This report presents the study design and recruitment outcomes for the ‘Health in Germany’ panel, a long-term population-based health survey infrastructure developed by the Robert Koch Institute. The initial recruitment was conducted using a stratified random sample of the German population and a mixed-mode approach combining web-based and paper questionnaires. We examine participation rates across demographic subgroups, assess sample composition, and analyze potential selection effects. The panel recruitment survey for the ‘Health in Germany’ panel utilized the residents’ registration offices as the sampling frame. A two-stage stratified (cluster) sample was drawn from 359 primary sampling units across Germany. A mixed-mode approach was employed, offering both online and paper survey-mode on the basis of age groups. The sequence of survey modes was differentiated by age groups based on information from the residents’ registration offices. For respondents aged 16–69 years, a sequential mixed-mode design, offering the online mode first and only with the second reminder the paper survey-mode (also called push-to-web strategy), was applied. For respondents aged 70 years and older a simultaneous mixed-mode design was used, offering the online and paper survey-mode with the invitation. Participants completed a first panel recruitment survey in which socio-demographic and health data were collected. Selection effects and sample composition were analyzed via logistic regression models and compared with official population data. A total of 62,556 interviews were conducted, with 49,766 participants consenting to join the panel. After double opt-in registration process (for online participants), 47,863 remained. Response rates were higher among women and younger participants. Online participation predominated in the sequential design, whereas offline participation was more common in the simultaneous design. Logistic regression indicated higher participation among women and residents of smaller municipalities. Overall, the sample composition aligned broadly with population benchmarks, except for education and citizenship. The first recruitment study for the ‘Health in Germany’ panel established one of Europe’s largest population-based health panels through a mixed-mode design. Future expansions include regular health surveys, biometric measurements, complementary self-recruitment alongside the probability-based sample, and the development of a mobile survey app.

Background:As the RKI's new data collection infrastructure, the RKI Panel 'Health in Germany' offers the opportunity to regularly collect primary data on topics relevant to public health among the population in Germany (survey mode: online - CAWI and written - PAPI). This article presents the participation rates for the sub-waves and the composition of the sample. It also describes the special features of the 2024 annual survey. Methods:The 2024 annual survey followed on from the initial recruitment study of the RKI panel. For this survey wave, the registered panel participants were surveyed in three sub-waves with four different questionnaires on different topics. Results:Participation rates between 81.3 % and 75.3 % were achieved in the three sub-waves of the 2024 annual survey. In the first sub-wave, 38,212 people participated, and in the second, 36,134 interviews were conducted. The third and final sub-wave comprised 35,786 interviews. Conclusions:The 2024 annual survey provides a comprehensive data basis for various public health-related issues. The following topics are covered: physical and mental health, use of healthcare services, health-related behaviour, health literacy, social conditions, and the relationship between climate change and health. The data refer to the German resident population aged 18 and over.

Day care study showed no differences in long-term symptoms in children who were and were not infected during COVID-19 outbreaks COVID-19 has tended to be mild in children, but the risk of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) being transmitted in day care centres has been high. 1 Our aim was to fill the gap in the research on the long-term symptoms experienced by young children after becoming infected.

Background:The panel infrastructure Health in Germany, which is currently being set up, is geared towards the needs of public health research in Germany. The panel will consist of extensive probability and non-probability samples. This infrastructure will be used to collect survey data, measurement data and laboratory data to describe the health situation on an ongoing basis and make them available promptly. Methods:For the initial drawing of the probability sample, the sampling frame of the residents' registration offices (EMA) established in Germany is used. The study design follows a mixed-mode approach in which the invited persons can choose whether to participate in the survey online or in paper form. Four surveys per year are planned for the regular operation of the panel (regular annual wave). Ad-hoc studies on specific topics or acute issues are also possible. Conclusions:The panel provides a new infrastructure for continuous epidemiological studies to monitor the health of the population in Germany. This data basis strengthens the health monitoring and health reporting of the federal government, enabling a prompt and adaptable response to emerging data needs.

Abstract Background The Robert Koch Institute (RKI) is developing a new panel infrastructure, ‘Health in Germany,’ to enhance public health research through continuous, rapid data collection from questionnaire surveys, measurements, and laboratory analyses. Using online and offline collection methods (CAWI and PAPI), the project aims to have 30,000 registered panelists by Spring 2024. Methods The sample of the recruitment study is based on address data from Germany’s local registration offices, whereby a mixed-mode design is used for data collection. Individuals aged 16-69 receive an initial online-only invitation, followed by postal reminders that include a paper questionnaire. For those aged 70 and above, both online and paper options are available from the outset. Incentives include an unconditional €5 cash payment for all invitees and an additional €10 for successful registration into the panel infrastructure. Results The initial response rate of the recruitment study is 35%. Of the CAWI participants, approx. 90% expressed willingness to participate again, with approx. 80% completing the online registration. To date, over 42,000 panelists have been recruited. Further detailed results on response rates, non-response bias, and sample composition will be presented at the conference. Conclusions RKI’s ‘Health in Germany’ is one of the largest probability panels in public health research, effectively gathering and analyzing data. The recruitment success and strong participant engagement highlight the infrastructure’s efficiency and its significant contribution to epidemiological research in Germany. Key messages • Successful recruitment of over 42,000 panelists demonstrates robust engagement and effective implementation. • The push-to-web strategy (or web-push strategy) underscores the infrastructure’s adaptability and efficiency.

In der Studie Gesundheit in Deutschland aktuell (GEDA 2019/2020-EHIS) beantworteten 23.001 Menschen im Alter ab 15 Jahren zwischen April 2019 und September 2020 Fragen zur Gesundheit und zur Lebenssituation. Die Ergebnisse sind repräsentativ für die in Deutschland lebende Wohnbevölkerung ab 15 Jahren. Die Responserate lag bei 21,6 %. Die Fragebogeninhalte basieren auf der dritten Welle der Europäischen Gesundheitsbefragung (European Health Interview Survey, EHIS), die in allen EU-Mitgliedstaaten durchgeführt wurde. Sie umfasst die vier Module Gesundheitszustand, Gesundheitsversorgung, Gesundheitsdeterminanten und sozioökonomische Variablen. Die harmonisiert erhobenen EHISDaten besitzen ein hohes Maß an internationaler Vergleichbarkeit. Sie stellen eine wichtige Informationsgrundlage für die europäische Gesundheitspolitik und -berichterstattung dar und werden vom Statistischen Amt der Europäischen Union (Eurostat) zur Verfügung gestellt. Die Daten sind Grundlage für die Gesundheitsberichterstattung des Bundes. Der Zeitraum der Datenerhebung ab April 2019 berücksichtigte knapp ein Jahr vor der SARS-CoV-2-Pandemie und fiel dann ab März 2020 in die Anfangsphase der Pandemie. Somit stehen mit der aktuellen GEDA-Welle Daten für die Erforschung von gesundheitlichen Auswirkungen im zeitlichen Zusammenhang mit der SARS-CoV-2-Pandemie zur Verfügung. STUDIENMETHODIK · GESUNDHEITSBEFRAGUNG · TELEFONINTERVIEW · GESUNDHEITSMONITORING · EHIS · RESPONSE

Between April 2019 and September 2020, 23,001 people aged 15 or over responded to questions about their health and living conditions for the German Health Update (GEDA 2019/2020-EHIS). The results are representative of the German resident population aged 15 or above. The response rate was 21.6%. The study used a questionnaire based on the third wave of the European Health Interview Survey (EHIS), which was carried out in all EU member states. EHIS consists of four modules on health status, health care provision, health determinants, and socioeconomic variables. The data are collected in a harmonised manner and therefore have a high degree of international comparability. They constitute an important source of information for European health policy and health reporting and are made available by the Statistical Office of the European Union (Eurostat). They also form the basis of the Federal Health Reporting undertaken in Germany. Data collection began in April 2019, just under a year before the beginning of the SARS-CoV-2 pandemic, and continued into its initial phase, as of March 2020. As such, data from the current GEDA wave can also be used to conduct research into the health impact of the SARS-CoV-2 pandemic.

Introduction: Until today, the role of children in the transmission dynamics of SARS-CoV-2 and the development of the COVID-19 pandemic seems to be dynamic and is not finally resolved. The primary aim of this study is to investigate the transmission dynamics of SARS-CoV-2 in child day care centers and connected households as well as transmission-related indicators and clinical symptoms among children and adults.Methods and Analysis: COALA ("Corona outbreak-related examinations in day care centers") is a day care center- and household-based study with a case-ascertained study design. Based on day care centers with at least one reported case of SARS-CoV-2, we include one- to six-year-old children and staff of the affected group in the day care center as well as their respective households. We visit each child's and adult's household. During the home visit we take from each household member a combined mouth and nose swab as well as a saliva sample for analysis of SARS-CoV-2-RNA by real-time reverse transcription polymerase chain reaction (real-time RT-PCR) and a capillary blood sample for a retrospective assessment of an earlier SARS-CoV-2 infection. Furthermore, information on health status, socio-demographics and COVID-19 protective measures are collected via a short telephone interview in the subsequent days. In the following 12 days, household members (or parents for their children) self-collect the same respiratory samples as described above every 3 days and a stool sample for children once. COVID-19 symptoms are documented daily in a symptom diary. Approximately 35 days after testing the index case, every participant who tested positive for SARS-CoV-2 during the study is re-visited at home for another capillary blood sample and a standardized interview. The analysis includes secondary attack rates, by age of primary case, both in the day care center and in households, as well as viral shedding dynamics, including the beginning of shedding relative to symptom onset and viral clearance.Discussion: The results contribute to a better understanding of the epidemiological and virological transmission-related indicators of SARS-CoV-2 among young children, as compared to adults and the interplay between day care and households.

Existing health survey data of individuals who are 65+ years of age is limited due to the exclusion of the oldest old and physically or cognitively impaired individuals. This study aimed to assess the effects of a sequential mixed-mode design on (1) contact and response rates, (2) sample composition and (3) non-response bias. A register-based random sample of 2,000 individuals 65+ years was initially contacted by mail to answer a health questionnaire. Random subgroups of initial non-responders were further contacted by telephone or home visits. Participation by interview or proxy was possible. After postal contact only, the initial contact and response rates were 51.7% and 37.8%, respectively. The contact and response rates increased to 71.1% and 44.6%, respectively, after all contact steps. A different sample composition regarding sociodemographic (i.e., older individuals) and health characteristics (i.e., worse self-rated health, more functional impairments) was achieved by the inclusion of those late participants. Ill health was the second most frequent reason for non-participation. Personal contact modes are important to increase contact and response rates in population-based health studies and to include hard-to-reach groups such as the oldest or physically impaired individuals. However, non-response bias still occurred.

Nursing home residents (NHRs) are systematically excluded from the target populations of most population-based health surveys, which may result in biased prevalence estimates. Researchers who wish to include NHRs in surveys face several challenges including difficulty sampling and contacting NHRs and greater levels of functional impairments impeding participation. A population-wide, register-based, random sample of 8,000 older individuals (57.1% women, mean age=76.2 years) in six primary sampling units (PSUs) in Germany was used to analyse NHR coverage. The contact and response rates among NHRs were compared to those among persons living in private households in two PSUs (N=2,000) by applying an informed sequential mixed-mode design. All persons received a health questionnaire by mail, and random subgroups of initial non-respondents were further contacted by telephone or personal visits. The population-wide, register-based, random sample included a substantial proportion of NHRs that nearly approximated the national rate of 4.2% NHRs among individuals ≥65 years. Never-theless, undercoverage of a specific subgroup of NHRs was apparent. The contact and re-sponse rates were significantly lower among NHRs than persons in private households (contact: 49.0% vs. 72.9%; response: 20.0% vs. 45.9%). Therefore, it remains questionable if NHRs can be included in regular national health monitoring programmes.

Repräsentative Daten zur gesundheitlichen Lage hochaltriger Personen in Deutschland sind derzeit begrenzt, da diese Personengruppe unter anderem in den bisherigen RKI-Gesundheitssurveys nur unzureichend erreicht oder ausgeschlossen wurde. Um zukünftig verlässlichere Daten für Präventionsbedarfe zur Verfügung stellen zu können, wurde in einer Gesundheitsbefragung ab 65 Jahren ein erweitertes Erhebungsdesign zur Verbesserung der Teilnahmeraten dieser Zielgruppe getestet.

Gesundheitlich eingeschränkte ältere Menschen, insbesondere Pflegeheimbewohner/innen (PHB), sind in den bisherigen RKI-Gesundheitssurveys nur begrenzt erreicht worden oder waren von der Grundgesamtheit ausgeschlossen. Im Rahmen der Machbarkeitsstudie „Improving Health Monitoring in Old Age“ (IMOA), gefördert durch die Robert-Bosch-Stiftung, wurde ein erweitertes Erhebungsdesign getestet, mit dem die Erreichbarkeit dieses Personenkreises künftig verbessert werden soll.

Die Datenlage zur Gesundheit älterer Menschen in Deutschland ist aktuell unzureichend. Im Rahmen des durch die Robert Bosch-Stiftung geförderten Projekts „Improving Health Monitoring in Old Age“ (IMOA) erarbeiten wir ein Konzept zur Erweiterung des bundesweiten Gesundheitsmonitorings für die Bevölkerung ab 65 Jahren, das dazu beitragen soll, bestehende Datenlücken zu schließen. Wichtiger Bestandteil des Projekts ist die Definition von Kernindikatoren für die Gesundheit im höheren Lebensalter.

Background Population-based surveys currently face the problem of decreasing response rates. Mixed-mode designs are now being implemented more often to account for this, to improve sample composition and to reduce overall costs. This study examines whether a concurrent or sequential mixed-mode design achieves better results on a number of indicators of survey quality. Methods Data were obtained from a population-based health interview survey of adults in Germany that was conducted as a methodological pilot study as part of the German Health Update (GEDA). Participants were randomly allocated to one of two surveys; each of the surveys had a different design. In the concurrent mixed-mode design ( n = 617) two types of self-administered questionnaires (SAQ-Web and SAQ-Paper) and computer-assisted telephone interviewing were offered simultaneously to the respondents along with the invitation to participate. In the sequential mixed-mode design ( n = 561), SAQ-Web was initially provided, followed by SAQ-Paper, with an option for a telephone interview being sent out together with the reminders at a later date. Finally, this study compared the response rates, sample composition, health indicators, item non-response, the scope of fieldwork and the costs of both designs. Results No systematic differences were identified between the two mixed-mode designs in terms of response rates, the socio-demographic characteristics of the achieved samples, or the prevalence rates of the health indicators under study. The sequential design gained a higher rate of online respondents. Very few telephone interviews were conducted for either design. With regard to data quality, the sequential design (which had more online respondents) showed less item non-response. There were minor differences between the designs in terms of their costs. Postage and printing costs were lower in the concurrent design, but labour costs were lower in the sequential design. No differences in health indicators were found between the two designs. Modelling these results for higher response rates and larger net sample sizes indicated that the sequential design was more cost and time-effective. Conclusions This study contributes to the research available on implementing mixed-mode designs as part of public health surveys. Our findings show that SAQ-Paper and SAQ-Web questionnaires can be combined effectively. Sequential mixed-mode designs with higher rates of online respondents may be of greater benefit to studies with larger net sample sizes than concurrent mixed-mode designs.

The Robert Koch Institute (RKI) regularly conducts nationally representative cross-sectional studies (KiGGS, DEGS and GEDA) as part of the nationwide health monitoring system. In addition to these health surveys, data is collected in telephone interviews either on specific thematic fields (such as diabetes) or specific groups (such as medical staff) that were not or only insufficiently covered by the larger health surveys. As they are flexible and fast, ad hoc surveys conducted via telephone interviews can respond to specific epidemiological and health political questions. This article describes the procedures applied in ad hoc telephone interview surveys, which were newly introduced as a standardised method in 2017 and are applied by the Laboratory for Health Surveys at the RKI. The article presents the stages of project management such as concept development, establishment of a concept for data protection, questionnaire development, pre-test and field phase, calculation of weighting factors and provision of the final data set. The aim is to describe the process and shed light on the standardised procedures, the reported quality indicators and the breadth of possible scenarios of application.

Introduction: Influenza vaccination of children with underlying chronic diseases is currently recommended in Germany, but targeting all children constitutes an alternative approach to control seasonal influenza. To inform the modelling of vaccination impact and possible communication activities, we aimed to assess among parents the acceptance of universal childhood vaccination against seasonal influenza and possible modifiers.Methods: We conducted a telephone survey in households in Germany using random digit dialing. We interviewed parents with children aged <18 years by constructing three hypothetical scenarios in subsequent order: (1) hearing about the influenza vaccination recommendation through the media, (2) the vaccine being recommended by a physician, and (3) being informed about the availability of the vaccine as a nasal spray. We calculated the proportion of parents who would immunize their child and used univariable and multivariable logistic regression to identify factors associated with influenza vaccination intention.Results: Response was between 22 and 46%. Of 518 participants, 74% were female, mean age was 41.3 years. Participants had on average 1.6 children with a mean age of 8.9 years. In scenario 1, 52% of parents would immunize their child, compared to 64% in scenario 2 (p < 0.01) and to 45% in scenario 3 (p = 0.20). Factors independently associated with vaccination acceptance in scenario 1 were previous influenza vaccination of the child or parent (adjusted odds ratio [aOR] 4.5 and 8.6, respectively), perceived severity of influenza.(aOR = 5.1) and living in eastern Germany (aOR = 2.4).Conclusion: If seasonal influenza vaccination was recommended for all children, more than half of the parents would potentially agree to immunize their child. Involving physicians in future information campaigns is essential to achieve high uptake. As intranasal vaccine administration is non-invasive and easily done, it remains unclear why scenario 3 was associated with low acceptance among parents, and the underlying reasons should be further explored. (C) 2017 Elsevier Ltd. All rights reserved.

Main goal of the Improving Health Monitoring in Older Age (IMOA) project is to provide a framework for an indicator-based public health monitoring of the population aged 65 years and older. The workshop served as a forum to discuss and agree upon relevant concepts with gerontologists, nursing care and public health scientists.