Modeling Interviewer Effects in a Large National Health Study

Interviewers play a critical role in determining the quality of data collected in face-to-face surveys. Interviewers can have positive effects on recruiting sample members to participate, leading to higher response rates. Conversely, interviewers can have negative effects on the quality of measurement. The literature suggests that interviewers can bias answers when observable characteristics of the interviewer influence the respondent to answer questions a certain way. For example, the sex or race of interviewers may influence respondents’ answers about their own attitudes toward sex or race. However, it is more common for differences in interviewer behavior, such as how questions are asked or how answers are probed, to affect the variability of responses. These differences in interviewer characteristics and behaviors lead to answers that are clustered by the interviewer giving rise to a within interviewer correlation that inflates the estimated variability of survey statistics. The size of this increased variability or interviewer effect is often difficult to estimate in face-to-face surveys since standard estimation techniques assume interpenetrated designs that randomly assign interviewers to areas. Instead, multilevel models that control for respondent and area effects are often used to isolate interviewer effects from area effects in non-interpenetrated designs. This study uses multilevel models to model interviewer effects in the National Health Interview Survey (NHIS), a large national survey of approximately 35,000 households conducted annually. The NHIS is an entirely interviewer-administered survey conducted primarily face-to-face with some telephone follow-up. Using 2017 data, we begin by estimating multilevel models to compute estimates of interviewer variance across a variety of questions in the NHIS. The goal is to determine the extent to which interviewer variance is present in NHIS estimates. The analysis will include questions that vary by characteristics such as question sensitivity, question length, and response format. The models will include controls for Census demographics within areas to help separate interviewer effects from area effects. The next step in the analysis will attempt to understand the extent to which certain interviewer-level variables can explain the interviewer effects, including how much of the interviewer-level variance is explained by interviewer experience. We also include a measure of the interviewers’ cooperation rates to understand if differences in nonresponse error may explain some of the interviewer-level variance in key survey estimates. Finally, we will include interviewer-level variables such as average pace of the interview to understand how much of the variance may be explained by interviewer behavior. The overall goals of the paper are to 1) understand which questions on the NHIS are most vulnerable to interviewer effects, and 2) explain the relative impact of different potential causes of those effects

A Descriptive Profile of Abused Female Sex Workers in India

This descriptive study presents the profiles of abused female sex workers (FSWs) in Chennai, India. Of 100 abused FSWs surveyed using a structured questionnaire, severe forms of violence by intimate partners were reported by most (98%) respondents. Of the total sample, 76% experienced violence by clients. Sexual coercion experiences of the FSWs included verbal threats (77%) and physical force (87%) by intimate partners and forced unwanted sexual acts (73%) by clients. While 39% of the women consumed alcohol before meeting a client, 26% reported that their drunkenness was a trigger for violence by clients. The findings suggest that there is an urgent need to integrate services, along with public-health interventions among FSWs to protect them from violence. Recognition of multiple identities of women in the contexts of intimate relationships versus sex work is vital in helping women to stay safe from adverse effects on health

Increased Survival Among HIV-Infected PWID Receiving a Multi-Level HIV Risk and Stigma Reduction Intervention: Results From a Randomized Controlled Trial

In Vietnam, where 58% of prevalent HIV cases are attributed to PWID, we evaluated whether a multi-level intervention could improve care outcomes and increase survival

The Effect of a Multi-Level Intervention on the Initiation of Antiretroviral Therapy (ART) among HIV-Infected Men Who Inject Drugs and Were Diagnosed Late in Thai Nguyen, Vietnam

In Vietnam, an estimated 256,000 people are living with HIV, and 58% of HIV-infections reported are among people who inject drugs (PWID). While antiretroviral therapy (ART) is widely available in Vietnam, marginalized hard-to-reach male PWID, demonstrate significantly reduced and delayed access to ART

Social Desirability Response Bias and Other Factors That May Influence Self-Reports of Substance Use and HIV Risk Behaviors: A Qualitative Study of Drug Users in Vietnam

The accuracy of self-report data may be marred by a range of cognitive and motivational biases, including social desirability response bias. The current study used qualitative interviews to examine self-report response biases among participants in a large randomized clinical trial in Vietnam. A sample of study participants were reinterviewed. The vast majority reported being truthful and emphasized the importance of rapport with the study staff for achieving veridical data. However, some stated that rapport may lead to under reporting of risk behaviors in order not to disappoint study staff. Other factors that appeared to influence accuracy of self-reports include fear that the information may be divulged, desire to enroll in the study, length of the survey, and memory. There are several methods that can be employed to reduce response biases, and future studies should systematically address response bias and include methods to assess approaches and survey items are effective in improving accuracy of self-report data

Roles and Functions of Social Networks Among Men Who Use Drugs in ART Initiation in Vietnam

Support from social network members may help to facilitate access to HIV medical care, especially in low resourced communities. As part of a randomized clinical trial of a community-level stigma and risk reduction intervention in Thai Nguyen, Vietnam for people living with HIV who inject drugs (PWID), 341 participants were administered a baseline social network inventory. Network predictors of antiretroviral therapy (ART) initiation at the six-month follow-up were assessed. The social networks of PWID were sparse. Few participants who reported injectors in their networks also reported family members, whereas those who did not have injectors were more likely to report family members and network members providing emotional support and medical advice. In multivariate models, having at least one network member who provided medical advice predicted ART initiation at six months (OR=2.74, CI=1.20–6.28). These results suggest the importance of functional social support and network support mobilization for ART initiation among PWID

ASSOCIATION BETWEEN HIV KNOWLEDGE AND RISK BEHAVIOR IN PERSONS WHO INJECT DRUGS IN THAI NGUYEN, VIETNAM

In Vietnam, HIV infection is concentrated in key populations including persons who inject drugs (PWID). The majority of PWID can name specific transmission routes of HIV, yet risk behaviors remain high. We conducted a cross-sectional survey of 1355 PWID in Thai Nguyen Province, Vietnam, to and compare their HIV knowledge with their self-reported risk behavior. Broader knowledge of HIV transmission, measured by a higher composite HIV knowledge score, was associated with a 19.5% lower adjusted odds of giving a used needle to another (p=0.011), and 20.4% lower adjusted odds of using a needle that another had used (p=0.001). A higher knowledge score was associated with 13.1% higher adjusted odds of consistent condom use (p=0.083). These results suggest a broader knowledge may reflect characteristics about how individuals obtain knowledge or the way that knowledge is delivered to them, and may be associated with their ability to engage in risk reduction behavior

外傷性上皮?腫ノ一例

BackgroundIn Vietnam, an estimated 256,000 people are living with HIV, and 58% of HIV-infections reported are among people who inject drugs (PWID). While antiretroviral therapy (ART) is widely available in Vietnam, marginalized hard-to-reach male PWID, demonstrate significantly reduced and delayed access to ART.MethodsWe investigated the effect of a randomized four-arm multi-level intervention trial on ART initiation among male PWID. Our analysis was conducted among a subset of trial participants (n = 136), who were newly diagnosed as HIV-infected, treatment naïve, and eligible for ART (baseline late diagnosis). The trial arms included: 1, standard of care (HIV testing and counseling); 2, structural-level intervention (door-to-door communications and community video screenings); 3, individual-level intervention (counseling plus group support); and 4, individual-level plus structural-level intervention. In a time-to-event analysis, we used a non-parametric approach for competing risks to estimate cumulative incidence function (CIF) for ART initiation (event of interest) by arm and the difference in CIF for each trial arm as compared to Arm 1. Follow-up was conducted at 6, 12, 18 and 24 months. Data collection occurred from 2009 to 2013.FindingsBy 24-months, 61.0% initiated ART, and 30.9% had died prior to ART initiation. In the first 6 months, participants in arm 4 (individual plus community intervention) had a 28% (95% confidence interval (CI): 6-50%) increased probability of initiating ART. Despite increasing coverage of ART in all arms throughout follow-up, participants in arm 4 retained a 31% (95% CI: 5-56%) increased probability of initiating ART. The individual and community components of the intervention were only effective when delivered together.ConclusionsMarginalized, hard-to-reach men, who do not routinely engage in HIV services, and therefore come into care late, may benefit significantly from both individual counseling and group support, in combination with community-focused stigma reduction, when being referred and attempting to initiate urgently needed ART

Lupus en Argentina. Pacientes no respondedores al tratamiento estándar y belimumab como posible opción. Datos del registro RELESSAR

Introducción: el lupus es una enfermedad compleja y varias veces de difícil abordaje. Alcanzar la remisión es uno de los objetivos, incorporando opciones terapéuticas. Objetivos: describir las características generales de los pacientes según el estado de la enfermedad y el uso de belimumab. Materiales y métodos: estudio de corte transversal, registro RELESSAR. Se definió el estado de la enfermedad como: remisión: SLEDAI=0 y sin corticoides; baja actividad de la enfermedad: SLEDAI >0 y ≤4 y sin corticoides; control no óptimo: SLEDAI >4 y cualquier dosis de corticoides. Resultados: se incluyeron 1.277 pacientes, 23,4% en remisión, 12,6% en baja actividad y 63,8% con control no óptimo. En este último grupo eran más jóvenes y con menor duración de la enfermedad; presentaban mayores índices de actividad y cronicidad, y mayor empleo de inmunosupresores. Solo el 22,3% de los pacientes con criterio potencial de uso de belimumab (lupus eritematoso sistémico activo a pesar del tratamiento estándar) lo recibía en ese momento. Las variables asociadas a hospitalizaciones fueron: terapia con corticoides, ciclofosfamida y mayor SLICC. Conclusiones: se refleja la complejidad del manejo de estos pacientes y se visualizan aspectos estructurales como la desigualdad. El uso del belimumab resultaría beneficioso en los pacientes seleccionados

Chapter 21: Modeling Interviewer Effects in the National Health Interview Survey. Appendix 21

Supplemental Table A21.1 Questions, Question Characteristics, and Intra-Interviewer Correlations (IIC) Table A21.2 Descriptive Statistics for Respondent and Case Characteristics Included in Multi-Level Models Table A21.3 Descriptive Statistics for County Measures Included in Multi-Level Models Table A21.4 Descriptive Statistics for Interviewer Characteristics Included in Multi-Level Models Table A21.5 Mock Dataset Structure Depicting Questions, Interviewer Groups, and IIC