The adult population’s well-being, health and services – FinSote

Quality Description

Relevance of statistical data

The statistic published by the Finnish Institute for Health and Welfare (THL) describes the well-being and health of the Finnish adult population and social and health care services by region and population group. The statistics are produced from a sample-based national survey on health, well-being and services (FinSote), which was carried out for the first time in 2018.

The national health and social welfare registers provide region-specific information on the well-being and health of Finns in the scope of these services and on the use of the services. However, the registers alone cannot comprehensively describe all phenomena related to the health and well-being of the population. FinSote data includes monitoring data by population group on key phenomena. Information on these phenomena is not available in the registers. The phenomena include people's lifestyles and experiences. This statistic produces information on the population's service needs, the population's experiences of the functioning of social and health care services, and equality between population groups and regions. The topics of the statistic include living conditions and quality of life, inclusion and functional capacity, health, work and functional capacity, lifestyle, insecurity and experiences of violence, the use and availability of social and health services, equality of services, social assistance and benefits, the use of electronic services, and the funding and costs of social and health care.

The information is used especially by decision-makers, officials and health care and social welfare professionals working in the management and evaluation of the social welfare and health care reform. 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.

This statistic, produced since 2018, replaces the previous Regional Health, Welfare and Services (ATH) study carried out by the Finnish Institute for Health and Welfare, which produced information on the overall development of adult welfare and services in 2010–2017 by region and population group [1]. The indicators for the ATH study and the FinSote study are available on the THL's Terveytemme.fi and Sotkanet websites.

In addition to the biennial FinSote survey, the Finnish Institute for Health and Welfare also conducts other population studies. The material of the FinHealth 2017 study contains information on the health and welfare of adults, their functional capacity and use of services. The School Health Promotion Study, on the other hand, produces information on primary school pupils, 8th and 9th graders and secondary education students at the municipal level every two years. In addition, national, regional and municipal indicators on the welfare and health of Finns using services have been compiled in Sotkanet based on register data.

Methodology

The statistic is based on a biennial FinSote survey. This statistical report is based on FinSote 2020 data, the results of which will be reported in spring 2021. The data were collected in September 2020 - February 2021 using surveys that could be answered as by post or online. The nationally representative sample of the study consists of the population who permanently resides in Finland and is aged 20 or over. The sampling method was stratified random sampling design. The study has no upper age limit. The survey was sent to 61,600 people using data from the Population Information System. The sample size for all the wellbeing services counties (22) was 2,800 persons/wellbeing services county. 2000 people aged 20–74/wellbeing services county and 800 people aged 75 or over/wellbeing services county. The sampling method corresponds to the requirement for a social welfare and health care assessment, which is to obtain results from each wellbeing services county by age group. In addition, municipalities and other regions have the opportunity to order an additional sample to the study, which can be used to monitor the development of the area.

The study includes survey forms tailored for three different age groups (20–54, 55–74, 75+) 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 survey or refuses to participate in the study, but no more than four times. Taking the survey is voluntary.

In 2020, a total of 28,199 people responded to the survey, and the response rate was 46.4%. When reviewed by age group, the coverage was 29.9% for people aged 20–54, 59.4% for people aged 55–74 and 58.9% for people aged 75 and older (Appendix table 1).

Appendix table 1. Response rate (%) by wellbeing services county and age group in the FinSote 2020 materials (pdf 122 kB).

Each year, the group of respondents has been adjusted with weighting to correspond to the population in general (mainland Finland 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 detailed information on data collection in 2020 and the survey forms can be found on the THL website [2], and information on data collection in previous years for the Regional Health and Welfare Survey can be found on the Terveytemme.fi website.

The printing, mailing and storage of the survey study forms are 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 [3]. The weighting factor is 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 FinSote study is carried out every two years. The extensive sample size (in 2018, the sample size was 59,400, in 2020, 61,600) enables data production for regions or equivalent areas. 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 will be published around 2 to 4 months after the end of the data collection phase.

Availability and transparency/clarity of data

The FinSote study has been implemented since 2018 and its results are reported as comparable indicators. The indicators are available free of charge at Terveytemme.fi and the Sotkanet.fi website. The Terveytemme.fi website contains indicators by well-being services county and population group, with confidence intervals according to the latest division of local authority. The information is also available from the Finnish Institute for Health and Welfare 's statistics and indicator bank Sotkanet (sotkanet.fi). Sotkanet contains the results of approximately 100 indicators across the country and by region according to age, gender and education. However, no regional information is published on Sotkanet on indicators with a low number of respondents and high rate of uncertainty due to randomness. These include indicators describing user experiences in social services and with benefits. The website also includes the municipal-specific results of municipalities that ordered an additional sample in different research years. Sotkanet provides information directly to welfare reports through an open interface. The statistic also has its own website thl.fi/tilastot/finsote.

Comparability of statistical data

The questions in the FinSote study are largely comparable with similar international and national studies. The following have been taken into consideration in the preparation of data collection: The data content of the European Health Interview Survey and other data collected at the EU level related to health, as well as other surveys and health examination studies concerning the population carried out by the Finnish Institute for Health and Welfare. 

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 National FinHealth Study compiles data on similar phenomena of public health and well-being in health examinations and surveys, but due to differences in data collection methods, the results cannot be directly compared [4].

The results of the FinSote 2020 study are largely comparable with the results of the FinSote 2018 study, as the data collection method and several research questions have remained almost the same in both studies. The sampling of the study has changed slightly between 2018 and 2020, as the new regional division of the social welfare and health care reform has divided Uusimaa into five different health and social services counties [5]. The change in sampling may affect the results of the study. Data collection for FinSote 2020 was also carried out during the coronavirus epidemic and the resulting emergency conditions. The impact of the epidemic and its restrictive measures on people's daily lives and experiences should be taken into account when comparing the results from 2018 and 2020. 

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 FinSote survey data collection forms contain permanent and changing sections. Key issues related to the wellbeing, 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 2020 survey. From the perspective of promoting wellbeing and health, the most important additions to the 2020 form are the questions concerning perceived safety and insecurity as well as a short positive mental health indicator (SWEMWBS). Similarly, questions concerning long-term illnesses and health promotion and disease prevention measures (such as influenza vaccination, cholesterol and blood pressure measurements in healthcare) were removed from the form. As regards social welfare and health care, questions related to freedom of choice were removed. In addition, the formulation of question concerning experiences in social and health services was conformed to be consistent with background questions on the OECD’s quality indicators. The data are not comparable with the 2018 data for these questions.

Special issues concerning the 2020 statistics

In 2020, additional questions about two current phenomena were added to the FinSote survey. In addition to questions common to everyone, each respondent was given either more specific questions concerning the use of digital services (so-called digital module, random sample of a national sample: 400 people aged 20–74/wellbeing services county and 200 people aged 75 or over/wellbeing services county, total n = 13,200) or questions about the effects of the coronavirus epidemic (so-called corona module, for the rest of the national sample: 1,600 people aged 20–74/wellbeing services county and 600 people aged 75 or over/wellbeing services county, total n = 48,400). The results of questions concerning the use of electronic services in the digital module and the main form are reported in a separate report on digitalisation and e-services in social and health care. The report was published in June 2021 [6]. The results of the Coronavirus module have been reported in a separate publication in December 2020 [7].

Sources

1) 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.

2) FinSote 2020 survey forms. [Website]. Referenced on 21 May 2021.

3)  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.

4) Koponen P, Borodulin K, Lundqvist A, Sääksjärvi K ja Koskinen S (Ed.). Health, functional capacity and welfare in Finland – FinHealth 2017 study. Finnish Institute for Health and Welfare (THL). Report 4/2018 [In Finnish].

5) Government, 2020. Health and social services reform. [Website]. Referenced on 21 May 2021.

6) Kyytsönen, M., Aalto, A.-M., Vehko, T. (2021). Social and health care online service use in 2020–2021: Experiences of the population. Finnish Institute for Health and Welfare (THL). Report 7/2021.

7) Parikka S, Ikonen J, Koskela T, Hedman L, Kilpeläinen H, Aalto A-M, Sainio P, Ilmarinen K, Holm M & Lundqvist A. Koronan vaikutukset vaihtelevat alueittain – eroja myös ikääntyneillä sekä toimintarajoitteisilla verrattuna muuhun väestöön. Preliminary results of the national FinSote survey in autumn 2020. Online publication: thl.fi/finsote

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