Health exams in Vietnam

As access to health care increases, public health advocates encourage ordinary people to get regular check-ups to detect problems before they become serious (and expensive). But not everyone follows this advice. This survey of people in Vietnam explores the factors leading people to get regular check-ups.

Motivation

Medical care for serious diseases can be very expensive, and in countries without established socialized medical systems it can impose serious hardships on patients. Ideally, patients would get regular check-ups (or “general health examinations”, GHEs) so that serious conditions could be detected and treated early, before they cause serious problems. This would save money and improve public health.

However, there are many possible obstacles to getting everyone to go to regular check-ups. They might be too expensive, or too difficult to schedule; some people may not trust doctors or believe that check-ups have any value; or some people may have had bad experiences when they previously tried to get check-ups.

Public health researchers in Vietnam wanted to explore these reasons and determine what obstacles prevented widespread use of regular check-ups. They conducted an interview survey in Hanoi and Hung Yen, Vietnam, by traveling to “secondary schools, hospitals, companies, government agencies and randomly selected households in Hanoi” and interviewing people in person for about 10-15 minutes. This dataset contains the raw data from that survey.

Data

There were 2,068 valid responses to the survey, out of 2,479 people approached. This dataset includes all the valid responses.

Data preview

vietnam-health.csv

Variable descriptions

Variable	Description
id	A unique ID for each survey respondent
date	Probably the date of the interview, in YYYYMMDD format
Age	Age of survey respondent (years)
Sex	Sex of survey respondent
Jobstt	Job status: stable, unstable, student, retired, homemaker, or other
MaritalStt	Marital status: married, unmarried, other
Edu	Maximum educational attainment (PostGrad = post-graduate, Grad = college or university, Second = high school, Hi = middle school)
height	Height (cm)
weight	Weight (kg)
place	Place the survey was conducted
BMI	Body mass index, calculated from height and weight
HealthIns	Whether the respondent has health insurance
RecExam	Time since the respondent last visited a doctor with symptoms of a disease (less12 = less than 12 months, b1224 = between 12 and 24 months, g24 = over 24 months, unknow [sic] = respondent doesn’t know)
RecPerExam	Time since respondent last visited a doctor for a check-up, not prompted by a specific illness. Coded in the same way
ReaExam	Reason for their last check-up (noti.disease = concern over illness or epidemic, adv.sig = worrying symptoms, request = requested by an employer or insurance company, volunteer = no immediate reason)
Wsttime	Does the respondent believe check-ups are a waste of time?
Wstmon	Does the respondent believe check-ups are a waste of money?
DiscDisease	Is the respondent afraid of check-ups because they’re afraid of discovering a disease?
Lessbelqual	Does the respondent have little faith in the quality of medical service?
NotImp	Does the respondent believe check-ups are not urgent or important?
HthyPriority	Does the respondent believe health is a first priority?
ComSubsidy	Are check-ups subsidized by the respondent’s employer or community?
Habit	Did the respondent get the habit of regular check-ups from their family or employer?
FlwHealth	Does the respondent constantly follow updates on their health measures?
PerTrmt	Is the respondent receiving long-term medical treatment?
AcqTrmt	Is a member of the respondent’s family receiving long-term medical treatment?
StabHthStt	Are the respondent and their family all in good health?
MedCabinet	Does the respondent keep a medical cabinet and basic medical equipment at home?
Tooluseskills	Does the respondent have the skills to use basic medical equipment?
ExpCare	Does the respondent have experience taking care of a sick family member?
ExamTools	Does the respondent’s family regularly take simple medical measurements, like blood pressure or weight?
UseMon	If the respondent were provided cash to have a check-up, what would they do? allsoon = use all the money to have a check-up soon, partly = use part of the money for a check-up and save the rest, later = take all the money and have a check-up later
Tangibles	Perceived quality of medical equipment and personnel at check-ups. Scale of 1 to 5, 1=lowest quality
Reliability	Perceived ability of examiner to perform medical services that meet the patient’s expertations, scale of 1 to 5
Respon	Perceived timeliness of check-up service, scale of 1 to 5
Assurance	Perceived knowledge or ability to assure professional reliance, scale of 1 to 5
Empathy	Perceived thoughtfulness and sense of responsibility of medical staff, scale of 1 to 5
StChoise	Respondent’s preferred way of dealing with new symptoms: clinic = go to a clinic, askrel = ask family and relatives for advice, selfstudy = do personal research.
CHPerc	Respondent’s general opinion of public health (good, quite good, bad, unknown)
SuitFreq	How often respondent believes check-ups should be done (6m = every 6 months, 12m = every 12 months, 18m = every 18 months, g18m = less often than every 18 months)
AffCost	How much the respondent believes a check-up should cost (low = less than 1 million VND, med = from 1 to 2 million VND, hi = over 2 million VND)
UseIT	Is the respondent willing to use information technology to detect health problems, if it’s reliable?
AfterIT	If a healthcare app indicated that the respondent needed to have a check-up, would they arrange one?
SuffInfo	Respondent’s rating of the sufficiency of information they received in check-ups, 1 to 5 scale
AttractInfo	Respondent’s rating of the attractiveness of information they received in check-ups, 1 to 5 scale
ImpressInfo	Respondent’s rating of the impressiveness of information they received in check-ups, 1 to 5 scale
PopularInfo	Respondent’s rating of the popularity of information they received in check-ups, 1 to 5 scale
SuitExer	How much time the respondent thinks people should spend on sports and physical exercise to stay in shape (units not given)
EvalExer	How much time the respondent spends on sports and physical exercise (verysuff = ‘more than enough’, quitesuff = ‘enough’, little = ‘only a little’, trivial = ‘none or almost none’
Age_gr	The respondent’s age, broken into one of five categories

Questions

Suppose the Assistant Minister of Health is interested in increasing the number of people who get annual health exams. The Ministry could simply send reminders or offer incentives to anyone who does not appear for an exam each year. But the budget is limited and they cannot afford to try to convince every possible patient to get a check-up. Also, the Ministry does not know why people do not sign up for exams, and understanding why could help them make policy changes or make their public relations campaigns more effective. (For example, if people tend to think check-ups are a waste of money, their advertising should emphasize how cheap they are; if people don’t believe medical service is high-quality, the advertising should emphasize the expertise and training of doctors.)

1. Overall, how do people rate the attractiveness, impressiveness, sufficiency, and popularity of information they receive in checkups? Give summaries of these variables, as well as variables like assurance, reliability, and empathy that indicate how medical personnel may be able to improve.
2. Build a classifier to predict whether the respondent had a check-up in the last 12 months (using RecPerExam). Use predictors that plausibly could be related, and discuss which predictors have the strongest relationship with the outcome. Which make a person less likely to get a check-up every twelve months?
3. The original paper (see citation below) used logistic regression to evaluate how RecPerExam can be predicted by Wsttime, Wstmon, HthyPriority, FlwHealth, and HealthIns. Try to replicate their analysis and evaluate whether logistic regression is a good modeling choice. How do its results compare to your classifier?
4. One plausible hypothesis is that none of these factors matter much unless you have health issues or know someone in their family with health issues. (This is in StabHthStt.) That is, if nobody you know has serious health issues, you may not decide to get check-ups, regardless of how attractive impressive or inexpensive they are. If you do, then the factors do influence your probability of getting a check-up. Test this hypothesis.

References

Q-H Vuong (2017). Survey data on Vietnamese propensity to attend periodic general health examinations. Scientific Data 4 170142. https://doi.org/10.1038/sdata.2017.142

Data available from the Open Science Framework: https://osf.io/afz2w/