Early evaluation: hurdles in the road for Pioneer health and social care integration programme

The final report from the ‘early evaluation of the Integrated Care and Support Pioneer programme’s first 18 months suggests the 14 English areas comprising its original cohort have been making some headway (11 others joined them last year). But many are finding the going tough in terms of progress towards the initiative’s goal of ‘whole system’ integration organised around the needs of individuals and their carers

The effect of mode and context on survey results: analysis of data from the Health Survey for England 2006 and the Boost Survey for London.

BACKGROUND: Health-related data at local level could be provided by supplementing national health surveys with local boosts. Self-completion surveys are less costly than interviews, enabling larger samples to be achieved for a given cost. However, even when the same questions are asked with the same wording, responses to survey questions may vary by mode of data collection. These measurement differences need to be investigated further. METHODS: The Health Survey for England in London ('Core') and a London Boost survey ('Boost') used identical sampling strategies but different modes of data collection. Some data were collected by face-to-face interview in the Core and by self-completion in the Boost; other data were collected by self-completion questionnaire in both, but the context differed. Results were compared by mode of data collection using two approaches. The first examined differences in results that remained after adjusting the samples for differences in response. The second compared results after using propensity score matching to reduce any differences in sample composition. RESULTS: There were no significant differences between the two samples for prevalence of some variables including long-term illness, limiting long-term illness, current rates of smoking, whether participants drank alcohol, and how often they usually drank. However, there were a number of differences, some quite large, between some key measures including: general health, GHQ12 score, portions of fruit and vegetables consumed, levels of physical activity, and, to a lesser extent, smoking consumption, the number of alcohol units reported consumed on the heaviest day of drinking in the last week and perceived social support (among women only). CONCLUSION: Survey mode and context can both affect the responses given. The effect is largest for complex question modules but was also seen for identical self-completion questions. Some data collected by interview and self-completion can be safely combined

Increasing prevalence of male homosexual partnerships and practices in Britain 1990-2000: evidence from national probability surveys.

OBJECTIVES: To estimate the prevalence and timing of homosexual experience among British men; to explore the patterns of sexual practices and partnerships in 2000, and behavioural and attitudinal changes between 1990 and 2000 among men who have sex with men (MSM). DESIGN: Two large, stratified probability sample surveys of the general population. METHODS: Trained interviewers administered a combination of face-to-face and self-completion questionnaires to men aged 16 to 44 years resident in Britain (n = 6000 in 1990 and n = 4762 in 2000). RESULTS: In 2000, 2.8% of British men reported sex with men in the past 5 years. 46.0% of MSM reported five or more partners in the past 5 years, and 59.8% reported unprotected anal intercourse in the past year. A total of 33.0% of MSM reported one or more female partner(s) in the past year. In comparison with 1990, there was a significant increase in the proportion of MSM in the population in 2000, and among these men, in the proportion reporting receptive anal intercourse in the past year [age-adjusted odds ratio (OR), 2.08; 95% confidence interval (CI), 1.08-4.00], but no significant change in self-perceived HIV-risk (age-adjusted OR, 1.11; 95% CI, 0.49-2.51) or HIV testing in past 5 years (age-adjusted OR, 1.14; 95% CI, 0.57-2.25). CONCLUSIONS: Evidence of increasing prevalence of homosexual intercourse among the British male population coupled with increases in some HIV-risk behaviours among MSM suggests overall increasing numbers at risk in the population. Although these changes may partly reflect an increased willingness to report these behaviours, our results are consistent with increasing incidence of sexually transmitted infections and behavioural surveillance data

Common mental disorders and ethnicity in England : the EMPIRIC Study

Background. There is little population-based evidence on ethnic variation in the most common mental disorders (CMD), anxiety and depression. We compared the prevalence of CMD among representative samples of White, Irish, Black Caribbean, Bangladeshi, Indian and Pakistani individuals living in England using a standardized clinical interview. Method. Cross-sectional survey of 4281 adults aged 16–74 years living in private households in England. CMD were assessed using the Revised Clinical Interview Schedule (CIS-R), a standardized clinical interview. Results. Ethnic differences in the prevalence of CMD were modest, and some variation with age and sex was noted. Compared to White counterparts, the prevalence of CMD was higher to a statistically significant degree among Irish [adjusted rate ratios (RR) 2.09, 95% CI 1.16–2.95, p=0.02] and Pakistani (adjusted RR 2.38, 95% CI 1.25–3.53, p=0.02) men aged 35–54 years, even after adjusting for differences in socio-economic status. Higher rates of CMD were also observed among Indian and Pakistani women aged 55–74 years, compared to White women of similar age. The prevalence of CMD among Bangladeshi women was lower than among White women, although this was restricted to those not interviewed in English. There were no differences in rates between Black Caribbean and White samples. Conclusions. Middle-aged Irish and Pakistani men, and older Indian and Pakistani women, had significantly higher rates of CMD than their White counterparts. The very low prevalence of CMD among Bangladeshi women contrasted with high levels of socio-economic deprivation among this group. Further study is needed to explore reasons for this variation

Reported sexually transmitted disease clinic attendance and sexually transmitted infections in britain: prevalence, risk factors, and proportionate population burden.

BACKGROUND: We examined attendance at sexually transmitted disease (STD) clinics and the prevalence, distribution, and associated demographic and behavioral factors of self-reported sexually transmitted infections (STIs) in a population survey of sexual attitudes and lifestyles. METHODS: We analyzed data from stratified probability sample surveys obtained through the British National Surveys of Sexual Attitudes and Lifestyles (Natsal), which was undertaken in 1990 (n=13,765) and 2000 (n=11,161) among men and women aged 16-44 years. National STD surveillance data for 1999 were used to determine disease- and risk factor-specific proportionate population burden (PPB). RESULTS: Between 1990 and 2000, the number of subjects who reported having attended an STD clinic during the past 5 years increased from 4.3% to 7.6% among men and from 3.3% to 6.6% among women. In 2000, 3.0% of men and 4.0% of women reported having received a diagnosis of an STI during the past 5 years; 77.6% of men and 60.3% of women with an STI had attended an STD clinic. Reported STI acquisition was independently associated with age, increasing numbers of sex partners, male homosexual partners, and partners from abroad (for women only). Of all reported STIs during the past 5 years (PPB, 10.2%), 10.2% were reported by the 2.9% of men who reported having had homosexual partners during the past 5 years. Of all reported STIs in the past 5 years (PPB, 41.6%), 41.6% were reported by the 4.0% of women who reported having > or =10 sex partners during that time. Analysis of national STI surveillance data showed that the PPB for new episodes of Chlamydia trachomatis diagnosed among homosexual men was 2.8%, that for gonorrhea was 17.4%, and that for syphilis was 32.1%. CONCLUSIONS: Numbers and types of sexual partnerships remain the dominant individual and population risk factors for STI acquisition. Combined population behavior and surveillance data demonstrate the high PPB for STIs attributable to key risk factors. PPB may be a useful indicator of epidemic "phase" and may help target resources and guide prevention strategies

Investigating the relationship between HIV testing and risk behaviour in Britain: National Survey of Sexual Attitudes and Lifestyles 2000.

OBJECTIVES: To estimate the prevalence of, and identify factors associated with, HIV testing in Britain. DESIGN: A large, stratified probability sample survey of sexual attitudes and lifestyles. METHODS: A total of 12,110 16-44 year olds completed a computer-assisted face-to-face interview and self-interview. Self-reports of HIV testing, i.e. the timing, reasons for and location of testing, were included. RESULTS: A total of 32.4% of men and 31.7% of women reported ever having had an HIV test, the majority of whom were tested through blood donation. When screening for blood donation and pregnancy were excluded, 9.0% of men and 4.6% of women had had a voluntary confidential HIV test (VCT) in the past 5 years. However, one third of injecting drug users and men who have sex with men had a VCT in the past 5 years. VCT in the past 5 years was significantly associated with age, residence, ethnicity, self-perceived HIV risk, reporting greater numbers of sexual partners, new sexual partners from abroad, previous sexually transmitted infection diagnosis, and injecting non-prescribed drugs for men and women, and same-sex partners (men only). Whereas sexually transmitted disease clinics were important sites for VCT, general practice accounted for almost a quarter of VCT. CONCLUSION: HIV testing is relatively common in Britain; however, it remains largely associated with population-based blood donation and antenatal screening programmes. In contrast, VCT remains highly associated with high-risk (sexual or drug-injecting) behaviours or population sub-groups at high risk. Strategies to reduce undiagnosed prevalent HIV infection will require further normalization and wider uptake of HIV testing

Ethnic variations in sexual behaviour in Great Britain and risk of sexually transmitted infections: a probability survey.

BACKGROUND: Ethnic variations in the rate of diagnosed sexually transmitted infections (STIs) have been reported in many developed countries. We used data from the second British National Survey of Sexual Attitudes and Lifestyles (Natsal 2000) to investigate the frequency of high-risk sexual behaviours and adverse sexual health outcomes in five ethnic groups in Great Britain. METHODS: We did a stratified probability sample survey of 11161 men and women aged 16-44 years, resident in Great Britain, using computer-assisted interviews. Additional sampling enabled us to do more detailed analyses for 949 black Caribbean, black African, Indian, and Pakistani respondents. We used logistic regression to assess reporting of STI diagnoses in the past 5 years, after controlling for demographic and behavioural variables. FINDINGS: We noted striking variations in number of sexual partnerships by ethnic group and between men and women. Reported numbers of sexual partnerships in a lifetime were highest in black Caribbean (median 9 [IQR 4-20]) and black African (9 [3-20]) men, and in white (5 [2-9]) and black Caribbean (4 [2-7]) women. Indian and Pakistani men and women reported fewer sexual partnerships, later first intercourse, and substantially lower prevalence of diagnosed STIs than did other groups. We recorded a significant association between ethnic origin and reported STIs in the past 5 years with increased risk in sexually active black Caribbean (OR 2.74 [95% CI 1.22-6.15]) and black African (2.95 [1.45-5.99]) men compared with white men, and black Caribbean (2.41 [1.35-4.28]) women compared with white women. Odds ratios changed little after controlling for age, number of sexual partnerships, homosexual and overseas partnerships, and condom use at last sexual intercourse. INTERPRETATION: Individual sexual behaviour is a key determinant of STI transmission risk, but alone does not explain the varying risk across ethnic groups. Our findings suggest a need for targeted and culturally competent prevention interventions

Early evaluation of the integrated care and support pioneers programme: interim report

This interim report is intended to provide a description of (roughly) the first twelve months of Pioneer development, drawing out some of the similarities and differences between the sites, the barriers they are encountering in their ambitious attempts to integrate health and social care services, and the approaches they are taking to overcome these barriers. This progress report of the development of the Pioneers during their first year presents interim findings which may be subject to change by the time the final report of the early evaluation is independently peer reviewed and prepared for publication in summer 2015

Using the Web to Collect Data on Sensitive Behaviours: A Study Looking at Mode Effects on the British National Survey of Sexual Attitudes and Lifestyles.

BACKGROUND: Interviewer-administered surveys are an important method of collecting population-level epidemiological data, but suffer from declining response rates and increasing costs. Web surveys offer more rapid data collection and lower costs. There are concerns, however, about data quality from web surveys. Previous research has largely focused on selection biases, and few have explored measurement differences. This paper aims to assess the extent to which mode affects the responses given by the same respondents at two points in time, providing information on potential measurement error if web surveys are used in the future. METHODS: 527 participants from the third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3), which uses computer assisted personal interview (CAPI) and self-interview (CASI) modes, subsequently responded to identically-worded questions in a web survey. McNemar tests assessed whether within-person differences in responses were at random or indicated a mode effect, i.e. higher reporting of more sensitive responses in one mode. An analysis of pooled responses by generalized estimating equations addressed the impact of gender and question type on change. RESULTS: Only 10% of responses changed between surveys. However mode effects were found for about a third of variables, with higher reporting of sensitive responses more commonly found on the web compared with Natsal-3. CONCLUSIONS: The web appears a promising mode for surveys of sensitive behaviours, most likely as part of a mixed-mode design. Our findings suggest that mode effects may vary by question type and content, and by the particular mix of modes used. Mixed-mode surveys need careful development to understand mode effects and how to account for them