The Italian Behavioral Risk Factor Surveillance System – PASSI (Progressi delle Aziende Sanitarie per la Salute in Italia) www.epicentro.iss.it/passi Pirous Fateh-Moghadam for the PASSI Coordinating Group National Centre for Epidemiology, Surveillance and Health Promotion
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The Italian Behavioral Risk Factor Surveillance System – PASSI (Progressi delle Aziende Sanitarie per la Salute in Italia) Pirous.
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The Italian Behavioral Risk Factor
Surveillance System – PASSI(Progressi delle Aziende Sanitarie per la Salute in Italia)
www.epicentro.iss.it/passi
Pirous Fateh-Moghadam for the PASSI Coordinating Group
National Centre for Epidemiology, Surveillance and Health Promotion
Background•57 million inhabitants
•21 regions
•Universal health care and preventive services
– Local Health Units (LHU) 1 unit per 300,000 residents
(100,000 – 1,000,000)
– Stewardship: interpretation of national guidelines (national health plans) by regional health authorities
Emilia-Romagna
LHU of Bologna
Example:
Data on health behaviours • Collected by National Institute of Statistics
(ISTAT) with several limitations: – quinquennial surveys– national and regional level– delay in dissemination of data– items included not always useful for public
health planning and evaluation
lack of data on health behaviour at LHU level, where many health interventions
are planned and (sometimes) evaluated
PASSI (Progressi delle Aziende Sanitarie per la Salute in Italia)
• 2005 and 2006:– Two pilot cross-sectional studies testing
materials and methods for the future implementation of a surveillance system
– Knowledge shared by CDC/BRFSS experts was very useful in setting up the system
• In 2006 the MoH funded the National Centre for Epidemiology, Surveillance and Health Promotion (CNESPS) to develop ongoing surveillance of behavioral risk factors and preventive measures included in the National Prevention Plan
A system able to:
– Collect useful and representative data on health behaviors at LHU level
– Provide timely feedback planning and evaluation of programs/interventions
– Facilitate comparisons between LHU/regions identify best practices
– Permit comparisons with international data– Last but not least:
• Promote the professional development of local and regional staff
• Increase the use of epidemiological data at local level
Method• Since 2007 ongoing (monthly) data collection
in each participating LHU: – telephone interviews of at least 275
persons/year/LHU – Interviewers: LHU personnel using a standardized
questionnaire (questions adapted from BRFSS, Cindi, Steps, ISTAT comparisons)
• Participants selected from LHU population registers using stratified random sampling
• Inclusion criteria: age 18-69, residence in catchment area, availability of telephone number (mobile or land-line, obtained through various sources)
The technological infrastructure of PASSI: an innovative system using free and open-source software
• e-Passi: a web-based infrastructure to collect, centralize and analyze data
• Because of technological heterogeneity among local health units and variable technical capacities among users, the infrastructure must be flexible, user-friendly, and independent of local hardware and software installations
• A smart client application that uses a readily-available internet browser for:– stand-alone functions for data entry and real-time record
saving (XML format) on interviewers’ computers– interview tracking (assignment, current status)– CATI-like data entry– automatic and secure (SSL) upload of completed
interviews
Source: Paolo Brunetti, Gabriele Dallago, Steno Fontanari, Stefano Menegon
Topics included: priorities of the National Health Plan
• quality of life
• smoking habits
• physical activity
• diet
• alcohol consumption
• driving behavior
• cardiovascular risk factors
• cancer screening
• vaccinations
• mental health
• domestic accidents
• socio-demographic aspects
The questionnaire114 questions, many administered to specific subpopulations (e.g. cancer screening) or categories (e.g. present smokers)
Not only behaviours…• Public health interventions
– Screening programmes– Counselling by general practitioners– Optional modules on:
• Police interventions for drunk drivers• Evaluation of special health promotions programmes
implemented at regional level (“Genitori più”)• Diabetes• Work place safety• H1N1 Influenza
• Importance of social determinants of health:– All risk factors/compliance with public health programmes
are broken down by• Income• Education
Data collection (2007-2009)
• 21/21 Regions have begun data collection since April 2007, though not all at the same time
• Health personnel involved and trained: ~ 1.000 • Complete interviews: ~ 96,000
– 21,996 in 2007– 37,560 in 2008– 36,016 in 2009 (preliminary)
• Intervention planning and evaluation– National and regional prevention plan– Local intervention planning
• Dissemination of results (reports & fact sheets on specific issues)
Sustainability• National and regional public health
authorities are embedding surveillance issues in the main Italian frameworks on prevention of chronic diseases – National and Regional Prevention Plans – Gaining Health
• Since Passi does not use call centers the motivation of the interviewers and supervisers is paramount– Economic benefits (only in some regions)– Passi as a means of professional growth…
Training plan• Promoting the professional development of local and
regional staff is one of the main objectives of the project
• Training activities:1) short courses for the start-up of the system
– stepwise process involving regional and local coordinators and interviewers
– completed in all Regions
2) two year cycle of courses and supervised activities on surveillance systems, communication, and public health interventions leading to a Master’s degree in Epidemiology and Surveillance (in cooperation with Tor Vergata University, Rome)
3) Ongoing annual training programmes on national, regional and local level
The web site offers news, documentation and other services for the network and the public health community (forums, material for training activities, etc.) www.epicentro.iss.it/passi
PASSI-one: a monthly newsletter for the surveillance network, in electronic format, freely downloadable from the web site15 issues already published
PASSI on the Internet
Under construction
• Data analyses (2009) on regional and local level:– Epi-info programme codes – Blue-print of reports
• Release of dataset 2007-2009 possibility of subgroup and trend analyses
• Development of web-site for interactive data interrogation
• More scientific pubblications on international journals
Delivered to Regions&LHU by
coordinating group
Integration of data on behavioural risk factors
• OKkio (repeated survey)– Overweight, obesity and physical activity of
school-children (elementary school)
• HBSC (repeated survey)– Adolescence
• PASSI (ongoing monitoring)– Adults (18-69)
• PASSI d’Argento (repeated survey)– Elderly people (65+)
Centro nazionale di epidemiologia, sorveglianza e promozione della salute (CNESPS), Istituto Superiore di Sanità, RomaSandro BALDISSERA, Nancy BINKIN, Barbara DE MEI, Gabriele FONTANA,Valentina MINARDI, Alberto PERRA, Valentina POSSENTI, Stefania SALMASO
Dipartimento di sanità pubblica, Azienda USL di CesenaNicoletta BERTOZZI
Dipartimento di Statistica, Università degli studi Ca’ Foscari, VeneziaStefano CAMPOSTRINI
Dipartimento di sanità pubblica, AUSL ModenaGiuliano CARROZZI
Direzione generale della prevenzione sanitaria, Dipartimento prevenzione e comunicazione, Ministero della salute, RomaPaolo D’ARGENIO, Stefania VASSELLI
Dipartimento di prevenzione, ASL Caserta 2Angelo D’ARGENZIO
Direzione promozione della salute, Azienda provinciale per i servizi sanitari, TrentoPirous FATEH–MOGHADAM
Ufficio di statistica, Istituto superiore di sanità, RomaGiada MINELLI
Dipartimento prevenzione AUSL Roma CMassimo O. TRINITO
ZadigromaEva BENELLI, Stefano MENNA
The PASSI Coordinating Group at national level
Extra slides
Gaining Health
86% of deaths and 77% of the disease burden in the WHO European Region are caused by non-communicable diseases
Gaining Health is the European strategy to tackle the most important behavioral risk factors linked to this group of disorders
Guadagnare Salute
In 2007 the Italian Ministry of Health (MoH) approved the programme “Guadagnare Salute”, designed to improve the quality of life and well-being of people through health promotion
All 21 Italian Regions agreed to participate
A national system, a local implementation
Emilia-Romagna PASSI is focused on Italy’s 180+ Local Health Units (LHU)