Non-response in surveys of very old people

Disability during the last ten years of life: evidence from a register-based study in Austria

Analyses of late-life disability based on survey data of the oldest old often suffer from non-representative samples due to selective participation and attrition. Here, we use register data on the Austrian long-term care allowance (ALTCA) as a proxy for late-life disability. In this retrospective mortality follow-back study, we analyze receipt of ALTCA, a universal cash benefit based on physician-assessed disability in activities of daily living during the last 10 years of life, among all decedents aged 65 years and over from 2020 in Austria (n = 76,781) and its association with sex, age at death, and underlying cause of death. We find that on average, ALTCA was received for 3.5 and 5.3 years in men and women. At 10 years before death, 10% of men and 25% of women received ALTCA, which increased to 56% and 77% at one year before death. Both the probability and duration of ALTCA increased with age at death and varied by cause of death: Those who died from cancer, myocardial infarction, and external causes of death were less likely to receive ALTCA and for shorter durations, while those who died from dementia, Parkinson's disease, chronic heart disease, or chronic lung disease were more likely to receive it and longer so. Overall, our register-based estimates of the prevalence of late-life disability were higher than previous survey-based estimates. Policy-makers should be aware that costs of long-term care will rise as life expectancy rises and deaths from dementia and chronic heart disease will likely increase in the rapidly aging European societies.

Sociodemographic inequalities in the incidence of COVID-19 in National Household Sample Survey cohort, Brazil, 2020

OBJECTIVE

To verify the association between sociodemographic factors and the time until the occurrence of new cases of COVID-19 and positive tests for SARS-CoV-2 in Brazil, during the period from May to November 2020, based on a cohort of Brazilians participating in the COVID-19 National Household Sample Survey.

METHODS

A concurrent and closed cohort was created using monthly data from the PNAD COVID-19, carried out via telephone survey. A new case was defined based on the report of the occurrence of a flu-like syndrome, associated with loss of smell or taste; and positivity was defined based on the report of a positive test, among those who reported having been tested. Cox regression models were applied to verify associations. The analyzes took into account sample weighting, calibrated for age, gender and education distribution.

RESULTS

The cumulative incidence of cases in the overall fixed cohort was 2.4%, while that of positive tests in the fixed tested cohort was 27.1%. Higher incidences were observed in the North region, in females, in residents of urban areas and in individuals with black skin color. New positive tests occurred more frequently in individuals with less education and healthcare workers.

CONCLUSION

The importance of prospective national surveys is highlighted, contributing to detailed analyzes of social inequalities in reports focused on public health policies.

Psychosocial predictors of mobility assistive devices non-adherence among older adults

Background: Mobility assistive devices (MADs) provide support to older adults to improve their quality of life; however, research shows that as many as 75% of older adults are non-adherent to prescribed MADs. This study investigated the psychosocial factors that predict non-adherence to MADs among older adults.Methods: A sample of Canadian older adult MADs users who resided in a long-term care facility was included. The data was collected using the Psychosocial Impact of Assistive Devices Scale (PIADS), and the Medical Outcomes Study Social Support Survey (mMOS-SS). Data analysis was performed using SPSS 28. Descriptive statistics were used to describe the sample and the study variables. Pearson correlation coefficients were used to evaluate the association between the study variables. Variables that were associated with non-adherence in a univariate analysis were subsequently entered into a multiple regression analysis.Results: The sample comprised 48 residents (26 females and 22 males), with a mean age of 86.8. In the univariate analysis, scores from the three PIADS subscales, namely, Competence, Adaptability, and Self-esteem, and the Social Support scale were significantly correlated with non-adherence (p < 0.05). In the multiple regression analyses, only Self-esteem significantly predicted non-adherence (p < 0.05), and this model explained between 43.5 and 54.3% of the variance in non-adherence.Conclusion: This study revealed that the Self-esteem construct, which includes several concepts related to psychological well-being, was the only significant predictor of non-adherence among the studied sample of older adults. The clinical implications of the findings are subsequently discussed.

Prevalence and characteristics of long COVID-19 in Jordan: A cross sectional survey

Early in the pandemic, the spread of the emerging virus SARS-CoV-2 was causing mild illness lasting less than two weeks for most people, with a small proportion of people developing serious illness or death. However, as the pandemic progressed, many people reported suffering from symptoms for weeks or months after their initial infection. Persistence of COVID-19 symptoms beyond one month, or what is known as long COVID-19, is recognized as a risk of acute infection. Up to date, information on long COVID-19 among Jordanian patients has not been reported. Therefore, we sought to conduct this cross-sectional study utilizing a self-administered survey. The survey asks a series of questions regarding participant demographics, long COVID-19 symptoms, information about pre-existing medical history, supplements, vaccination history, and symptoms recorded after vaccination. Chi square analysis was conducted on 990 responders, and the results showed a significant correlation (P<0.05) between long COVID-19 syndrome and age, obesity, chronic illness, vitamin D intake, number of times infected by COVID-19, number of COVID-19 symptoms and whether the infection was pre or post vaccination. The long-term symptoms most enriched in those with long COVID-19 were tinnitus (73.4%), concentration problems (68.6%) and muscle and joint ache (68.3%).A binomial logistic regression analysis was done to explore the predictors of long COVID-19 and found that age 18-45, marital status, vitamin D, number of COVID-19 symptoms and signs after vaccination are positive predictors of long COVID-19, while zinc intake is a negative predictor. Although further studies on long-term persistence of symptoms are needed, the present study provides a baseline that allows us to understand the frequency and nature of long COVID-19 among Jordanians.

Socioeconomic Inequalities in COVID-19 Vaccine Hesitancy and Uptake in Greece and Cyprus during the Pandemic

Despite the rigorous investigation of the phenomenon of vaccine hesitancy and refusal during the COVID-19 pandemic, the socioeconomic determinants of this phenomenon remain poorly investigated on a global scale. Following proportional quota sampling, we conducted a population-based cross-sectional study. We recruited participants on-site and online from different settings, regions, and socioeconomic strata in two Eastern Mediterranean populations, Greece and Cyprus. Our approach provided a nationwide sample (n = 576) approaching the adult population structure of the two countries, with a slight underrepresentation of men and older people. Our results indicate clear socioeconomic differences in vaccine hesitancy and vaccination coverage, consistent with wider social inequalities in health. In particular, we reveal a clear socioeconomic gradient characterized by lower vaccine hesitancy and higher vaccination coverage, with increasing educational attainment and income. Additionally, participants residing in semi-urban areas show higher vaccine hesitancy and have lower vaccination coverage than those residing in urban and rural areas. Our results could inform Public Health approaches aiming to tackle the alarming phenomenon of vaccine hesitancy by enabling the targeting of population groups who are particularly vaccine-hesitant, rendering such approaches more targeted and effective while at the same time reducing inequalities in the control and prevention of infectious diseases.

Voting Behaviour and Health Among the Oldest-old in Germany: Results from a Population-Based Cross-Sectional Study

Background If voter turnout reflects social or health inequalities, then these inequalities can reduce equal political representation. Research suggests that poor health impedes voting and contributes to low turnout, especially among the oldest-old (80 years and older). Therefore, we examine the determinants of voting behaviour in more detail, with a special focus on the role of health status among the oldest-old. Methods The analysis was based on a population-based sample of older adults living in Germany’s largest federal state, North Rhine-Westphalia (n = 1826). The outcome was participation in the last federal election. As determinants, we included subjective, functional, mental, and cognitive health; mobility; institutional living; education; social embeddedness; party attachment; habituation; and conformist attitudes. We used logistic regression models to calculate odds ratios and 95% confidence intervals. Results The overall turnout rate was 84.6% (95%-CI:82.9–86.3), which shows that most of the oldest-old participate in elections. Results from logistic regressions revealed that lower formal education and limitations in functional, cognitive, and mental health were associated with lower odds of voting; while habituation, party attachment, and partnership were associated with higher odds of voting. Conclusion Most of the oldest-old in Germany participate in elections. Still, our results hint at the existence of important inequalities in turnout rates. Given that older adults constitute an increasing share of the electorate, and that those who are less likely to vote are often among those most directly affected by political decisions, all individuals who are willing and able to participate in elections should be given the necessary support to actually do so.

Individual characteristics associated with the utilization of nursing care in the very old population: a cross-sectional study

BACKGROUND

As older adults ≥80 years are often underrepresented in previous studies, little is known about their characteristics associated with the utilization of nursing care services. Therefore, this study examined individual (predisposing, enabling, and need) predictors of nursing care utilization in the very old population of North Rhine-Westphalia (NRW) in Germany.

METHODS

Data from a representative cross-sectional study included 1531 community-dwelling individuals and nursing home residents aged ≥80 years. Multinomial regression was applied to investigate the factors that explain the use of outpatient care services, day care, and/or private care (odpNCU), and inpatient nursing care (inpNCU).

RESULTS

Overall, 1083 (69.9%) participants did not use nursing care services (noNCU), 339 (21.9%) used outpatient, day, and/or private care, and 127 (8.2%) used inpatient nursing care. Compared to noNCU, odpNCU was associated with a higher likelihood of being older [odds ratio (OR) = 1.06, 95% confidence interval (CI): 1.01-1.11], having no partner (OR = 0.58, 95%CI: 0.37-0.91), experiencing higher functional (basic activities of daily living, OR = 0.02, 95%CI: 0.01-0.04; instrumental activities of daily living, OR = 0.18, 95%CI: 0.11-0.30) and cognitive disabilities (OR = 0.63, 95%CI: 0.44-0.89). Compared to noNCU, nursing home residents were more likely older (OR = 1.14, 95%CI: 1.07-1.22), had lower socioeconomic status (OR = 0.98, 95%CI: 0.97-1.00), were childless (OR = 3.83, 95%CI: 1.71-8.56) and without partners (OR = 0.43, 95%CI: 0.20-0.96), socially isolated (OR = 3.94, 95%CI: 2.06-7.55), were more likely to be lonely (OR = 2.94, 95%CI: 1.58-7.89), more functionally (basic activities of daily living, OR = 0.01, 95%CI: 0.00-0.03; instrumental activities of daily living, OR = 0.04, 95%CI: 0.02-0.09) and cognitively impaired (OR = 0.48, 95%CI: 0.31-0.74), but they were less likely to experience five or more chronic conditions (OR = 0.42, 95%CI: 0.20-0.88) and less likely to be physically pre-frail (OR = 0.24, 95%CI: 0.10-0.58) and frail (OR = 0.09, 95%CI: 0.03-0.27).

CONCLUSIONS

Individual need factors dominated in explaining odpNCU, suggesting that the very old population in NRW may have equitable access to these services. As social structure, region, and social resources explain inpNCU, this type of care may be inequitably accessible.

Food safety behavioural changes among the population in Sub-Saharan Africa during the COVID-19 first wave

Sub-Saharan Africa (SSA) is known as a region that is highly affected by foodborne illnesses; and like the rest of the world, SSA is also deeply concerned about the COVID-19 pandemic. Despite the risk of infection by the SARS-CoV-2 coronavirus from food products and food packaging being thought to be very low, it does not exclude possibilities of cross-contamination. This study aimed at assessing that risk based on the population’s key food safety Knowledge, Attitude, and Practices (KAP) that might be considered important to limit eventual virus propagation. A cross-sectional study consisting of an online survey was carried out between June and July 2020 (during the first wave of COVID-19 in the region). This study was targeted at Sub-Saharan Africans aged at least 18, and 817 participants from 5 developing countries (Cameroon, Ethiopia, Ghana, Kenya, and Nigeria) and South Africa (a middle-income country) were recorded. Most of the respondents appeared to be aware of COVID-19, its symptoms, and the protective measures. The awareness of the pandemic led to a reduction in street foods consumption, a rise in the preference for cooked foods, and a greater awareness of hygiene during food preparation and washing of fruits and vegetables before eating. Females appeared to be more knowledgeable on food safety KAP. Globally, higher KAP scores were revealed as the respondents were mature (age, employment, marital status, household, monthly income) and they were able to make responsible choices. Though the risk of the spread of COVID-19 through food contamination appears limited, efforts need to be made to sensitize the public (especially the most exposed communities) about the challenge behind food safety.

The medium-term consequences of COVID-19 lockdown on lifestyle among Spanish older people with hypertension, pulmonary, cardiovascular, and musculoskeletal-diseases, depression, and cancer

Objectives

To assess the influence of different chronic diseases on lifestyle and health behaviours changes after COVID-19 lockdown in Spanish older people compared to people without these diseases and compare the differences in these changes between both periods.

Methods

1092 participants (80.3±5.6y;66.5%women) from two Spanish cohorts were included. Telephone-based questionaries were used to evaluate health risk behaviours and lifestyle during lockdown and 7-months later. Self-reported physician-based diagnosis of chronic diseases was also reported. Cox-proportional models adjusted for main confounders were applied.

Results

Improvements concerning lifestyle were found in older people with chronic diseases, although they worsened the physical component (except cancer). When they were compared to those without these diseases, hypertension was associated with a lower frequency of increased alcohol consumption (Hazard ratio:0.73[95% confidence interval:0.55;0.99]). Pulmonary diseases were associated with a lower risk of both decreased sedentary time (0.58[0.39;0.86]) and worsening sleep quality (0.56[0.36;0.87]), while CVD was only associated with a lower frequency of decreased sedentary time (0.58[0.38;0.88]). Depression was linked to a higher risk of increasing diet quality (1.53[1.00;2.36]). Cancer was less likely to worsen sleep quality (0.44[0.22;0.89]), but more likely to worsen their social contact frequency (2.05[1.05;3.99]). No significant association related to musculoskeletal diseases.

Conclusion

Beneficial changes in health risk behaviours and lifestyle after the COVID-19 lockdown in older people with chronic diseases were found. Particularly, older people with hypertension, pulmonary disease and cancer showed beneficial changes after lockdown compared to their counterparts without diseases. Those with CVD and depression showed lifestyles that could involve a health risk.

Survey research among older migrants: Age-related differences in contact and cooperation

Background and Objectives

Given the increasing academic interest in older migrants, this study aims at examining the likelihood of establishing contact and cooperation in a survey among first-generation migrants in Germany, comparing migrants of age 50 and older with younger migrants (aged 16–49).

Research Design and Methods

We analyze data from the Migrants’ Welfare State Attitudes (MIFARE) study collected in Germany, which contains information about first-generation migrants from 9 different origin groups living in private households. Potential survey participants were contacted via mail and invited to participate in a paper- or online-based survey. In addition, an incentive experiment was implemented and age-dependent response rates were analyzed. Using logistic regression analyses, we compare older and younger migrants with regard to their likelihood of contact, cooperation, reaction to incentives, and mode choice.

Results

Within the MIFARE study, older migrants are more likely to be contacted than younger ones. Older migrants are also more likely to cooperate in survey research than younger migrants. Both groups respond equally positively to the use of unconditional incentives. Lastly, older migrants show a strong preference to fill out the questionnaire on paper, rather than online.

Discussion and Implications

Older first-generation migrants living in private households are easier to contact and are more likely to cooperate in survey research than younger first-generation migrants. Offering unconditional incentives and surveys on paper are likely to increase response rates among older migrants.

Successful ageing in the oldest old: objectively and subjectively measured evidence from a population-based survey in Germany

Despite rapid increase of people aged 80 and over, concepts of successful ageing (SA) are primarily examined for people below that age. Therefore, successful ageing was examined in a population-based representative sample of N = 1863 people aged 80 to 102 (NRW80+) with 11% living in institutionalized settings. In this survey on quality of life and well-being, multiple linear and logistic regression models were used to calculate the distribution of successful agers. According to Rowe and Kahn's objective definition, 9% of the sample aged successfully, but one-third (33%) still met four to five SA criteria. This is in line with the theoretical a priori criterion of 10% in a normal distribution of a sample, while 80% age normally and 10% pathologically. However, averages of life satisfaction, affective well-being, positive ageing experience and valuation of life were high. The majority of the oldest old (65%) are successful agers in their own subjective perception, which is not in line with objective measurements. Moreover, 11% of objectively measured successful agers do not meet subjective criteria. These empirical findings reveal a remarkable discrepancy between objective and subjective criteria of SA. Future research on concepts that define successful ageing for the oldest old should consider more holistic markers of success, e.g., outcomes of productive social engagement.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10433-021-00609-7.

Determinants of psychosocial factors among the oldest old - Evidence from the representative "Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)"

OBJECTIVES

Our aim was to examine socioeconomic and health-related variables associated with psychosocial factors among the oldest old.

METHODS

Cross-sectional data were used from the representative "Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)" consisting of individuals aged 80 years and over (n = 952, average age was 86 years) living in North Rhine-Westphalia (most populous state of Germany). Established tools were used to quantify loneliness, life satisfaction and depressive symptoms. Socioeconomic and health-related determinants were included in regression analysis.

RESULTS

Multiple linear regressions showed that higher life satisfaction was associated with a greater network size, lower functional impairment and better self-rated health. Moreover, higher loneliness was associated with being unmarried, a smaller network size, worse self-rated health and higher functional impairment. Additionally, more depressive symptoms were associated with lower age (i.e., 80-84 years compared to 90 years and over), asset poverty, the presence of multimorbidity, higher functional impairment and worse self-rated health.

CONCLUSIONS

Our study identified various socioeconomic and health-related factors associated with worse psychosocial factors among the oldest old. This knowledge may assist in targeting oldest old individuals at risk for worse psychosocial factors.

The NRW80+ study: conceptual background and study groups

Background

The study “Quality of life and well-being of the very old in North Rhine-Westphalia NRW80+” aims at giving a representative picture of the quality of life (QoL) in this population. Conceptually, QoL research has rarely considered the values of older individuals themselves and societal values, and their relevance for successful life conduct. Empirically, comparisons of different age groups over the age of 80 years are rare and hampered by quickly decreasing numbers of individuals in oldest age groups in the population of very old individuals.

Study design and theoretical framework

This paper describes the population of the NRW80+ study and different age groups of very old individuals with respect to biographical background. Furthermore, using the challenges and potentials model of QoL in very old age (CHAPO), key aspects of QoL in late life are discussed and the importance of normative stipulations of what constitutes a successful life conduct are highlighted. In the NRW80+ study older age groups (i.e., 85–89 years, 90+ years) were deliberately overrepresented in the survey sample to enable robust cross-group comparison. Individuals willing to participate in the study but unable to participate in the interview themselves for health reasons were included by means of proxy interviews.

The total sample included 1863 individuals and 176 individuals were represented by proxy interviews. Pronounced differences were observed between age groups 80–84 years (born 1933–1937, N = 1012), 85–89 years (born 1928–1932, N = 573), and 90 years or older (*born before 1927, N = 278) with respect to education, employment and the timing of major life events (e.g., childbirth).

Conclusion

Different life courses and resulting living conditions should be considered when discussing QoL disparities in very old age.

Nursing Home Residents Aged over 80-A Cross-Sectional Analysis on Which Activity Traits Correlate to Positive Affect

Admission to a care facility is assumed to enhance depressive symptoms and dependent behavior in old age. In this context, the relevance of participation in activities that make everyday life in a care facility more pleasant has been pointed out. This study examines if there is a relationship between participation in different activities as well as the frequency of this participation and the positive affect of nursing home residents aged over 80. Data from the unique cross-sectional representative study ‘Quality of life and subjective well-being of the very old in North Rhine-Westphalia’ in Germany (n = 150, aged 90.15 years in average) were used. The data were collected between 08/2017 and 02/2018 using computer-assisted personal interviewing. The variability in and frequency of activity participation functioned as independent, and positive affect as dependent variable. Multiple regression analysis was performed. Residents’ predicted positive affect significantly increased with a higher variability in activity participation. There was no independent effect of frequency in participation. Our findings indicate that there is a significant and positive relationship between participating in a high number of different activities and the overall positive affect of residents aged over 80 years. This does not hold true for the frequency of participation.

What Factors Are Associated With Response Rates for Long-term Follow-up Questionnaire Studies in Hand Surgery?

BACKGROUND

Long-term follow-up studies are an important tool in the evaluation of orthopaedic illness and its treatment options. However, a patient's participation in a follow-up study may be affected by several factors, leading to variability in response rates and the risk of selection bias.

QUESTIONS/PURPOSES

(1) What is the average response rate in hand surgery questionnaire studies? (2) What factors are associated with higher and lower response rates to research questionnaires? (3) What factors are associated with higher and lower contact, initial participation, and completion rates?

METHODS

We included 798 adult patients who were enrolled in one of 12 questionnaire follow-up studies in the hand and upper extremity service of our institution. All included studies evaluated patient-reported outcomes for the surgical treatment of upper extremity conditions using questionnaires and all used the same enrollment design. Patients were invited by letter to ask if they would be willing to participate, and we informed them that they would be contacted by telephone at least three times if they did not respond to the letter. Patients were contacted at a median of 6.6 years (interquartile range [IQR] 3.7 to 11) after surgery. The successful response rate was 49% (390 of 798 patients). We manually reviewed records to collect data on patient characteristics, and we performed bivariate analysis and multivariable logistic regression analysis to identify factors associated with the contact rate (percentage of patients reached by either mail, phone, or email), initial response rate (percentage of reached patients who initiated participation), completion rate (percentage of patients who initiated participation and completed the entire follow-up questionnaire), and our primary outcome successful response rate (percentage of patients who were contacted and who completed the entire questionnaire).

RESULTS

The average response rate in hand surgery questionnaire studies was 49% (390 of 798 patients). In the multivariable analysis, enrollment of women (odds ratio 1.43 [95% confidence interval 1.03 to 1.97]; p = 0.031) was independently associated with higher response rates. On the contrary, a longer follow-up time from surgery (OR 0.95; 95% CI 0.92 to 0.99]; p = 0.015) and multiple researchers contacting patients (OR 0.51 [95% CI 0.37 to 0.71]; p < 0.001) were independently associated with lower response rates. The contact rate was higher for women (OR 1.46 [95% CI 1.03 to 2.06]; p = 0.034) and patients with higher income (OR 1.000007 [95% CI 1.000001 to 1.000013]; p = 0.019). The contact rate was lower in patients with a longer follow-up time from surgery (OR 0.93 [95% CI 0.90 to 0.97]; p = 0.001). The initial participation rate was lower when patients were contacted by multiple researchers (OR: 0.34 [95% CI 0.23 to 0.52]; p < 0.001). Studies with a lower number of questions (36; IQR 22 to 46) were completed more frequently than studies with a higher number of questions (51; IQR 39 to 67; p = 0.044).

CONCLUSIONS

Studies assessing long-term outcomes that have a large proportion of men and longer follow-up time tend to have lower response rates. When performing a follow-up study, it seems beneficial to have one researcher contact the patients and use a shorter questionnaire. Results of this study can help clarify the response rates in hand surgery follow-up questionnaire studies and help with the planning of future follow-up studies.

LEVEL OF EVIDENCE

Level II, prognostic study.

Trends of Physical Functioning, Morbidity, and Disability-Free Life Expectancy Among the Oldest Old: Six Repeated Cross-Sectional Surveys Between 2001 and 2018 in the Vitality 90+ Study

BACKGROUND

It remains unclear whether increasing longevity is accompanied by a compression or expansion of poor health and disability. We examined trends of physical functioning and morbidity in a population aged 90 and older, and disease- and disability-free life expectancy (LE) at age 90 between 2001 and 2018 in Finland's third most populated city.

METHODS

We used survey data from the Vitality 90+ Study, which comprises a series of six repeated mailed surveys (7,590 observations). Information on mortality came from Statistics Finland. We examined trends of functioning (activities of daily living [ADL] and mobility) and cardiovascular and dementia morbidity using age-adjusted generalized estimating equation models stratified by sex. In addition, age-, sex-, and period-specific health expectancies were calculated using Sullivan's method.

RESULTS

Over time, functioning improved, especially, in women, and morbidity increased in men. From 2001 to 2018, LE at age 90 increased by 5.3 months for men and 6.4 months for women. LE without ADL disability increased by 5.0 months for men and 8.4 months for women, and LE without mobility disability by 6.0 months for men and 4.4 months for women. LE without cardiovascular and dementia morbidity decreased for men (2.6 months) and increased for women (1.9 months).

CONCLUSIONS

In relative terms, we found a compression of disability for both sexes and an expansion of morbidity for men. Although the trends overall are rather positive, the increase in absolute morbidity and, to some extent, in disability will inevitably mean increasing care needs with population aging.

A research tool for measuring non-participation of older people in research on digital health

BACKGROUND

Healthcare services are being increasingly digitalised in European countries. However, in studies evaluating digital health technology, some people are less likely to participate than others, e.g. those who are older, those with a lower level of education and those with poorer digital skills. Such non-participation in research - deriving from the processes of non-recruitment of targeted individuals and self-selection - can be a driver of old-age exclusion from new digital health technologies. We aim to introduce, discuss and test an instrument to measure non-participation in digital health studies, in particular, the process of self-selection.

METHODS

Based on a review of the relevant literature, we designed an instrument - the NPART survey questionnaire - for the analysis of self-selection, covering five thematic areas: socioeconomic factors, self-rated health and subjective overall quality of life, social participation, time resources, and digital skills and use of technology. The instrument was piloted on 70 older study persons in Sweden, approached during the recruitment process for a trial study.

RESULTS

Results indicated that participants, as compared to decliners, were on average slightly younger and more educated, and reported better memory, higher social participation, and higher familiarity with and greater use of digital technologies. Overall, the survey questionnaire was able to discriminate between participants and decliners on the key aspects investigated, along the lines of the relevant literature.

CONCLUSIONS

The NPART survey questionnaire can be applied to characterise non-participation in digital health research, in particular, the process of self-selection. It helps to identify underrepresented groups and their needs. Data generated from such an investigation, combined with hospital registry data on non-recruitment, allows for the implementation of improved sampling strategies, e.g. focused recruitment of underrepresented groups, and for the post hoc adjustment of results generated from biased samples, e.g. weighting procedures.