Using respondent-driven sampling (RDS) to recruit illegal poly-substance users in Cape Town,South Africa: implications and future directions

Background

South Africa continues to witness an increase in illicit poly-substance use, although a precise measurement continues to be compounded by difficulties in accessing users. In a pilot attempt to use respondent-driven sampling (RDS)—a chain referral sampling method used to access populations of individuals who are ‘hard-to-reach’—this article documents the feasibility of the method as recorded in a simultaneously run, multisite, poly-substance study in Cape Town. Here we aim to a) document the piloting of RDS among poly-substance users in the three socio-economic disparate communities targeted; b) briefly document the results; and c) review the utility of RDS as a research tool.

Methods

Three cross-sectional surveys using standard RDS procedures were used to recruit active poly-substance users and were concurrently deployed in three sites. Formative research was initially conducted to assess the feasibility of the survey. To determine whether RDS could be used to successfully recruit poly-substance users, social network characteristics, such as network size was determined.

Results

A 42.5 % coupon return rate was recorded in total from 12 initial seeds. There were vast differences in the recruitment chains of individual seeds—two generated more than 90 recruits, and 2 of the 10 recruitment chains showing a length of more than 10 waves. Findings include evidence of the use of 3 or more substances in all three sites, high levels of unemployment among users, with more than a third of participants in two sites reporting arrest for drug use in the past 12 months.

Conclusions

Our results indicate that RDS was a feasible and acceptable sampling method for recruiting participants who may not otherwise be accessible. Future studies can use RDS to recruit such cohorts, and the method could form part of broader efforts to document vulnerable populations.

     

Preferred reporting items for studies mapping onto preference-based outcome measures: the MAPS statement

Background and aim

‘Mapping’ onto generic preference-based outcome measures is increasingly being used as a means of generating health utilities for use within health economic evaluations. Despite publication of technical guides for the conduct of mapping research, guidance for the reporting of mapping studies is currently lacking. The MApping onto Preference-based measures reporting Standards (MAPS) statement is a new checklist, which aims to promote complete and transparent reporting of mapping studies.

Methods

In the absence of previously published reporting checklists or reporting guidance documents, a de novo list of reporting items was created by a working group comprised of six health economists and one Delphi methodologist. A two-round, modified Delphi survey with representatives from academia, consultancy, health technology assessment agencies and the biomedical journal editorial community was used to identify a list of essential reporting items from this larger list.

Results

From the initial de novo list of 29 candidate items, a set of 23 essential reporting items was developed. The items are presented numerically and categorised within six sections, namely (1) title and abstract; (2) introduction; (3) methods; (4) results; (5) discussion; and (6) other. The MAPS statement is best applied in conjunction with the accompanying MAPS explanation and elaboration document.

Conclusions

It is anticipated that the MAPS statement will improve the clarity, transparency and completeness of reporting of mapping studies. To facilitate dissemination and uptake, the MAPS statement is being co-published by seven health economics and quality of life journals, and broader endorsement is encouraged. The MAPS working group plans to assess the need for an update of the reporting checklist in 5 years’ time.

     

Use of cognitive interviews in the development of the PLUS-M item bank

Purpose

Measuring constructs such as mobility with patient-reported outcomes (PROs) can enhance clinical and scientific understanding of how health conditions, like lower limb amputation, impact patients’ lives. When developing PRO questionnaires, cognitive interviews (CIs) are used to examine whether survey items are understandable, clear, and meaningful. The aim of this study was to use CIs to inform item development for the Prosthetic Limb Users Survey of Mobility (PLUS-M), a PRO that measures mobility in prosthetic limb users.

Methods

Thirty-six CIs were conducted with 30 prosthetic limb users. Each participant responded to up to 30 items from the PLUS-M candidate item set. Each item was reviewed by a minimum of five participants who differed in self-reported mobility, literacy, level of amputation, and time since amputation. Items were revised based on participant feedback, and substantially revised items were re-evaluated through additional CIs.

Results

Feedback from CIs identified substantial issues in 76 of the total 156 items. These items were subsequently modified or eliminated.

Conclusion

Cognitive interviews were an essential qualitative step in the development of the PLUS-M item bank and resulted in better functioning items.     

Loss of control over eating in pre-adolescent youth: the role of attachment and self-esteem

Objective

The present study aimed to add to the limited literature on the role of self-esteem and attachment for the explanation of loss of control over eating (LC) among pre-adolescent boys and girls.

Method

Self-report questionnaires were administered to a community sample of 555 children (8–11 years; 47% female).

Results

Children reporting LC (17.6% of the sample) were characterized by a lower self-esteem and less secure attachment toward both of their parents. No gender differences emerged. Moreover, the relation between self-esteem and LC was fully mediated by attachment toward mother and partially mediated by attachment toward father.

Discussion

The present study provides preliminary evidence for the idea that the influence of self-esteem on LC seems to operate through a third variable that is an insecure relationship with the parents. Longitudinal research is needed to further elucidate the influence of interpersonal factors on the development of LC.     

Finding evidence for comparing medical interventions: AHRQ and the Effective Health Care Program

Objective

This article discusses search methodology to identify evidence for comparative effectiveness reviews (CERs) as practiced by the Effective Health Care program.

Study Design and Setting

Review.

Results

Search methods described attempt to overcome the bias inherent in the publication and distribution of clinical evidence. Bibliographic databases and search strategies are discussed with special emphasis on searching for observational studies and harms data. Other techniques described include the use of key articles, citation tracking, hand searching, and personal communications. Strategies for locating gray literature, such as clinical trial protocols and regulatory information, are described. Search reporting and other practical matters are also discussed.

Conclusion

Better reporting and further research on search strategies is needed to develop additional evidence-based recommendations.     

Kosteneffektivit?t von aktiven und passiven Zugangswegen zu russischsprachigen Migranten in der Suchtpr?vention

Background

In the present study cost and cost-effectiveness of alternative access paths to Russian-speaking migrants were analysed, using the example of orientation meetings about addiction prevention: active recruitment, passive recruitment and combined (active and passive) recruitment.

Methods

Recruitment effectiveness was defined as the number of participants and number of persons addressed (i.e. persons with prevention motivation). Collection of effectiveness and cost data was based on surveys amongst participants, mediators and programme coordinators.

Results

The passive recruitment strategy proved to be ineffective: only 0.2 participants per orientation meeting were recruited. Costs per orientation meeting were comparable for combined (813 euros) and active (792 euros) recruitment, but combined recruitment proved to be more effective and more cost-effective. Combined recruitment reached more participants (18.9 versus 15.2) and the percentage of persons addressed was higher (21% versus 17%).

Conclusion

For most programmes in the literature costs per participant of passive recruitment is much lower compared to active recruitment. The present study does not reproduce these results. A possible explanation is that recruitment requires an efficient network into migrant-specific communities if a sensitive issue like addiction prevention is addressed.     

Content validity of Patient-Reported Outcomes Measurement Information System (PROMIS) items in the context of HIV clinical care

Purpose

To assess content validity and patient and provider prioritization of Patient-Reported Outcomes Measurement Information System (PROMIS) depression, anxiety, fatigue, and alcohol use items in the context of clinical care for people living with HIV (PLWH), and to develop and assess new items as needed.

Methods

We conducted concept elicitation interviews (n = 161), item pool matching, prioritization focus groups (n = 227 participants), and cognitive interviews (n = 48) with English-speaking (~75 %) and Spanish-speaking (~25 %) PLWH from clinical sites in Seattle, San Diego, Birmingham, and Boston. For each domain we also conducted item review and prioritization with two HIV provider panels of 3–8 members each.

Results

Among items most highly prioritized by PLWH and providers were those that included information regarding personal impacts of the concept being assessed, in addition to severity level. Items that addressed impact were considered most actionable for clinical care. We developed additional items addressing this. For depression we developed items related to suicide and other forms of self-harm, and for all domains we developed items addressing impacts PLWH and/or providers indicated were particularly relevant to clinical care. Across the 4 domains, 16 new items were retained for further psychometric testing.

Conclusion

PLWH and providers had priorities for what they believed providers should know to provide optimal care for PLWH. Incorporation of these priorities into clinical assessments used in clinical care of PLWH may facilitate patient-centered care.

     

Assessing the precision of a time-sampling-based study among GPs: balancing sample size and measurement frequency

Background

Our research is based on a technique for time sampling, an innovative method for measuring the working hours of Dutch general practitioners (GPs), which was deployed in an earlier study. In this study, 1051 GPs were questioned about their activities in real time by sending them one SMS text message every 3 h during 1 week. The required sample size for this study is important for health workforce planners to know if they want to apply this method to target groups who are hard to reach or if fewer resources are available. In this time-sampling method, however, standard power analyses is not sufficient for calculating the required sample size as this accounts only for sample fluctuation and not for the fluctuation of measurements taken from every participant. We investigated the impact of the number of participants and frequency of measurements per participant upon the confidence intervals (CIs) for the hours worked per week.

Methods

Statistical analyses of the time-use data we obtained from GPs were performed. Ninety-five percent CIs were calculated, using equations and simulation techniques, for various different numbers of GPs included in the dataset and for various frequencies of measurements per participant.

Results

Our results showed that the one-tailed CI, including sample and measurement fluctuation, decreased from 21 until 3 h between one and 50 GPs. As a result of the formulas to calculate CIs, the increase of the precision continued and was lower with the same additional number of GPs. Likewise, the analyses showed how the number of participants required decreased if more measurements per participant were taken. For example, one measurement per 3-h time slot during the week requires 300 GPs to achieve a CI of 1 h, while one measurement per hour requires 100 GPs to obtain the same result.

Conclusions

The sample size needed for time-use research based on a time-sampling technique depends on the design and aim of the study. In this paper, we showed how the precision of the measurement of hours worked each week by GPs strongly varied according to the number of GPs included and the frequency of measurements per GP during the week measured. The best balance between both dimensions will depend upon different circumstances, such as the target group and the budget available.

     

Long-term projections of the harm-benefit trade-off in prostate cancer screening are more favorable than previous short-term estimates

Objective

To project long-term estimates of the number needed to screen (NNS) and the additional number needed to treat (NNT) to prevent one prostate cancer death with prostate-specific antigen (PSA) screening in Europe and in the United States.

Study Design and Setting

A mathematical model of disease-specific deaths in screened and unscreened men given information on overdiagnosis, disease-specific survival in the absence of screening, screening efficacy, and other-cause mortality is presented. A simulation framework is used to incorporate competing causes of death.

Results

Assuming overdiagnosis and screening efficacy consistent with European Randomized study of Screening for Prostate Cancer (ERSPC) results, we project that, after 25 years, 262 men need to be screened and nine additional men need to be screen detected to prevent one prostate cancer death. Corresponding estimates of the NNS and the additional NNT under a range of overdiagnosis rates that are consistent with U.S. incidence are 186-220 and 2-5.

Conclusions

Long-term estimates of the NNS and the additional NNT are an order of magnitude lower than the short-term estimates published with the results of the ERSPC trial and may be consistent with cost-effective PSA screening in the general U.S. population.     

Efficient Screening for Impairments in Peer Functioning Among Mid-to-Late Adolescents Receiving Clinical Assessments for Social Anxiety

Background

Impairments in peer relations comprise a core feature of social anxiety, particularly among adolescents. Yet, these impairments may also stem from concerns that commonly co-occur with social anxiety, namely depressive symptoms and attention-deficit/hyperactivity disorder (ADHD) symptoms.

Objective

Although peer-related impairments spike during adolescence, we know relatively little about efficiently screening for peer-related impairments that specifically index those impairments relevant to adolescent social anxiety.

Method

We recruited 89 adolescents (M?=?14.5 years, 64% female, 65.1% African American) who varied on evaluation-seeking status (30 evaluation-seeking; 59 community control). On a preliminary phone screen, parents provided reports on three peer-related impairment items identified in prior work as particularly discriminative: number of friends, trouble making friends, and trouble keeping friends. Parents and adolescents completed survey measures of social anxiety and mental health concerns commonly linked to social anxiety (i.e., depressive symptoms, ADHD symptoms).

Results

Increased peer-related impairments were uniquely related to increased social anxiety, controlling for depressive symptoms and ADHD symptoms. Increased peer-related impairments also predicted increased risk for being above the clinical cut score on measures of social anxiety, depressive symptoms, and ADHD symptoms. The number of peer-related impairments significantly distinguished adolescents on evaluation-seeking status.

Conclusions

Using a short list of three items assessing peer-related impairments (number of friends, trouble making friends, and trouble keeping friends) one can efficiently screen for peer-related impairments of specific relevance to adolescent social anxiety. These findings have important implications for leveraging efficient, evidence-based screening devices when clinically assessing adolescent social anxiety, particularly in low-resource mental health settings.

     

Factors associated with uptake of subdermal contraceptive implants in a young Kenyan population

Background

Subdermal contraceptive implants may be a reasonable option for young women in sub-Saharan Africa; little is known about factors associated with method uptake in this subpopulation.

Study Design

Four hundred women aged 18–24 years who sought short-acting hormonal contraception were offered an opportunity to use an implant instead. Cross-tabulations and logistic regression analysis were used to examine participant characteristics and other factors associated with choosing an implant.

Results

Twenty-four percent of participants chose the implant. Participants with greater than 4 years of contraceptive need were over three times more likely to choose an implant [odds ratio (OR), 3.4; 95% confidence interval (CI), 1.6–6.9]. Women with health concerns over short-acting hormonal methods (OR, 2.2; 95% CI, 1.3–3.6) and those who expressed some difficulty returning to a clinic (OR, 1.9; 95% CI, 1.1–3.1) were about twice as likely to choose an implant. Product attributes such as long-acting protection and convenience were cited reasons for choosing an implant.

Conclusions

The implant appears to be an attractive option for a fairly large proportion of young women in Kenya. Within this age group of implant users, homogeneity of demographic characteristics relative to short-acting users suggests that the product has broad appeal.     

Factor structure of the Q-LES-Q short form in an enrolled mental health clinic population

Purpose

The Quality of Life, Enjoyment, and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF) is a recovery-oriented, self-report measure with an uncertain underlying factor structure, variously reported in the literature to consist of either one or two domains. We examined the possible factor structures of the English version in an enrolled mental health population who were not necessarily actively engaged in care.

Methods

As part of an implementation trial in the U.S. Department of Veterans Affairs mental health clinics, we administered the Q-LES-Q-SF and Veterans RAND 12-Item Health Survey (VR-12) over the phone to 576 patients across nine medical centers. We used a split-sample approach and conducted an exploratory factor analysis (EFA) and multi-trait analysis (MTA). Comparison with VR-12 assessed construct validity.

Results

Based on 568 surveys after excluding the work satisfaction item due to high unemployment rate, the EFA indicated a unidimensional structure. The MTA showed a single factor: ten items loaded on one strong psychosocial factor (α?=?0.87). Only three items loaded on a physical factor (α?=?0.63). Item discriminant validity was strong at 92.3%. Correlations with the VR-12 were consistent with the existence of two factors.

Conclusions

The English version of the Q-LES-Q-SF is a valid, reliable self-report instrument for assessing quality of life. Its factor structure can be best described as one strong psychosocial factor. Differences in underlying factor structure across studies may be due to limitations in using EFA on Likert scales, language, culture, locus of participant recruitment, disease burden, and mode of administration.

     

Epidemiology of rabies post-exposure prophylaxis—United States of America, 2006–2008

Background

The United States of America (USA) does not have a national reporting system for rabies post-exposure prophylaxis (PEP). We describe the epidemiology of PEP in the USA so recommendations can be made during a PEP shortage.

Methods

A two-part questionnaire designed to evaluate PEP distribution practices and estimate PEP use was administered to state health department representatives.

Results

Seventy-five percent of participants responded that no public health guidance was needed to make a recommendation for PEP. The annual national average PEP use is 23,415 courses of PEP (range: 10,645–35,845).

Conclusion

PEP is loosely monitored and a precise estimate of PEP use is unknown. Improved national surveillance for PEP is needed.     

Validity of a measure to assess the child-care nutrition and physical activity environment

Background

Licensed child-care centers represent an opportunity to positively influence children's health behaviors. Valid and easy-to-use measures of the child-care environment are needed to assess the influence of environmental change on health.

Objective

To develop and validate a self-administered survey to assess the nutrition and physical activity environment of child-care centers, and to identify domains that may be evaluated adequately through self-report.

Design

A survey was developed to assess four areas related to nutrition and physical activity: center policies, practices related to the social environment, physical environment, and nutrition quality. Development involved review of the literature, existing measures, and regulations/standards as well as collaboration with a working group. The survey was pilot tested and feedback was sought from expert consultants. It was administered statewide and validated against a menu rating tool, interviews with a center director, and a direct observation tool that was developed for this study.

Participants/setting

Participating sites were drawn from Child and Adult Care Food Program-participating licensed Connecticut child-care centers serving 13 or more children aged 3 to 5 years. Survey responses from 146 center directors were included, as were 62 center menus, and director interviews and observational data from 33 sites.

Primary outcomes/statistical analyses

Criterion validity of the survey was assessed through percent agreement with mirroring items in the additional measures. Healthy and unhealthy food scores were calculated for menu and survey tools, and Pearson correlations were computed.

Results

Percent agreement with criterion outcomes ranged from 39% to 97%, with 61% of items achieving agreement ≥80%. Agreement was highest for nutrition and policy domains, and lowest for physical activity and barriers to promoting health. Correlations between food scores across measures were moderate.

Conclusions

The self-report survey demonstrated adequate criterion validity. We make recommendations for improving validity of low-agreement items and for the use of more labor-intensive evaluation procedures for domains not adequately assessed through self-report.     

A family planning clinic partner violence intervention to reduce risk associated with reproductive coercion

Background

This study examined the efficacy of a family-planning-clinic-based intervention to address intimate partner violence (IPV) and reproductive coercion.

Study Design

Four free-standing urban family planning clinics in Northern California were randomized to intervention (trained family planning counselors) or standard of care. English-speaking and Spanish-speaking females ages 16–29 years (N=906) completed audio computer-assisted surveys prior to a clinic visit and 12–24 weeks later (75% retention rate). Analyses included assessment of intervention effects on recent IPV, awareness of IPV services and reproductive coercion.

Results

Among women reporting past-3-months IPV at baseline, there was a 71% reduction in the odds of pregnancy coercion among participants in intervention clinics compared to participants in the control clinics that provided standard of care. Women in the intervention arm were more likely to report ending a relationship because the relationship was unhealthy or because they felt unsafe regardless of IPV status (adjusted odds ratio=1.63; 95% confidence interval=1.01–2.63).

Conclusions

Results of this pilot study suggest that this intervention may reduce the risk for reproductive coercion from abusive male partners among family planning clients and support such women to leave unsafe relationships.     

Describing reporting guidelines for health research: a systematic review

Objective

To describe the process of development, content, and methods of implementation of reporting guidelines for health research.

Study Design and Setting

A systematic review of publications describing health research reporting guidelines developed using consensus.

Results

Eighty-one reporting guidelines for health research were included in the review. The largest number of guidelines do not focus on a specific study type (n = 35; 43%), whereas those that do primarily refer to reporting of randomized controlled trials (n = 16; 35%). Most of the guidelines (n = 76; 94%) include a checklist of recommended reporting items, with a median of 21 checklist items (range: 5-64 items). Forty-seven (58%) reporting guidelines were classified as new guidance. Explanation documents were developed for 11 (14%) reporting guidelines. Reporting-guideline developers provided little information about the guideline development process. Developers of 50 (62%) reporting guidelines encouraged endorsement, most commonly by including guidelines in journal instructions to authors (n = 18; 36%).

Conclusions

Reporting-guideline developers need to endeavor to maximize the quality of their product. Recently developed guidance is likely to facilitate more robust guideline development. Journal editors can be more confident in endorsing reporting guidelines that have followed these approaches.     

Perceptions of family planning and abortion education at a faith-based medical school

Background

Because of religious beliefs against contraception and abortion, family planning education is limited at faith-based institutions. The purpose of this study was to assess medical students' satisfaction with family planning education at a faith-based medical school.

Study Design

A self-administered anonymous questionnaire was designed and distributed to all second- and fourth-year students (n=273) at a faith-based medical school during the 2008–2009 academic year. The questionnaire included items on adequacy of and preference for amount and content of family planning preclinical education and clinical training.

Results

A total of 220 students completed the questionnaire for a response rate of 80.6%. The majority of respondents described the preclinical education as inadequate and preferred increased content on contraception (73.9%), sterilization (68.6%) and abortion (65.2%). The majority of fourth-year students reported appropriate contraceptive clinical training (69.0%), but inadequate sterilization training (54.8%) and abortion training (71.4%) during their third-year OB/GYN clerkship. Approximately half of fourth-year students (51.8%) desired clinical abortion training.

Conclusion

The majority of students enrolled at a faith-based medical school rated their current family planning education as inadequate and desired additional opportunities.