Implementing Adult Risk Factor Implementing Adult Risk Factor Surveillance in ManitobaSurveillance in Manitoba

Case Studies

ARFS Symposium

January 26, 2011

OutlineOutline

• Regional experiences with Adult RFS• Interlake Paper Survey• Assiniboine Telephone Survey• Brandon Workplace Survey

• Intent, Process & Lessons Learned• Why do we need to continue?

Interlake RHAInterlake RHA

• Sub- committee of the Health Promotion Working Group • Identified need for local level data for planning

(esp. CDPI)• questions based on existing surveys (ie SHAPES,

CCHS) • questions aimed at obtaining valid, reliable, local

level data on risk factors in our region • Adults surveyed in CDPI communities and

control communities across the region

Interlake RHAInterlake RHA• Methodology

• Random sample chosen from telephone listing• Households were called to obtain agreement to

complete the survey• Survey was mailed out & returned postage

prepaid

• Approx 3000 surveys distributed – 2300 returned – ~80% response rate

• First survey to provide baseline data

Interlake RHAInterlake RHA

• Disseminated survey results (in community level reports) to• CDPI committees

• RHA programs/services, mgmt/Board

• Community partners

• Results used to identify target populations & develop targeted health promotion strategies

Assiniboine Telephone SurveyAssiniboine Telephone Survey

• Public Health Agency of Canada grant • Goals:

• Obtain valid, reliable local risk factor data• Disseminate risk factor findings to community &

staff• Identify target populations & risk factors for health

promotion activities• Gather data to allow for comparison of

methodology with other regions

MethodologyMethodology

• Compare approaches (mail vs. telephone)• Randomized telephone survey• Based on Interlake RHA survey of adults• 9 CDPI & 5 control communities• 2600 surveys• Contracted to professional survey company

Resources RequiredResources Required• Grant for data collection• Methodology discussion/planning• Data analysis• Report writing• Knowledge exchange

• CDPI communities• Regional programs, managers• Regional summary posted online

Brandon Workplace SurveyBrandon Workplace Survey• Sub-committee of the Healthy Brandon

Leadership Team• Need for valid, local level data to inform CDPI

efforts

• Component of CDPI evaluation plan

• Focus on workplace culture rather than individual trends

• Survey initially developed based on existing surveys (Interlake RHA, CCHS) – pilot tested

• Questions to explore reasons for behaviours• Four surveys developed, each addressing a

modifiable risk factor

Brandon Workplace SurveyBrandon Workplace Survey

Methodology• Broad range of businesses and industry invited

to participate• Random sample from participating workplaces• Surveys completed on-site, gathered by

administration staff and picked up RHA

402 surveys distributed; 228 returned - ~ 57% return rate

Brandon Workplace SurveyBrandon Workplace Survey

• Resources Required• Data Management team including workplace

contact• Comprehensive plan for surveillance process• Printing costs• Scanning software• Data analysis

Lessons LearnedLessons Learned

• Mail Survey Approach• Used community-based recruiting• Resource intensive for RHA (training & time for recruiters,

data capture)• Builds internal capacity & may create stronger connections

with community• May be selection bias (acquaintances of recruiters)• May exclude people with lower literacy skills• Costs per survey depend on response• Useful for smaller scale surveillance

(Continued)

Lessons Learned (cont’d)Lessons Learned (cont’d)

• Telephone Survey Approach• Random digit dialing• Did not reach people without a land line phone• Efficient data collection method, with minimal impact on

RHA staff• Sample size guaranteed• Requires communication strategy to promote survey• Costs can be determined before beginning• Redirected knowledge exchange funds to achieve data

analysis(Continued)

Lessons LearnedLessons Learned

• Workplace Survey Approach• Efficient data collection method• Opportunity to strengthen community

connections• Participants not representative of the region• Gender issues with survey completion• May be selection bias with organizational self-

selection and internal recruitment• Challenges with interpretation and reporting -

survey by occupation rather than by company

Overall Lessons LearnedOverall Lessons Learned

• Regions at different stages of readiness• Consider economies of scale for large projects

• Multiple regions participating could reduce costs• Consider lasting effects

• Internal capacity• Connection with communities

• Timing is important • Season • Be aware of other projects

• Build on the success of others• Knowledge exchange capacity essential

• Requires organizational commitment

Why did we do risk factor Why did we do risk factor surveillance?surveillance?

• Key to controlling epidemics of chronic disease is primary prevention

• Based on comprehensive population-wide programs

• Basis of chronic disease prevention is:• identification, prevention & control of major common

risk factors

Risk factors of today are the diseases of tomorrow• Source: WHO STEPS Manual

Impact of chronic diseaseImpact of chronic disease

• Common, preventable underlie most chronic diseases

• Leading cause of death & disability• Leading risk factor globally is high blood pressure

• Followed by tobacco use, high total cholesterol, low fruit/vegetable consumption

Major risk factors combined = 80% of deaths from heart disease & stroke

• Source: WHO STEPS Manual

Economic CostsEconomic Costs

• 3 risk factors:• Unhealthy eating• Physical inactivity• Tobacco use

• Annual economic burden in Manitoba $1,615,600,000

• Making the Case for Primary Prevention

(Available on Heart & Stroke Foundation & Health in Common Websites)

Why do we need to continue?Why do we need to continue?

• Surveys cannot be one-offs• Surveillance involves commitment to

ongoing, repeated data collection• Essential to identify trends in prevalence

• Source: WHO STEPS Manual

• Embed surveillance in organizational practices to support program planning• Need for evaluation of health interventions• Build organizational capacity for RFS