Representativeness of the FluWatchers Participatory Disease Surveillance Program 2015-2016 to 2018-2019: How do participants compare with the Canadian population?

BACKGROUND:FluWatch is Canada's national surveillance system that monitors the spread of influenza. Its syndromic surveillance component monitors the spread of influenza-like illness (ILI) in near-real time for signals of unusual or increased activity. Syndromic surveillance data are collected from two main sources: the Sentinel Practitioner ILI Reporting System and FluWatchers.We evaluated the representativeness of the most recent participant population to understand changes in representativeness since 2015, to identify demographic and geographic gaps and correlates/determinants of participation to characterize a typical participant. METHODS:In this serial cross-sectional study, characteristics of participants during four consecutive influenza seasons (2015-2016, 2016-2017, 2017-2018 and 2018-2019) were compared with the 2016 Canadian Census and the 2015-2016, 2016-2017, 2017-2018 and 2018-2019 National Seasonal Influenza Vaccination Coverage Surveys. Associations between demographic factors and the level of user participation were also analyzed among the 2018-2019 FluWatchers population. RESULTS:Infants (0-4 years) and older adults (65 years and older) were under-represented in FluWatchers across all four influenza seasons. Female and urban participants were significantly over-represented. Vaccination coverage remained significantly higher among the FluWatchers populations from the past four influenza seasons across all age groups. Level of participation among FluWatchers was associated with age and vaccination status, but not with sex or geography. Over its four years of implementation, the FluWatchers participant population became more representative of the Canadian population with respect to age and geography (urban/rural and provincial/territorial). CONCLUSION:FluWatchers participants under-represent the tails of Canada's age distribution and over-represent those who engage in health promoting behaviours as indicated by high influenza vaccine coverage, consistent with typical volunteer-based survey response biases. Representativeness would likely improve with targeted recruitment of under-represented groups, such as males, older adults and Canadians living in rural areas.