Survey background, structure and sampling

Citizens' readiness to use electronic services has increased in Finland: According to Statistics Finland, in 2014 already 90% of Finnish people aged 16–74 used internet-based e-services, and the majority of them had network connections at home (Tilastokeskus 2014). Changing health care provision and administrative structures, population aging and personnel and resource shortages will increase the interest in developing electronic services for citizens in social welfare and health care. The new e-health strategy has ambitious goals and an action plan for implementing e-health and e-welfare services in Finland by 2020 (Ministry of Sosial affairs and Health 2015). The aim is to support the social and health care reform in Finland and activate citizens in maintaining their well-being through development of social and health care information management and e-services. The strategy strives to ensure that citizens use online services and produce information on their health for themselves and for professionals. The means to achieve this include ensuring availability of reliable online information on health and well-being and services that support it, a national platform for storing and sharing citizen’s own measurement results, and further development of online services developed in the Ministry of Finance in an Action Programme on e-services and democracy (SADe-programme).

In 2014, prior to the e-health and e-welfare strategy implementation, e-health and e-welfare services provided for citizens at national level included viewing of electronic prescriptions and patient data in addition to the e-government services for the health and welfare sector, which had been developed by the Ministry of Finance in SADe-programme). Already in 2010, there were numerous local internet-based services provided by the municipalities and hospital districts, as well as a wealth of development projects as depicted in Table 1 (Hyppönen, Iivari et al. 2011).

Table1 Local internet-based services and development projects in 2010

Application to services (social care)/

Patient-provided anamnesis (health care)

8 % 27 % 21

Self-assessment 19 % 3/21 10 % 26

Triage 74 % 29

Storing of patient-provided health data

1 % 1/21 45

Mediating of patient-provided health data project co-funded by the Ministry of Social Affairs and Health and the Ministry of Finance in Finland. It represents the baseline of e-health and e-welfare services in Finland in 2014 and provides a reference point against which the strategy deployment and goals can be benchmarked later as e-health and e-welfare services expand. The study questions were:

 To what extent do citizens use different health care service functionalities traditionally vs. electronically?

 What experiences do citizens have of existing electronic e-health functionalities?

 What are citizens’ needs regarding e-health services/functionalities?

5.1.1 Survey design and structure

The questionnaire was designed using prior questionnaires from Finland (Jauhiainen, Sihvo et al. 2014, Kaikkonen, Murto et al. 2014), Denmark (Tornbjerg, Bertelsen 2014), Canada (HarrisDecima, The Conference Board of Canada 2012), the USA (Silvestre, Sue et al. 2009, DeSilva 2014), and Norway (Wangberg, Andreassen et al. 2009) of citizens’ and patients’ experiences of e-services. In addition, the goals of the SADe-programme and information needs of the developers, implementers and managers of the national e-health and e-welfare services were collected as a basis for designing the survey. A ready-made survey could not be found to meet all the information needs. A longstanding Regional Health and Well-being Study (ATH) (Kaikkonen, Murto et al. 2014) had useful questions regarding respondents' background information, health, health behaviour and use of health services, which were adopted into the questionnaire. The questionnaire contains the topics presented in Table 2.

Table 2 Citizen survey structure

Survey Topics No. of questions No. of

sub-questions

1. Demographics of the respondent 9 2

2. Health, functional ability and life style 8 5

3. Utilisation rate of health service functionalities

(traditionally/ electronically) 2 21

4. Utilisation on behalf of others 1 9

5. Utilisation rate of specific web-services 1 18

6. Adequacy/ sufficiency of listed services 1 14

7. Average cost and time spent on one visit 1 2

8. Usability and utility of electronic services 1 3

9. Importance of goals for developing e-health and

e-welfare services 1 19

10. Barriers to uptake/ use of e-services 1 20

11. Importance of getting listed services

electronically 1 25

12. Interest in participating in development of

e-health and e-welfare services 1

13. Comments 1

The electronic version of the survey questionnaire is presented in http://urn.fi/URN:ISBN:978-952-302-563-9

5.1.2 Sampling and data

A representative sample (N=15 000) of the Finnish population in terms of age, gender, municipality of residence and language spoken, who were not living in an institution and were over 18 years old, was obtained from the Population Register

Centre in May 2014. The respondents received a letter containing a cover letter, a response form, and a raffle ticket to participate in a draw for several prizes if they were to participate. In addition, a postage-paid envelope was included, in which the respondent could return the completed questionnaire. The questionnaire contained an internet address for the electronic version of the survey, as well as a personal username for those who wanted to respond electronically.

The survey was conducted in May to August 2014. There were two reminders sent to the respondents, one in the second half of June, and another at the end of July. Altogether 4703 questionnaires were returned (original response rate 35%), of which 453 were via the Internet, and the remaining 4250 were on paper. In order to accept the questionnaire into the data sample, 60% of questions needed to be answered in addition to the obligatory questions. A total of 4015 replies were accepted and included in the final analysis (final response rate 27%).

5.1.3 Representativeness and weighting of the sample

In spite of the sampling method (representative sample from the population register), it is impossible to control who will respond. Regionally and by language the respondents represented well the actual population, but age and gender variation was typical for surveys: Women and older people were the most active respondent groups. For this reason the data were weighted using population data from Statistics Finland to correspond to the population characteristics (Table 3)

5.1.4 Data analysis

Descriptive analyses (distributions and cross tables where the significance of responses was tested by the chi-square test) and logistic regression analyses were carried out mainly by a statistical analysis program from the research company TNS Gallup Oy. In addition THL used SPSS software to further analyse the data where the results were interesting to follow up and present. The results are reported using tables and graphs. The cases were weighed according to gender, age, region and language spoken in order to ensure representativeness of the data (Table 3).

Table 3 Weighing of the cases over the age of 76 years. One third had a university-level and one third vocational intensity (Figure 1).

Figure 1 Respondents’ age and education distribution.

0 %