Information for the 2012-13 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) and National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey (NATSINPAS) was obtained by trained ABS interviewers, through Computer Assisted Personal Interview (CAPI) and, for the second NATSINPAS interview conducted in non-remote areas through Computer Assisted Telephone Interview (CATI), with all selected members of in-scope households (see Scope and Sample Design for further information). For the purpose of these surveys, a household was defined as one or more persons, at least one of whom is aged 18 years and over and at least one Aboriginal or Torres Strait Islander person of any age, usually resident in the same private dwelling.
Interviewers were primarily recruited from a pool of trained ABS interviewers who had previous experience on ABS household surveys and particularly in Aboriginal and Torres Strait Islander communities where possible. Those selected to work on the NATSIHS and/or NATSINPAS undertook further classroom training and were required to satisfactorily complete home study exercises. In addition, all selected interviewers participated in Indigenous Cultural Awareness training. All phases of the training emphasised an understanding of the survey concepts, definitions and procedures in order to ensure that a standard approach was employed by all interviewers. Regular communication between field staff and survey managers was maintained throughout the survey via database systems set up for the survey.
Interviewers were allocated a number of dwellings (a workload) at which to identify if anyone living at the dwellings were of Aboriginal or Torres Strait Islander origin, and where there was, seek to conduct an interview. The size of the workload was dependent upon the area involved and whether or not the interviewer was required to live away from home to collect the data. Interviewers living close to their workload area in urban areas usually had larger workloads.
Dwellings in non-remote areas selected in NATSINPAS, with at least one respondent who completed their interview and provided a contact phone number, were allocated to NATSINPAS CATI workloads. Dwellings were progressively released to interviewers once the '8 days since CAPI interview' timeframe had passed for all respondents in a dwelling.
In non-remote and remote non-community NATSIHS and NATSINPAS sample areas, a screening process was undertaken which involved interviewers first making contact with a household and asking any responsible adult (ARA) member of the household, "Is anyone in this household of Aboriginal or Torres Strait Islander descent?". For 'Yes' responses, the interviewer would explain the survey, provide a survey brochure that included background information and a guarantee of confidentiality, and organise a suitable time to conduct the interview.
For remote communities selected in the NATSIHS or NATSINPAS samples, ABS Regional Offices contacted communities and health clinics by telephone prior to enumeration commencing and sent a Community Approach Letter as confirmation. In communities, standard household survey approaches were modified to take account of language and cultural issues. In addition, interviewers worked in teams of two, one male and one female, to collect the survey information. The interviewers were accompanied, wherever possible, by local facilitators, usually one male and one female, who assisted in the conduct and completion of the interviews. The Aboriginal and Torres Strait Islander facilitators explained the purpose of the survey to respondents, introduced the interviewers, assisted in identifying the usual residents of a household and in locating residents who were not at home and, where necessary, assisted respondent understanding of the questions.
For all selected households, general characteristics of the household were obtained from the ARA. This information included basic demographic characteristics of all usual residents of the dwelling as well as the relationships between those people (e.g. spouse, son/daughter, not related). The ARA was also asked to nominate the person(s) in the household who were best able to provide information about children in the household, and information about household income and other household characteristics, such as (where applicable to the survey) food security, dwelling structure, financial stress or household smoking.
From the information provided by the ARA about the household composition, the survey instrument established those persons in scope of the survey and selected those residents to be included in the survey. The selection was made on a random basis by the computer assisted instrument. For NATSIHS, in non-remote areas up to two Aboriginal and/or Torres Strait Islander adults and up to two Aboriginal and/or Torres Strait Islander children were selected in a household, while remote areas had up to one Aboriginal and/or Torres Strait Islander adult and up to one Aboriginal and/or Torres Strait Islander child selected. For NATSINPAS, up to one Aboriginal and/or Torres Strait Islander adult and up to one Aboriginal and/or Torres Strait Islander child were selected in all households.
If the dwelling contained only usual residents aged under 18 years, or no Aboriginal or Torres Strait Islander person was identified during the completion of the household form, no further information was collected from that household.
A personal interview was conducted with the selected adult(s) (where possible), and an adult was asked to respond on behalf of the selected children aged under 15 years. In some instances, adult respondents were unable to answer for themselves due to significant long-term illness or disability. In these cases, a person responsible for them was interviewed on their behalf, provided the interviewer was assured that this was acceptable to the selected person. Where possible, the respondent was still present during the interview and physical measurements were taken where appropriate. If the respondent was not able to be present for the interview certain questions were not asked.
In circumstances where there were language difficulties, other persons in the household or local facilitators (within the community sample) may have acted as an interpreter if this was suggested by the respondent. If not, the respondent was recorded as a non-response to the survey.
Where permission was granted by a parent or guardian, children aged 15-17 years were interviewed in person. If permission was not granted, questions were answered by an adult, who may or may not have been the selected adult respondent in the household. The person answering on behalf of the 15-17 year old was referred to as the Child Proxy. Whether a child proxy was used for an interview is available as a data item. There are also data items available identifying parent presence or proxy use at other stages of the survey, including for the alcohol, non-remote child physical activity, smoking and nutrition topics, where applicable to the survey.
For questions related to the household, such as food security and household income, the ARA identified a household spokesperson to answer these questions. This person may or may not have been the selected adult respondent. They also did not need to be an Aboriginal or Torres Strait Islander person.
To obtain a personal interview with selected respondents, interviewers made appointments as necessary. In some cases appointments were made by telephone, however all interviews were conducted face-to-face with the exception of the second interviews for NATSINPAS which was conducted by telephone using CATI for non-remote respondents. Interviews may have been conducted in private or in the presence of other household members according to the wishes of the respondent. To reduce sensitivities, non-remote respondents in NATSIHS aged 15 years and over were asked to complete substance use questions through a privately completed Computer Assisted Self Interviewing (CASI) instrument.
In non-remote and remote non-community workloads where a respondent initially refused to participate in the survey, a follow up letter was sent to the respondent and a second visit was made where possible. At the follow-up visits, the survey objectives and importance of participating in the survey were emphasised, and any particular concerns the respondent may have had were addressed. Persons missed from the survey through non-contact or refusal were not replaced.
In remote communities, there was no follow-up of refusals. Interviewers were instructed to make every effort to convert refusals at the initial contact stage by explaining, with the assistance of a local facilitator, the importance of the survey and the confidentiality provisions under which the ABS operates. If there was a high non-response in a community due to some event occurring, such as a funeral, interviewing in that community was postponed, where possible, to a more appropriate time.
The questionnaire was administered by experienced ABS interviewers, who had received specific training for the survey. The questionnaire was further supported by detailed interviewer instructions, covering general procedural issues as well as specific instructions relating to individual questions.
The questionnaire is not fully indicative of the range of information available from the survey, as additional items were created in processing the data. For example, ABS classifications were applied to raw data inputs for better representation of collected information. Additionally, some questions were asked solely for the purpose of enabling or clarifying other questions, and are not available in survey results.
The 2012-13 NATSIHS and NATSINPAS utilised Computer Assisted Interview (CAI) instruments to collect the data.
The CAI instrument allows:
- data to be captured electronically at the point of interview, which removes the cost, logistical, timing and quality issues associated with transport, storage and security of paper forms, and transcription/data entry of information from forms into electronic format
- the ability to use complex sequencing to define specific populations for questions, and ensure word substitutes used in the questions were appropriate to each respondent's characteristics and prior responses
- the ability, through data validation (edits), to check responses entered against previous responses, reduce data entry errors by interviewers, and enable seemingly inconsistent responses to be clarified with respondents at the time of interview. The audit trail recorded in the instrument also provides valuable information about the operation of particular questions, and associated data quality issues
- some derivations to occur in the instrument itself, assisting in later processing
- auto-coding systems to be incorporated, reducing interview and processing time
- data to be delivered in an electronic format compatible with ABS data processing facilities.
The questionnaires were field tested to ensure:
- data was obtained in an efficient and effective way
- there was minimum respondent concern about the sensitivity or privacy aspects of the information sought
- there was effective respondent/interviewer interaction and acceptable levels of respondent burden
- operational aspects of the survey were satisfactory; e.g. arrangement of topics, sequencing of questions, adequacy and relevance of coding frames, etc.
The questionnaires employed a number of different approaches for recording information at the interview.
- Questions where responses were classified by interviewers to one or more of a set of predetermined response categories. This approach was used for recording answers to the more straightforward questions, where logically a limited range of responses was expected or where the focus of interest was on a particular type or group of responses (which were listed in the questionnaire, with the remainder being grouped together under ‘other’).
- Questions where responses were recorded by interviewers as reported, for subsequent classification and coding by office staff during processing. This style of question was used for potentially more complex topics such as health conditions or medications used.
- Questions asked in the form of a running prompt; that is, predetermined response categories were read out to the respondent one at a time until the respondent indicated agreement to one or more of the categories (as appropriate to the topic) or until all the predetermined categories were exhausted.
- Questions asked in association with prompt cards. Printed lists of possible answers to the question were shown the respondent who was asked to select relevant responses. Listing a set of possible responses (either in the form of a prompt card or a running prompt question) served to clarify the question or to present various alternatives, to refresh the respondent’s memory and at the same time assist the respondent to select an appropriate response.
- Procedures for obtaining the measured height, weight, waist and hip circumference as well as blood pressure of respondents. Interviewers took the physical measurements using a variety of techniques (see: Body Mass and Physical Measurements and Blood Pressure for more information).
To ensure consistency of approach, interviewers were instructed to ask the interview questions exactly as written. In certain areas of the questionnaire however, interviewers were asked to use indirect and neutral prompts at their discretion, where the response given was, for example, inappropriate to the question asked or lacked sufficient detail necessary for classification and coding. This occurred particularly in relation to type of medical condition where interviewers were asked to prompt for a condition if a treatment or symptom was initially reported.
The questionnaires were designed to be administered using standard ABS procedures for conducting population interview surveys, with regard to the particular aims of the survey and the individual topics within it, and the methodological issues associated with those topics. Other factors considered in designing the questionnaires included the length of individual questions, the use of easily understood words and concepts, the number of subjects and overall length of the questionnaires, and the sensitivity of topics. Where appropriate, previous ABS questions on the topics covered were adopted.
National Aboriginal and Torres Strait Islander Health Survey
The questionnaire used for the 2012-13 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) was based on the 2011-12 National Health Survey (NHS), and modified as appropriate to incorporate Aboriginal and Torres Strait Islander population specific survey content. The non-remote child (5-17 years) physical activity questions were based on the 2011-12 National Nutrition and Physical Activity Survey (NNPAS) and reflect modifications also applied to the NATSINPAS. Some differences in question wording and content are apparent between the remote and non-remote questionnaires. Information on these differences can be found in the specific topic pages of this Users’ Guide.
Information collected included:
National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey
- Household information - basic demographic data about usual residents of the household (e.g. sex, age, date of birth, Indigenous status, marital status) and details of the relationship between individuals in each household. This information was obtained from the ARA. The data was also used to enable the selection of respondents in the dwelling. Information was also recorded on the calls made to the dwelling by the interviewer, and the subsequent response status of the household in the survey (e.g. fully responding, refusal, vacant dwelling, etc.).
- Household information - was obtained from a household spokesperson who, on behalf of the entire household, provided information about the dwelling, household income, financial stressors, food security and household smoking. The household spokesperson was aged 18 years or over.
- Personal Adult Interview - information was collected from the selected adult about demographic, socio-economic and health characteristics (e.g. physical measurements, long-term health conditions, risk factors, and health-related actions they had taken).
- Personal (or proxy) Child Interview - information was collected on selected demographic and health characteristics. Questions on socio-economic characteristics, smoking and alcohol were not asked of children aged under 15 years, and questions on levels of psychological distress were not asked of persons aged under 18 years. Physical measurements were taken for children aged 2 years and older (5 years and older for blood pressure measurements).
The questionnaire used for the 2012-13 National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey (NATSINPAS) was based on the 2011-12 National Nutrition and Physical Activity Survey (NNPAS), modified as appropriate to incorporate Aboriginal and Torres Strait Islander population specific survey content. Some differences in question wording and content are apparent between the remote and non-remote questionnaires. Information on these differences can be found in the specific topic pages of this Users’ Guide.
The 2012-13 NATSINPAS questionnaire comprised multiple approaches to collection. Information collected from the primary questionnaire included:
- Household information - basic demographic data about usual residents of the household (e.g. sex, age, date of birth, birthplace, Indigenous status, marital status) and details of the relationship between individuals in each household. This information was obtained from the ARA. The data was also used to enable the selection of respondents in the dwelling.
- Household information - was obtained from a household spokesperson who on behalf of the entire household provided information about household income and food security. The household spokesperson was aged 18 years or over.
- Personal Adult Interview - information was collected from the selected adult about demographic, socio-economic, health characteristics (e.g. physical measurements, long-term health conditions, and risk factors).
- Personal (or proxy) Child Interview - information was collected on selected demographic and health characteristics. Questions on socio-economic characteristics and smoking were not asked of children aged under 15 years. Physical measurements were taken for children aged 2 years and older (5 years and older for blood pressure measurements).
In addition to the primary questionnaire, additional collection methods and instruments were developed to support special requirements for components of the survey.
National Aboriginal and Torres Strait Islander Health Measures Survey
- Due to the size and complexity of the 24-hour dietary recall collection, a separate instrument was developed for use in the CAPI and the non-remote CATI. Further details will be available in this Users’ Guide upon first release of Nutrition data.
- The collection of Pedometer data involved distributing a Daily Activity Sheet (an example of which will be available in the Downloads tab at a later date) to non-remote respondents who agreed to participate in this component during the CAPI. This sheet was then used by the respondent to record specified information for each day (up to 8 days) that they wore the pedometer. The follow-up telephone interview (CATI) used to collect 2nd day dietary recall data for non-remote areas was also used to collect from participating respondents their Pedometer data. Specific information on the content and collection methodology of the Pedometer component will be provided in more detail at a later date.
The 2012-13 National Aboriginal and Torres Strait Islander Health Measures Survey (NATSIHMS) involved adult respondents, in both the NATSIHS and NATSINPAS, volunteering to provide blood and/or urine samples for analysis.
The interview components of the NATSIHS and NATSINPAS were conducted under the Census and Statistics Act (CSA) 1905
. The biomedical component of the NATSIHS and NATSINPAS was collected under the Privacy Act 1988
and was subject to ethics approval. Ethics approval was sought and gained (for the NATSIHMS component only) from the following Ethics Committees at the national level:
- Australian Government Department of Health and Ageing’s Departmental Ethics Committee
Ethics approval for the NATSIHMS component was also required at the jurisdictional level for New South Wales, South Australia, Western Australia, Northern Territory and for Queensland Health Service Districts. Ethics approval was sought and gained (for the NATSIHMS component only) from the following Ethics Committees:
- Aboriginal Health and Medical Research Council Ethics Committee in New South Wales
- Aboriginal Health Research Ethics Committee in South Australia
- Western Australian Aboriginal Health Ethics Committee in Western Australia
- Western Australia Country Health Service (WACHS) Research Ethics Committee in Western Australia
- Central Australian Human Research Ethics Committee in Northern Territory
- Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research in Northern Territory
- several Human Research Ethics Committees of Queensland Government Hospital and Health Services districts.
At the completion of NATSIHS or NATSINPAS questions, interviewers explained the voluntary Biomedical component and provided a written Information Sheet. Only selected respondents aged 18 years and above were in scope. Adult respondents were determined to be out of scope of the NATSIHMS in proxy interviews where the situation was deemed appropriate to use a proxy for the adult interview and the respondent was not present.
Most NATSIHMS blood and urine samples were collected at Sonic Healthcare collection clinics or alternatively via a home visit or temporary clinic held at Aboriginal Medical Services (AMS) using standard operating procedures for phlebotomy collection. However, IMVS Pathology provided the service for regional areas in South Australia and Northern Territory, albeit the same standard collection procedures were used.
Informed consent was sought through completion of a consent form. A copy of the consent form was left with the respondent. Those that agreed to take part were provided a Referral Form to complete (including whether specific medications or supplements were regularly taken) and provide to the collection centre or temporary clinic. There were different forms for remote and non-remote samples and examples of these referral and consent forms can be found in the Downloads page of this product.
Pathology tests conducted in the NATSIHMS included markers of chronic disease such as blood sugar levels, cholesterol and kidney function, markers of nutritional status, as well as markers of exposure to chemicals such as nicotine.
Specific information on the content, collection methodology and quality assurance of the biomedical component can be found in the Biomedical Measures chapter of this Users' Guide.