Executive summary
In May 2002, the Australian Health Ministers’ Advisory Council endorsed the conduct of a pilot test of the proposed Australian Health Measurement Survey (AHMS). This was with a view to conducting the first AHMS in conjunction with the 2004–05 Australian Bureau of Statistics National Health Survey (NHS), providing funds were available and the pilot was successful. The AHMS proposal was developed by Australian Government Department of Health and Ageing, the Australian Bureau of Statistics (ABS) and the Australian Institute of Health and Welfare (AIHW), with assistance from Public Health Information Development Unit and the Inter-Governmental Steering Committee.
The pilot, jointly funded by the Australian Government Department of Health and Ageing and the AIHW, was run in early 2003 by the ABS and AIHW. The measurement fieldwork was undertaken in Adelaide, Melbourne and regional Victoria by the International Diabetes Institute and involved just over 500 participants aged 2–74 years. To reflect a survey proper, eligible participants were recruited at the end of a pilot test of the NHS. The NHS component was conducted by the ABS.
The AHMS fieldwork involved a home visit to collect demographic information, physical measurements (height, weight, waist circumference, blood pressure and lung function) and a saliva specimen. Participants aged 12 years and over were also asked to complete a food frequency questionnaire and to visit a local pathology collection centre for the collection of blood and urine specimens—a home visit was arranged if needed. Half of the participants were required to fast before the blood samples were taken, in order to test the effect of fasting on the response rate. Depending on the fasting status, the blood was analysed for total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, homocysteine and glucose. Urine was analysed for albumin, albumin/creatinine ratio and iodine.
Selected results were sent to all adult participants and to the parents/guardians of children who participated. If participants wished, these were also sent to their doctor. Feedback of urgent adverse results was handled immediately by a survey doctor.
The pilot was overseen by the AHMS Project Group with representation from the Australian Government Department of Health and Ageing, the ABS and AIHW. Ethical approval was obtained from AIHW’s Ethics Committee. The main ethical concerns were respondent burden, obtaining adequate consent (and assent from children) and ensuring the safety of those entering the home.
The main objective of the AHMS pilot was to test response rates at each stage of recruitment and to assess response rates among those allocated to a fasting or non-fasting sample. Following recruitment losses in the NHS, just under half (47.9%) of eligible individuals consented to being contacted about participating in the AHMS component. Of the total eligible sample, physical measurements were obtained from 39.3% of participants, blood samples from 23.0% and urine samples from 21.6%. There were no significant differences in response rates between fasting and non-fasting samples.
Although the conduct of the pilot was considered to be successful, these response rates were not satisfactory to justify running a full AHMS based on this approach as part of the 2004–05 NHS, and there was no funding available for further pilot testing or for the AHMS proper. Future development of an AHMS program should consider a protocol involving a standalone survey to reduce respondent burden and thus the number of potential drop-out points, the omission of participants aged less than 18 years of age as the response rate among 12-17 year-olds was particularly low, and reducing the range of measurements taken.
In addition, linking an AHMS with a detailed national nutrition survey should also be given consideration because of the overdue need for these data.