Screening University Students for Health Checks With an Electronic Health Questionnaire in Finland: Protocol for a Retrospective, Register-Based Cohort Study

Abstract

Background Health questionnaires and health checks are an established part of preventive health care services in Finland. However, only very limited research of these has been conducted. The Finnish Student Health Service (FSHS) provides primary health care services to all bachelor’s and master’s degree university students (approximately 134,500 students) in Finland. FSHS’s statutory health examination process of university entrants includes an electronic health questionnaire (eHQ) and, based on the students’ eHQ responses, a subsequent health check if necessary. To our knowledge, no previous studies have been published on the use of questionnaires for screening students for general health checks. Objective The general aim of the study is to evaluate the health examination process of university entrants. The objectives are to determine how students’ self-reported health in the eHQ and participation in the health examination process are associated with graduation, mental health problems, and the use of student health care services. Methods This is an ongoing, nationwide, retrospective, register-based cohort study with a 6-year follow-up. The study population is the cohort of university entrants (N=15,723) from the 2011-2012 academic year. These students were sent the eHQ, which consisted of 26 questions about health, health habits, social relations, and studying. Based on the eHQ responses, students were referred to one of the following interventions: (1) a health check, (2) an appointment other than a health check (eg, physiotherapy), or (3) electronic feedback to support a healthy lifestyle, when the other interventions were not necessary. Multiple comparisons will be made within these groups using logistic regression. The primary outcome variables are graduation, having a mental health problem, and attending a health check. The use of FSHS health care services will be studied with the cluster analysis method. The data have been obtained from three nationwide registers: the eHQ register, the medical records of FSHS, and the Higher education achievement register. The data have been linked using personal identity codes. Results As of August 2019, the data collection and processing are complete and the statistical analyses are in progress. Preliminary results are expected in autumn 2019. Further publications are expected in 2020, and two PhD theses are expected to be completed by the end of 2022. Conclusions Studying practical procedures in primary health care is highly important for resource allocation and the development of evidence-based processes. This study will be the first to assess the usage of a health questionnaire in screening students for health checks. The findings of this study will contribute to the field of preventive health care. The main practical implication is the development of the FSHS’s health examination process. We hypothesize that participation in the health examination process enhances academic achievement and the detection of university students’ mental health problems early on in their studies. International Registered Report Identifier (IRRID) DERR1-10.2196/14535

Association between university students’ two-staged health screening and student health care utilisation: register based observational study

“…The study design has been described in detail previously. 18 The study was conducted in a real-life setting and used the register data that the FSHS produced regarding its health examination process and other services. The population was the national cohort of university entrants from the 2011–2012 academic year in Finland (n=15 723).…”

“…The FSHS’s statutory ongoing two-staged health screening process was designed in 2008 to identify and support students at risk for decreased study ability. 18 19 The first stage, the eHQ, included 26 questions about health, social relations and studying ( online supplemental file 2 ). The eHQ responses were evaluated by public health nurses.…”

“…16 17 The basis of the preventative work in the FSHS is a two-staged health screening process, which includes an electronic Health Questionnaire (eHQ) provided to all university entrants and a subsequent health check, when necessary, based on the students’ eHQ responses. 18 19 …”

Associations between e-health questionnaire responses, health checks and graduation: Finnish register-based study of 2011–2012 university entrants

“…This was a nationwide register-based cohort study with a 6-year follow-up, the design and methodology of which have been described previously. 2 We used the Strengthening the Reporting of Observational Studies in Epidemiology cohort checklist when writing our report. 30 The study was a real-life study on an ongoing FSHS health examination process.…”

“…The basis of preventive work in FSHS is a statutory health examination process that was designed to identify and support students at risk of decreased study ability. 2 22 23 The process includes an Electronic Health Questionnaire (eHQ) provided to all university entrants and a subsequent health check when necessary based on the students’ eHQ responses. The eHQ consists of several questions about health, social relations and studying, and it has been shown to facilitate the identification of students’ health problems.…”