Learning from our Success:

Building a Parent-Only RRFSS

3rd Annual RRFSS Workshop, June 23, 2004Ruth Sanderson

Middlesex-London Health Unit

ruth.sanderson@mlhu.on.ca

Outline

Background on MLHU Parent Survey

Breastfeeding Example

Next Steps & Implications

Current Situation

• Parent-Only Survey at MLHU.• RRFSS-like.• Built on success of RRFSS

– same infra-structure, same modules, flexibility/ responsiveness, staff acceptability/familiarity etc.).

Why do this?

• Challenge to monitor local-level change related to child health– E.g. positive-parenting, breast-feeding duration.

• More ECD funding in 2003 for “traditional surveys” related to child health.

• Couldn’t buy “time” on RRFSS – thought we’d buy “sample”.

What was Done?• Jan/ Feb 2003

– Special Request to augment MLHU’s RRFSS sample of parents of children < 12 years old.

– 22% of RRFSS sample parents of children <12 yrs.

• 2003– Consultation with ISR led to separate RRFSS-like

Parent Survey, piloted, negotiated cost.

• Mar/Nov 2004– Conducting Parent Survey.

Eligibility Questions

• Children under 12 in household.

• Completely or partially responsible for raising and looking after a child in this household.

Content• Reproductive Health (Prenatal Care, Folic Acid Use)

• Breastfeeding• Breastfeeding Policy and Awareness• Bike Helmet• Childhood Injury Prevention: Beliefs and

Perceptions (added Campaign Awareness)*• Car Seat Safety Booster Seat*• Positive Parenting* Parent11.wma

Content (Demographics)• Age• Income• Ethnicity• Marital Status• Child demographics• Relationship to child (parent etc.)

Parent10.wma

Modifications to RRFSS• Minimal development time

required.• Parent pre-selection required

some modifications in the existing RRFSS modules to reflect that interviewer knows that these people are already parents of a child under 12.– E.g. bike helmet safety, positive-

parenting /one index child

Parent Survey Details• Sample frame

– Households with children under 12 in Middlesex-London and adults that indicate they have responsibility for raising a child.

• Sample size– Approximately 100 / month for 900 total.

• Time frame– Mar.– Nov. 2004.

• Interview Length – 12.6 minutes.

Parent13.wma

Response Rates• Eligible households =14% of phone numbers

– 843 eligible households with parents of child under 12 years old of 6,081 phone calls (June 11, 2004)

• Response rate =62%– 520 completions of 843 total estimated eligible

• Participation Rate =95%– 520 completions of 547 complete and refusals

Sample Characteristics• Relationship to Child:

– Parent (92%), step-parent (3%), guardian/grandparent/other (4%).

• Gender: 61% female.• Marital Status: 82% married/ living with partner.• City or County: 75% City of London.• Age Group:

– 18-24 yrs (4%), 25-34 yrs (33%), 35-44 yrs (49%), 45-54 yrs (12%), 55+ (1%).

Example: Breastfeeding

• To increase to 50% the percentage of infants breastfed up to six months by the year 2010 (MHPSG, 1997).

• 47% (42.8-51.2) in MLHU area in 1998 breastfed for 6 months or more (n=535).

Example: Breastfeeding

• Very difficult to measure improvement (difficult to have sufficient sample size for reasonable estimate).

• 6% of RRFSS sample eligible– 70 females aged 18-49 years old reported having

had children in past 5 years out of total adult sample of 1209 for MLHU (RRFSS 2002).

Example: Breastfeeding

• 30% of Parent Survey sample eligible– 143 females aged 18-49 years old reported having

had children in past 5 years out of total parent sample of 476 for MLHU .

(Parent Survey, March-May 2004)

Parent4.wma Parent5.wma

Example: Breastfeeding

• With an anticipated sample of 290 by year end we would be able to detect a difference if duration rate increased to 57%– 57% (95% C.I. 51.3-62.7) from

47% (95% C.I. 42.8-51.2).

Breastfeeding Results

• 46% (37.9-54.3) breastfed > 6 months – Females (18-49) who reported having had a baby

in the past 5 years (59/ 142 one no answer).

• 56.2% of those that initiated breastfeeding breastfed for > 6 months – Females 18-49 years old excluding those currently

breastfeeding (59/105).

(Parent Survey, March-May 2004)

What’s Next?

• MLHU is considering repeating Parent Survey in 2006.

• Encourage longer-term planning and co-ordination for information needs– Managers considering pooling resources.

Implications

• RRFSS infra-structure is solid base for other surveys.

• General RRFSS may not be sufficient to monitor change in public health indicators particularly for child health or other sub-populations.

Public Health Question

Do we need an ongoing RRFSS-like survey that can monitor specific issues for children and families on the local level?