2006 National STD Prevention Conference Beyond The Hidden Epidemic : Evolution or Revolution?
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Transcript of 2006 National STD Prevention Conference Beyond The Hidden Epidemic : Evolution or Revolution?
Reaching Patients for Interviews: Comparison of Randomized
Telephone vs. In-person Interviewing
California Enhanced Gonorrhea Surveillance Project
Michael C. Samuel, DrPHJennifer Chase, MSPH; Jayne Bradbury, MPH; Gail Bolan, MD
California DHS STD Control Branch
2006 National STD Prevention ConferenceBeyond The Hidden Epidemic: Evolution or
Revolution?Jacksonville, FL May 8-11, 2006
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Number of Gonorrhea Cases by Region 1999 to 2005
4/2006 Provisional Data - CA DHS STD Control Branch
Background• Increases in gonorrhea in all demographic groups in
California since 1999 (also see Poster PS3 #109)
• Standard surveillance does not provide behavioral risk data needed to understand these increases
• California Enhanced GC Surveillance, part of national OASIS Project, established to obtain behavioral data
• Strong tradition of in-person interviews in STD programs
Objective
• Compare telephone versus in-person interviews• Differences in resources required• Difference in quality of data• Differences in reported risk behaviors
Methods - 1
• Sample of cases reported through case-based surveillance
• Consecutive sample to 100 female and 100 male cases in each jurisdiction
AlamedaFresnoKernLong BeachOrangeSan BernardinoSanta Clara
• Participating Local Health Jurisdictions:
Methods - 2
• Randomized cases to telephone (2/3) or in-person (1/3) interviews with roll of die
• Compared selected characteristics of cases by interview method using• Wilcoxon rank sum test for continuous variables• Fishers exact test for proportions
• Excluded incarcerated cases from analysis since all had to be interviewed in-person
• Dates of diagnosis and interview• Case investigation time• Length of interview
• Subjective interviewer assessment:• “How cooperative was the patient with the interview?”• “..assessment of the reliability of data collected…?”• “Very” cooperative/reliable compared to all others
• Behavioral risk factors
Data collected
2983 reported during project period
2552 randomized
1695 randomized to
telephone (66.4%)
857 randomized to
in person (33.6%)
26 in jail
43in jail
461 interviewed
(60%)
894interviewed
(56%)
812 interviewed by
telephone(91%)
82 interviewed in
person (9%)
329 interviewed in
person (71%)
132 interviewed by
telephone (29%)
42 ineligible for
interview
59ineligible for
interview 1610
eligible for interview
772eligible for interview
Data Flow
311 interviewed
(65%)
641interviewed
(63%)
586 interviewed by telephone
(91%)
55 interviewedin person
(9%)
216 interviewed in person (70%)
95 interviewed by telephone
(31%)
1026 eligible for interview
& randomized to telephone
476eligible for interview & randomized to in
person
* Excludes 2 local health jurisdictions due to protocol exceptions
Data Flow – Selected Jurisdictions*
Comparison of time periods between telephone and in-person interviews
Telephone In-person P value
Time from diagnosis to interview (mean # days)
23 21 p<0.05
Case investigation time (mean # minutes)
22 40 p<0.001
Length of interview (mean # minutes)
16 19 p<0.001
* Excludes 2 local health jurisdictions due to protocol exceptions
Comparison of interviewer assessment of data quality telephone and in-person interviews
Telephone In-person P value
% patients “very cooperative”
73% 76% NS
% patients “very reliable”
54% 59% NS
* Excludes 2 local health jurisdictions due to protocol exceptions
Comparison of reported risk behaviors between telephone and in-person interviews
Number of sex partners prior to GC diagnosis Telephone In-person P value
3 months Mean 1.8 2.1 NS
Median 1 1
75th percentile 2 2
12 months Mean 3.6 5.3 NS
Median 2 2
75th percentile 3 3
* Excludes 2 local health jurisdictions due to protocol exceptions
Comparison of reported risk behaviors between telephone and in-person interviews
Reported risk behavior (%) Telephone In-person P value
HIV positive (MSM only) 22% 13% NS
Methamphetamine use 9% 11% NS
Prior GC infection 16% 23% p<0.05
Incarceration history (males) 24% 35% p<0.05
Sex partner incar. hx (females) 34% 43% NS
Gave money/drugs for sex 2% 5% p<0.05
Victim of sexual assault 3% 6% NS
* Excludes 2 local health jurisdictions due to protocol exceptions
Conclusions - 1
• Telephone interviews more likely to be completed than in-person interviews
• Telephone interview process required less staff time than in-person interviews
Conclusions - 2
• No statistically significant difference in subjective interviewer assessment of data quality between interview methods
• Most reported risk factors not significantly different between interview methods
• Trend toward more reported risk in in-person compared to telephone interviews for all risk factors--three statistically significant
Next Steps/Recommendations
• Because of advantages of telephone interviews, consider their use, but emphasize interviewer training
• Consider use of other technologies to improve data collection• computer assisted interviewing technology• Internet-based methods
Acknowledgements• CA DHS STD Control Branch
• Jessica Frasure • Denise Gilson• Jan King• Susan Watson
• Roxanne Aguirre • Emily Banaag• George Camarillo Rosemary
Collins• Stewart Coulter• Stacy Goldsby• Marcella Herrera Esteban
Inzunza• Edwin Lopez • Elaine Martinez • Ivan Meyer• Judy Ochoa• Rachel Salazar • Joe Sanchez• Ruth Sanchez• Lisa Schroeder• Linda Wool
• Centers for Disease Control (CDC)• Lori Newman
• Alameda Co.• Gay Calhoun • Arnette Hayes• Monica Leite• Georgia Schreiber
• Fresno Co.• Kern Co• Long Beach• Orange Co.
• San Bernardino Co.• Carmen Arias• Eric Frykman • Flo Medina• Gabriela Miramontes• Chuck Morrison• Becky Nanyonjo• Stephen Nozaki• Rebecca Nanyonjo
• Santa Clara Co.• Robert Brizuela • Marilyn Cornier• Matilda Emmanuel• Debbie Martinez
For more info:Michael C. Samuel, Dr.P.H.