AIDS and behavioural risk factors in women in inner city Baltimore: a comparison of telephone and face to face surveys

Patient feedback on hospital pharmacists’ consultation skills: A feasibility study using the Interpersonal Skills Questionnaire (ISQ)

Background

Improvement in practitioners’ consultation skills (CSs) can be driven by patient feedback, however, to date, no study has been conducted with reference to pharmacy consultations. The Interpersonal Skills Questionnaire (ISQ) is potentially appropriate for collecting patient feedback on pharmacists’ CSs. This study aims to explore the feasibility of collecting patient feedback on hospital pharmacists’ CSs using the ISQ, to identify the acceptability of the feedback process, and to identify methods to enhance the process in the future.

Methods

The study was conducted in a teaching hospital, United Kingdom, between 2018 and 2019. A diverse sample of pharmacists with patient-facing roles was purposively selected. The study comprised three phases. Pharmacists collected feedback from patients following their consultation using the ISQ utilising a third person whenever possible (phase-1). Data analysis and individual report writing was conducted by a private company. Interviewing a sample of patient participants by telephone (phase-2), and interviewing pharmacists face-to-face after receiving feedback reports (phase-3). All interviews were transcribed verbatim and thematically analysed. The study received approval by the NHS Health Research Authority.

Results

Six pharmacists were included. Of the 119 distributed ISQs, 111 were returned (response rate 93%). Patients were mostly recruited by their consulting pharmacists (72%, n = 80). All pharmacists and 14 patients were interviewed. Participants were positive about patient feedback and its role in enhancing CSs. Most did not encounter any problem with the process, however, some pharmacists struggled to find a third person. The ISQ was mostly viewed suitable to assessing pharmacy consultations. Some reports highlighted areas to improve (e.g. protecting patient’s privacy).

Conclusions

Collecting feedback is feasible, acceptable and may enhance CSs, however, the process was associated with challenges such as finding a third person. Several measures should be considered to make the process more feasible within the hospital pharmacy setting.

A Descriptive Study Using an Intercept Survey: Knowledge, Attitudes, Beliefs, and Behaviors About Systemic Antibiotic Use in Adults Who Reported a Wound Within the Previous Year

PURPOSE

This project examined knowledge, attitudes, beliefs, and behaviors about systemic antibiotic use for persons who reported a wound within the previous year.

DESIGN

Secondary data analyses of 505 adults from a cross-sectional, prospective, intercept survey where every fifth adult was randomly approached to participate.

SUBJECTS AND SETTING

Twenty-six participants (5.15% of the parent sample) stated having a wound within the previous year.

METHODS

Participants were "interviewed" using the Facilitators and Barriers to Consumer Use of Antibiotics questionnaire that included demographics, health, information sources, antibiotic knowledge, attitudes, beliefs, and behavior questions. Hierarchical agglomerative cluster analysis was used to find clusters of items on the attitude, beliefs, and behavior questions.

RESULTS

Sample demographics included 15 women and 11 African Americans, and 17 had some college education. Knowledge about antibiotics had a mean correct score of 10 out of 15 (67%) questions. Higher antibiotic knowledge was significantly related to higher education (rs = 0.69, P < .001). There were 2 attitude and beliefs clusters: most participants (>85%) recognized the need for medical supervision of antibiotic use (cluster 1), and beliefs about the need for antibiotics to prevent illness or treat wounds varied in 27% to 62% of participants (cluster 2). There were 4 behavior clusters: almost all participants 96% (cluster 1) filled and took the antibiotic if prescribed; greater than 71% (cluster 2) disagreed with unapproved methods of obtaining antibiotics; greater than 87% (cluster 3) used prescribed antibiotics correctly; and 36% of participants heard about antibiotic resistance through television or radio or Internet (40%) (cluster 4).

CONCLUSIONS

Knowledge about antibiotics was low, while attitudes were positive. These findings support the need for research and evidence-based information on the role of antibiotics in wound care.

The consideration of building maintenance at design stage in public buildings

Purpose

Effective building maintenance management is vital for reducing the impact of building defects and costly building maintenance work. Such practice significantly contributes to the public sector in terms of cost reduction, improved effectiveness and efficiency in maintenance works, increasing safety and well-being of the occupants, expanding the life of building stocks and expanding the value of investment for the government building assets. The maintenance practice in Malaysia is still emerging in comparison to many developed nations. The purpose of this study is to determine the current scenario of the building maintenance approach at the design stage in public buildings in Malaysia.

Design/methodology/approach

An extensive questionnaire survey was held, involving 312 key players (38 per cent out of 820 predetermined participants) in Malaysia.

Findings

The analysis showed that building maintenance in public building in Malaysia still uses the reactive approach. Despite the Malaysian Government’s adoption of a proactive maintenance approach, unfortunately, there are some misunderstandings among the key players regarding the approach. The research results demonstrate that the key players had a lack of understanding on the concept of the proactive maintenance management approach and that they were either ignorant or had insufficient awareness of proactive maintenance approach.

Originality/value

The contribution of this study is useful for the government to adopt a more proactive building maintenance policy at the design stage, to give awareness on proactive building maintenance to the key players in their construction project and as a guide to the key players to adopt a maintenance plan at the design stage of work.

Using Virtual Reality to Improve Antiretroviral Therapy Adherence in the Treatment of HIV: Open-Label Repeated Measure Study

Background

Nonadherence to HIV medications is a serious unsolved problem and is a major cause of morbidity and mortality in the HIV-positive population. Although treatment efficacy is high if compliance is greater than 90%, about 40% of people with HIV do not meet this threshold.

Objective

This study aimed to test a novel approach to improve medication adherence by using a low-cost virtual reality (VR) experience to educate people with HIV about their illness. We hypothesized that people with HIV would be more likely to be compliant with the treatment following the 7-minute experience and, therefore, should have decreasing viral load (VL), increasing cluster of differentiation 4⁺ (CD4⁺) cell counts, and improved self-reported adherence.

Methods

We showed the VR experience to 107 participants with HIV at a county hospital in Los Angeles, California. Participants were asked to self-report how often they take their medications on a Likert-scale. The self-reported question (SRQ) was given before and at least 2 weeks after the VR experience. We also compared VL and CD4⁺ cell counts before and on average 101 days after the experience. VL and CD4⁺ were obtained per the clinic’s standard care protocol. Two-tailed paired t tests were performed on the initial and follow-up SRQ scores, VL, and CD4⁺. We restricted the CD4⁺ analysis to participants who had a pre-CD4⁺ below normal (defined as 500 cells/mm³). To reduce the possibility that VL were trending down and CD4⁺ were trending up regardless of the VR experience, 2 serial VL and CD4⁺ obtained before the experience were also compared and analyzed. Immediately following the VR experience, participants were given a 4-question Likert-type postexperience questionnaire (PEQ) that assessed their opinions about the experience.

Results

SRQ scores improved from pre to post experience with high significance (P<.001). VL decreased from pre to post experience by 0.38 log₁₀ copies/mL (95% CI 0.06-0.70; P=.02). In contrast, the 2 serial VL obtained before the experience showed no statistically significant changes. There was also a statistically significant increase in CD4⁺ (95% CI –3.4 to –54.3 cells/mm³; P=.03). Analysis of the PEQ revealed that VR was comfortable for almost all of the participants and that most participants believed the experience to be educational and that it would improve their medication adherence.

Conclusions

The findings suggest that the low-cost VR experience caused an increased rate of antiretroviral therapy adherence that resulted in a decrease of VL and an increase of CD4⁺. Further studies are required to explore the duration of this effect and whether these results are generalizable to other treatment settings and populations.

Comparing reporting of abortions in three nationally representative surveys: methodological and contextual influences

BACKGROUND

Abortions are known to be underreported in surveys. Previous research has found a number of ways in which survey methodology may affect respondents' willingness to disclose abortions. The social and political climate surrounding abortion may also create stigma affecting abortion reporting, and this may vary between countries and over time.

METHODS

We estimate the extent of underreporting in three nationally representative population surveys by comparing survey rates with routine statistics, in order to explore the ways in which survey methodology and cultural context might influence reporting of abortion. Data are analysed from two National Surveys of Sexual Attitudes and Lifestyles, conducted in 2000 and 2010 (Natsal-2 and Natsal-3) in Britain, and the Fertility, Contraception and Sexual Dysfunction survey (FECOND) conducted in 2010 in France. The three surveys differ with regard to survey methodology and context.

RESULTS

There was no strong evidence of underreporting in Natsal-2, which collected data on abortion using a direct question. There was evidence of underreporting in Natsal-3 and FECOND, both of which collected data on abortion through a pregnancy-history module. There was no evidence of a difference in the extent of underreporting between Natsal-3 and FECOND, which differed with regard to survey methodology (self-administered module in Natsal-3, telephone interview in FECOND) and country context.

CONCLUSION

A direct question may be more effective in eliciting reports of abortion than a pregnancy-history module.

Impact of a Community-level Intervention on HIV Stigma, Homophobia and HIV Testing in New York City: Results from Project CHHANGE

BACKGROUND

HIV stigma and homophobia are barriers to access to HIV prevention and treatment services. Project CHHANGE, Challenge HIV Stigma and Homophobia and Gain Empowerment, was a multicomponent intervention designed to reduce community-level HIV stigma and homophobia via workshops, space-based events and bus shelter ads delivered to community-based organizations and neighborhood residents in a high HIV prevalence, primarily African-American, Black and/or Afro-Caribbean, neighborhood in New York City (NYC).

METHODS

Serial cross-sectional, street intercept surveys among residents of the invention neighborhood and matched control neighborhood were conducted before and after the intervention. Propensity score matching and generalized estimating equation regression models assessed the impact of CHHANGE on HIV stigma and homophobia. HIV testing service utilization data were assessed and multivariable models of self-reported HIV testing among post-intervention street survey respondents were built.

RESULTS

We did not find a significant treatment effect on HIV stigma and homophobia among residents of the intervention neighborhood as compared with control community residents. However, HIV testing increased by 350% at the testing site in the intervention community after the intervention implementation. Further, lower HIV stigma, attending an HIV stigma workshop and having friends or family living with HIV were independently associated with past six-month HIV testing among post-intervention respondents in both neighborhoods.

CONCLUSIONS

CHHANGE was feasible and acceptable to community residents. Evaluating community-level interventions is challenging. Our triangulated approach yielded somewhat conflicting results, which may be due to design limitations. Further research is needed to understand whether and how CHHANGE affected HIV testing.

Evaluation of a Community-Based Latino Heart Disease Prevention Program in Metropolitan Washington D.C

Cardiovascular disease (CVD) is the leading cause of death for Latinos living in the United States. This population is generally unaware of important lifestyle or behavioral changes that can prevent CVD. The National Heart, Lung, and Blood Institute (NHLBI) in collaboration with a community alliance designed and implemented Salud para su Corazón (Health for Your Heart), a culturally specific, community-based initiative to increase awareness about heart disease risk factors and knowledge about heart disease prevention, and to promote heart-healthy lifestyles. The initiative included messages about smoking cessation; weight loss if overweight; increase in physical activity; and checking blood pressure and cholesterol and treating them if high. Messages were communicated through multiple mass media, interpersonal, and outreach channels. A summative evaluation assessed the impact of the campaign. A pre- and post-campaign survey was conducted in the intervention community to assess whether the messages reached the target audience, and if the initiative had an effect. The sample of respondents included over 300 participants. Results showed that respondents were significantly more aware of risk factors for CVD after the campaign, and had greatly increased their knowledge of ways to prevent heart disease. Current behaviors to prevent cardiovascular disease had not changed at the post campaign measurement. Television, radio, and doctors were the most frequently cited sources of information for learning about the Salud para su Corazón initiative. Furthermore, the specific messages recalled and the source of information cited at post-test were similar to those promoted in the campaign, indicating it was successful in reaching the target audience.

Assessing health status, behavioral risks, and health disparities in American Indians living on the northern plains of the U.S

OBJECTIVE

We assessed health status and behavioral risks in American Indians (AIs) from rural, northern plains reservation communities.

METHODS

AI interviewers from the communities administered the core and optional modules of the Behavioral Risk Factor Surveillance System (BRFSS) to 404 AI adults randomly selected from housing lists from four AI tribal communities located on the northern plains of the U.S. The BRFSS interview assessed several health functioning areas including medical conditions, preventive screenings, and behavioral risks. We measured health disparities by comparing the AI sample data with a northern plains statewide (North Dakota) sample and a U.S. national sample. We compared outcomes with BRFSS statewide (North Dakota) and U.S. national data from telephone-based interviews.

RESULTS

AI participants showed a significantly greater prevalence of diabetes, coronary heart disease, myocardial infarction, smoking, obesity, and heavy alcohol use than either the regional or national samples. They also reported being less likely to engage in leisure-time physical activity and to have had age-appropriate preventive screenings for several diseases including colorectal cancer, prostate cancer, breast cancer, and cardiovascular disease.

CONCLUSIONS

Face-to-face interviews conducted by AI community members are an effective means of gathering health information about AIs living in rural, reservation communities. AIs living in these communities on the northern plains have a much higher prevalence of many health-risk behaviors and some medical conditions than are found in the general population. Improved health-care access, better preventive screenings, and culturally appropriate community-based health promotion programs and policies should be examined as possible ways to reduce health disparities.

Assessing Racial Health Inequality in Older Adulthood: Comparisons From Mixed-Mode Panel Interviews

OBJECTIVES

Estimates of the extent of health disparities among Black and White older adults are not consistent across studies. The purpose of this study was to systematically compare responses from Black and White older adults in telephone and face-to-face interviews in order to determine whether estimates of racial health inequality vary by survey interview mode.

METHODS

By using data from a mixed-mode panel study, I compared estimates of changing health inequality for Black and White older adults collected from face-to-face and telephone interviews. I calculated trajectories of physical disability by using latent growth models across seven waves of data.

RESULTS

Face-to-face interviews yielded consistently higher reports of disability relative to telephone interviews of the same persons. Black adults had significantly greater and increasing disability than did White adults for both interview modes. After adjusting for covariates, I found that Black and White older adults had parallel disability trajectories in face-to-face interviews but a widening gap in disability over time in telephone interviews.

DISCUSSION

Researchers should judiciously consider whether estimates of racial health inequality-and change in disability more broadly-may be misleading because of interview-mode effects.

A cross-national study of subjective sexual well-being among older women and men: findings from the Global Study of Sexual Attitudes and Behaviors

Subjective sexual well-being refers to the cognitive and emotional evaluation of an individual's sexuality. This study examined subjective sexual well-being, explored its various aspects, examined predictors across different cultures, and investigated its possible associations with overall happiness and selected correlates, including sexual dysfunction. Data were drawn from the Global Study of Sexual Attitudes and Behaviors, a survey of 27,500 men and women aged 40-80 years in 29 countries. The cross-national variation of four aspects of sexual well-being (the emotional and physical satisfaction of sexual relationships, satisfaction with sexual health or function, and the importance of sex in one's life) was explored using cluster analysis, and relationships among sexual well-being, general happiness, and various correlates were examined using ordinary least squares regression and ordered logistic regression. Results from the cluster analysis identified three clusters: a gender-equal regime and two male-centered regimes. Despite this cultural variation, the predictors of subjective sexual well-being were found to be largely consistent across world regions.

Mode of questionnaire administration can have serious effects on data quality

BACKGROUND

One of the main primary data collection instruments in social, health and epidemiological research is the survey questionnaire. Modes of data collection by questionnaire differ in several ways, including the method of contacting respondents, the medium of delivering the questionnaire to respondents, and the administration of the questions. These are likely to have different effects on the quality of the data collected.

METHODS

This paper is based on a narrative review of systematic and non-systematic searches of the literature on the effects of mode of questionnaire administration on data quality.

RESULTS

Within different modes of questionnaire administration, there were many documented potential, biasing influences on the responses obtained. These were greatest between different types of mode (e.g. self-administered versus interview modes), rather than within modes. It can be difficult to separate out the effects of the different influences, at different levels.

CONCLUSIONS

The biasing effects of mode of questionnaire administration has important implications for research methodology, the validity of the results of research, and for the soundness of public policy developed from evidence using questionnaire-based research. All users of questionnaires need to be aware of these potential effects on their data.

Obtaining sensitive information from a wary population: a comparison of telephone and face-to-face surveys of welfare recipients in the United States

Recent studies reveal the benefits of technological developments such as audio computer assisted self-interviewing (A-CASI) in interview methodology, especially for surveys of sensitive behavior and information. However, we believe that the selection of mode of administration depends not only on the technology available and the behavior of interest, but also on the specific population under study. We therefore assess survey mode effects on reported rates of alcohol and drug use among welfare recipients, an especially important group for scholars and public health agencies. The sample consisted of adult recipients of Temporary Assistance to Needy Families (TANF) in Oklahoma, January 2001. Adjusting for demographic characteristics, employment, and education, we employ odds ratios to compare 30-day, 1 year, and lifetime prevalence estimates from telephone and face-to-face surveys. Telephone methodology yields similar or higher estimates for lifetime prevalence of alcohol, marijuana, and hard drug use and abuse, though lower estimates of recent use. We discuss our findings in relation to underfunded public health agencies that must efficiently assess and respond to local levels of drug abuse and we conclude that mode selection may depend upon the population under study.

Sexual behavior and sexual dysfunctions after age 40: The global study of sexual attitudes and behaviors

OBJECTIVES

To assess the importance of sex and the prevalence of sexual dysfunction among middle-aged and older adults throughout the world. Increasing life expectancy has been accompanied by improvements in the health of the middle-aged and elderly, but little is known about how this has affected their sexual experience.

METHODS

Data were collected in 29 countries from 27,500 men and women aged 40 to 80 years using a standardized questionnaire (self-completed or by interview). Sexual dysfunction was defined as frequent and persistent problems. They included early ejaculation and erectile difficulties in men, lubrication difficulties and pain during intercourse in women, and a lack of sexual interest, an inability to achieve orgasm, and a feeling of unpleasurable sex in both.

RESULTS

More than 80% of the men and 65% of the women had had sexual intercourse during the past year. Of these subjects, the most common dysfunctions were early ejaculation (14%) and erectile difficulties (10%) among the men and a lack of sexual interest (21%), inability to reach orgasm (16%), and lubrication difficulties (16%) among the women. Overall, 28% of the men and 39% of the women said that they were affected by at least one sexual dysfunction.

CONCLUSIONS

The results of our study indicate that sexual desire and activity are widespread among middle-aged and elderly men and women worldwide and persist into old age. The prevalence of sexual dysfunctions was quite high and tended to increase with age, especially in men. Although major between-country differences were noted, this global study revealed some clear and consistent patterns.

Sexual problems among women and men aged 40–80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors

The Global Study of Sexual Attitudes and Behaviors (GSSAB) is an international survey of various aspects of sex and relationships among adults aged 40-80 y. An analysis of GSSAB data was performed to estimate the prevalence and correlates of sexual problems in 13,882 women and 13,618 men from 29 countries. The overall response rate was modest; however, the estimates of prevalence of sexual problems are comparable with published values. Several factors consistently elevated the likelihood of sexual problems. Age was an important correlate of lubrication difficulties among women and of several sexual problems, including a lack of interest in sex, the inability to reach orgasm, and erectile difficulties among men. We conclude that sexual difficulties are relatively common among mature adults throughout the world. Sexual problems tend to be more associated with physical health and aging among men than women.

Comparación entre encuestas telefónicas y encuestas «cara a cara» domiciliarias en la estimación de hábitos de salud y prácticas preventivas

OBJECTIVE

This study examines the influence of the interview method (telephone or face-to-face in households) on the assessment of health behaviors and preventive practices.

MATERIAL AND METHOD

The same questionnaire was completed by two independent samples of the population aged 18-64 years living in the municipality of Madrid. One sample (n = 1,391 subjects) completed the questionnaire by telephone interview and the other (n = 739) by face-to-face interview in households. The results of the two samples for 28 variables related to anthropometry, physical activity, food consumption, tobacco and alcohol use, preventive practices and injuries were compared.

RESULTS

The telephone sample had a higher rate of failed contact (31.8% vs. 22.2%) but a greater degree of cooperation than the sample for the face-to-face interview (83.0% vs. 74.0%). In total, 19 of the 28 variables showed a relative variation of less than 10% between the two surveys; the differences found were between 10 and 20% for eight variables and were higher than 20% for one variable. Differences were statistically significant for only four variables (sedentary leisure time, consumption of vegetables, giving up smoking and cholesterol measurement), with a relative variation of 6.1% (p < 0.01), 10% (p < 0.001), 36.7% (p < 0.01) and 8.6% (p < 0.01), respectively. The total cost of the telephone interview was half that of the face-to-face household interview.

CONCLUSIONS

The results of both surveys were very similar. Because of its lower cost, the telephone interview is a good option in public health research when data collection by interview is required.

Effects of two telephone survey methods on the level of reported risk behaviours

OBJECTIVE

Reporting bias due to social desirability is an important consideration in carrying out surveys on sensitive issues. The study compared the frequency of self reported sensitive behaviours and response rates between the conventional "telephone interviewer method" (TIM) and a combined interviewer and computerised data capturing method (telephone interviewer and computerised questionnaire method, or TICQM).

METHODS

A total of 580 males and 582 females were recruited and randomly assigned to either of the two methods in a cross sectional study. The overall response rate was about 51.6%.

RESULTS

While the two methods both had high completion and low item non-response rates, the TICQM respondents reported higher frequencies of sensitive risk behaviours. Sexually active female respondents interviewed by the TICQM were more likely to report that their sex partners were their steady boyfriend, instead of their husband; and were also more likely to admit that they had had "one night stand" experiences or had undergone an HIV antibody test, when compared with their counterparts in the TIM group. Similar contrasts were observed for sexually active male respondents, that the TICQM group were more likely to report that they had had sexual intercourse with female sex workers or non-regular sex partners. Sex differences in the strength of association were observed between some studied behaviours (for example, HIV testing and substance abuse) and modes of data collection.

CONCLUSION

The choice of data collection method has a significant impact on the results of sensitive studies; special attention should be given to designing the study and interpreting the results.

The reliability of telephone interviews compared with in-person interviews using memory aids

PURPOSE

Information obtained by telephone interviews and in-person interviews is generally considered comparable, but it is unclear if extensive memory aids can be used effectively with telephone interviews. We compared a telephone interview to an in-person interview using the same questionnaire and memory aids in both.

METHODS

A convenience sample of 103 women, aged 25 to 69 years, completed a telephone interview and at least four weeks later, completed an in-person interview. Memory aids included a life events calendar, cue lists, and worksheets.

RESULTS

Agreement values, measured by kappa/weighted kappa, were as follows: parity (1.00), age at menarche (0.76), menopausal status (0.95), a history of reproductive organ surgery (0.98) or tubal ligation (0.91), self-reported infertility (0.76), and a first degree family history of breast/ovarian cancer (0.90). Agreement values for duration variables, measured by the intraclass correlation, were as follows: lactation (0.96), oral contraceptive use (0.98), any hormone replacement therapy (0.98), exclusive estrogen and progesterone therapy (0.83), and exclusive estrogen therapy (0.99).

CONCLUSIONS

The good to excellent level of agreement found in this study indicates that telephone administration of our questionnaire with extensive memory aids is a reliable method of obtaining detailed exposure information relative to in-person interviews.

The impact of touch-tone data entry on reports of HIV and STD risk behaviors in telephone interviews

Respondents concerns about privacy can decrease reporting of HIV and STD risk behaviors in general population telephone surveys. The purpose of this paper is to describe the results of an experimental study evaluating whether one method for increasing privacy, touch-tone data entry (TTDE), is effective in increasing estimates of sexual behaviors from a population-based survey. We conducted a random-digit-dial telephone survey of adults in New Jersey (n = 405), with half the respondents using TTDE for answering sexual behavior questions. TTDE led to increased reports of same-sex sexual behavior, certain HIV and STD risk factors, and concern about one s risk for HIV and STD transmission. TTDE also narrowed the difference between men s and women s reports of the number of different sexual partners over the past 10 years. The feasibility and limitations of TTDE are discussed, as well as possible alternative interpretations that consider the impact of TTDE on the dynamics of the interaction between the respondent and the interviewer.

Effectiveness of an intervention to reduce HIV transmission risks in HIV-positive people

BACKGROUND

As many as one in three HIV-positive people continue unprotected sexual practices after learning that they are HIV infected. This article reports the outcomes of a theory-based intervention to reduce risk of HIV transmission for people living with HIV infection.

METHODS

Men (n=233) and women (n=99) living with HIV-AIDS were randomly assigned to receive either (1) a five-session group intervention focused on strategies for practicing safer sexual behavior, or (2) a five-session, contact-matched, health-maintenance support group (standard-of-care comparison). Participants were followed for 6 months post-intervention.

RESULTS

The intervention to reduce risk of HIV transmission resulted in significantly less unprotected intercourse and greater condom use at follow-up. Transmission-risk behaviors with non-HIV-positive sexual partners and estimated HIV transmission rates over a 1-year horizon were also significantly lower for the behavioral risk-reduction intervention group.

CONCLUSIONS

This study is among the first to demonstrate successful HIV-transmission risk reduction resulting from a behavioral intervention tailored for HIV-positive men and women.

Telephone follow-up in a randomized controlled trial in a less developed country: feasibility, validity and representativeness

Telephone follow-up would offer considerable advantages over other modes of follow-up in less developed countries, if it were feasible and the findings were valid and generalizable. Telephone follow-up was assessed in the context of a randomized controlled trial of chest radiography in South African children. Hospital-based clinical outcomes were measured from hospital records, and also by telephone, in a subset of the same patients who offered a contact telephone number. Of 398 subjects offering a telephone number 308 (77.4%) were followed to recovery or for 28 days. Kappa statistics for a subsequent hospital visit, hospital admission, and chest radiograph were 0.88, 0.83, and 0.56, respectively. The effect of chest radiography did not differ significantly in participants accessible and not accessible by telephone. Telephone follow-up was feasible and produced valid and generalizable results at low cost.

The public health approach to the prevention of sexual violence

This paper presents the public health approach to the prevention of sexual violence. The public health approach addresses primary, secondary, and tertiary levels of prevention. An explanation of each level of prevention is given as it relates to the area of sexual violence. Additionally, the public health approach attempts to shift the focus of prevention from potential victims to potential perpetrators. The four steps of the public health model are presented with examples of how the Centers for Disease Control and Prevention are applying this model to sexual violence prevention.

Estimating the proportion of homes with functioning smoke alarms: a comparison of telephone survey and household survey results

OBJECTIVES

This study determined the proportion of homes with functioning smoke alarms in a low-income area experiencing a high rate of residential fire-related injuries.

METHODS

An on-site survey of households was conducted to confirm the results of a telephone survey.

RESULTS

In the telephone survey, 71% of households reported having functioning smoke alarms. In the household survey, 66% of households reported having functioning alarms; however, when the alarms were tested, the percentage dropped to 49%.

CONCLUSIONS

Telephone surveys may overestimate the presence of functioning smoke alarms in some populations. Thus, the use of telephone surveys to establish baseline measures could significantly affect the evaluation of smoke-alarm giveaway programs.

Women's perceptions of group support and adaptation to breast cancer

Formal cancer support groups are thought to assist women to adapt to the physiological and psychosocial sequelae of breast cancer. To shed some light on this untested clinical assumption, this Roy Adaptation Model of Nursing-based study was designed to explore women's own reports about their adaptation to breast cancer and their participation in support groups. This article reports the results of the quantitative content analysis of structured telephone interviews with 70 women who participated in group social support and education for breast cancer. Almost three-quarters of the women expressed a positive change in attitude towards breast cancer, and all regarded participation in the groups as positive. A majority reported adaptive physiological, self-concept, role function, and interdependence mode effects of breast cancer and group participation. Additional research is needed to show how different types of cancer support groups, including social support and education groups and psychotherapy groups, contribute to women's responses. Research is also needed to separate the effects of group social support and education from other sources of social support that may have contributed to the women's responses, and to further explore feelings of normalization expressed by some women.

Reliability and validity of self-report measures of HIV-related sexual behavior: progress since 1990 and recommendations for research and practice

The trustworthiness of self-reported sexual behavior data has been questioned since Kinsey's pioneering surveys of sexuality in the United States (Kinsey et al., 1948, 1953). In the era of HIV and AIDS, researchers and practitioners have employed a diversity of assessment techniques but they have not escaped the fundamental problem of measurement error. We review the empirical literature produced since Catania et al.'s (1990) review regarding reliability and validity of self-administered and automated questionnaires, face-to-face interviews, telephone interviews, and self-monitoring approaches. We also provide specific recommendations for improving sexual behavior assessment. It is imperative that standardized self-report instruments be developed and used for sexual risk-behavior assessment.

The feasibility of a street-intercept survey method in an African-American community

OBJECTIVES

This study evaluates the feasibility of a nonquota, street-intercept survey method that utilized random selection of interview sites.

METHODS

The street-intercept survey was compared with a random digit-dial telephone survey conducted in the same catchment area among African-American adults aged 18 or older.

RESULTS

The street-intercept survey's response rate was 80.2%; residence rate, 85.3%; interview completion rate, 97.9%; interference rate, 4.0%; and yield rate, 2.5 interviews per interviewer per hour. The street-intercept method produced more representative distributions of age and sex than the random-digit-dial survey.

CONCLUSIONS

The street-intercept method is a feasible alternative to traditional population survey methods and may provide better access to harder-to-reach segments of the urban population in a safe manner.