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Journal of Public Health Advance Access originally published online on May 16, 2007
Journal of Public Health 2007 29(3):316-320; doi:10.1093/pubmed/fdm022
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© The Author 2007, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved

Accuracy of health examination results self-reported by Japanese participants



Hideki Fukuda, Assistant Professor in Oral Health1,

Fumiaki Shinsho, Director of Dental Health Center2
1 Department of Oral Health, Unit of Social Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8588, Japan
2 Nanko Community Dental Health Center in Sayo, 1005-1 Simotokusa, Sayo-town Hyogo 679-5211, Japan

Address correspondence to Hideki Fukuda, E-mail: fhideki{at}nagasaki-u.ac.jp

Background We evaluated the accuracy of self-reported health examination results by participants regarding their most recent public health examination by comparing their answers to the medical records in order to determine individual factors related to self-reporting accuracy.

Methods The study was conducted at Settsu City in Osaka prefecture, Japan, in 1998 with 3570 participants who underwent general health examinations conducted by the municipal government. All participants were interviewed regarding their lifestyle as well as health guidance given at their previous examination, after which their answers were compared with the data from their medical records. The adjusted odds ratio (OR) for providing accurate self-reporting was calculated by multivariate logistic analyses.

Results The frequency of accurate self-reporting was 49.4% and the overall Kappa value was 0.34. The OR for accurate self-reporting was lowest for those who have a poor lifestyle compared with those who had a good lifestyle.

Conclusion The accuracy of self-reported health examination results was poor. We concluded that information based on self-reported results of a health examination must be considered carefully. Further, lifestyle was found to be associated with the ability to accurately recall. Thus, methods for providing guidance to individuals with a poor life style must be carefully examined.

Keywords: accuracy of self-reporting, general health examination, lifestyle


   Background
TOP
 Background
Methods
 Results
 Discussion
 Conflict of interest statement
 References
 
A national health policy termed ‘Kenkou-Nippon-21’ (Healthy Japan 21), instituted in Japan in 2000, recommends that all residents seek to promote their own health and urges municipal governments to support such self-motivated health promotion. With imrplementation of this health policy, it has become important for residents to receive health examinations regularly and change their daily habits for a healthier lifestyle by using appropriate guidance based on the results of those examinations.

As of 2001, there were 3244 separate Japanese municipal governments, each of which have the responsibility to conduct general health examinations for their residents aged ≥40 as mandated by the ‘Act of the Elderly’ in 1984. The number of individuals who attended such examinations in Japan in 2002 was 12.3 million and the utilization rate of those results among targeted individuals was reported to be 42.6%. As part of the follow-up procedure following those health examinations, the municipal governments provide appropriate health guidance to all individuals based on the results.

There are numerous studies on the accuracy of answers given during personal interviews or in self-reported questionnaires related to clinical events, such as cancer screening tests,1–9 hospitalization,10 fractures11 and medication use.12 However, few have been conducted regarding the accuracy of self-reported general health examination results. In order to promote the efforts of the general population to promote their own health, it is essential to maintain accurate health information. The purpose of this study was to evaluate the accuracy of self-reported health results obtained at general health examinations compared with the records kept by the municipal government in order to determine individual factors related to self-reporting accuracy.


   Methods
TOP
 Background
 Methods
Results
 Discussion
 Conflict of interest statement
 References
 
The present study was conducted in S. City, a municipal government in Osaka prefecture, Japan. In 2000, the population was 83 000 and individuals aged ≥65 years comprised 13%. General health examinations were offered by the municipal government in 1998, which were utilized by 3570 residents. All residents of S. City who utilized a general health examination at least once during the period from 1993 to 1997 were asked to participate in this study, of whom 2638 were enrolled. Each subject was interviewed regarding their daily lifestyle and health status by trained nurses.

S. City has a health committee that plans and evaluates health-related activities provided by the city, which is composed of physicians, university academic staff, citizen representatives and city health department staff. The present study design and contents of the questionnaire were discussed and approved by that committee. All participants received a brochure explaining the objectives of the study prior to the interview.

On the basis of the results of the general health examination, S. City provides the following types of health guidance to all examinees based on the results.

Normal—no need for medical guidance or detailed physical examination.

Need medical advice—medical advice needed to change to an appropriate lifestyle.

Need physical examination—detailed physical examination needed.

Need medical consultation—medical consultation with a physician needed.

The self-reported health results from the most recent general health examination was compared with the medical records kept by S. City municipal government. If a participant answered correctly regarding the health guidance given after his/her last general health examination, his/her answer was defined as accurate self-reporting.

Health department staff of S. City compared the data from the questionnaire with municipal medical records using the subject name. After matching the data, personal information, such as name, address, and phone number, were deleted before analyzing the results.

General health examination has been carried out by all Japanese municipalities in order to find risk behaviors and conditions for the occurrence of lifestyle-related diseases. Current smoking status, current drinking status and obesity are considered risk factors for lifestyle-related diseases in the questionnaire, with the answers categorized into three groups and points, as follows:

Current smoking status: no = 0 points, <19 cigarettes per day = 1 point, ≥20z per day = 1 point.

Current drinking status: none = 0 points, <45 g of ethanol per day = 0 points, >45 g of ethanol per day = 1 point.

Body mass index (BMI): <24.2 = 0 points, ≥24.2 = 1 point.

A lifestyle index ranging from 0 to 3 points was calculated by adding the points of the above three variables, with larger numbers considered to indicate a poor lifestyle.

Percentage of accurate self-reporting was calculated using the official medical records. In addition to this, Kappa statistics, which correct the proportion of agreement due to chance, were used to evaluate the agreement between the self-reported health guidance and medical records. Kappa values <0.40 were considered to indicate poor to fair agreement, from 0.40 to 0.60 indicated moderate agreement, 0.60 to 0.80 indicated substantial agreement and 0.80 to 1.00 indicated nearly perfect agreement.13 The adjusted odds ratio (OR) for providing accurate self-reporting was calculated by logistic analyses using SPSS 12.0 J.


   Results
TOP
 Background
 Methods
 Results
Discussion
 Conflict of interest statement
 References
 
The frequency of accurate self-reporting was 49.4% and the overall Kappa value was 0.34, indicating that the accuracy of the self-reported health guidance was poor. Further, 1207 of the 2638 participants indicated that their previous health results were better than the actual, for a percentage of overestimation of 45.8%. In contrast, the percentage of underestimation was only 4.9% (Table 1).


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  		Table 1 Discrepancy between actual results and self-reported results from the most recent health examination

 
The frequency of accurate self-reporting declined significantly with increasing lifestyle index points, as those who with a poor health condition tended to provide an inaccurate self-report in comparison with those whose lifestyle condition was good or excellent. The frequency of accurate self-reporting also decreased in order of actual health guidance (normal, 90.1%; need medical advice, 52.5%; need physical examination, 46.6%; need medical consultation, 42.9%). In addition, the time elapsed from the last health examination was a significant factor related to accurate self-reporting frequency (Table 2).


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  		Table 2 Percentage of accurate self-reporting by individual participants

 
After adjusting for all of the variables, the OR for accurate self-reporting was significantly associated with lifestyle index, perceived health status, actual health results from the last health examination and time elapsed from the last health examination. The OR for accurate self-reporting was lowest for those who had 2 or 3 points in the lifestyle index (OR = 0.58 with 95% CI = 0.40–0.86), compared with the excellently perceived health condition (OR = 0.66 with 95% CI = 0.48–0.92), need medical consultation (OR = 0.08 with 95% CI = 0.05–0.13), and ≥5 years from the last health examination (OR = 0.23 with 95% CI = 0.07–0.83) (Table 3).


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  		Table 3 Association of individual characters to accurate self-reporting

 

   Discussion
TOP
 Background
 Methods
 Results
 Discussion
Conflict of interest statement
 References
 
A general health examination is useful for determining individual health status and promoting healthy behavior. However, the present results showed that the accuracy rate of self-reporting of those results was only 49% and the Kappa values were also poor. Irie et al.14 studied the correct recollection of medical checkups of Japanese industry personnel and found that the accuracy rate of those workers was 49%, which was the same as seen in our study. The participants in both studies were community dwelling, and approximately half could not accurately recall the results of their last health examination. On the basis of these results, we concluded that caregivers must carefully investigate the information presented regarding the self-reported health status.

The OR for providing accurate self-reporting was lowest among those categorized as need medical consultation. S. City provides mass health examinations at the city health center, which must be traveled to independently. Even those categorized as need medical consultation must first go to the health center from their residence and wait for a few hours for their turn. Thus, such individuals likely do not have severe physical problems, although they may have abnormal physical values, indicating such conditions as hypertension, hyperglycemia and cholesteremia. The high prevalence and insidious nature of those conditions increase the likelihood that individuals are unaware of their condition,15 and those who regard themselves to have a below average risk tend to have lower anxiety levels. Irie et al.14 considered that individuals who mistakenly stated their actual health status at a follow-up examination were inclined to have an optimistic view, whereas individuals determined as need medical consultation but without severe health symptoms might not seriously consider their health risk and underestimate the importance of the official guidance received. The results obtained in the present study support those notions, as participants who indicated their health status to be excellent had a lower accuracy rate than those who considered their health to be poor, possibly because of a misunderstood concept of their own health.

According to a national survey in 2003, the rate of smoking was 46.8% among men and 11.3% among women in Japan, and the alcohol consumption rate among males was also higher. In the present study, the accuracy rate among males was lower than that among females. We considered that males may be less concerned about their health status, and health guidance for males should be explained more carefully.

The present results showed that lifestyle was significantly associated with accurate self-reporting. A few studies12,16,17 regarding the relationship between accurate recall and lifestyle have been conducted, which found that lifestyle habits such as smoking only slightly influenced the recall of past drug use or hospitalization. Relationship between lifestyle and recall was complex, because lifestyle such as smoking, drinking and obesity were associated with socio-economic status.18–21 Current smoking status, lower educational attainment and lower income were associated with a failure to identify smoking as the main cause of death.22 Low socio-economic status group had low adherence to calcium/vitamin D intake23 and mammography utilization.24 It is possible that those who have a poor lifestyle or low socio-economic status may be less interested in their health status. Health examination results should be carefully explained to individuals with a poor lifestyle and low socio-economic status. Evaluation of socio-economic status was not available in this study and it is recommended that further studies address this issue.

The adjusted OR for accurate self-reporting by older participants was significantly lower than by younger participants, as a decline in memory with increase in age is a common finding. The percentage of those who ‘need medical consultation’ from the last health examination is thought to be higher among older participants than younger participants. Result of the latest examination may change with age of participants. However, the results of the latest health examination was associated with accurate self-reporting significantly after adjusting for age of participants.

A long period since the latest health examination was associated with incorrect answers. Accurate self-reporting rate decreased from 51% among those who received health examination last year to 25% among those who received the latest examination before 5 years. We would like to recommend the residents to receive health examination annually, because recall of their medical results will likely to disappear after years.

To promote individual health awareness with appropriate guidance, local governments in Japan should explain the results carefully to the residents who belong to the groups with poor recall.


   Conflict of interest statement
TOP
 Background
 Methods
 Results
 Discussion
 Conflict of interest statement
References
 
None declared.


   References
TOP
 Background
 Methods
 Results
 Discussion
 Conflict of interest statement
 References
 

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