Introduction

The information presented on carers and the extent to which social supports exist was collected as part of the Irish Health Survey 2019. The main results for this survey will be published on December 11^th and a publication focused on the health status of persons with disabilities will be published on December 14^th. 

The detail in the rest of these background notes are sourced from the relevant parts of the Main Results publication, as the data collection for carers and social supports was collected as part of the main health survey.

The questions asked of respondents to provide the information for this publication were as follows (the question numbers relate to the order in which they were asked during the survey):

Q47: How many people do you feel are close enough to you that you could count on them if you had a serious personal problem (none, 1 or 2, 3 to 5, 6 or more)?

Q48: How much concern and interest do other people show in what you are doing (a lot of concern or interest, some concern or interest, uncertain, little concern or interest, no concern or interest)?

Q49: How easy would it be to get practical help from neighbours if you needed it (very easy, easy, possible, difficult, very difficult)?

Q50: Do you provide care or assistance to one or more persons suffering from some age problem, chronic health condition or infirmity, at least once a week?

Q51: If yes: Are the person or persons concerned family members?

Q52: If yes: How many hours a week do you give the care or assistance?

Q53: Do you have difficulty doing any of the following (no difficulty, some difficulty, a lot of difficulty, cannot do it by myself)

• Feeding yourself?
• Getting in and out of a bed or a chair?
• Dressing and undressing?
• Using toilets?
• Bathing or showering?

Q54A: If you are 65 years or older: In relation to the activities of the previous question: Do you usually receive help with one or more of the activities?

Q54B: If you are 65 years or older: In relation to the activities of the previous question: Do you need to receive help for one or more of the activities?

Q55: If you are 65 years or older: Do you have difficulty doing any of the following (no difficulty, some difficulty, a lot of difficulty, cannot do it by myself, never tried it or do not need to do it) :

• Preparing meals
• Using the telephone?
• Shopping?
• Managing medication?
• Doing light housework?
• Doing heavy housework?
• Taking care of finances and everyday administrative tasks?

Q56A: If you are 65 years or older: In relation to the activities of the previous question: Do you usually receive help with one or more of the activities? (Yes/No)

Q56B: If you are 65 years or older: In relation to the activities of the previous question: Do you need to receive help for one or more of the activities (Yes/No)? 

A copy of the Irish Health Survey questionnaire is available here: Irish Health Survey 2019 Questionnaire

Purpose of Survey

The Irish Health Survey (IHS) was collected under Regulation (EC) No 1338/2008 of the European Parliament and of the Council of 16 December 2008 on Community statistics on public health and health and safety at work¹. This survey fulfils the need for public health policies to obtain reliable data on health status, health care usage and health determinants.

The Central Statistics Office wishes to thank the participating households for their co-operation in agreeing to take part in the survey, and for facilitating the collection of the relevant data. 

Questionnaire

The Irish Health Survey was designed in line with the third wave of the European Health Interview Survey (EHIS)². The collection of the data under the aforementioned European Regulation implies that harmonised data can be obtained across the European continent.

The Irish Health Survey can be divided into three fundamental components. These are the European Health Status Module (EHSM), the European Health Care Module (EHCM), and the European Health Determinants Module (EHDM). Elements of the EHSM were analysed for this Carers and Social Supports publication.

The European Health Status Module:

The module on health status is a central element of the survey. It allows measurement of the health status of the population in general, and not only in relation to specific health problems. It covers different aspects and dimensions of health: physical and mental health, chronic and temporary problems and specific conditions. It covers the general impact on the functional status and the limitations in activities of daily living of the respondents. The first three general questions on self-perceived health, long standing illnesses or health problems, and activity limitations constitute the Minimum European Health Module (MEHM). 

Sample Design

The sample was derived for the General Household Survey (GHS)[3]. It is a multi-stage cluster sample resulting in all households in Ireland having an equal probability of selection. The sample is stratified using administrative county and the Pobal HP (Haase and Pratschke) Deprivation Index (quintile).

A two-stage sample design is used. Firstly, 1,200 blocks are selected using Probability Proportional to Size (PPS) sampling. All occupied households on Census night 2016 within each block were eligible for selection in the Social Statistics Sample.

Secondly, households within blocks were selected using simple random sampling (SRS) without replacement for inclusion in the survey sample. This ensures each household in the sample frame has an equal probability of selection.

The sample size is based on a simple random sampling approach and before design effects are factored in, this was determined by Eurostat as 5,125 for Ireland. Adjusting this figure for the design effect (to account for how the sampling is actually conducted in practice) means that a higher achieved sample is required – thus the approximately 7,600 responses actually collected by this survey. 

Data Collection

Once the second stage of the sampling procedure is complete, a single individual is randomly selected from each household.  This individual must be aged 15 years or older. Once the individual is selected, their responses are collected face-to-face (CAPI) via a tablet. Proxies were not allowed for data collection.

It is worth noting the data for the previous Irish Health Survey 2015 (Irish Health Survey 2015) was collected via paper survey form (PAPI) . This paper survey form was completed by the respondent and returned by post. 

There were 7,621 respondents to this survey in 2019. The reference period for the survey is 2019. Data collection began in Q2 2019 and, to achieve a sufficient number of responses, data collection finished in Q1 2020 (as agreed with Eurostat). 

Grossing/derivation of results

The GHS grossing procedure aligns the distribution of persons covered in the sample with independently determined population estimates at the level of sex, five-year age group and region. The grossed population aged 15 years or older is 3,925,556 persons.

To provide national population results, the survey results were weighted to represent the entire population (15+). The survey results were weighted to agree with population estimates broken down by age group, sex, ISCED11 and region.

Household weights were calculated for all households in the initial sample. The design weights are computed as the inverse of the selection probability of the unit. The purpose of design weights is to eliminate the bias induced by unequal selection probabilities.

These design weights were then adjusted for non-response. This eliminated the bias introduced by discrepancies caused by non-response, particularly critical when the non-responding households are different from the responding ones in respect to some survey variables as this may create substantial bias in the estimates. Design weights are adjusted for non-response by dividing the design weights of each responding unit in the final/achieved sample by the (weighted) response probability of the corresponding group or strata.

To obtain the final household weights for the results, after the previous steps were carried out, the distribution of households by deprivation, NUTS3 region, sex and age was calibrated to the population of households in Quarter 1 2018 (as derived from the LFS Survey). The CALMAR2-macro, developed by INSEE, was used for this purpose. 

Region

The regional classifications in this release are based on the NUTS (Nomenclature of Territorial Units) classification used by Eurostat. Until Q4 2017, the NUTS3 regions corresponded to the eight Regional Authorities established under the Local Government Act, 1991 (Regional Authorities) (Establishment) Order, 1993, which came into operation on 1 January 1994 while the NUTS2 regions, which were proposed by Government and agreed by Eurostat in 1999, were groupings of those historic NUTS3 regions.

However, the NUTS3 boundaries were amended on 21^st of November 2016 under Regulation (EC) No. 2066/2016 and have come into force from Q1 2018. These new groupings are reflected in the CSO publications from Q1 2018 onwards. The changes resulting from the amendment are that County Louth has moved from the Border to the Mid-East and what was formerly South Tipperary has moved from the South-East to the Mid-West, resulting in the new NUTS2 and NUTS3 regions: 

Deprivation Index

The Pobal Haase-Pratschke Deprivation Index is used to create the underlying sample and is used to analyse the data. The Index uses Census data to measure levels of disadvantage or affluence in a geographical area. More detailed information on the index can be found on the Trutz-Haase website.

The results are presented by quintiles, five equal-sized groups of households, with the first quintile representing the most disadvantaged area and the fifth quintile representing the least deprived/most affluent area.

First Quintile - Very disadvantaged

Second Quintile - Disadvantaged

Third Quintile - Average

Fourth Quintile - Affluent

Fifth Quintile - Very affluent (least deprived) 

Disclosure control

Estimates for number of persons where there are less than 30 persons in a cell are too small to be considered reliable. These estimates are presented with an asterisk (*) in the relevant tables.

Where there are 30-49 persons in a cell, estimates are considered to have a wider margin of error and should be treated with caution. These cells are presented with parentheses [ ].

In the case of rates, these limits apply to the denominator used in generating the rate. In the case of annual changes, both the current year and the preceding year are taken into account when deciding whether the estimate should be suppressed or flagged as having a wider margin of error. 

Mental Health Status Definition

The Personal Health Questionnaire (PHQ-8), 8-item depression screener, was selected as the instrument to monitor mental health and it encompasses a subset of the negative mental health dimension – mental health problems.  It is an instrument for assessing and monitoring the prevalence and severity of current depressive symptoms and functional impairment and to make tentative depression diagnosis.  It is originally derived from the Brief Health Questionnaire, Depression Module (PHQ-9).

Mental health status is calculated using data from question thirteen of the questionnaire.  In this question, there are eight items measuring various negative mental health effects experienced in the previous two weeks.  Each of these items has four possible answers:

• None of the days
• Several of the days
• More than half of the days
• Nearly every day

Each of these responses is then given a score; None of the days = 0, Several of the days = 1, More than half of the days = 2, and finally Nearly every day = 3.  The respondent’s scores for each of the eight items are then summed, giving a maximum of 24.  The levels of depression are identified by their final score, and the categories are as follows:

• 0-4:        None to minimal depression
• 5-9:        Mild depression
• 10-14:    Moderate depression
• 15-24:    Moderately severe or severe depression. 

¹ Regulation (EC) No 1338/2008

² European Health Interview (EHIS)

  [3] The General Household Survey (GHS) is a national survey that place takes place three or four times each year. The survey usually has a core of common demographic questions that are always asked (e.g. age, sex, education, etc.) plus one or more specific sets of survey questions that will change each year. You can find more information here:  General Household Survey.