Eurostat, the statistical office of the European Union

Unit F5: Education, health and social protection

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EHSIS was designed to measure the biopsychosocial model of disability introduced by the International Classification of Functioning, Disability and Health (ICF, World Health Organization, 2001). According to this model applied to the survey, disabled people are those who face barriers to participation associated, inter alia, with a health problem or basic activity limitation. Thus, the survey primarily explored the barriers to life opportunities faced by people with health problems and impairments.

EHSIS questionnaire covered the following sections:

• The socio-economic background (classificatory questions),
• A health component (Minimum European Health Module and a list of groups of longstanding health conditions); list of different impairments (limitation in basic activities): seeing, hearing, walking, …; activities of daily living (ADL: self-care activities such as feeding oneself, dressing, bathing, …), and instrumental activities of daily living (IADL: domestic life activities, such as managing money, shopping, using the telephone, housekeeping), and
• Ten areas on important facets of life that enable an individual to be a fully functional and integrated member of society (identified as being of most relevant ones from ICF): mobility, transport, accessibility to buildings, education and training, employment, internet use, social contact and support, leisure pursuits, economic life, attitudes and behaviour. For each of these areas, disadvantages or restrictions to social participation that people (with and without a longstanding health problem or a basic activity difficulty) face in their everyday lives were investigated.

Model questionnaire and other relevant documents are available on CIRCABC in European Health and Social Integration Survey (EHSIS).

Information on the questionnaire development is available in the public part of the Circabc website: https://circabc.europa.eu/w/browse/8f8ab081-ca6a-4738-bf5a-d73e67f8e1f0

EHSIS results are produced in accordance with the relevant international classification systems. The main classification used is ISCED 1997  for the educational attainment level.

The results refer to persons aged 15 and over years living in private households.

According to the biopsychosocial model applied to the survey, people with disabilities are those who face barriers to participation in any of 10 the life areas, associated inter alia with a health problem or basic activity limitation. Therefore, a person identifying a health problem or basic activity limitation as barrier in any life domain is categorised as disabled.

 As regards the severity of disability, several measures can be derived from the survey. The following ones were considered for presenting the results:

• Severity of disability indicator calculated by adding up the number of life areas where a respondent encounters a barrier associated with a health problem or basic activity limitation. The following levels were created:
  • LD1  Barriers to participation in 1 life domain 
  • LD2-3  Barriers to participation in 2-3 life domains 
  • LD_GE4  Barriers to participation in 4 or more life domains 
• Severity of disability indicator computed on the basis of the need of disabled persons for specialised equipment or personal help. The levels considered are:
  • AS1015 Assistance needed 
  • AS1095 No assistance needed 

Longstanding health problem: A longstanding health problem is a health condition or disease which has lasted or is likely to last for at least 6 months. The main characteristics of a longstanding condition or disease are that it is permanent and may be expected to require a long period of supervision, observation or care. Acute (temporary) health problem, such as a sprained ankle or a respiratory tract infection are not considered as being longstanding.

Basic activities captures a wide range of physical, sensory and mental actions performed by an individual in his/her everyday life: seeing, hearing, walking, climbing steps, remembering or concentrating, communicating, stretching, holding, gripping or turning.

Personal care activities refer to the most essential activities for self-care in daily life for a person: feeding himself/herself, getting in and out of bed or chair, dressing and undressing, using the toilet, bathing or taking a shower.

Household care activities refer to those activities required to live independently and maintain an ordinary/usual household: preparing meal, using the telephone, shopping, managing medication, housework, taking care of finances and everyday administrative tasks.

For the above mentioned activities, respondents were asked the rate the level of difficulty in performing them using the following scale:

1. No difficulty
2. Some difficulty
3. A lot of difficulty
4. Cannot do at all / Unable to do

In the presentation of the results, when the above mentioned activities are used as breakdown, only 2 categories are considered:

• Difficulty, including any degree of difficulty (i.e. some difficulty, a lot of difficulty, cannot do at all/unable to do)
• No difficulty

Persons

Population aged 15 and over living in private households and usually residing in Member States (except Croatia and Ireland), Iceland and Norway. Persons living in collective households and institutions were not covered.

The survey was run in 26 Member States (Croatia and Ireland did not run the survey), Iceland and Norway.

The data refer to 2012/2013.

Not applicable.

Indicators are reported in absolute values (number of persons).

Data collection lasted from 1.5 months (Hungary) to 8 months (Portugal) between September 2012 and July 2013. Data refer to the current situation of the population.

EHSIS was a one-shot survey launched by Eurostat through calls for tenders (2 waves). Only five national statistical authorities (Denmark, Hungary, Latvia, Slovenia and Spain) were partly or fully involved in running the survey, otherwise it was run by private companies. The contract for Ireland was cancelled and consequently the survey was not conducted in this country. Croatia was not a EU Member State at the time of launching the call for tender and therefore not included in the list of participating countries. Spain run the survey but not through the 2 waves of the call for tender. The lists of contracting authorities in each participating country are available here:

• http://ec.europa.eu/eurostat/documents/3948917/5908893/2013-S-015-020059-EN.PDF/2ddea6a5-bded-4d00-89a2-60a0eace98f9
• http://ec.europa.eu/eurostat/documents/3948917/5904753/2012-S-143-237998-EN.PDF/a4c49c89-f446-4107-9d62-ac80d4b9ee8e

 Not applicable.

Regulation (EC) No 223/2009 on European statistics (recital 24 and Article 20(4)) of 11 March 2009 (OJ L 87, p. 164), stipulates the need to establish common principles and guidelines ensuring the confidentiality of data used for the production of European statistics and the
access to those confidential data with due account for technical developments and the requirements of users in a democratic society.

Access to EHSIS micro-data is not currently planned to be granted.

Not applicable.

Not available.

In line with the Community legal framework and the European Statistics Code of Practice Eurostat disseminates European statistics on Eurostat's website (see item 10 - 'Accessibility and clarity') respecting professional independence and in an objective, professional and transparent manner in which all users are treated equitably. The detailed arrangements are governed by the Eurostat protocol on impartial access to Eurostat data for users.

Only 2012 data are available.

None

None

Please consult free data on-line. Health/disability dedicated section

EHSIS microdata are not yet available for research purposes.

http://ec.europa.eu/eurostat

Model questionnaire and other relevant documents are available on CIRCABC in European Health and Social Integration Survey (EHSIS).

See the forthcoming European Health and Social Integration Survey. EU comparative quality report.

Not available.

In order to reach a high level of comparability, a model questionnaire with instructions for interviewers was developed and the contracting authorities were asked to translate it according to a standard translation protocol. No deviation was allowed except those resulting from cultural differences and the data collection method used (adaptations were needed in case of telephone or web-based interviews). This is complemented by Eurostat consistency and integrity checks on the microdata so that minimum output quality standard is reached. In addition, data are accompanied with national quality reports stating the accuracy and reliability of the data.

EHSIS results are mainly used by the DG Employment, Social Affairs and Inclusion in order to monitor progress towards the implementation of Article 31 ‘Statistics and data collection’ of the UN Convention and the objectives of the European Disability Strategy.

Other key users include other Directorates of the Commission, National Statistics Institutes (NSIs), disabled people organisations, international organisations, news agencies and researchers.

Eurostat does not carry out any satisfaction survey targeted at users of disability statistics.

EHSIS covers only people aged 15 and over living in private households, i.e. persons living in collective households and in institutions are excluded from the target population.

As EHSIS was run through calls for tenders, the contracting authorities in each participating country were obliged to follow strictly the model questionnaire proposed by Eurostat and to deliver the micro-data according to a standard defined by Eurostat.

The calls for tenders asked that for each country, the sampling design be based on a probability sampling method ensuring accurate and representative results for the whole population aged 15 and over living in private households within that country. Also, the calls for tenders defined the minimum sample sizes to be achieved in each participating country. Substitution was not allowed and the survey was administered to only one person in a household.

Standard errors of key indicators are commonly used as a measure of the reliability of data collected through sample survey. In their quality reports, the contracting authorities provided the standard error for 6 disability measures:

• Number of respondents with a longstanding illness or health problem
• Number of respondents that were severely limited in activities people usually do because of health problems for at least the past 6 months
• Number of respondents prevented from using buildings because of a longstanding health condition, illness or disease
• Number of respondents prevented from using buildings because of longstanding difficulties with basic activities
• Number of respondents prevented from doing the kind of paid work they want to do because of a longstanding health condition, illness or disease

Number of respondents prevented from doing the kind of paid work they want to do because of longstanding difficulties with basic activities

a) Coverage errors

Failure to include all members from the target population in the sampling frame yields coverage error.

A variety of sampling frames were employed across countries. In all countries the frames were as exhaustive as possible with respect to the target population. Population registers were used in 11 countries, random digit dialing (RDD) and list-assisted RDD was used in 10 countries, and area probability samples were drawn in the remaining seven countries. In 18 countries, the sampling frame was updated during the year of the survey data collection (2012); in seven countries (CY, CZ, EE, IT, LT, MT, and ES) the frame was a year older. An older frame (dated between 2001-2006) was used only in three countries (EL, PT, RO).

• Countries not using a sampling frame for the selection of the sample but other methods such as, random digit dialing (Belgium, Estonia, France, Netherlands, Sweden and UK), address generator application (Czech Republic, Italy).
• Countries using a sampling frame for the selection of the sample. Population registers and list of phone numbers were the most used sources for the sampling frame. Other sources included the population census and a dwelling register.

A systematic source of coverage problems is the time lag between the reference date for the selection of the sample and the fieldwork period, which should be made the shortest. In most countries, the sampling frame was updated in 2011 or 2012, except for Greece and Portugal (2001) and Romania (2004).

b) Measurement errors

Quantifying measurement error can be difficult and, therefore, more emphasis is placed on attempting to control for measurement error through the survey implementation process.

Generally, measurement errors arise from the questionnaire, the interviewer, the respondent and the data collection method used.

Questionnaire. Each contracting authority was asked to translate the questionnaire into their target language following a specific translation protocol. No deviation from the model questionnaire was allowed except those resulting from cultural differences and adaptations for telephone or web based interviews. It is difficult to know whether or not any major deviations from the model questionnaire exist, since national translations were not checked.

Interviewer. Several quality indicators were asked to ensure high performance during fieldwork:

• Interviewer recruitment: one requirement was that only interviewers who had finished lower secondary education and with previous experience in population surveys should be used during fieldwork. A majority of contracting authorities recruited interviewers with at least an education level of ISCED 3-4 or higher.
• Interviewer training: specific survey-related training sessions were required for both the interviewers and their supervising staff.
• Interviews/supervisor ratio: the minimum number of supervisors requested was one per 500 interviews conducted.
• Respondent/interviewer ratio: the survey being designed for face-to-face data collection, the recommendation was that the maximum number of interviews by interviewer is 70. A higher ratio was agreed for other data collection methods.
• Contact attempts made before declaring nonparticipation: in general, countries administering the survey face-to-face reported lower mean number of contact attempts than did those via telephone. The average number of contact attempts made in the face-to-face surveys was 2.3 while for the telephone surveys was 9.
• Back-checking: at least 15% subsample of interviews had to be back checked to ensure data quality

Respondent. Proxy interviews typically induce measurement error in the survey estimates as proxies are asked to report on someone other than themselves, for whom they may not have the most accurate information. This is especially true for private behaviours, subjective perceptions, or sensitive topics. Most countries allowed for proxy interviews, but employed stringent rules as to when proxies should be allowed. Since many of the questions in the EHSIS interview are subjective and rely on respondent’s own assessment of their situation, proxy interviews were permissible only when the sampled person was severely impaired.

Data collection method. The survey was designed for face-to-face administration, but in some countries it was administered using the telephone or via a web-based application. The use of different modes of data collection can lead to mode effects, where the same questions asked in different modes produce different results. The way information is communicated to respondents can influence the thought process involved in interpreting questions and response options. Furthermore, category order effects, which can cause variations in the selection process of response categories, can occur as a result of these differences. In self-administered surveys or surveys where respondents are asked to read from a list shown on a card the tendency is to choose answer categories towards the beginning of a list of options. In contrast, in telephone-administered surveys where response options are read out by interviewers the tendency is to choose categories towards the end of a list to be selected.

c) Processing errors

Between data collection and the beginning of statistical analysis for the production of statistics, data must undergo a certain processing: coding, data entry, data editing, imputation, etc. There are no estimates available on the rate of processing errors.

d) Non-response errors

Traditionally, face-to-face surveys yield the highest response rates, followed by telephone survey, mail and web. One caveat in the calculation of the response rates for EHSIS is that they do not account for cases with unknown eligibility. Thus, in telephone surveys for example, ring-no-answer cases are likely included in the denominator (eligible units), even though it is unknown whether these are business lines, or otherwise nonworking numbers. This possibility might explain the drastically low response rates for telephone surveys, in particular when using the random digit dialing method for selecting the sample (in such cases, the response rate was below 20%).

In most countries, the main reason for nonreponse was refusal to take part in the interview. In only 10 countries (Belgium, Denmark, Estonia, Finland, Latvia, Lithuania, Malta, Portugal, Romania and Sweden), the main reason for nonresponse was failure to contact the selected sampled person. The extent to which refusals and noncontacts are systematically different from those interviewed in the EHSIS on disability-related measures may introduce bias in the estimates reported by country. Most countries used post-stratification to adjust for nonresponse.

Contracting authorities were asked to transmit the micro-data file to Eurostat within 21, respectively 17 months from the date of signature of the contract (depending on the wave of the call for tender).

Transmission of the micro-data file was done according to the calendar indicated in the tender specifications and individual contracts. Several countries sent revisions after the initial transmission.

EHSIS was implemented as an input harmonised survey. The questionnaire for this survey has been prepared in detail in order to take into account the problems of comparability and of harmonisation between countries. A model questionnaire in English (questions, answer categories, filters, etc.) and the corresponding interviewers’ guidelines were provided to the contracting authorities with the requirement to follow them strictly. No deviation was allowed except those resulting from cultural differences and the data collection method used (adaptations were needed in case of telephone interviews). Tender specifications also specified the standard translation protocol that contracting authorities had to follow in order to translate the model questionnaire and the interviewers’ guidelines.

 Not applicable.

Some EHSIS datasets can be compared with datasets from the 2011 Labour Force Survey ad hoc module on employment of disabled people and European Health Interview Survey wave 1. See Health dedicated section on Eurostat website.

Not available.

The costs of the survey in each participating country (except for Spain which run the survey without funds from the European Commission) are available here:

• http://ec.europa.eu/eurostat/documents/3948917/5908893/2013-S-015-020059-EN.PDF/2ddea6a5-bded-4d00-89a2-60a0eace98f9
• http://ec.europa.eu/eurostat/documents/3948917/5904753/2012-S-143-237998-EN.PDF/a4c49c89-f446-4107-9d62-ac80d4b9ee8e

Not applicable.

Not applicable.

Survey data collected through calls for tenders.

Not applicable (one-time survey).

The survey was designed for face-to-face administration, but in some countries the survey was administered using the telephone or via a web-based application. The decision as to which mode to use was based on cost and the appropriateness of a particular mode in a given country.

Prior to the dissemination of results, Eurostat checks the data quality and consistency.

EU aggregate is calculated aggregating estimated population totals from Member States.

 Not applicable.

No additional comments.