The Effect of Framing and Placement on Linkage Consent

Linking health survey data with health insurance data: methodology, challenges, opportunities and recommendations for public health research. An experience from the HISlink project in Belgium

In recent years, the linkage of survey data to health administrative data has increased. This offers new opportunities for research into the use of health services and public health. Building on the HISlink use case, the linkage of Belgian Health Interview Survey (BHIS) data and Belgian Compulsory Health Insurance (BCHI) data, this paper provides an overview of the practical implementation of linking data, the outcomes in terms of a linked dataset and of the studies conducted as well as the lessons learned and recommendations for future links.Individual BHIS 2013 and 2018 data was linked to BCHI data using the national register number. The overall linkage rate was 92.3% and 94.2% for HISlink 2013 and HISlink 2018, respectively. Linked BHIS-BCHI data were used in validation studies (e.g. self-reported breast cancer screening; chronic diseases, polypharmacy), in policy-driven research (e.g., mediation effect of health literacy in the relationship between socioeconomic status and health related outcomes, and in longitudinal study (e.g. identifying predictors of nursing home admission among older BHIS participants). The linkage of both data sources combines their strengths but does not overcome all weaknesses.The availability of a national register number was an asset for HISlink. Policy-makers and researchers must take initiatives to find a better balance between the right to privacy of respondents and society's right to evidence-based information to improve health. Researchers should be aware that the procedures necessary to implement a link may have an impact on the timeliness of their research. Although some aspects of HISlink are specific to the Belgian context, we believe that some lessons learned are useful in an international context, especially for other European Union member states that collect similar data.

Privacy Attitudes toward Mouse-Tracking Paradata Collection

Survey participants' mouse movements provide a rich, unobtrusive source of paradata, offering insight into the response process beyond the observed answers. However, the use of mouse tracking may require participants' explicit consent for their movements to be recorded and analyzed. Thus, the question arises of how its presence affects the willingness of participants to take part in a survey at all-if prospective respondents are reluctant to complete a survey if additional measures are recorded, collecting paradata may do more harm than good. Previous research has found that other paradata collection modes reduce the willingness to participate, and that this decrease may be influenced by the specific motivation provided to participants for collecting the data. However, the effects of mouse movement collection on survey consent and participation have not been addressed so far. In a vignette experiment, we show that reported willingness to participate in a survey decreased when mouse tracking was part of the overall consent. However, a larger proportion of the sample indicated willingness to both take part and provide mouse-tracking data when these decisions were combined, compared to an independent opt-in to paradata collection, separated from the decision to complete the study. This suggests that survey practitioners may face a trade-off between maximizing their overall participation rate and maximizing the number of participants who also provide mouse-tracking data. Explaining motivations for paradata collection did not have a positive effect and, in some cases, even reduced participants' reported willingness to take part in the survey.

Ethical Considerations for Augmenting Surveys with Auxiliary Data Sources

Survey researchers frequently use supplementary data sources, such as paradata, administrative data, and contextual data to augment surveys and enhance substantive and methodological research capabilities. While these data sources can be beneficial, integrating them with surveys can give rise to ethical and data privacy issues that have not been completely resolved. In this research synthesis, we review ethical considerations and empirical evidence on how privacy concerns impact participation in studies that collect these novel data sources to supplement surveys. We further discuss potential approaches for safeguarding participants' data privacy during data collection and dissemination that may assuage their concerns. Finally, we conclude with open questions and suggested avenues for future research.

Reducing Nonresponse and Data Linkage Consent Bias in Large-Scale Panel Surveys

Selection bias is an ongoing concern in large-scale panel surveys where the cumulative effects of unit nonresponse increase at each subsequent wave of data collection. A second source of selection bias in panel studies is the inability to link respondents to supplementary administrative records, either because respondents do not consent to link or the matching algorithm fails to locate their administrative records. Both sources of selection bias can affect the validity of conclusions drawn from these data sources. In this article, I discuss recently proposed methods of reducing both sources of selection bias in panel studies, with a special emphasis on reducing selection bias in the US Health and Retirement Study.

Public opinion on sharing data from health services for clinical and research purposes without explicit consent: an anonymous online survey in the UK

OBJECTIVES

UK National Health Service/Health and Social Care (NHS/HSC) data are variably shared between healthcare organisations for direct care, and increasingly de-identified for research. Few large-scale studies have examined public opinion on sharing, including of mental health (MH) versus physical health (PH) data. We measured data sharing preferences.

DESIGN/SETTING/INTERVENTIONS/OUTCOMES

Pre-registered anonymous online survey, measuring expressed preferences, recruiting February to September 2020. Participants were randomised to one of three framing statements regarding MH versus PH data.

PARTICIPANTS

Open to all UK residents. Participants numbered 29 275; 40% had experienced an MH condition.

RESULTS

Most (76%) supported identifiable data sharing for direct clinical care without explicit consent, but 20% opposed this. Preference for clinical/identifiable sharing decreased with geographical distance and was slightly less for MH than PH data, with small framing effects. Preference for research/de-identified data sharing without explicit consent showed the same small PH/MH and framing effects, plus greater preference for sharing structured data than de-identified free text. There was net support for research sharing to the NHS, academic institutions, and national research charities, net ambivalence about sharing to profit-making companies researching treatments, and net opposition to sharing to other companies (similar to sharing publicly). De-identified linkage to non-health data was generally supported, except to data held by private companies. We report demographic influences on preference. A majority (89%) supported a single NHS mechanism to choose uses of their data. Support for data sharing increased during COVID-19.

CONCLUSIONS

Support for healthcare data sharing for direct care without explicit consent is broad but not universal. There is net support for the sharing of de-identified data for research to the NHS, academia, and the charitable sector, but not the commercial sector. A single national NHS-hosted system for patients to control the use of their NHS data for clinical purposes and for research would have broad support.

TRIAL REGISTRATION NUMBER

ISRCTN37444142.

Public opinion on sharing data from health services for clinical and research purposes without explicit consent: an anonymous online survey in the UK

OBJECTIVES

UK National Health Service/Health and Social Care (NHS/HSC) data are variably shared between healthcare organisations for direct care, and increasingly de-identified for research. Few large-scale studies have examined public opinion on sharing, including of mental health (MH) versus physical health (PH) data. We measured data sharing preferences.

DESIGN/SETTING/INTERVENTIONS/OUTCOMES

Pre-registered anonymous online survey, measuring expressed preferences, recruiting February to September 2020. Participants were randomised to one of three framing statements regarding MH versus PH data.

PARTICIPANTS

Open to all UK residents. Participants numbered 29 275; 40% had experienced an MH condition.

RESULTS

Most (76%) supported identifiable data sharing for direct clinical care without explicit consent, but 20% opposed this. Preference for clinical/identifiable sharing decreased with geographical distance and was slightly less for MH than PH data, with small framing effects. Preference for research/de-identified data sharing without explicit consent showed the same small PH/MH and framing effects, plus greater preference for sharing structured data than de-identified free text. There was net support for research sharing to the NHS, academic institutions, and national research charities, net ambivalence about sharing to profit-making companies researching treatments, and net opposition to sharing to other companies (similar to sharing publicly). De-identified linkage to non-health data was generally supported, except to data held by private companies. We report demographic influences on preference. A majority (89%) supported a single NHS mechanism to choose uses of their data. Support for data sharing increased during COVID-19.

CONCLUSIONS

Support for healthcare data sharing for direct care without explicit consent is broad but not universal. There is net support for the sharing of de-identified data for research to the NHS, academia, and the charitable sector, but not the commercial sector. A single national NHS-hosted system for patients to control the use of their NHS data for clinical purposes and for research would have broad support.

TRIAL REGISTRATION NUMBER

ISRCTN37444142.

Does Benefit Framing Improve Record Linkage Consent Rates? A Survey Experiment

Survey researchers are increasingly seeking opportunities to link interview data with administrative records. However, obtaining consent from all survey respondents (or certain subgroups) remains a barrier to performing record linkage in many studies. We experimentally investigated whether emphasizing different benefits of record linkage to respondents in a telephone survey of employee working conditions improves respondents' willingness to consent to linkage of employment administrative records relative to a neutral consent request. We found that emphasizing linkage benefits related to "time savings" yielded a small, albeit statistically significant, improvement in the overall linkage consent rate (86.0) relative to the neutral consent request (83.8 percent). The time savings argument was particularly effective among "busy" respondents. A second benefit argument related to "improved study value" did not yield a statistically significant improvement in the linkage consent rate (84.4 percent) relative to the neutral request. This benefit argument was also ineffective among the subgroup of respondents considered to be most likely to have a self-interest in the study outcomes. The article concludes with a brief discussion of the practical implications of these findings and offers suggestions for possible research extensions.