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Background: Health examination surveys (HESs), carried out in Europe since the 1950's, provide valuable information about the general population's health for health monitoring, policy making, and research. Survey participation rates, important for representativeness, have been falling. International comparisons are hampered by differing exclusion criteria and definitions for non-response.Method: Information was collected about seven national HESs in Europe conducted in 2007-2012. These surveys can be classified into household and individual-based surveys, depending on the sampling frames used. Participation rates of randomly selected adult samples were calculated for four survey modules using standardised definitions and compared by sex, age-group, geographical areas within countries, and over time, where possible.Results: All surveys covered residents not just citizens; three countries excluded those in institutions. In two surveys, physical examinations and blood sample collection were conducted at the participants' home; the others occurred at examination clinics. Recruitment processes varied considerably between surveys. Monetary incentives were used in four surveys. Initial participation rates aged 35-64 were 45% in the Netherlands (phase II), 54% in Germany (new and previous participants combined), 55% in Italy, and 65% in Finland. In Ireland, England and Scotland, household participation rates were 66%, 66% and 63% respectively. Participation rates were generally higher in women and increased with age. Almost all participants attending an examination centre agreed to all modules but surveys conducted in the participants' home had falling responses to each stage. Participation rates in most primate cities were substantially lower than the national average. Age-standardized response rates to blood pressure measurement among those aged 35-64 in Finland, Germany and England fell by 0.7-1.5 percentage points p.a. between 1998-2002 and 2010-2012. Longer trends in some countries show a more marked fall.Conclusions: The coverage of the general population in these seven national HESs was good, based on the sampling frames used and the sample sizes. Pre-notification and reminders were used effectively in those with highest participation rates. Participation rates varied by age, sex, geographical area, and survey design. They have fallen in most countries; the Netherlands data shows that they can be maintained at higher levels but at much higher cost. [ABSTRACT FROM AUTHOR]

Aims: In the 1980s, participation rates in health interview and health examination surveys were around 80% while now they are around 50–60%. There is also evidence that non-participation is selective. Low participation rates and selective non-participation may cause bias to our survey results based on participants alone. We aim to increase knowledge on cultural differences in acceptance and feasibility of different recruitment methods. Methods: The European Health Examination Survey Pilot Project, conducted in 2009–2012, included pilot surveys in 12 countries among people aged 25–64 years. Information about recruitment methods and participation rates in these surveys was collected. Results: Participation rates ranged from 16% to 57% for men and from 31% to 74% for women, where in most surveys women had higher participation rates than men. A variety of recruitment and promotion methods were used to obtain as high participation rates as possible. Combinations of phone calls, invitation letter and home visits were used to recruit invitees. Obtaining valid phone numbers for survey invitees was difficult in several countries. Incentives, websites and promotion in local media were used to promote the surveys. Conclusions: The European Health Examination Survey Pilot surveys showed that obtaining a participation rate above 50% for a representative population sample is possible but it requires hard work and a well-planned recruitment strategy. Recruitment methods used in one country may not be possible to use in another country due to cultural norms and national regulations. [ABSTRACT FROM PUBLISHER]