Epidemiologic Interviews

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Epidemiologic Interviews
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Section Overview

• Interviewing techniques for collecting unbiased
  data
• Strategies for dealing with common interview
  problems

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Goal of epidemiologic interview

• To collect data without bias (data that
  accurately represents the true situation)

How can this be done?
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Techniques for collecting unbiased interview data
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Techniques for collecting unbiased interview data

• Use a standard questionnaire
• Other interview techniques
• Appropriate non-verbal communication
• Appropriate interview environment
• Inclusion of as many eligible subjects as
  possible

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Questionnaire

• Standard instrument for collecting data
• Use ensures that the same set of questions are
  asked of each person in the same way

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Type of information collected

• Subject identifier
• Name
• Contact information
• Number
• Clinical
• Signs symptoms
• Laboratory results
• Medical history
• Disease outcomes

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Type of information collected

• Risk factor data
• Activities / behaviors
• Food history
• Travel history
• Demographic characteristics
• Age
• Gender
• Race/ethnicity
• Residence

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Question types

• Close ended question with predetermined answers
• Open ended questions without predetermined
  answers

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Question types
Close - ended Question
Open - ended Question
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Script
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Skip pattern
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Using the questionnaire to collect high quality
information

• Before interview
• During interview

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Before the interview

• Review questionnaire before interview
• Make sure you understand scripts, questions and
  skip patterns
• Resolve any questions
• Fill out sections in advance as needed

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During the interview

• Read each question and its responses exactly as
  written
• Only skip a question if you are directed to do so
• Dont skip questions because you believe you know
  the answer
• Only accept an answer after you have finished
  reading the question and all the responses
• Dont rush or go too slowly

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During the interview

• Also read introductory script and other scripts
  exactly as written
• If the interviewee doesnt understand a question
• Re-read the entire question and the answers
• Dont rephrase in your own words or suggest an
  answer
• Mark Dont Know if necessary

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During the interview

• If a person is not sure of an answer
• Use a neutral statement to encourage an answer
  such as Which answer is closest to the way you
  feel?
• Mark Dont Know if necessary

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During the interview

• When documenting answers
• Write clearly
• Record responses to open-ended questions verbatim
  
• Indicate if an interviewee refused to answer a
  question

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Other factors that can affect quality of data
collected

• Non-verbal communication
• Body language
• Intonation
• Interviewing environment

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Nonverbal communication

• Communication that is not spoken eye contact,
  facial expressions, posture, intonation
• Significance
• 65-85 of the meaning of a message comes from the
  nonverbal component
• People believe the nonverbal message more than
  the verbal message

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Need for neutral body language

• Your body language (facial expression, posture)
  can send a message that can change subjects
  answers

How might this happen?
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Non-neutral body language

• Display of disapproval / surprise
• Facial expression, intake of breath
• e.g. after report of number of sexual partners,
  diet for the week
• May result in the subject being less honest when
  answering future questions

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Non-neutral body language

• Signs of interviewer lack of interest
• Lack of eye contact, fidgeting
• May result in subject
• Taking interview less seriously giving less
  consideration to answers
• Providing less detail to speed up

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Nonverbal communication tips

• Eye contact
• Establish eye contact when not reading questions
• Facial expressions and intonation
• Use neutral expression / tone OR
• mirror interviewees expression

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Nonverbal communication tips

• Posture
• Orient shoulders toward interviewee
• Dont cross arms
• Remove objects between you and interviewee
• Lean slightly forward
• Personal space
• Sit or stand no closer than 18 inches from the
  interviewee

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Intonation

• Its not just what you say but how you say it
• Your intonation can
• portray boredom, disapproval, surprise
• Lead a person to a particular answer

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Conducting telephone interviews

• It is particularly important to
• Convey professionalism with your voice by
  speaking clearly and sounding self-assured
• Be aware of your intonation

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Interview environment

• An uncomfortable environment will distract
  interviewee
• noisy, busy, too hot, too cold
• Fix what you can, acknowledge what you cant

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Interview environment

• The presence of other people may affect the
  truthfulness of a subjects answers
• Ensure as private an environment as possible

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Inclusion of subjects in interview

• Assess / verify eligibility using standard
  criteria / case definition
• Ask all eligible people to participate
• Avoid systematic exclusion of some eligible
  people e.g.
• People who have a difficult accent
• People who live in a particular neighborhood

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Inclusion of subjects in interview

• Consider how you ask someone to participate
• Would you be willing to participate?
• You dont want to participate, do you?

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Ethical interviewing

• Keep information confidential
• Do not share information with unauthorized people
• Make sure interview forms are kept safe
• Treat interviewee with courtesy and respect
• Thank interviewee for his/her contribution

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Strategies for Common Interviewer Challenges

• Recruitment during the interview

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Dont be surprised

• When scheduling or conducting an interview, you
  may be asked challenging questions such as
• Why cant you mail me the survey?
• Why cant you ask someone else?
• How do I know this survey is legitimate?
• How did you get my telephone number?
• Do you have the authority to collect this
  information?

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Questions about the investigation design

• Such as the interview format, interviewees
  inclusion in study, etc.
• Tell the person that
• the investigation has been carefully designed to
  provide a quick and accurate answer to an
  important public health question.
• His / her input is valuable

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Questions about your authority to conduct
interview / have access to his/her information

• Tell the person that Connecticut statue gives the
  Department of Public Health the authority to
  collect the information necessary to investigate
  any disease that it deems a special problem

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Regulations of Connecticut State Agencies

• Section 19a-36-A6
• Requires that medical info be given to the DPH
  when requested
• Gives the DPH the authority to determine what
  information is needed to investigate any given
  outbreak
• Section 19a-36-A7
• Gives the DPH authority to investigate any
  disease that it deems a special problem
  (non-reportable disease)

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Questions about investigation legitimacy

• Reiterate that you are representing a department
  of public health
• If necessary, have the person contact your
  supervisor to verify the legitimacy of the
  investigation

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Questions about the usefulness of the survey

• Re-read the introductory script concerning the
  reason for conducting the survey
• Tell the interviewee that
• you value his/her contribution
• His/her participation will help to ensure that
  the survey gives an accurate picture of the
  situation

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Interviewee said he/she is too busy

• Offer to schedule at a time which works for the
  interviewee make a specific date
• Stress importance of survey
• Let person know how long it should take
• Avoid racing through interview

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Interviewee is reluctant to disclose information

• Ensure a private interview environment
• Stress that according to Connecticut Statute, the
  information will be kept confidential
• Indicate that he/she can refuse to answer any
  question
• Assure the person that the questions are being
  asked of all subjects

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Connecticut General Statutes, Section
19a-5Confidentiality of Records Procured by DPH

• All information, records of interviews, written
  reports, statements, notes, memoranda, or other
  data, including personal dataprocured by the
  DPH for the purpose of reducing morbidity or
  mortality from any cause or condition shall be
  used solely for the purposes of disease control
  and prevention by the DPH. Such
  informationshall not be admissible as evidence
  in any action of any kind nor its contents
  disclosed in any way

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Interviewee goes off topic while answering a
question

• Redirect the person back to the question
• I see. Let me repeat the question so that we
  make sure we are staying on the right track
• Offer to reschedule if interviewee is too tired /
  unwell to participate

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Interviewee has limited English

• Speak slowly and listen carefully
• If you cannot understand or be understood
• politely discontinue interview
• record termination on the questionnaire
• tell your supervisor

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Interviewee wants feedback or information during
the interview

• Tell interviewee that
• You cant comment on the answers
• There are no right or wrong answers
• He / she will be given an opportunity to ask
  questions at the end of the interview

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Interview doesnt know he/she has a given
diagnosis / exposure

• Inform person that the diagnosis was made (or
  exposure was identified) as part of a public
  health investigation
• Suggest the interviewee call his/her doctor for
  further information about condition

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Summary

• Certain techniques can improve the quality of
  interview data
• Read scripts and questions exactly as written
• Skip only those questions you are instructed to
  skip
• Maintain neutral intonation and body language
• Public health has the authority to collect
  information for an investigation
• All information must be kept confidential

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Acknowledgements

• Adapted from the Florida Center for Public Health
  Preparedness Intermediate Field Investigation
  Response Surveillance Training