Courage Project Europe Map

One of the most pressing policy issues in the 21st century for the European Commission certainly is the need to have valid and reliable measures to describe population ageing. COURAGE in EUROPE is a three-year project involving 12 partners from 4 European Countries and the World Health Organization. It was born in order to help answering this pressing need integrating other International studies on disability and ageing with an innovative perspective and a validated protocol.

COURAGE in Europe has developed original tools to evaluate the role of the built environment and social networks as determinants of health and disability on an ageing population. The main survey to evaluate the determinants has been conducted by the partners in Finland, Poland and Spain where the survey has been administered to around 3000 persons aged 50+ years, and to 1000 persons aged 18-49.

» COURAGE leaflet (PDF file)

» Datasets from Poland, Spain and Finland are being finalised and data analysis is ongoing

The COURAGE in EUROPE project aims:

  • to develop assessment instruments;
  • to demonstrate the reliability and validity of the assessment instruments;
  • to demonstrate substantial innovations in ageing survey methodology;
  • to provide cross-population analysis and a baseline for longitudinal data collection.

After an in-depth critique of existing ageing studies, COURAGE in EUROPE has developed measures of health and health-related outcomes for an ageing population. These measures are under validation in Spain, Poland and Finland and will be grounded in the WHO’s International Classification of Functioning, Disability and Health (ICF). The ICF offers the only framework for evidence-based measurement of non-fatal health outcomes scientifically valid.

COURAGE in EUROPE is not proposing “another” ageing study, but the development of a tool useful to measure health and health-related outcomes for an ageing population. It offers objective and evidence-based prevalence trends and relates them to both quality of life and well-being outcomes as well as to the role of health determinants such as the built environment and social networks. Understanding ageing and its determinants will have a considerable impact on public health policies helping identifying strategies for intervention.



COURAGE in EUROPE has developed and is still validating in Spain, Poland and Finland, measures of health and health-related outcomes for an ageing population.
The main parts of this protocol are:
Courage Project Questionnaires

  • Individual Questionnaire (socio-demographic characteristics, work history, health state descriptions, anthropometrics and performance tests, risk factors, chronic conditions, health care utilization);
  • Social cohesion and social networks questionnaire;
  • Subjective well-being and quality of life;
  • Built environment self-reported questionnaire;
  • Built environment outdoor checklist.

A proxy version and the re-test item selection version are also available.




  • Development of the research protocol: it will be composed of well established (i.e. for quality of life and for objective health state measurement) as well as of recently developed tools. The two most important new instruments will be developed to assess the effect of built environment and for the effect of social networks, on persons’ health state;
  • Pilot testing of the protocol;
  • Training of interviewers;
  • Field trial of the protocol: a general survey to evaluate the determinants of healthy ageing has been conducted in Finland, Poland and Spain. Approximately 12.000 persons have been enrolled in total;
  • Analysis of survey results: testing of the validity and reliability of the protocol and definition of a baseline cohort for longitudinal studies.



WP1 – Development of protocol and of ICF-based assessment instrument
Workpackage Leader: INNCB

Task 1.1 Analysis of existing data sets
Task 1.2 Preparation of draft instrument based on existing material
Task 1.3 Preparation of the protocol
Task 1.4 Development of analytical strategies for longitudinal data
Task 1.5 Instruments language adaptation (Finnish/Polish/Spanish) and pre-testing of the instrument
Task 1.6 Systematic review of the relationship between functioning profiles in later life with early childhood adversity
Task 1.7 Systematic review of the relationship between social networks and functioning profiles in later life

D1.1 Report of analytical methods to be used in surveys with complex designs and repeated evaluations over time of the same subject
D1.2 Report on systematic review of relationship between late life health and health related outcomes, early childhood adversities, built environment and social networks

WP2 – Training
Workpackage Leader: UAM

Task 2.1 Training of trainers-supervisors
Task 2.2 Training of interviewers at the survey sites

D2.1: Training and survey manual

WP3 – Validation of ICF-based instruments in Finland, Spain, Poland through a population study
Workpackage Leader: PSSJD

Task 3.1 Design and protocol of the validation study
Task 3.2 Development of quality assurance procedures and implementation for field work
Task 3.3 Completion of field work
Task 3.4 Preparation of the final cleaned, weighted data set

WP4 – Cross-population comparative analysis and interpretation of results of WP3
Workpackage Leader: WHO

Task 4.1 Development of analytical strategy and cross-sectional analysis plan
Task 4.2 Statistical analysis of the data sets collected
Task 4.3 Analytical report
Task 4.4 Final COURAGE Protocol for surveys on health, quality of life and well being in ageing

D 4.1 Report on statistical modeling techniques for a comparative analysis on health outcomes and QOL
D 4.2 COURAGE in EUROPE survey results, including analytic reports on determinants of health, quality of life and well-being, and a detailed examination of the role of the built environment and social networks

WP5 – Dissemination
Workpackage Leader: INNCB

Task 5.1 Design of a dissemination plan
Task 5.2 Creation and maintenance of the COURAGE in Europe website
Task 5.3 Organisation of international conferences
Task 5.4 Dissemination of final project results
Task 5.5 Final Conference

D5.1 Project website
D5.2 Final plan for the use and dissemination of foreground

WP6 – Management
Workpackage Leader: INNCB

Task 6.1: Communication with the European Commission
Task 6.2: Administration of the financial contribution
Task 6.3: Reporting
Task 6.4: Legal and administrative issues
Task 6.5: Organisation of project meetings
Task 6.6: Harmonisation of procedures and documentation
Task 6.7 Independent Evaluation

D6.1 Periodic report
D6.2 Final report

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