHOLD BRIEF FACE-TO-FACE INTERVIEWS .............................................................................. 19 4.3 COMPUTER ASSISTED TELEPHONE INTERVIEW (CATI) ...................................................................... 19 4.4 POSTAL SELF-ADMINISTERED SURVEYS............................................................................................. 20 5. INITIAL TESTING OF THE QUESTIONNAIRE ......................................................................... 21 5.1 TRANSLATION AND COGNITIVE INTERVIEWING................................................................................... 21 5.2 TRANSLATION AND BACK-TRANSLATION ............................................................................................ 21 5.3 PILOT TESTS .................................................................................................................................... 21 6. SITES................................................................................................................................................... 23 6.1 SELECTION OF PARTICIPATING COUNTRIES....................................................................................... 23 6.2 SAMPLING PLANS ............................................................................................................................. 23 6.3 TRAINING OF INTERVIEWERS AND TRAINERS ...................................................................................... 25 6.4 IMPLEMENTATION OF SURVEY IN THE FIELD...................................................................................... 25 6.5 QUALITY ASSURANCE ....................................................................................................................... 26 6.6 FEEDBACK DURING DATA COLLECTION............................................................................................ 26 6.7 ETHICAL ASPECTS ............................................................................................................................ 27 7. DATA COLLECTION AND MANAGEMENT............................................................................... 28 7.1 DATA CODING.................................................................................................................................. 28 7.2 DATA ENTRY PROGRAM .................................................................................................................... 28 7.3 DATA TRANSFER............................................................................................................................... 28 7.4 DATA QUALITY CHECKS ................................................................................................................... 29 7.5 DATA CLEANING AND FEEDBACK...................................................................................................... 29 7.6 QUALITY ASSURANCE STEPS FOR DATA ............................................................................................. 29 8. DATA ANALYSIS STRATEGIES.................................................................................................... 30 8.1 BASIC DESCRIPTIVE ANALYSIS........................................................................................................... 30 8.2 SPECIFIC ANALYSES FOR HEALTH STATE VALUATIONS ....................................................................... 31 8.3 SPECIFIC ANALYSES FOR HEALTH SYSTEM RESPONSIVENESS.............................................................. 31 9. PRELIMINARY RESULTS .............................................................................................................. 32 9.1 PARTICIPATING COUNTRIES............................................................................................................ 34 9.2 RESULTS BY SURVEY MODES........................................................................................................... 34 9.3 REPRESENTATIVENESS OF SAMPLES ................................................................................................ 36 9.4 SURVEY LENGTH ............................................................................................................................ 37 9.5 RELIABILITY OF THE SURVEY INSTRUMENT ...................................................................................... 38 9.6 IMPLEMENTATION OF MEASURED CALIBRATION TESTS .................................................................... 40 9.7 VIGNETTE IMPLEMENTATION .......................................................................................................... 41 9.8 OVERALL SURVEY METRICS ............................................................................................................ 42 9.9 COMPARISON OF SURVEY MODE EFFECTS ....................................................................................... 47 9.10 COMPARISON TO OTHER MULTI-COUNTRY SURVEYS........................................................................ 51 9.11 COSTS............................................................................................................................................ 54 9.12 SELECTED RESULTS ON HEALTH MODULE ...................................................................................... 55 9.13 SELECTED RESULTS ON RESPONSIVENESS MODULE......................................................................... 56 9.14 SELECTED RESULTS ON ADULT MORTALITY..................................................................................... 57 10. DISCUSSION AND CONCLUSIONS ............................................................................................ 58 10.1 FEASIBILITY AND UTILITY ............................................................................................................... 58 10.2 USE OF DATA................................................................................................................................. 58 10.3 APPROACHES FOR CROSS-POPULATION COMPARABILITY................................................................. 58 10.4 SURVEY COSTS ............................................................................................................................... 59 10.5 PLANS FOR THE WORLD HEALTH SURVEY (2001-2002)................................................................... 59 11. REFERENCES.................................................................................................................................. 63 APPENDICES......................................................................................................................................... 67 APPENDIX 1: LIST