Specific research questions

1. What is it known about the migration process and its association to health and to the model on the Social Determinants of Health (SDH)? [Chapters 1 to 4]

Using the CASEN survey 2006:

2. What are the demographic characteristics of international immigrants in Chile and how do they compare to the Chilean-born? [Chapter 6]

3. What are the socioeconomic conditions of this group and how do they compare to the Chilean-born? [Chapter 7]

4. Do immigrants report having access to the Chilean health care system and how does this compare to the Chilean-born? [Chapter 8]

5. What is the health status (recent and chronic conditions) of international immigrants in Chile and how does it compare to the Chilean-born population? [Chapters 9 and 10]

6. What are the living conditions and health status of those who preferred not to report their migration status in the CASEN survey 2006, and how do they compare to the international immigrant population? [Chapter 11]

7. How do the key findings from this research contribute to the current knowledge of immigrants in Chile and what are their potential policy implications in this country and Latin America? [Chapter 12]

142 5.3.1 Type of study

Cross-sectional secondary data analysis from an anonymous national representative survey conducted in 2006 in Chile, the CASEN survey.

5.3.2 Instrument

In Chile, three possible sources of data exist to study migrants, those being information from the Migration Department in the Chilean Government, Census data, and, since 2006, the CASEN survey. The first has significant limitations for the measurement and exploration of undocumented migration and the second (Census) is one of the best sources of data on demographic characteristics, but does not provide a wide range of information on health status to relate to the socioeconomic determinants of the migrant population. The CASEN survey is the only dataset available in Chile that overcomes this limitation, but also presents significant limitations of its own, in particular, a high rate of missing values on migration status. This aspect will be further described and explored in the second part of this thesis, especially in Chapter 11.

The National Socioeconomic Characterization Survey (CASEN) is a national population based survey carried out in Chile by the Ministry of Planning since 1987. It describes the socioeconomic situation, as well as the impact of social programmes on living conditions, for the Chilean population. The CASEN survey is conducted by the Chilean Ministry of

Planning (MIDEPLAN), in collaboration with the National Institute of Statistics (INE) and the University of Chile (MIDEPLAN, 2006). The 2006 instrument for data collection appears in Appendix-1 (Appendix Book, in Spanish only). This survey is conducted in order to:

1. Provide information to characterize the situation of households and the population, especially those in poverty and the groups identified as priorities for social policy, with respect to demographics, education, health, housing, occupation and income.

2. To estimate the coverage, targeting and distribution of major tax expenditure on social programs nationwide, to assess their impact on households.

143 5.3.3 Sample

5.3.3.a) Sample design

The sampling frame of the CASEN survey in 2006 included every region in Chile (XV regions). The inclusion criteria for random selection of households were: (1) all urban counties with over 40 000 inhabitants; and (2) all rural counties irrespective of the number of inhabitants. It also included people living in transient camps in any of these counties, who represented less than 1% of the total population. There was a random selection of a small proportion of counties with less than 40 000 inhabitants, but hard to reach counties were excluded, because of their very difficult geographical access (overall exclusion of 16 counties from 351 in total).

5.3.3.b) Sampling strategy

The determination of the sample size of the 2006 CASEN survey considered the inclusion of each of the XV regions of the country (and the urban and rural communities within each of them) of a size that allowed later adequate reliability estimations. It was intended to establish a maximum absolute error of 5% and a confidence level of 95%, assuming maximum

variance (MIDEPLAN, 2006). The geographical boundaries between regions and communities within the regions were categorised by pre-defined geographical “sections”

provided by a national directory of sampling units, which was estimated in 2003 by the Chilean National Statistics Institute (INE). The complex sampling strategy used in the CASEN survey considered urban and rural stratification and two stages of random selection of participants. The first stage considered the random selection of the pre-defined sections.

The second stage was a random selection of the households within those sections. Finally, information at an individual level was collected for all the members of the selected households, from a single respondent.

5.3.3.c) Sample size and response rate

The sample for the analysis consisted of 268 873 people who belonged to a sample of 73 720 households (44 854 urban and 28 866 rural ones) from 335 counties across the 13 regions of Chile (from a total of 351 counties in the country, representing 95.4% of the total Chilean territory) (INE, 2009). The response rate of the 2006 CASEN survey was 84.8%. The mean number of households included in the CASEN survey per region was representative of the total population within each region and also representative of the population in each urban and rural setting from each region (MIDEPLAN, 2006; INE, 2009).

144 5.3.4 Recruitment and data collection

5.3.4.a) First Phase: Pre-test

Having defined the questionnaire in consultation with various stakeholders and prior to the data collection, a pre-test was conducted in order to make a quantitative and qualitative analysis of responses to the questionnaire. This was conducted in order to assess the quality of the questions, the clarity of its contents and to determine the average time required for the interview. For the pre-test, 610 urban and 390 rural questionnaires were conducted. With the results from this piloting test, corresponding adjustments were made to the questionnaire and its implementation in the field.

5.3.4.b) Data collection

Data collection technique was a face-to-face interview during November and the first half of December in 2006. Ideally, the person who took part in the interview was the head of household or spouse. However, if not present, any household member over 18 was invited to answer the survey.

A data quality surveillance system was established during data collection. In order to detect systematic non-sampling errors and missing data, a comprehensive strategy of information control was developed, which firstly consisted of a manual review of the surveys. If

systematic errors or missing values were found, then the questionnaires were returned to the interviewer for correction and completion. In addition, a random sample of around 10% of households surveyed was revisited for assessment of the accuracy of the information collected in the first visit. Data validation was also conducted through exploratory data analysis during the data collection and transcription of the instruments. The original instrument used in the CASEN survey is available in Appendix 1 in the Appendix book.

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