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

Southern Region

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Bay Area Region

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Northern Region

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Central Region

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'99 '00 '01 '02 '03 '04 '05San Francisco

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Los Angeles

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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.

510-620-3198msamuel@dhs.ca.gov