Callers' ability to understand advice received from a telephone health-line service: comparison of self-reported and registered data

OBJECTIVE: To validate users' perception of nurses' recommendations to look for another health resource among clients seeking teleadvice. To analyze the effects of different users' and call characteristics on the incorrectness of the self-report. DATA SOURCES/STUDY SETTING: This study is a secondary analysis of data obtained from 4,696 randomly selected participants in a survey conducted in 1997 among users of Info-Santé CLSC, a no-charge telenursing health-line service (THLS) available all over the province of Québec. STUDY DESIGN/DATA COLLECTION: Self-reported advice from follow-up survey phone interviews, conducted within 48 to 120 hours after the participant's call were compared to the data consigned by the nurse in the computerized call record. Covariables concerned characteristics of callers, context of the calls, and satisfaction about the nurses' intervention. Association between these variables and inaccurate reports was identified using multinomial logistic regression analyses. PRINCIPAL FINDINGS: Advice to consult were recorded by the nurse in 42 percent of cases, whereas 39 percent of callers stated they had received one. Overall disagreement between the two sources is 27 percent (12 percent by false positive and 15 percent by false negative) and kappa is 0.45. Characteristics such as living alone (adjusted OR = 2.5), calls relating to psychological problems (OR = 2.8), perceived seriousness (OR = approximately 2.6), as well as others, were associated with inaccurate reports. CONCLUSIONS: Telephone health-line providers should be aware that many callers appear to interpret advice to seek additional health care differently than intended. Our findings suggest the need for continuing quality control interventions to reduce miscommunication, insure better understanding of advice by callers, and contribute to more effective service.