4720.0 - National Aboriginal and Torres Strait Islander Social Survey: User Guide, 2014-15  
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HEALTH


Overview

This chapter provides information on a range of health measures that were collected in the 2014–15 National Aboriginal and Torres Strait Islander Social Survey (NATSISS), including:


Self-assessed health status

This self-assessed measure is based on the person's overall physical and mental health both generally and in comparison to the period one year prior to the survey interview. All people were asked to rate their health on the following scale:
  • excellent;
  • very good;
  • good;
  • fair; or
  • poor.

Responses for children aged 0–14 years were provided by a proxy.

People aged one year and over were asked to compare their general health at the time of the interview to one year prior. Responses were based on the following:
  • much better now;
  • a bit better now;
  • about the same;
  • a bit/little worse now; or
  • much worse.

Patient experience

People aged 15 years and over were asked if they had seen a general practitioner (GP) in the previous 12 months about their own health. In remote areas, the question wording included 'GP or a doctor at the clinic'. Seeing a GP or doctor refers to:
  • consultations at a GP;
  • visits where an appointment had been made;
  • consultations for physical conditions and initial consultations for psychological conditions; and
  • appointments to refill prescriptions.

If these circumstances applied in a remote setting, but a local GP was not available, visits to a doctor at a clinic or other place was taken to be equivalent. However, the following were not included as instances of seeing a GP or doctor:
  • visits to a hospital or emergency department in emergency situations;
  • referrals to specialists;
  • visits to or from a nurse; and
  • visits to any other type of health professional such as a naturopath or psychologist.

People who had seen a GP in the previous 12 months for their own health were asked three subsequent questions relating to:
  • how often a GP listened carefully to you;
  • how often a GP showed respect for what you had to say; and
  • how often did a GP spend enough time with you.

These questions only referred to the doctor(s) the respondent saw; not nurses or other staff. The response options for each of these questions were:
  • always;
  • often;
  • sometimes;
  • rarely; and
  • never.

Comparison to the 2008 NATSISS

All questions relating to patient experience are new in the 2014–15 NATSISS and are unable to be compared to 2008.

Child health and health services

All questions relating to child health for persons aged 0–14 years were answered by a child proxy.

Children aged 1–14 years were also asked whether aspects of their health had led to concerns about learning. The response could have been yes or no and related to the child's health only.

The proxies of children aged 0–14 years were asked where the child usually goes when they have a problem with their health. Responses were based on the following:
  • Aboriginal Medical Service (AMS);
  • other community health clinic;
  • a maternal and child health centre;
  • hospital (including casualty, outpatients or emergency area);
  • a doctor/General Practitioner (GP) (outside AMS, health clinic or hospital);
  • traditional healer;
  • chemist;
  • a relative or other community person;
  • other health professional (eg naturopath, dietician); or
  • don't usually seek health care.

More than one response could be provided.

Eye or sight problems

The proxies of children aged 0–14 years were asked whether the child had any problems with their eyes or sight. If the child did not have or it was unknown if they had any problems, the proxy was skipped to subsequent questions on ear or hearing problems. If the child had problems with their eyes or sight, the proxy was asked to identify which one(s) from the following:
  • difficulty reading/seeing close up (long sightedness);
  • difficulty seeing far away (short sightedness);
  • totally blind in both eyes;
  • totally blind in one eye;
  • partially blind in both eyes;
  • partially blind in one eye;
  • glaucoma;
  • cataracts;
  • trachoma;
  • lazy eye;
  • retinopathy;
  • other; or
  • don't know.

More than one response could be provided.

The child's proxy was asked for how long the child had the eye or sight problem(s). Responses could be provided in months or years, or the child may have had the problem(s) since they were born. Responses were output numerically as a value ranging from 1 to 188 months. Where a response was less than one month, it was rounded to one month.

The child's proxy was also asked what type of treatment the child had been given for their eye or sight problem(s), based on the following:
  • wears glasses/contact lenses;
  • medication (including eye drops);
  • surgery;
  • checked by an eye or sight specialist;
  • a walking stick or guide dog;
  • other;
  • no treatment sought;
  • no treatment available; or
  • unable to afford treatment.

More than one response could be provided.

Ear or hearing problems

The proxies of children aged 0–14 years were asked whether the child had any problems with their ears or hearing. If the child did not have or it was unknown if they had any problems the proxy was skipped to subsequent questions on teeth or gum problems. If the child had ear or hearing problems, the proxy was asked to identify which one(s) from the following:
  • total deafness;
  • deaf in one ear;
  • hearing loss/partially deaf;
  • ringing in ears (tinnitus);
  • runny ears or glue ear (otitis media);
  • tropical ear/swimmer's ear (otitis externa);
  • other; or
  • don't know.

More than one response could be provided.

The child's proxy was asked for how long the child had the ear or hearing problem(s). Responses could be provided in months or years, or the child may have had the problem(s) since they were born. Responses were output numerically as a value ranging from 1 to 188 months. Where a response was less than one month, it was rounded to one month.

The child's proxy was also asked what type of treatment the child had been given for their ear or hearing problem(s), based on the following:
  • wears a hearing aid;
  • medication (including eardrops or antibiotics);
  • surgery;
  • checked by an ear or hearing specialist;
  • cochlear implant;
  • other;
  • no treatment sought;
  • no treatment available; or
  • unable to afford treatment.

More than one response could be provided.

Teeth or gum problems

Teeth cleaning habits

The proxies of children aged 0–18 months were asked whether the child had any teeth and, if so, were then asked about teeth cleaning. If not, they were skipped to questions in a subsequent topic.

The proxies of children aged 0–14 years (who had teeth) were asked how often the child brushes their teeth. For children aged 0–8 years, brushing included where someone else cleaned their teeth for them. Responses were based on the following:
  • more than twice a day;
  • twice a day;
  • once a day;
  • 5–6 days a week;
  • 3–4 days a week;
  • 1–2 days a week;
  • doesn't clean teeth; or
  • doesn't have teeth.

Dental problems

The proxies of children aged 0–14 years (who had teeth) were asked whether the child had any of the following problems:
  • cavities (holes) or dental decay;
  • tooth or teeth filled because of dental decay;
  • teeth pulled out because of dental decay;
  • an accident caused breakage or loss of teeth;
  • bleeding or sore gums;
  • Needs braces/plate/retainer;
  • other problems with teeth or gums;
  • no problems with teeth; or
  • don't know.

The wording of the response categories differed slightly between non-remote and remote areas, but were treated the same. More than one response could be provided. If the child did not have or it was unknown if there were any problems, the proxy was skipped to subsequent questions about dental visits. If the proxy reported that the child had at least one teeth or gum problem, they were asked how long the child had the problem(s). Responses could be provided in months or years. Responses were output numerically as a value ranging from 1 to 188 months. Where a response was less than one month, it was rounded to one month.

Dental visits

The proxies of children aged 0–14 years (who had teeth) were asked about the child's visits to the dentist. They were asked when the last time was that the child went to a dentist about their teeth, based on the following:
  • less than 3 months ago;
  • 3 months to less than 6 months ago;
  • 6 months to less than a year ago;
  • 1 year ago to less than 2 years ago;
  • 2 years ago or more;
  • never; or
  • don't know.

The proxies of all children (who had teeth), except those who had never been to a dentist, were then asked where the child last went to the dentist. Responses were based on the following:
  • private dental practice (including specialist);
  • government dental clinic (including dental hospital);
  • school dental clinic;
  • dentist at Aboriginal/Torres Strait Islander Medical Service or Community Clinic;
  • other; or
  • don't know.

The proxies of children aged 0–14 years (who had teeth) were also asked whether in the 12 months prior to interview there was ever a time when the child needed to go to a dentist but didn't. If the child did not need to, or it was unknown if they needed to go, the proxy was skipped to questions in a subsequent topic.

The proxies of children who needed to go to the dentist, but didn't, were then asked why the child didn't go, based on the following:
  • cost;
  • treated badly because Aboriginal or Torres Strait Islander;
  • service not culturally appropriate;
  • language problems;
  • transport/distance;
  • waiting time too long or not available at the time required;
  • not available in the area;
  • could not find time to take child (including personal/family responsibilities);
  • dislikes service professional/afraid/embarrassed;
  • felt it would be inadequate;
  • decided not to seek care (for the child); or
  • other.

More than one response could be provided.

Comparison to the 2008 NATSISS

Type of teeth or gum problems included a new category in 2014–15: 'needs braces/plate/retainer'.

Infant and maternal health

The 2014–15 NATSISS collected information on children aged 0–3 years and the health of their birth mother during pregnancy and childbirth. Responses were provided by the child's proxy who may or may not have been their birth mother. It should be noted that although the child has been identified as being of Aboriginal or Torres Strait Islander origin, the birth mother may not be.

Pregnancy and childbirth


If the child's proxy was not the birth mother, they were asked if they would be able to answer some questions about the mother's pregnancy and when the child was born. If the proxy responded they were unable to do so they were skipped to questions in a subsequent topic. If the proxy responded that they did not know, they were still asked further questions.

Child's birth

The proxies of children aged 0–3 years were asked whether the child was born late, on time or early. Responses were based on the following:
  • late birth—42 weeks or more;
  • on time—37 to 41 weeks;
  • somewhat early—33 to 36 weeks;
  • very early—32 weeks or less; or
  • don't know.

Information about children aged 0–3 years and their weight at birth was also collected. Responses could be provided in kilograms/grams or pounds/ounces, or they may have said that they did not know. Responses were output numerically as a value ranging from 1 to 9994 grams.

For children aged 0–3 years, the proxy was asked to think about where the child's mother lived and when the child was born. They were asked to provide a location for where the child was born, based on the following:
  • in the closest hospital;
  • in another hospital;
  • at a birthing clinic;
  • at a general medical clinic or facility;
  • at home;
  • somewhere else; or
  • don't know.

If the child was born at a hospital or clinic the proxy was also asked how far away from the mother's home this was, based on the following:
  • less than 10 kilometres;
  • 10–24 kilometres;
  • 25–49 kilometres;
  • 50–99 kilometres;
  • 100–249 kilometres;
  • 250 kilometres or more; or
  • don't know.

Health during pregnancy

The proxy was asked whether the child's mother had to spend any time in hospital, other than to give birth (where applicable), because of the pregnancy. The response could have been yes or no, or they may have said they did not know.

The proxy of children aged 0–3 years also provided information on whether the child's mother had any check-ups during the pregnancy. If the child's mother did not have or the proxy did not know if they had any pregnancy check-ups they were skipped to subsequent questions on pregnancy issues. If the child's mother had check-ups during pregnancy the proxy was asked whether the check-ups were regular, that is, at least one check-up every two months. The response could be yes, no or don't know.

The proxies of children aged 0–3 years were asked about any issues the child's mother may have had during the pregnancy and whether after the mother found out she was pregnant she was told by a doctor or nurse that she had:
  • diabetes or sugar problems; or
  • high blood pressure.

The response could be yes, no or don't know.

The proxy was asked whether the child's mother took any supplements that included folic acid or folate prior to or during pregnancy. Responses were based on the following:
  • yes, both prior to and during pregnancy;
  • yes, prior to pregnancy;
  • yes, during pregnancy;
  • no; or
  • don't know.

The proxy was also asked whether during the pregnancy the child's mother took any other medications or supplements, like heart tablets, iron tablets or cold and flu tablets. The response could be yes, no or don't know.

Substance use during pregnancy

If the proxy of a child aged 0–3 years was the child's mother, questions were asked about tobacco and alcohol/grog use during pregnancy. Due to the potentially sensitive nature of the questions, a refusal response to these questions was possible. The child's mother was asked whether, after finding out she was pregnant, during the pregnancy she:
  • drank any alcohol/grog;
  • smoked any cigarettes or chewed any tobacco; or
  • used any other substances like smoking marijuana, drinking Kava, sniffing petrol or taking any other illicit drugs.

The response could be yes, no, don't know, or a refusal. If the child's mother did not know or did not want to answer she was skipped to the subsequent question.

Pregnancy or birth advice

If the proxy of a child aged 0–3 years was also the child's birth mother, they were asked whether they sought or got any advice or information about pregnancy or giving birth during their pregnancy. If they did not seek or get advice or information they were skipped to later questions on the child's birth. If the child's mother sought or got information they were asked where this was from, based on the following:
  • single class or seminar (presentation, talk);
  • series of classes or group sessions (more than one attended);
  • individual counselling/discussion with health service provider;
  • accessing books, videos/DVDs or websites;
  • discussion/advice from family or friends;
  • discussion/advice from community elders or traditional medicine woman;
  • other; or
  • don't know.

More than one response could be provided.

Comparison to the 2008 NATSISS

The following information was collected in 2008, but was not collected in 2014–15:
  • Type of health professional child's mother consulted for pregnancy check-ups; and
  • Number of nights child's mother spent in hospital after birth.

Disability status

Types of conditions

A disability or restrictive long term health condition exists if a limitation, restriction, impairment, disease or disorder, has lasted, or is expected to last for six months or more, and restricts everyday activities.

Conditions restricting everyday activities

People aged 15 years and over were first asked to think about a selection of conditions they may have that had lasted, or were expected to last, six months or more. If a person did not have one of the selected conditions, they were skipped to a question about further conditions. If a person had at least one of the selected conditions, they were asked to identify which, based on the following:
  • shortness of breath, or difficulty breathing;
  • chronic or recurring pain;
  • a nervous or emotional condition;
  • long term effects as a result of a head injury, stroke or other brain damage;
  • a long term condition that requires treatment or medication; or
  • any other long term condition, such as arthritis, asthma, heart disease, Alzheimer's disease, dementia, etc.

The wording of the response categories differed slightly between non-remote and remote areas, but were treated the same. More than one response could be provided.

If people did have a condition, they were then asked if the condtion(s) they had reported restricted them in their everyday activities, and if so, which ones.

All people aged 15 years and over were then asked about the presence of any other conditions that had lasted, or were expected to last, for six months or more, based on the following:
  • sight problems not corrected by glasses or contact lenses;
  • hearing problems not corrected by hearing aids;
  • speech problems;
  • blackouts, fits or loss of consciousness;
  • difficulty learning or understanding things;
  • limited use of arms or fingers;
  • difficulty gripping things;
  • limited use of legs or feet;
  • a condition that restricts their physical activity or physical work (eg back problems, migraines);
  • any disfigurement or deformity; or
  • any mental illness for which help or supervision is required.

Again, the wording of the response categories differed slightly between non-remote and remote areas, but were treated the same. More than one response could be provided.

If a person did not report any conditions from this second list, and had earlier said they did not have any type of condition from the first list which restricted them in their every day activities, they were considered to have no disability or restrictive long term condition, and were skipped to questions in a subsequent topic. Otherwise, people were sequenced to questions about severity of restrictions.

Severity of restriction

People were then asked a series of questions in order to determine the severity of their restriction or limitation. People were asked if they ever needed help or supervision with everyday tasks, including:
  • Bathing or showering;
  • Dressing and /or undressing;
  • Eating and/or feeding;
  • Going to toilet;
  • Bladder / bowel control;
  • Moving around away from home;
  • Moving around at home;
  • Getting in or out of a bed or chair; and
  • Understanding and/or being understood by friends, family or strangers, (including use of sign language / lip reading).

The response could be yes or no. If a person said they didn't need help with these tasks, they were asked if they ever have difficulties with the tasks. If a person said they did need help with the tasks, they were asked if they always needed help with these tasks. The response could be yes or no to both of these questions.

If a person needed help or had any difficulties with these everyday tasks, they were sequenced to questions about schooling and employment restrictions. Otherwise, they were asked if they used any aids to perform the everyday tasks listed. In remote areas, examples of aids were provided and were 'a walking stick, wheelchair, hearing aid, or a ramp'. The response could be yes or no.

People were then asked if they could perform basic mobility tasks. People were asked if they could:
  • easily walk 200 metres;
  • walk up and down stairs without a handrail;
  • easily bend to pick up an object from the floor; and
  • use public transport without difficulty, help or supervision.

More than one response could be provided, with a response of yes or no required for each mobility task. In remote areas, the list of mobility tasks did not include using public transport. People who were asked about use of aids and mobility tasks were then sequenced to questions about schooling and employment restrictions.

Schooling and employment restrictions

People aged 15–64 years were asked whether their schooling was affected because of the condition(s) reported. Respondents were prompted with the following examples:
  • not attending school/further study due to condition;
  • needing time off school/study;
  • attending special school/classes; and
  • other related difficulties.

The response could be yes or no.

People aged 15–64 years were also asked whether they had difficulties with employment because of the condition(s) reported. Respondents were prompted with the following examples of employment being affected:
  • type of job;
  • number of hours worked;
  • finding suitable work;
  • need time off work; and
  • permanently unable to work due to condition.

The response could be yes or no.

Disability status

A person's disability status was categorised using responses provided about the type(s) of condition(s) they had, whether any condition restricted everyday activities and whether help or supervision was required for tasks.

Disability status categories include:
  • profound core activity limitation—a specified condition for which the person always requires help or supervision in one or more core activities;
  • severe core activity limitation—a specified condition for which the person ever requires help or supervision in one or more core activities;
  • moderate core activity limitation—a specified condition for which the person has difficulties performing one or more core activities;
  • mild core activity limitation—a specified condition for which the person uses aids to perform one or more core activities, or cannot perform basic mobility tasks;
  • has a schooling / employment restriction only;
  • has no specific limitation or restriction;
  • has no disability, but has non-restrictive long-term health condition—this person does not have any of the specified conditions from this module, but has been diagnosed with a long term condition, identified in a separate question set. See 'long term health conditions'; and
  • no disability or long-term health condition—the person does not have any of the specified conditions.

Disability type

Responses provided about the type(s) of condition(s) and whether any condition restricted everyday activities were used to categorise a person's disability type.

Disability type categories include:
  • sight, hearing, speech;
  • physical;
  • intellectual;
  • psychological;
  • head injury, stroke, or brain damage;
  • type not specified; and
  • has no disability.

'Type not specified' includes people whose condition(s) that restricted everyday activities were:
  • a long term condition that requires treatment or medication; or
  • any other long term condition, such as arthritis, asthma, heart disease, Alzheimer's disease, dementia, etc.

A person may have been categorised to more than one disability type.

Types of restrictions

Responses provided about the type(s) of condition(s) and the condition(s) that restricted everyday activities were used to categorise the type of restriction(s).

Type of restrictions includes the following categories:
  • Shortness of breath, or difficulty breathing;
  • Chronic or recurring pain;
  • A nervous or emotional condition;
  • Long-term effects as a result of a head injury, stroke or other brain damage;
  • Any other long-term condition that requires treatment or medication;
  • Any other long-term condition such as arthritis, asthma, heart disease, Alzheimer's disease, dementia, etc;
  • Sight problems not corrected by glasses or contact lenses;
  • Hearing problems;
  • Speech problems;
  • Blackouts, fits or loss of consciousness;
  • Difficulty learning or understanding things;
  • Limited use of arms or fingers;
  • Difficulty gripping things;
  • Limited use of legs or feet;
  • Any condition that restricts physical activity or physical work (eg back problems, migraines);
  • Any disfigurement or deformity;
  • Any mental illness for which help or supervision is required; and
  • No disability.

Comparison to the 2008 NATSISS

The disability module in 2014–15 was updated to reflect the current standard. There are some differences between the question wording and ordering between 2008 and 2014–15. In the 2008 NATSISS, the questions used to ascertain disability status differed for people living in non-remote and remote areas. In remote areas, the wording of screening questions to establish disability status was less detailed and people were not specifically asked whether they had any mental illness for which help or supervision was required. In 2014–15, the module was the same for both remote and non-remote, apart from minor wording changes in remote areas to aid comprehension. Rates should not be compared between the two surveys for remote areas. For further information see Appendix 1: Data comparability with the 2008 NATSISS, from the National Aboriginal and Torres Strait Islander Social Survey, 2014–15 (cat no. 4714.0).

The following information was collected in 2008, but was not collected in 2014–15:
  • Type of educational restriction due to disability; and
  • Type of employment restriction due to disability.

Long-term health conditions

For the first time, the 2014–15 National Aboriginal and Torres Strait Islander Social Survey (NATSISS) collected information on diagnosed long-term health conditions. These differed from the disability or restrictive long term health conditions in that they did not have to cause a restriction, but must have been diagnosed by a doctor or a nurse. People aged 15 years and over were asked if they had ever been told by a doctor or nurse that they had the following physical and mental health conditions:
  • asthma;
  • bronchitis or emphysema;
  • arthritis or osteoporosis;
  • cancer;
  • diabetes;
  • heart disease (including angina, high blood pressure, or heart attack);
  • stroke;
  • kidney disease;
  • back pain or back problems;
  • problems with eyes or eyesight;
  • problems with ears or hearing;
  • depression or feeling depressed;
  • anxiety or feeling anxious or nervous;
  • behavioural or emotional problems;
  • harmful use of, or dependence on, drugs or alcohol; and
  • any other health conditions.

Respondents were asked to include only conditions that that has lasted, or was likely to last, six months or more. Where a person identified one of the above conditions, they were classified as being 'diagnosed with a long-term condition'. There were two exceptions where conditions should not have been included where they had been diagnosed by a doctor or nurse:
  • asthma, where a person had out-grown childhood asthma; and
  • diabetes, where it was gestational diabetes or diabetes insipidus.

Mental health conditions

A person was determined to have a mental health condition if they had been diagnosed with any of the following:
  • depression or feeling depressed;
  • anxiety or feeling anxious or nervous;
  • behavioural or emotional problems; or
  • harmful use of, or dependence on, drugs or alcohol.
Comorbidity

Three 'comorbidity' outputs were derived from diagnosed long-term health conditions:
  • Comorbidity—Renal;
  • Comorbidity—Musculoskeletal; and
  • Comorbidity—Chronoic lower respiratory.

Each of these data items are concerned with a sub-set of the long-term health conditions data. The categories in the renal data item are concerned only with the diagnosis of diabetes, kidney disease and heart disease. The categories in the musculoskeletal data item are concerned only with arthritis/osteoporosis and back pain/back problems. The categories in the chronic lower respiratory data item are concerned only with asthma and bronchitis/emphysema.

Comparison to the 2008 NATSISS

All questions relating to long-term health conditions are new in the 2014–15 NATSISS and are unable to be compared to 2008.