Hennepin County (Minnesota) Public Health’s Survey of the Health of All the Population and the Environment (SHAPE)
Urban Landreman, Hennepin County
Hennepin County (Minnesota) Public Health has administered the Survey of the Health of All the Population and the Environment (SHAPE) [www.Hennepin.us/SHAPE] every four years since 1998. The survey includes questions on a wide range of health topics. Historically, approximately 10,000 residents respond to the SHAPE survey. A key goal of SHAPE is to get responses for a representative sample of all the subpopulations who live in Hennepin County. Hennepin County covers a large geographic area including the city of Minneapolis and rural areas. The residents of the county form a spectrum from the very affluent to those well below the Federal Poverty Level (FPL), many racial/ethnic groups, and who speak many languages.
As with almost every general population survey, response rates have been dropping especially among the traditionally under-represented groups. For SHAPE to provide accurate countywide estimates, however, getting responses from those precise groups – whose health statuses and behaviors are often quite different from those who are more affluent – is vital.
The core of SHAPE 2022 was mailing a self-administered survey to approximately 42,000 randomly-selected households in the county. The project team anticipated that even with the employment of disproportionation sampling to increase the selection probability of under-represented populations, the respondents in the address-based sample (ABS) would likely be over-represented by Whites, older and more affluent households.
To address that challenge, an in-person data collection mode was introduced. In addition to the mailed survey, the project team partnered with ten community-based organizations which serve subpopulations which are traditionally under-represented in population-based mail surveys. The participating community-based organizations received a stipend and were invited to include a few of their own questions along with the core SHAPE 2022 questions.
In partnership with those organizations, fifty in-person events were held where people were invited to complete an augmented SHAPE survey (the core SHAPE survey, the additional community-based organizations, and the respondent’s address). The events were staffed by SHAPE team members and interns, some of whom were multi-lingual, along with volunteer translators from the community organizations. Persons who completed a survey at the in-person events were given a small stipend.
Of the 2,072 persons who completed the survey at the in-person events, 1,898 provided an address. Some of those addresses were outside of Hennepin County, a homeless shelter, or a non-existent address. After removing cases where the address was not usable, 132 cases listed an address that was an exact match for one of the ABS addresses which had not returned a survey. These were included in the combined sampled used for county-wide analysis as non-response conversion cases. In addition, 1,308 cases listed an address that was within 200 meters of an ABS address which had not returned a survey. These cases were included in the analysis as sample replacement cases.
The demographic profile of the respondents who completed the survey in the ABS was quite different than that of those who completed the survey at the in-person events.
For example, 18.9% of the ABS respondents lived in households that were below 200% of the FPL compared to 81.2% of the in-person respondents. Similarly, 13.9% of the ABS respondents were persons of color compared to 85.7% on the in-person respondents.
Combining the in-person respondents with the ABS respondents brought the combined sample much closer to the demographic profile of Hennepin County as a whole. Since the health profile of the traditionally under-represented adults is often different from that of the rest of the population, the estimates for health behaviors and statuses using the combined sample, are likely to be more representative and less biased for the county as a whole.