Canadian Survey of Experiences with Primary Health Care (CSE-PHC)

Detailed information for 2007-2008

The general purpose of the survey is to measure Canadians' experiences with health care, specifically, experiences with various types of doctors and clinics, access to different types of health care including emergency room and prescription medication use. Special attention was given to respondents diagnosed with certain chronic conditions in terms of their general experiences and their participation in managing their own health care.

Data release - February 5, 2009

• Questionnaire(s) and reporting guide(s)
• Description
• Data sources and methodology
• Data accuracy
• Documentation

Description

The objectives of the CSE-PHC are to collect data on issues relating to experiences with health care that impact Canadians; to provide a picture of access and utilization of primary care; to provide information on issues specific to Canadians living with chronic conditions and their experiences with the health care system; and to provide information for the development of effective policies and strategies to help improve health care for all Canadians.

The CSE-PHC data can be used by researchers, non-governmental organizations, community planners, governments and the public. Results will provide a holistic perspective of Canadians' experiences with health care and identify as well as raise awareness about the issues that affect people living with chronic conditions. Also, the information collected by this survey will inform the decision-making process and provide data for the use of resources. It will also provide baseline data to monitor change over time.

Reference period: The gathered information is valid for the 12 months leading up to the interviews.

Subjects

• Health
• Health care services

Data sources and methodology

Target population

The survey was conducted with Canadians aged 18 years or older living in private dwellings in the 10 provinces and the three territories. Persons living on Indian Reserves or Crown lands, residents of institutions, full-time members of the Canadian Armed Forces and residents of certain remote regions are excluded from this survey.

Instrument design

The Health Council of Canada (HCC) and Canadian Institute for Health Information (CIHI) provided input into the development of the 2008 draft questionnaire, this included mapping to 27 health indicators developed by CIHI. A new version of the questionnaire was created to reflect the research goals, objectives and indicators of the co-sponsors. The length was dramatically reduced and the flow of the interview was improved. The redesign questionnaire was translated by Official Languages and Translation Division and tested in conjunction with Environics Research Group using face to face interviews in both official languages in four Canadian cities. The testing was conducted with respondents from various age groups and ethnic backgrounds. A portion of the test group was comprised of people diagnosed with chronic conditions. Further changes to the questionnaire were implemented based on the results of the questionnaire testing process. Once a final version of the questionnaire was decided on, specifications were drawn up and a CATI application was developed and tested. Specifications for valid ranges and inter-question consistency were incorporated into the CATI application to the extent feasible.

Sampling

This is a sample survey with a cross-sectional design.

The survey sample was expanded and a sampling strategy was developed to permit national as well as provincial level estimates of survey results.

The sample for this survey was drawn from the Canadian Community Health Survey (CCHS, record number 3226), Cycle 4.1 and consisted of 16,482 respondents. Only the CCHS respondent, not the whole household, was eligible for selection. Almost the entire available sample was used in six of the 10 provinces (Newfoundland, New Brunswick, Nova Scotia, Prince Edward Island, Manitoba and Saskatchewan) in order to maximize the minimum estimable proportion (min p) of some very small variables of interest. Otherwise the target of a 7% min p was used in order to determine the sample size in the four provinces where extra sample was available.

Data sources

Data collection for this reference period: 2008-04-14 to 2008-06-30

Responding to this survey is voluntary.

Data are collected directly from survey respondents.

An introductory letter was mailed to respondents approximately one week before data collection began. Collection was done by computer assisted telephone interview (CATI).

The CATI system has a number of generic modules which can be quickly adapted to most types of surveys. A front-end module contains a set of standard response codes for dealing with all possible call outcomes, as well as the associated scripts to be read by the interviewers. A standard approach set up for introducing the agency, the name and purpose of the survey, the survey sponsors, how the survey results will be used, and the duration of the interview was used. We explained to respondents how they were selected for the survey, that their participation in the survey is voluntary, and that their information will remain strictly confidential. Help screens were provided to the interviewers to assist them in answering questions that are commonly asked by respondents.

The CATI application ensured that only valid question responses were entered and that all the correct flows were followed. Edits were built into the application to check the consistency of responses, identify and correct outliers, and to control who gets asked specific questions. This meant that the data was already quite "clean" at the end of the collection process.

The survey manager met with senior staff responsible for collection to discuss issues and questions before the start of the training session. A description of the background and objectives as well as a detailed description of concepts and definitions particular to the 2008 CSE-PHC was provided for interviewers in their Interviewer Manual. A glossary of terms and a set of questions and answers were also included.

Interviewers were trained on the survey content through a classroom training session. In addition, the interviewers completed a series of mock interviews to become familiar with the survey, its concepts, definitions and the CATI application itself. Question and answer documentation was provided to the interviewers to assist them in answering questions that are commonly asked by respondents.

The data collection was conducted by specialized staff at Statistics Canada offices in Edmonton, Sturgeon Falls and Sherbrooke. The workload and interviewing staff within each office was managed by a project manager. The automated scheduler used by the CATI system ensured that cases were assigned randomly to interviewers and that cases were called at different times of the day and different days of the week to maximize the probability of contact. There were a maximum of 20 call attempts per case identified as a residential phone number; once the maximum was reached, the case was reviewed by a senior interviewer who determined if additional calls would be made. There were a maximum of 5 call attempts per case identified as an unknown phone number; if during these 5 call attempts a phone number was identified as belonging to a household the maximum was raised to 20.

There was no tracing of respondents, for those that moved between the time they completed the CCHS and the time they were contacted for the 2008 CSE-PHC. However, the CCHS captures alternate contact information for tracing respondents which proved to be very successful in locating people that had moved.

View the Questionnaire(s) and reporting guide(s) .

Error detection

The first stage of survey processing undertaken at head office was the replacement of any "out-of-range" values on the data file with blanks. This process was designed to make further editing easier.

The first type of error treated was errors in questionnaire flow, where questions which did not apply to the respondent (and should therefore not have been answered) were found to contain answers. In this case a computer edit automatically eliminated superfluous data by following the flow of the questionnaire implied by answers to previous, and in some cases, subsequent questions.

The second type of error treated involved a lack of information in questions which should have been answered. For this type of error, a non-response or "not-stated" code was assigned to the item.

Imputation

Since the data collected dealt with respondents' individual experiences with the health care system, imputation was not appropriate for most items. Consequently, missing data were coded as "Not stated".

Estimation

The principle behind estimation in a probability sample such as the 2008 CSE-PHC is that each person in the sample "represents", besides himself or herself, several other persons not in the sample. For example, in a simple random 2% sample of the population, each person in the sample represents 50 persons in the population.

The weighting phase is a step which calculates, for each record, what this number is. This weight appears on the microdata file, and must be used to derive meaningful estimates from the survey. For example, if the number of individuals who would definitely or probably recommend their primary care provider to a friend or relative is to be estimated, this would be done by selecting the records referring to those individuals in the sample with that characteristic and summing the weights entered on those records.

Quality evaluation

Quality assurance measures were implemented at every step of collection and processing. For example, measures such as the recruitment of qualified interviewers, proper training for specific survey concepts and procedures, observation of interviews to correct questionnaire design problems and instruction misinterpretations, procedures to ensure that data capture errors were minimized and edit quality checks to verify the processing logics were all put into place. Data are verified to ensure internal consistency.

Disclosure control

Statistics Canada is prohibited by law from releasing any data that would divulge information obtained under the Statistics Act that relates to any identifiable person, business or organization without the prior knowledge or the consent in writing of that person, business or organization. Various confidentiality rules are applied to all data that are released or published to prevent the publication or disclosure of any information deemed confidential. If necessary, data are suppressed to prevent direct or residual disclosure of identifiable data.

All names, addresses and telephone numbers were removed from the share data file. Since the data relates to personal experiences, there is no information that can be used to identify respondents. A Public Use Microdata File will be produced using this data and should be available in the fall of 2009.

Revisions and seasonal adjustment

This methodology does not apply to this survey.

Data accuracy

The response rate for the 2008 CSE-PHC was 71.0%.

Please refer to Chapter 8.0 (Data Quality) of the User Guide for detailed information.

Documentation

• Microdata User Guide: The Canadian Survey of Experiences with Primary Health Care 2007-2008
  • Format: Microdata User Guide: The Canadian Survey of Experiences with Primary Health Care 2007-2008 - ARCHIVED - PDF, 414.97[ARCHIVED - PDF, 414.97 kb]