Surveying Strategies for Hard-to-Survey Populations: Lessons From the Native Hawaiian and Pacific Islander National Health Interview Survey

Abstract

Calls for remedies for the persistent scarcity of accurate, reliable, national, disaggregated health statistics on hard-to-survey populations are common, but solutions are rare. Survey strategies used in community and clinical studies of hard-to-survey populations often cannot be, and generally are not, implemented at the national level. This essay presents a set of approaches, for use in combination with traditional survey methods in large-scale surveys of these populations, to overcome challenges in 2 domains: sampling and motivating respondents to participate. The first approach consists of using the American Community Survey as a frame, and the second consists of implementing a multifaceted community engagement effort. We offer lessons learned from implementing these strategies in a national survey, some of which are relevant to all survey planners. We then present evidence of the quality of the resulting data set. If these approaches were used more widely, hard-to-survey populations could become more visible and accurately represented to those responsible for setting national priorities for health research and services.

Heart Attack and Stroke Symptoms Knowledge of Native Hawaiians and Pacific Islanders in the United States: Findings From the National Health Interview Survey

“…Engaging in health risk behaviors increased the odds of knowing only one symptom of heart attack. This is a concerning finding, considering we found the vast majority of NHPI persons (84.3%) engage in at least one health risk behavior for heart attack or stroke, with the most common behavior being unhealthy weight; 74.7% of NHPI persons were overweight/obese, a rate higher than that of White and Black Americans (63.2% and 71.4%, respectively; Galinsky et al, 2017). Interventions for primary prevention of heart attack and stroke among NHPI should target obesity, and these interventions should consider incorporating information to improve heart attack and stroke symptoms knowledge, given the higher rate of mortality from these events among NHPI persons (Office of Minority Health, 2017a, 2017b), as well as our finding that those with this high-risk behavior are most likely to have limited heart attack and stroke symptoms knowledge.…”

“…NHPI have high rates of obesity, tobacco use, alcohol intake, and daily energy intake (Bitton, Zaslavsky, & Ayanian, 2010; Wong & Kataoka-Yahiro, 2017). Furthermore, they have a higher prevalence of hypertension and diabetes compared with the overall U.S. population (Bitton et al, 2010; Galinsky, Zelaya, Simile, & Barnes, 2017). They are 4 times more likely to die from a stroke (Office of Minority Health, 2017b) and 1.7 times more likely to die from heart disease compared with Whites (Office of Minority Health, 2017a).…”

Results and Strategies for a Diversity-Oriented Public Health Monitoring in Germany

“…The authors hypothesize that due to the personal contact, possible questions and doubts can be instantly addressed, and the details of the survey procedures can be explained. Other studies have shown that personal communication and building trust can increase response rates in migrant and other populations [ 17 , 41 , 71 , 72 , 79 , 80 ]. Our focus groups with face-to-face interviewers have shown that establishing personal contact was perceived as an effort in communication where the participants felt appreciated.…”

“…As other countries [ 10 , 11 , 12 , 13 , 14 ], Germany faces difficulties in adequately including hard-to-survey populations, amongst others people with migration history, people with lower educational levels, and people living in deprived areas, into nationwide public health monitoring. Several studies identifying ways on how to reach hard-to-survey populations either focus on specific sub-populations [ 15 , 16 , 17 , 18 ] and areas [ 16 , 19 , 20 ] or on inclusion into specific study types, for example, clinical trials [ 21 ] or intervention studies [ 15 , 22 ]. Recommendations on how to include hard-to-survey populations into a comprehensive public health monitoring are scarce [ 23 , 24 , 25 ].…”

Electronic cigarette use and psychological distress in the Native Hawaiian and Pacific Islander adults compared with other racial/ethnic groups: Data from the National Health Interview Survey, 2014

“…NHPI has also been documented as having higher rates of tobacco use. The percentage of NHPI currently smoking has been documented as high as 18.2%, compared with United States adults population at 17% (Galinsky, Zelaya, Simile, & Barnes, ). Although the limited literature documents that tobacco use and psychological distress may both disproportionally affect NPHIs, no large population‐based studies have documented E‐cigarette use in NHPI; no studies have compared E‐cigarette use in NHPI with other populations; and no studies have examined the connection between NHPI's psychological distress and E‐cigarette use.…”