Final october interviewing_techniquesPresentation Transcript
Public HealthInformation Network (PHIN) Series II Outbreak Investigation Methods: From Mystery to Mastery
Access Series Files Online http://www.vdh.virginia.gov/EPR/Training.asp Session slides Session activities (when applicable) Session evaluation forms Speaker biographies Alternate Web site: http://www.sph.unc.edu/nccphp/phtin/index.htm
Site Sign-in SheetPlease submit your site sign-in sheet and session evaluation forms to: Suzi Silverstein Director, Education and TrainingEmergency Preparedness & Response Programs FAX: (804) 225 - 3888
Series II Session V“Interviewing Techniques”
Series II Sessions Title Date“Recognizing an Outbreak” June 2“Risk Communication” July 7“Study Design” August 4“Designing Questionnaires” September 1“Interviewing Techniques” October 6“Data Analysis” November 3“Writing and Reviewing Epidemiological December 1Literature”
CDCOutbreak Management System Software Support: National Center for Public Health Informatics email@example.com / (800) 532-9929, option 6
OMS Applications• Track demographics, case investigations, and exposure contact relationships for persons, animals, events, travel events, vehicles, objects, organizations, other organisms, and locations.• Create household, social, or occupational relationships among records• Run OMS on desktops or laptops [CAPI]
OMS User InterfaceSource: http://www.cdc.gov/phin/software-solutions/oms/index.html
OMS User InterfaceSource: http://www.cdc.gov/phin/software-solutions/oms/index.html
OMS in Virginia Contact:Michael A. Coletta, MPHBioterrorism Surveillance CoordinatorDivision of Surveillance and InvestigationOffice of EpidemiologyTelephone: (804) 864-8099Email: firstname.lastname@example.org
Today’s PresentersAaron Wendelboe, MSPHDoctoral Candidate andGraduate Research Assistant,NC Center for Public Health PreparednessErin Rothney, MPHResearch Associate,NC Center for Public Health Preparedness
“Interviewing Techniques” Learning Objectives Upon completion of this session, you will:• Recognize the interrelatedness of interview techniques and questionnaire design• Understand key survey research terms• Understand the advantages and disadvantages of face-to-face, telephone, and computer assisted interview methods
Learning Objectives (cont’d.)• Understand the advantages and disadvantages of mail and Web-based survey implementation• Know what to address in interviewer training• Recognize good interview techniques• Understand confidentiality concerns from the perspectives of both the respondent and the outbreak investigator
Lecturer Aaron Wendelboe, MSPH Doctoral Candidate and Graduate Research Assistant,NC Center for Public Health Preparedness
Basic Steps of an Outbreak Investigation1. Verify the diagnosis and confirm the outbreak2. Define a case and conduct case finding3. Tabulate and orient data: time, place, person4. Take immediate control measures5. Formulate and test hypothesis6. Plan and execute additional studies7. Implement and evaluate control measures8. Communicate findings
Interviewing Techniques Introduction
Introduction• The role of interviews in outbreak investigations• Types of interviewing methods• Interrelatedness of interview method and questionnaire design• Key survey research concepts – Sampling – Response rates
Role of Interviews in Outbreak InvestigationsPrimary purpose: data collection• Case identification• Risk factor identification• Hypothesis generation
Questionnaire Design Interview Method Influenced by:• Length and format of questionnaire• Question types used in a survey• Cost considerations for survey implementation
SamplingSampling is the systematic selection of aportion of the larger source population. Asample should be representative of thelarger source population.
SamplingSource Pop: Students (12,000)Sampled pop (150 students)
Sampling Why Sample?Because it is more efficient – saves timeand money!
Sampling Sample sizeIs the purpose of the study to determine thesource of the outbreak?– A small number of cases and controls can reveal risk factors for infection.Is the purpose of the study to determine thenumber of persons who become sick over aspecific period of time [attack rate]?– A cohort study would require a larger sample.
Sampling Types of SamplingSimple Random Sample (SRS)Randomly select persons to participate in study.There are many variations of SRS.Convenience SampleChoose those individuals who are easilyaccessible.
Sampling Problems with Convenience Sampling• Based on subjective judgment• Cases may or may not be representative of the total population• May lead to biased results
Sampling Additional Resources: http://www.sph.unc.edu/nccphp/training/all_trainings/at_sampl.htm1. “Sampling Case Studies”2. “Survey Sampling: Precision, Sample Size, and Conducting a Survey”3. “Survey Sampling Terminology and Methods”
Response RatesResponse rates measure the percentage of yoursample that has participated in your survey. Example:Using the campus directory, you email a surveyto a random sample of 100 freshmen. 40 ofthose students complete the survey and return itelectronically. Your response rate is 40%.
Response RatesHigh response rates ensure that surveydata are representative of the sourcepopulation, and that results will be valid.
Response Rates Types of Non-response• Non-contact: No one at home• Refusal to participate• Inability to participate (due to language barrier or physical or mental condition)
Response RatesWhat is an average response rate?
Response Rates Determining Response RatesRefer to the American Association of Public Opinion Research website: www.aapor.org – Link to the document titled, “Standard definitions” from the home page.
Interviewer Administered Data Collection• Advantages and disadvantages of face-to-face interviews• Advantages and disadvantages of telephone interviews• Advantages and disadvantages of Computer assisted interviews
Face-to-Face Interview Advantages:• Higher response rate• Longer survey instrument• Can have more complex skip patterns• More accurate recording of responses – Less item non-response• Appropriate for hard to reach populations (e.g., illiterate, institutionalized)
Face-to-Face Interview Disadvantages:• Costly• Potential for interviewer error• Less anonymous than self-administered – Potential for dishonesty
Telephone Interview Advantages:• Less costly than face-to-face• Higher response rates than mailed• Quicker access to participants• Supervision of interviewers feasible• Can collect more sensitive information• Survey design can be more efficient
Telephone Interview Disadvantages:• Lower response rates than face-to-face• Shorter questionnaires used• Unable to capture important visual information (e.g., rash, working conditions)• Under-coverage (e.g., population without phones) – 2.1% of total population in Virginia
CAPI Example: NC PHRST TeamsNC PHRST Team public healthprofessionals use PDAs* for rapid needsassessment face-to-face interviews.* PDA: Personal Digital Assistant, also sometimes called hand-held computers, palmtops, and pocket computers
Field Data Collection EPI Info GIS Wireless: WIFI 802.11 or Bluetooth Field Team 4 Field Team 5 Field Team 1 Field Team 2 Field Team 3Field data collection using IPAQ Pocket PCs equipped with GPS, GIS software and data collection forms.
Pros: Pros:• Inexpensive • Eliminates double data entry• No special skills required for • Provides routing and direction- finding for field teams data recording • Improved randomization through GIS • Ability to quickly analyze and map data Cons:Cons: • Technology is expensive• Requires double data-entry • Learning curve / required – Greater risk of data errors training for data entry• Clipboard and paper more • Small screen size requires cumbersome in the field scrolling through many questionnaire pages
For More Information. . .Steven Ramsey, RSTeam Leader / Industrial HygienistPHRST-5Guilford County Health Department, NC(336) -641-8192
Self AdministeredData Collection Considerations
Self-administered Data Collection• Advantages and disadvantages of mailed questionnaires• Advantages and disadvantages of Web-based questionnaires
Mailed Questionnaire Advantages:• More anonymous• May collect more honest responses• No interviewer error• Less expensive• Respondent has more time to think about question
Mailed Questionnaire Disadvantages:• Questionnaire must be simple• Higher item non-response• Lower response rate• Data collection takes more time• Sample population must be literate• Coverage / frame deficiencies
Web-based Questionnaire Advantages:• Among some populations, most people may have access to the Web / email• Inexpensive and fast• No data entry required – Improves data quality• Many vendors send data in a variety of formats
Web-based Questionnaire Disadvantages:• Mandatory access to and experience with Internet• Potential connection speed and hardware / software capacity limitations• Potential for multiple responses from one individual• Potential for responses from non-sampled respondents• Need email address list to contact sample
Web-based Questionnaire Example: Dartmouth University: 698 (13.8%) of 5060 students had conjunctivitis in spring 2002• To identify risk factors... – web-based questionnaire set up – E-mail sent to 3682 undergraduates – No data entry - rapid analysis• 1832 responded (50% response rate)-- Source: An outbreak of conjunctivitis due to atypical Streptococcus pneumoniae. N Engl J Med. 2003;348 (12):1112-21.
Web-based Questionnaire For a list of vendors that provide Web- based survey tools, please visit:http://www.surveymonkey.com/Pricing.asp
Question and Answer Opportunity
5 minute break
Standardizing Interviews• The goal of standardization is to help minimize error, thereby yielding better data quality• Minimizing interviewer error is done through making surveys more standard or consistent
Error Interviewer Error:Deviation from expected answer due tothe effects of interviewers.
Interviewer Error Example: Gonorrhea outbreak Bias VarianceInterviewers probe on A male interviewerthe sexual history may elicit differentsection more among responses from anon-whites than female respondentwhites than a female interviewer.
Error Additional ResourceSchwarz, N., Groves, R., and Schuman,H., “Survey Methods” Chapter 4 in Gilbert,D. et al (Eds) (1998). The Handbook ofSocial Psychology. Boston: McGraw-Hill;pp 143 – 179.
Question Wording Criteria for Standardized Interview Questions• Must be fully scripted• Must mean the same thing to every respondent
2. Interviewer Selection
Interviewer SelectionCriteria for Telephone Interviewer Selection• Ability to read questions fluently• Clear and pleasant telephone voice• Responds quickly to respondent’s questions• Reliability
Criteria for Face-to-Face Interviewer Selection• Logistical skills (reading maps)• Good interpersonal skills• Independent workers• Reliability• In certain circumstances, parallel demographic characteristics among interviewers and interviewees
3. Interviewer Training
Interviewer Training• Training is NOT optional!• Trainings must be interactive• Interviewers must practice reading questions out loud• Provide support documentation (manual)
Interviewer Training Elements Purpose of survey How to use data collection instrument Respondent selection process Intent and meaning of each question How to record/code responses Administering questionnaire Addressing participants’ questions Methods for improving response rate Tracking calls / completed surveys / call- backs Confidentiality
Interviewer Training Respondent Selection ProcessProvide proxy respondent rules for adultsand children because proxy responseimpacts:– Data quality– Sampling
Interviewer Training Questionnaire Administration To establish legitimacy of the survey upon first contact, tell the respondent:Who is callingWhat is requestedWhy respondent should cooperateHow respondent was chosen
Interviewer Training Logistics Face-to-Face Telephone• Reading maps • Operation of equipment• Getting to • Operation of CATI respondents’ homes software (if applicable)• Reimbursement• Dress code• Scheduling callbacks
Interviewer Training Other Considerations• Record some resolution to each question – Are missing responses due to skip patterns or errors?• Review interview after completion – Missing responses – Illegible responses
Interviewer Training Interviewer ManualAn interviewer manual serves as areference to interviewers during interviewsand as survey documentation.
Interviewer Training Suggested Interviewer Manual Contents• Background information• Fieldwork• Interviewing techniques• Survey instrument terms and definitions
Interviewer Training Program Example Behavioral Risk FactorSurveillance System (BRFSS)
BRFSS Interviewer Training On-line training covers:• Why BRFSS data are important, how data are used• Interviewer responsibilities• Nuts and bolts of the interviewing process• Interviewing techniques
BRFSS Interviewer TrainingOn-line interviewer training available at:http://apps.nccd.cdc.gov/BRFSS_Training_Int/General information about BRFSS:http://www.cdc.gov/brfss/
4. Interviewing Procedures
Interviewing Procedures Rules• Read questions exactly as worded• Probe inadequate answers, if necessary• Record answers without interviewer discretion• Maintain rapport with respondents• Maintain an even pace
Interviewing Procedures Read questions exactly• Read entire question before accepting an answer• Clarify questions if necessary
Interviewing Procedures Read questions exactly• Use only standard definitions / clarification provided• Use the phrase: “Whatever x means to you”, OR “Whatever you think of as x.”• When asked to repeat only one of several response options, repeat ALL options given for a question
Interviewing Procedures ProbeA probe is a standardized way to obtainadditional information from a respondent.Use probes when a respondent’s answeris unclear or irrelevant.
ProbeExamples of responses requiring a probe:Interviewer: "In the past two weeks, have youbeen swimming in a public pool?”Irrelevant Response: “I swam in a lake at anational park last month."Unclear Response: “I stayed in a hotel with apool when I was on vacation last week."
Interviewing Procedures Standard Probe Examples• Repeat the question• Retrieve receipts / calendars• What do you mean? How do you mean?• If respondent has narrowed down answer: – Which would be closer? – If you had to choose, which would you pick?
Interviewing Procedures Recording Answers• Do not direct respondent toward an answer (leading)• Do not assume that an “answer” received in passing is correct• Do not skip questions, even if “answer” was given earlier• Do not remind respondent of earlier remark if answer differs from what you expect
Probing versus Leading Example:Interviewer: In the last 7 days, how many times did youeat prepared food at the dorm cafeteria? Would yousay: a. None d. 3 times b. Once e. More than 3 times c. TwiceRespondent:“Oh, gee, I didn’t go very often . . . maybe a few times.”
Probing versus Leading Example: Interviewer Probe (correct) “Which would be closer: none, once, twice, 3 times, or more than 3 times?” Interviewer Leading (incorrect)a. “So, would you say twice, or three times?”b. “Do you mean twice, or three times?”
Interviewing Procedures Maintain RapportAn interviewer should be:• Nonjudgmental• Noncommittal• Objective
Maintain Rapport “Any line can be said a thousand ways.” - BRFSS interviewer training Interviewers can put respondents at ease by doing the following:• Read the questions in a friendly, natural manner• Speak at a moderate rate of speed• Sound interested• Strive for a low-pitched voice
Feedback Helps Maintain RapportFeedback is a statement or action that indicatesto the respondent that s/he is doing a good job. – Give feedback only for acceptable performance - not “good" content. – Give short feedback phrases for short responses, longer feedback for longer responses. – Specific study information and interviewer task-related comments can serve as feedback. – Telephone interviewers should give feedback for acceptable respondent performance 30-50% of the time.
Feedback Examples• “I see…”• “Uh-huh”• “Thank you / Thanks”• “That is useful / helpful information”• “I see, that is helpful to know”• “That is useful for our research”• “Let me get that down”• “I want to make sure I have that right (REPEAT ANSWER)”• “We have touched on this before, but I need to ask every question in the order that it appears in the questionnaire”
Interviewing Procedures Maintain Even Pace• Pace refers to the rate of progression of the interview.• Pace can vary by question type.• Let the respondent set the pace.
Question and Answer Opportunity
Activity:Correct Interview ProceduresProbing vs. Leading vs. Feedback Completion time: 5 minutes
ActivityInterviewer: “Are you still experiencing Diarrhea?”Respondent 1: “I’m not sure”Respondent 2: “I definitely had diarrhea last Tuesday”Respondent 3: “Yes” Activity Instructions: How should the interviewer respond to these 3 answers? Provide an example of either a clarification, probe, or feedback that the interviewer could use. Try to think of one correct use of each technique.
Activity Suggested AnswerRespondent 1: “I’m not sure” Try a clarification: “For the purposes of this survey, we consider diarrhea to be 3 or more loose bowel movements in a 24 hour period.”
Activity Suggested AnswerRespondent 2:“I definitely had diarrhea last Tuesday” Try a Probe: “OK, but are you still experiencing diarrhea?”
Supervising InterviewersMonitoring, evaluation, and feedbackgiven to interviewers should focus on theway interviewers handle the question-answer process.
Other Supervision Tasks• Scheduling interviewers – Number of interviewers needed – Time calls / visits will be made• Setting up interview space• Tracking who has been called and who has not• Reviewing data from completed interviews
Confidentiality Human Subjects & Informed ConsentOutbreak investigations are considered apublic health emergency, with the purposeof identifying and controlling a healthproblem. Informed consent or InstitutionalReview Board (IRB) clearance are notrequired.
Confidentiality Human Subjects & Informed ConsentIf further analysis of outbreak investigationdata is conducted for the purpose ofresearch, IRB approval should beobtained.
Confidentiality Respondent PerspectiveOpening statement of every interviewshould indicate that all informationcollected will be kept confidential.
Confidentiality Outbreak Investigation Perspective• Do not discuss details about the outbreak• Provide only a brief description of the purpose of the survey at first contact
Question and Answer Opportunity
5 minute break
Guest Lecturer Erin Rothney, MPH Research AssociateNC Center for Public Health Preparedness
Overview• Provide real-life examples of situations where you will use interviewing techniques – Face-to-face interviewing – Telephone interviewing• Discuss advantages and disadvantages• Compare interviewing methods
Community Assessments• Identify the needs and strengths of a particular community from several stakeholder perspectives• Include interviewing community members and observing the environmental and individual characteristics and community infrastructure• Similar to rapid needs assessments, but completed within a longer time frame
Durham, NC Community Assessment• Fall 2002 - Spring 2003• Bragtown Neighborhood, Durham, NC• 5 person team• Interviewed residents and other stakeholders in Bragtown• 4 page survey, 60 minutes in length
Durham, NC Community Assessment Tasks:• Questionnaire design• Interviewer training• Interviewing• Facilitating focus groups• Analyzing data• Presenting data to the community
Survey Instrument Question Examples:Life in the Community• What do people in Bragtown do for recreation?• What types of religion are practiced in Bragtown?• What do people in Bragtown do for a living?• What political or government organizations exist in Bragtown?• What different cultural and ethnic groups live in Bragtown?• How do these different groups interact? Do they get along?Community Assets• What do you like about Bragtown?• What are some organizations within your community that positively affect you or your community? – Probe: What about political groups, environmental groups, church groups?• Who are the individuals within your community that you feel are positive leaders or role models? – Probe: Any others?
Interviewer Training• Active listening skills• Showing empathy• Using probes• Practice interviewing, not just reading questions
Face-to-face Interviews Challenges SolutionsHard to find people at home Schedule time ahead by phone or stop by and schedule more convenient timePeople may not want to Use the skills you learned invite a stranger into their in interviewer training to home gain trustCostly and time-intensive Have someone on staff method of interviewing train others on interviewing techniques; carpool; set time limits
Lessons Learned1. Study community demographics and characteristics before you interview2. Train interviewers before an immediate need3. People like to tell you their stories- could lead to relevant information
Telephone Interviews2004 E. coli Outbreak Investigation
E. coli Outbreak Investigation Telephone Interviews• Illness onset October - November 2004• Geographically dispersed cases in multiple states• Case-control study• Train-the-trainer, interviewer
E. coli Outbreak Investigation Telephone Interviews• Between 3 and 6 interviewers• Calls made between 3 p.m. and 8 p.m.• Quality control with one central interviewing location• News coverage piqued people’s interest in the outbreak investigation
Lessons Learned1. Practice reading through the questions and conducting an interview2. The media can be your friend3. Use an introductory script to relate the purpose of the phone call to the individual quickly – Identify and legitimize the interviewer – State reasons for conducting the survey – Assure that responses will be confidential
Summary [Face-to-face] [Telephone]Community Assessment Outbreak Investigation – Establish rapport – News coverage helped in recruiting people to participate – Identify people in a small geographic area – Widely distributed sample – Assess the environment of the area – We had the phone numbers of all the people who pre- bought tickets
Question and Answer Opportunity
Session Summary• Questionnaire design and interview methods are interrelated in the overall process of an outbreak investigation.• The primary purpose of interviews in outbreak investigations is to collect data for case identification, risk factor identification, or hypothesis generation.
Session Summary• Interview methods can be interviewer administered (face-to-face or telephone) or self administered (mailed, emailed, or Web-based). There are advantages and disadvantages to employing either method.• Sampling is the systematic selection of a representative portion of the larger source population to be interviewed. If the purpose of your study is to determine the point source of infection, you may be able to interview a smaller sample; if the purpose of your study is to calculate an attack rate, you may need to interview a larger sample.
Session Summary• Survey response rates measure the percentage of your sample that has participated in your survey. Average response rates vary from as little as 56% for mailed surveys to 75% for face- to-face surveys.• Non-response to surveys can be a result of no one being home, refusal to participate, or individual inability to participate (e.g., because of a language barrier or physical or mental condition).
Session Summary• Survey data collection error is a result of both bias and variance in the interview process.• Interviewer error can be prevented with adequate interviewer training and the standardization of survey instruments.
Session Summary• Develop and distribute an interviewer manual to provide interviewer support. Such documentation reduces error and enhances the quality of data collected.• Sound interviewing procedures include: reading questions exactly as they are worded; probing inadequate answers; recording answers without interviewer discretion; and maintaining rapport with respondents.
Next Session November 3rd 1:00 p.m. – 3:00 p.m. Topic: “Analyzing Data”
References and Resources1. American Statistical Association (1997). What Is a Survey? More About Mail Surveys. Alexandria, VA: Section on Survey Research Methods, American Statistical Association.2. American Statistical Association (1997). What Is a Survey? How to Collect Survey Data. Alexandria, VA: Section on Survey Research Methods, American Statistical Association.3. Centers for Disease Control and Prevention (2005). Outbreak Management System Demonstration Web site. http://www.cdc.gov/phin/software-solutions/oms/index.html .
References and Resources4. Fowler, F. and Mangione, T. (1990). Standardizing Survey Interviewing. Newbury Park: Sage Publications.5. Gregg, M. (ed). (1996). Field Epidemiology. Oxford University Press.6. Holstein, JA and Gubrium, JF. (1997). Active Interviewing. In Silverman, D. (Ed.) Qualitative Research: Theory, Method, and Practice. London: Sage Publications, pp. 113-129.7. Last, J.M. (2001). A Dictionary of Epidemiology: 4th Edition. Oxford University Press: New York.
References and Resources8. Levy, P. and Lemeshow, S. (1991). Sampling of Populations. John Wiley & Sons.9. Ramsey, S. et al (2005). Using GIS and GPS to Improve Public Health Response. Guilford County, NC Health Department Public Health Regional Surveillance Team 5.10. Rubin, HJ and Rubin, IS. (1995). Interviews as Guided Conversations. Qualitative Interviewing: The Art of Hearing Data. Sage Publications, pp. 1-16, 122-144.11. Salant, P. and Dillman, D. (1994). How to Conduct Your Own Survey. John Wiley & Sons.
References and Resources12. Stehr-Green, J.K. (2002). Gastroenteritis at a University in Texas: Case Study Instructor’s Guide. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention.13. U.S. Census Bureau (2005). Profile of Selected Housing Characteristics by State: Census 2000 Summary File 3 http ://factfinder.census.gov/servlet/QTTable?_bm=n&_lang=en&qr_name=D14. Weiss, R.S. (1994). Learning from Strangers: The Art and Method of Qualitative Interview Studies. New York: The Free Press.15. Wiggins, B. and Deeb-Sossa, N. (2000). Conducting Telephone Surveys. Chapel Hill, NC: Odum Institute for Research in Social Science.