Local problem solving in the Portuguese health examination survey: a mixed method study

Area of Science:

• Public Health
• Health Services Research
• Survey Methodology

Background:

• Declining participation rates in health surveys threaten representativeness and confidence in findings.
• The Portuguese national health examination survey (INSEF) in 2015 reported a participation rate of 43.9%.
• This rate is comparable to other national health examination surveys.

Purpose of the Study:

• To describe how local survey personnel conducted the INSEF survey.
• To detail strategies employed to address practical challenges.
• To identify methods used to enhance participation rates.

Main Methods:

• A literature search was followed by informal interviews with 14 public health officials.
• Forty-one local survey personnel completed anonymous questionnaires.
• Mixed methods analysis, informed by thematic analysis, was applied to interview and questionnaire data.

Main Results:

• A comprehensive manual enabled adherence to scientific standards while allowing local adaptation.
• Training workshops fostered team confidence, knowledge, and motivation for implementing local solutions.
• Empowered local teams used persuasive, personalized approaches to increase participant attendance.

Conclusions:

• Organizational improvisation (bricolage) provided a framework for understanding problem-solving with limited resources.
• A detailed manual, continuous monitoring, and interactive workshops were crucial for high scientific standards and participation.
• Effective communication and collaboration between central and local teams facilitated innovative solutions and addressed challenges.