2006 National STD Prevention Conference Beyond The Hidden Epidemic : Evolution or Revolution?

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

2. Number of Gonorrhea Cases by Region 1999 to 2005 4/2006 Provisional Data - CA DHS STD Control Branch

3. 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

4. Objective • Compare telephone versus in-person interviews • Differences in resources required • Difference in quality of data • Differences in reported risk behaviors

5. Methods - 1 • Participating Local Health Jurisdictions: Alameda Fresno Kern Long Beach Orange San Bernardino Santa Clara • Sample of cases reported through case-based surveillance • Consecutive sample to 100 female and 100 male cases in each jurisdiction

6. 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

7. Data collected • 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

8. Data Flow

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

10. Comparison of time periods between telephone and in-person interviews * Excludes 2 local health jurisdictions due to protocol exceptions

11. Comparison of interviewer assessment of data quality telephone and in-person interviews * Excludes 2 local health jurisdictions due to protocol exceptions

12. Comparison of reported risk behaviors between telephone and in-person interviews * Excludes 2 local health jurisdictions due to protocol exceptions

13. Comparison of reported risk behaviors between telephone and in-person interviews * Excludes 2 local health jurisdictions due to protocol exceptions

14. Conclusions - 1 • Telephone interviews more likely to be completed than in-person interviews • Telephone interview process required less staff time than in-person interviews

15. 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

16. 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

17. 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 Acknowledgements • 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. 510-620-3198 msamuel@dhs.ca.gov