title: Factors affecting study efficiency and item non-response in health surveys in developing countries: the Jamaica national healthy lifestyle survey.
abstract: BACKGROUND
  Health surveys provide important information on the burden and secular trends of risk factors and disease. Several factors including survey and item non-response can affect data quality. There are few reports on efficiency, validity and the impact of item non-response, from developing countries. This report examines factors associated with item non-response and study efficiency in a national health survey in a developing Caribbean island.
  
  
  METHODS
  A national sample of participants aged 15-74 years was selected in a multi-stage sampling design accounting for 4 health regions and 14 parishes using enumeration districts as primary sampling units. Means and proportions of the variables of interest were compared between various categories. Non-response was defined as failure to provide an analyzable response. Linear and logistic regression models accounting for sample design and post-stratification weighting were used to identify independent correlates of recruitment efficiency and item non-response.
  
  
  RESULTS
  We recruited 2012 15-74 year-olds (66.2% females) at a response rate of 87.6% with significant variation between regions (80.9% to 97.6%; p < 0.0001). Females outnumbered males in all parishes. The majority of subjects were recruited in a single visit, 39.1% required multiple visits varying significantly by region (27.0% to 49.8% [p < 0.0001]). Average interview time was 44.3 minutes with no variation between health regions, urban-rural residence, educational level, gender and SES; but increased significantly with older age category from 42.9 minutes in the youngest to 46.0 minutes in the oldest age category. Between 15.8% and 26.8% of persons did not provide responses for the number of sexual partners in the last year. Women and urban residents provided less data than their counterparts. Highest item non-response related to income at 30% with no gender difference but independently related to educational level, employment status, age group and health region. Characteristics of non-responders vary with types of questions.
  
  
  CONCLUSIONS
  Informative health surveys are possible in developing countries. While survey response rates may be satisfactory, item non-response was high in respect of income and sexual practice. In contrast to developed countries, non-response to questions on income is higher and has different correlates. These findings can inform future surveys.
authors.affiliation: Tropical Medicine Research Institute, the University of the West Indies, Mona, Kingston 7, Jamaica. rainfordw@cwjamaica.com
authors.forename: Rainford
authors.initials: R
authors.lastname: Wilks
authors.forename: Novie
authors.initials: N
authors.lastname: Younger
authors.forename: Jasneth
authors.initials: J
authors.lastname: Mullings
authors.forename: Namvar
authors.initials: N
authors.lastname: Zohoori
authors.forename: Peter
authors.initials: P
authors.lastname: Figueroa
authors.forename: Marshall
authors.initials: M
authors.lastname: Tulloch-Reid
authors.forename: Trevor
authors.initials: T
authors.lastname: Ferguson
authors.forename: Christine
authors.initials: C
authors.lastname: Walters
authors.forename: Franklyn
authors.initials: F
authors.lastname: Bennett
authors.forename: Terrence
authors.initials: T
authors.lastname: Forrester
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ward
authors.forename: Deanna
authors.initials: D
authors.lastname: Ashley
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D016001:Confidence Intervals; D003906:Developing Countries; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology*; D015994:Incidence; D007563:Jamaica / Q000453:epidemiology; D008019:Life Style; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015203:Reproducibility of Results; D012307:Risk Factors; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D016312:Treatment Refusal / Q000706:statistics & numerical data*