Reaching Patients for Interviews: Comparison of Randomized Telephone vs. In-person Interviewing California Enhanced Gonorrhea Surveillance Project Michael C. Samuel, DrPH Jennifer Chase, MSPH; Jayne Bradbury, MPH; Gail Bolan, MD California DHS STD Control Branch 2006 National STD Prevention Conference Beyond The Hidden Epidemic: Evolution or Revolution? Jacksonville, FL May 8-11, 2006

Number of Gonorrhea Cases by Region 1999 to /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 Alameda Fresno Kern Long Beach Orange San Bernardino Santa 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

Data Flow

* Excludes 2 local health jurisdictions due to protocol exceptions Data Flow – Selected Jurisdictions*

Comparison of time periods between telephone and in-person interviews TelephoneIn-personP value Time from diagnosis to interview (mean # days) 2321p<0.05 Case investigation time (mean # minutes) 2240p<0.001 Length of interview (mean # minutes) 1619p<0.001 * Excludes 2 local health jurisdictions due to protocol exceptions

Comparison of interviewer assessment of data quality telephone and in-person interviews TelephoneIn-personP 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 diagnosisTelephone In-personP value 3 monthsMean1.82.1NS Median11 75 th percentile22 12 monthsMean3.65.3NS Median22 75 th percentile33 * Excludes 2 local health jurisdictions due to protocol exceptions

Comparison of reported risk behaviors between telephone and in-person interviews Reported risk behavior (%)TelephoneIn-personP value HIV positive (MSM only)22%13%NS Methamphetamine use9%11%NS Prior GC infection16%23%p<0.05 Incarceration history (males)24%35%p<0.05 Sex partner incar. hx (females)34%43%NS Gave money/drugs for sex2%5%p<0.05 Victim of sexual assault3%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