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Methodological issues in adolescent health surveys: The case of the Swiss multicenteradolescent survey on health

Methodologische Probleme bei Gesundheitsbefragungen von Jugendlichen: Das Beispiel über die Gesundheit Jugendlicher in der Schweiz

Les questions methodologiques posées par les enquêtes sur la santé des adolescents: L'exemple de l'enquête suisse sur la santé des adolescents

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Sozial- und Präventivmedizin

Summary

In many countries, health care and prevention professionals face serious lack of data regarding health status, health care utilisation and lifestyles of adolescents. With reference to a survey on health and lifestyles of Swiss teenagers 15–20 years old, this paper reviews the different methodological issues linked with the conception and the realization of such a study. The main objective of the so-called “SMASH” project (Swiss Multicentric Adolescent Survey on Health) is like other similar researches, to gather health indicators, that is, to measure attitudes and behaviour regarding different aspects of health and lifestyles, to identify the perceived health needs of the respondents and to describe their utilisation of health care services. The main issues which are addressed in the paper are related to: 1) the choice of the channel and the instrument to be used (telephone, vs. face-to-face interview vs. self-administered questionnaire; 2) the sampling procedures (pure random vs. cluster school-based samples; size of the sample); 3) the design and the content of the questionnaire (choice of the areas to be covered, selection and wording of the questions); 4) the ethical considerations linked with the collection of data. One of the specificities of SMASH is the inclusion of youth participation at various steps and levels: the design of the questionnaire, the strategies used to gather the data, and the analysis of the results. Two important issues emerge from this review. First, the importance in the future of being able to rely on common indicators that could be used in different countries and settings through the construction of a validated instrument. Second, the fact that most of the surveys conducted in this field neglect several sub-populations of adolescents with special and important needs: handicapped adolescents, drop-outs and recent immigrants coming either as unskilled workers or as refugees. Surveys in such special in-need groups will have to be planned with specific designs, both in terms of content and of approach.

Zusammenfassung

In vielen Ländern fehlen den im Bereich der Pflege und der Prävention tätigen Berufsleuten Daten, auf die sie sich bei der Ausarbeitung ihrer Politik stützen können. Dieser Artikel beschreibt, am Beispiel einer Studie über Gesundheit und Lebensgewohnheiten der Schweizer Jugendlichen im Alter von 15 bis 20 Jahren die methodologischen Probleme, die mit der Entwicklung und Durchführung solcher Studien einhergehen. Ziel der “SMASH” (Swiss Multicentric Adolescent Survey on Health) ist es, brauchbare Gesundheitsindikatoren zu sammeln: Einstellungen und Verhalten bezüglich der Gesundheit und den Lebensgewohnheiten, Wahrnehmung der Bedürfnisse und Inanspruchnahme der Angebote im Pflegesystem. Die wichtigsten Bereiche, die im Artikel untersucht werden sind: 1) Auswahl der Verteilungswege und des Instrumentes zur Datensammlung (Telefon versus Interview versus Fragebogen); 2) Erstellung der Stichprobe (Zufallsstichprobe versus Klumpenstichprobe, Grösse der Stichprobe); 3) Design und Inhalt des Fragebogens (Auswahl der Bereiche, die gedeckt werden sollten, Formulierung der Fragen); 4) Ethische Erwägungen, die bei der Ausarbeitung einer solchen Befragung betrachtet werden müssen. Eine Besonderheit der SMASH ist die wohlüberlegte Wahl, Jugendlichen bei jeder Etappe der Befragung miteinzubeziehen (Design des Fragebogens, Verteilungsstrategien, Analyse der Ergebnisse). Zwei wichtige Probleme bleiben oft bei dieser Art von Befragung nicht gelöst. Einerseits fehlt es an einer Übereinstimmung bei der Auswahl der relevanten Indikatoren und der Instrumente, die internationale und wissenschaftlich zuverlässige Vergleiche zulassen. Andererseits besteht die Schwierigkeit, Untergruppen wie Migranten, junge Behinderte oder Jugendliche aus Randgruppen, die sehr spezifische Charakteristika und Bedürfnisse haben, in die Studie einzubeziehen.

Résumé

Dans beaucoup de pays, les professionnels chargés des soins et des activités de prévention auprès des jeunes manquent de données sur lesquelles s'appuyer dans l'élaboration de leurs politiques. En prenant comme exemple une étude sur la santé et les styles de vie des jeunes suisses de 15 à 20 ans, cet article passe en revue les problèmes méthodologiques liés à la conception et à la réalisation de ce type de recherche. Les objectifs de “SMASH” (Swiss Multicentric Adolescent Survey on Health) sont de récolter des indicateurs de santé pertinents: attitudes et comportements en matière de santé et de styles de vie, perception des besoins et utilisation des systèmes de soins. Les principaux domaines explorés dans l'article sont: 1) le choix du canal et de l'instrument de récolte des données (téléphone vs. interview vs. questionnaire); 2) les procédures d'échantillonage (aléatoire vs. par grappe, taille de l'échantillon); 3) le design et le contenu du questionnaire (choix des domaines à couvrir, énoncé des questions); 4) les considérations éthiques liées à la mise sur pied de ce type d'enquête. L'une des spécificités de SMASH est le choix délibéré d'impliquer les jeunes eux-mêmes à chaque étape de l'enquête (design du questionnaire, stratégies de distribution, analyse des résultats). Deux problèmes importants restent bien souvent non résolus dans ce type de recherche d'une part l'absence d'un véritable consensus sur le choix des indicateurs les plus pertinents et d'instruments dûment validés pouvant servir à des comparaisons internationales solides scientifiquement et d'autre part la difficulté d'atteindre des sous groupes de jeunes présentant des caractéristiques et des besoins bien spécifiques, comme les migrants, les jeunes handicapés ou encore les marginaux.

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  1. UEPP/IUMSP, Bugnon 17, CH-1005, Lausanne

    Françoise Narring & Pierre-André Michaud

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  1. Françoise Narring
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This survey was supported by a grand of the Swiss Office for Public Health (contract Nb.316.5139 et 316.92.5321) and cantonal authorities from all over Switzerland.

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Narring, F., Michaud, PA. Methodological issues in adolescent health surveys: The case of the Swiss multicenteradolescent survey on health. Soz Präventivmed 40, 172–182 (1995). https://doi.org/10.1007/BF01318638

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