title: Sample selection, recruitment and participation rates in health examination surveys in Europe--experience from seven national surveys.
abstract: BACKGROUND
  Health examination surveys (HESs), carried out in Europe since the 1950's, provide valuable information about the general population's health for health monitoring, policy making, and research. Survey participation rates, important for representativeness, have been falling. International comparisons are hampered by differing exclusion criteria and definitions for non-response.
  
  
  METHODS
  Information was collected about seven national HESs in Europe conducted in 2007-2012. These surveys can be classified into household and individual-based surveys, depending on the sampling frames used. Participation rates of randomly selected adult samples were calculated for four survey modules using standardised definitions and compared by sex, age-group, geographical areas within countries, and over time, where possible.
  
  
  RESULTS
  All surveys covered residents not just citizens; three countries excluded those in institutions. In two surveys, physical examinations and blood sample collection were conducted at the participants' home; the others occurred at examination clinics. Recruitment processes varied considerably between surveys. Monetary incentives were used in four surveys. Initial participation rates aged 35-64 were 45% in the Netherlands (phase II), 54% in Germany (new and previous participants combined), 55% in Italy, and 65% in Finland. In Ireland, England and Scotland, household participation rates were 66%, 66% and 63% respectively. Participation rates were generally higher in women and increased with age. Almost all participants attending an examination centre agreed to all modules but surveys conducted in the participants' home had falling responses to each stage. Participation rates in most primate cities were substantially lower than the national average. Age-standardized response rates to blood pressure measurement among those aged 35-64 in Finland, Germany and England fell by 0.7-1.5 percentage points p.a. between 1998-2002 and 2010-2012. Longer trends in some countries show a more marked fall.
  
  
  CONCLUSIONS
  The coverage of the general population in these seven national HESs was good, based on the sampling frames used and the sample sizes. Pre-notification and reminders were used effectively in those with highest participation rates. Participation rates varied by age, sex, geographical area, and survey design. They have fallen in most countries; the Netherlands data shows that they can be maintained at higher levels but at much higher cost.
authors.affiliation: Research Department of Epidemiology & Public Health, UCL, 1-19 Torrington Place, London, WC1E 6BT, UK. j.mindell@ucl.ac.uk.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Mindell
authors.affiliation: Istituto Superiore di Sanità, Viale Regina Elena n. 299, Rome, Italy. simona.giampaoli@iss.it.
authors.forename: Simona
authors.initials: S
authors.lastname: Giampaoli
authors.affiliation: Department 2 Epidemiology and Health Monitoring Division 25, Robert Koch Institute, Examination surveys and Cohort studies, General-Pape-Str. 62-66, Berlin, 12101, Germany. goesswalda@rki.de.
authors.forename: Antje
authors.initials: A
authors.lastname: Goesswald
authors.affiliation: Department 2 Epidemiology and Health Monitoring Division 25, Robert Koch Institute, Examination surveys and Cohort studies, General-Pape-Str. 62-66, Berlin, 12101, Germany. kamtsiurisp@rki.de.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kamtsiuris
authors.affiliation: Research Department of Epidemiology & Public Health, UCL, 1-19 Torrington Place, London, WC1E 6BT, UK. charlottemann@hotmail.com.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Mann
authors.affiliation: Department of Health, National Institute for Health and Welfare (THL), P.O. Box 30, Helsinki, FI-00271, Finland. satu.mannisto@thl.fi.
authors.forename: Satu
authors.initials: S
authors.lastname: Männistö
authors.affiliation: Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland. kmorgan@rcsi.ie.|Perdana University, Serdang, Malaysia. kmorgan@rcsi.ie.
authors.forename: Karen
authors.initials: K
authors.lastname: Morgan
authors.affiliation: Research Department of Epidemiology & Public Health, UCL, 1-19 Torrington Place, London, WC1E 6BT, UK. n.shelton@ucl.ac.uk.
authors.forename: Nicola J
authors.initials: NJ
authors.lastname: Shelton
authors.affiliation: Department Chronic Diseases Determinants, Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands. monique.verschuren@rivm.nl.
authors.forename: W M Monique
authors.initials: WM
authors.lastname: Verschuren
authors.affiliation: Department of Health, National Institute for Health and Welfare (THL), P.O. Box 30, Helsinki, FI-00271, Finland. hanna.tolonen@thl.fi.
authors.forename: Hanna
authors.initials: H
authors.lastname: Tolonen
mesh_terms: D000328:Adult; D000367:Age Factors; D005060:Europe; D005260:Female; D006306:Health Surveys / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D018579:Patient Selection; D018401:Sample Size; D055815:Young Adult