The adult population’s well-being and health – Healthy Finland survey

Quality description

The quality description of the adult population’s well-being and health assesses the reliability and suitability of the statistics for different purposes in accordance with the quality description recommendation of the Official Statistics of Finland (OSF).

Relevance of statistical data

The statistics are based on the Act on the National Institute for Health and Welfare (668/2008), under which the duties of the Finnish Institute for Health and Welfare (THL) include studying and monitoring the population’s welfare and health, among other things (Section 2). The statistics describes the well-being, health and experiences of health and social services of adults residing in Finland and changes that have taken place in these. The information is presented by population group and wellbeing services county.

The national health and social welfare registers provide information on the well-being and health of people in the scope of these services and on their service use. However, the registers do not provide information on many of the key areas of health and well-being. The Healthy Finland survey produces population group-specific and regional monitoring data on such key phenomena on which information cannot be obtained from registers. For example, these include lifestyle, perceived health and well-being, and service experiences.

The information is used especially by decision-makers, officials and health care and social welfare professionals working in the management and evaluation of social welfare and health care services. The data is also used in the planning and targeting of the promotion of welfare, health and safety, in the preparation of regional welfare reports, in the monitoring of service needs, and in the research of welfare and health differences between population groups.

The statistics, produced since 2022, replaces The adult population’s well-being, health and services – FinSote statistics [1] implemented by THL, which produced information on the well-being, health and service experiences of adults in 2018 and 2020 by wellbeing services county and population group. These statistics also replace the Health, Performance and Well-being in Finland - FinHealth 2017 statistics [2]. The statistics continue the tradition of surveys of the adult population that began with the Regional Health and Wellbeing Study (ATH) in 2010 [3].

The plan is to implement the questionnaire part of the Healthy Finland survey every two years. The health examination should be implemented to a sub-sample of the questionnaire part at intervals of about 6 years with less or more extensive content, depending on the national information needs.

Description of methods

The statistics are based on the questionnaire part of the Healthy Finland survey. The data of the survey were collected between September 2022 and February 2023 using forms that could be answered by post or online. The health examination part was carried out between January and June 2023.

The nationally representative sample of the survey consists of the population who permanently resides in Finland and is aged 20 or over. The survey has no upper age limit. The sample (n=61,600) was retrieved using a stratified random sample. The sample size for all the wellbeing services counties (22) was 2,800 persons/wellbeing services county (2,000 persons aged 20–74 years/wellbeing services county and 800 persons aged 75 or over/wellbeing services county). The sampling method responds to the need in the evaluation of social welfare and health care to obtain age group-specific results from each wellbeing services county.

Municipalities and other regions had the opportunity to order an additional payable sample for the questionnaire to be used to monitor the development of the area. In 2022, the questionnaire part of the survey was also carried out in Åland (additional sample n=2,800; 2,000 persons aged 20–74 years and 800 persons aged 75 or over). All in all, an invitation to the survey was sent to 65,986 people.

The survey includes questionnaires tailored for three different age groups (20–54 years, 55–74 years, 75+ years) in four languages: Finnish, Swedish, Russian and English. The subjects monitored during data collection are approached at certain intervals by post until the subject replies to the questionnaire or refuses to participate in the survey, but no more than four times. Taking the survey is voluntary.

In the 2022 survey data, a total of 28,154 people responded to the survey, and the response rate was 46.3 %. When reviewed by age group, the response rate was 36.8 % for people aged 20–64, 59.3 % for people aged 65 and over, and 57.0 % for people aged 75 and older (Appendix table 1).

Appendix table 1: Response rate (%) by wellbeing services county and age group in the data of the questionnaire part of the Healthy Finland 2022 survey (pdf 80 kB).

Each year, the group of respondents has been adjusted with weighting to correspond to the population in general (Finland’s population aged 20 or over). In addition, 95 % confidence intervals have been calculated for the results to illustrate the impact of random variations on the results.

More information about the data collection for the period 2022–2023 and the questionnaire forms are available on THL's website [4, 5]. Information on the FinSote, ATH and FinHealth surveys of previous years is also available in the Terveytemme.fi and Data resources catalogue web services.

The printing, mailing and storage of the questionnaire forms have been outsourced to the supplier. The completed paper forms are stored optically and some from the material to ensure quality. The optical data storage process includes logical checks to the responses as well as standardisation based on previously given instructions, for instance, regarding incorrectly answering questions. Once the research data arrived at the THL, they will be checked for possible errors, deficiencies and illogicalness. The responses to a form completed online are collected through the Finnish Institute for Health and Welfare's form service. Using structured descriptions, the data are combined into a single research database. In addition, data on the respondent's age, gender, marital status, mother tongue, number of people in the household and place of residence are combined with the survey data from the sample frame. The compiled statistics are compared with the corresponding data from the previous data collection. Any unclear information is checked and corrected as far as possible.

The Finnish Institute for Health and Welfare undertakes as a public authority to store and process the data complying with its secrecy obligation and data protection legislation. All persons involved in collecting and processing the data have a duty of non-disclosure.

Correctness and accuracy of data

The representativeness of the collection of data via a survey sent by post and available online can be assessed using nonresponse analyses, which involve using register data to examine how the research respondents and those who have opted out of responding differ from each other, and how the possible nonresponses affect the results. Response loss is corrected by using weighting factors produced using the Inverse Probability Weighting (IPW) method. The IPW method has been used in numerous surveys concerning the population, and it has also been found suitable for correcting the non-response of the Finnish population [6].

The weighting factors are calculated using the information available for the whole sample: Age, gender, marital status, level of education, language and area of residence. These variables have been used to model the responsiveness of each respondent, and the weighting factor to be studied is a combination of the inverse of that probability and the probability of the sample. The group studied using weighting factors represents the population from the perspective of the variables used in the calculation.

The coverage is lowest among young men, while the participation of older people is high. It is also known that survey respondents often unknowingly or consciously report lower levels of unfavourable health behaviour. In particular, a lack of underrepresentation in questions concerning alcohol and other intoxicant use is due, on the one hand, to the fact that people who consume large amounts of alcohol and are substance abusers are less likely on average to take part in studies and, on the other hand, to the fact that the participants underestimate their alcohol use. However, underestimations are not a problem when it can be assumed that this does not differ between the population in different regions.

Timeliness and promptness of published data

The questionnaire part of the Healthy Finland survey is carried out every two years. The extensive sample size (in 2022, the sample size was 61,600; in the FinSote survey of 2020, it was 61,600 and in 2018, 59,400) enables data production by wellbeing services county or equivalent area. The form contains a wide range of questions about the user experiences in social and health services and the well-being and health of the population.

The data of the questionnaire part of the survey is published around 2–4 months after the end of the data collection phase.

Availability and transparency of data

The Healthy Finland survey was implemented for the first time in 2022–2023. In 2018 and 2020, the data collection corresponding to the questionnaire part of the survey was carried out as the FinSote survey. The basic results of the questionnaire data of the years 2018, 2020 and 2022 are reported as comparable indicators. The indicators are available free of charge in THL’s statistics and indicator bank Sotkanet. The KUVA indicators that can be used in the evaluations of social welfare and health care services are also available in the Sotekuva web service. Furthermore, the results of the monitoring indicator and the 95 % confidence intervals are available as tables on the website of the Healthy Finland survey.

Sotkanet contains approximately 72 indicators, the results of which are published for the whole the country and by region according to age, gender and education. However, no regional information is published in Sotkanet on indicators with a low number of respondents and high rate of uncertainty due to randomness. For example, these include indicators describing user experiences in social services. The website also includes the results of municipalities or wellbeing services counties that ordered an additional sample in different years of the survey. Sotkanet provides information directly to welfare reports through an open interface. The statistic also has its own website at thl.fi/tilastot/tervesuomi.

Comparability of statistical data

The questions in the questionnaire part of the Healthy Finland survey are largely comparable with similar international and national surveys. In the preparation of the data collection, THL’s earlier surveys and health examination studies and the data content of the European Health Interview Survey and other health-related data collections at the level of the EU have been taken into account. However, it has been proven that the data collection method has an impact on the results, which should be taken into account when comparing the results of surveys and health examination studies or interview studies.

The results of questionnaire part of the Healthy Finland 2022 survey are largely comparable with the results of the FinSote 2018 and 2020 surveys, as the data collection method and several research questions have remained almost the same in both studies.

Indicators of the FinSote survey and the Regional Health and Wellbeing Study (ATH) are available at THL’s Sotkanet and Terveytemme.fi web services. Indicators of the FinTerveys survey are available in the Terveytemme.fi web service.

The development of many phenomena describing the health and lifestyle of the population can also be compared with the results obtained from the Regional Health and Wellbeing Study (2010-2017), the Health Behaviour and Health among the Finnish Adult Population Study (AVTK 1978-2014) and the Health Behaviour and Health among the Finnish Retirement-Age Population Study (EVTK 1985-2014). These phenomena include experienced health, obesity and daily smoking, the time series of which have been produced on the Sotkanet website since 1990 (daily smoking since 1996).

Clarity and consistency/cohesion

The forms of the questionnaire part of the Healthy Finland survey contain permanent and changing sections. Key issues related to the well-being, health and lifestyle of the population as well as issues related to the use of social and health services are permanent sections. In addition to permanent sections, additional questions can be added to the form to collect information on current phenomena (so-called module), which vary from year to year.

Most of the questions in the permanent sections remained unchanged in the 2022 survey. From the point of view of health and well-being promotion, the most important additions were the questions mapping inclusion and experiences of discrimination. Questions about gambling and cultural services were also added to the form. In addition, the questions about the consumption of food and beverages were modified. The order of the questions about social welfare and health care services on the form was changed. Furthermore, the questions about the financing of social welfare and health care services were removed and the number of questions about experiences of using social benefits was reduced.

Special issues concerning the 2022 statistics

In addition to the questionnaire part, a total of 9,973 persons were invited to the health examination part of the survey. Of them, 8,387 belonged to the sample of the actual questionnaire. In addition, an additional sample of 1,586 people was retrieved for the health examination part to supplement the sample with regard to certain localities in which the health examination was implemented.

The data collection of the questionnaire part of the Healthy Finland 2022–2023 survey continued until March 2023. Proportionally more responses were received to the last reminder sent at the beginning of 2023 than were in the data collection of the year 2020. This was mainly because the health examinations of the Healthy Finland survey were launched at the beginning of 2023, which also increased participation in the questionnaire by those invited to the survey. However, the majority of those who participated in the questionnaire responded during autumn 2022, which corresponds to the realisation of the data collection in the previous years 2018 and 2020.

Compared to the FinSote 2020 survey, no paper questionnaire was sent in the first approach to those aged 55–74 years in the Healthy Finland 2022 survey. This may also partly explain the later accumulation of the responses and the slightly fallen response rate in this age group compared to year 2020 (57.6 % vs. 59.7 %).

In 2022, the forms of the questionnaire part included additional questions about two themes. In addition to the questions common to all, every respondent aged 20–74 years received either specifying questions about work conditions and well-being at work (so-called Working life module, sample size 1,360 people/wellbeing services county) or questions about climate change, social status, wishes to have children and infertility treatments (so-called Future module, sample size 640 persons/wellbeing services county). Results from these themes will be reported in separate publications.

References

1) The adult population’s well-being, health and services - FinSote 2020. Statistical report 16/2021, 1 June 2021. Finnish Institute for Health and Welfare.

2) Koponen P, Borodulin K, Lundqvist A, Sääksjärvi K and Koskinen S (Eds.) Health, functional capacity and well-being in Finland – FinHealth 2017 Study. Report 4/2018. Finnish Institute for Health and Welfare.

3) Kaikkonen R, Murto J, Pentala-Nikulainen O, Koskela T, Virtala E, Härkänen T, Koskenniemi T, Ahonen J, Vartiainen E & Koskinen S. Alueellisen terveys- ja hyvinvointitutkimuksen perustulokset 2010–2017. Available at: terveytemme.fi/ath. Referenced on 17 May 2023.

4) THL, 2023a. Healthy Finland survey [Website]. Available at: thl.fi/healthyfinland. Referenced on 17 May 2023.

5) THL, 2023b. Questionnaires of the Healthy Finland Survey 2022–2023. [Website]. Available at: thl.fi/healthyfinland. Referenced on 17 May 2023.

6) Härkänen T, Kaikkonen R, Virtala E and Koskinen S. Inverse probability weighting and doubly robust methods in correcting the effects of non-response in the reimbursed medication and self-reported turnout estimates in the ATH survey. BMC Public Health. 2014;14:1150.

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