Interviewing methods in the health interview survey.
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An analysis of the admission interview used by schools in four health professions (veterinary medicine, allopathic medicine, optometry, and dentistry) portrays a largely similar approach to selection interviews: INTERVIEW USE: At least 80% of schools interview applicants. For schools that offer interviews, at least 40% of candidates are interviewed (a strong academic profile is the number one determinant of receiving an interview offer). The interview is one of the three most important selection tools used by schools. Less than 26% of schools fix the interview's weight in the selection process (fixed weights range from 31% to 35%). INTERVIEW PURPOSE AND CONTENT: The most common purposes of the interview are to (1) gather information, (2) make decisions, (3) verify information provided in other parts of the application, (4) recruit candidates, and/or (5) promote public relations. The most common characteristics and skills interviewers are interested in assessing are motivation for the profession, interpersonal skills, and communication skills. The desire to assess cognitive ability with the interview (>25% of schools) is surprising in view of the use of other selection tools (e.g., GPA). INTERVIEW FORMAT: Medical schools are more likely to offer two interviews per candidate, while optometry schools are more likely to offer one interview per candidate. Individual interviews (one interviewer, one candidate) are the predominant format among medical schools, while panel interviews (more than one interviewer, one candidate) are the most common format among optometry schools. The duration of the interview is 30 to 45 minutes. Interview questions most often address facts and knowledge, hypothetical situations, and the ability to meet program requirements. Most interviews do not meet the criteria for a structured interview, which has demonstrated greater validity and reliability than semi-structured or unstructured interviews. INTERVIEWERS: Interviewers are most likely to be health care faculty members (e.g., veterinarians at a veterinary school). Interviewers receive limited training. RECOMMENDATIONS FOR INCREASING INTERVIEW RELIABILITY AND VALIDITY: The purpose(s) of the interview must be clearly articulated so that the interview and interviewer training can be designed to achieve that purpose. Interview structure should be increased by developing a "job analysis" set of questions that is posed to all candidates and scored using behavioral anchors. Interviewers should receive more training in rater bias, listening skills, and interview structure. Panel interviews should be used to increase reliability. Interviewers should not have access to the candidate's application unless the interview is used to verify information. To increase the utility of the interview in the selection process, the weight of the interview in relation to other selection components should be determined.
A study of veterinary school admission interview practices across the USA and Canada was conducted in 1999. All 31 schools responded. INTERVIEW USE: Eighty-four percent of the veterinary schools interview applicants. Veterinary schools are more likely to interview resident than non-resident applicants (62% interviewed >or=49% of their resident applicants, while 77% interviewed or=77%). The five most common characteristics and skills the veterinary admission interview is intended to assess are communication skills, maturity, motivation for and interest in veterinary medicine, interpersonal skills, and knowledge of the veterinary profession (>or=92%). The least common characteristic or skill the veterinary admission interview is intended to assess is academic performance (23%). INTERVIEW FORMAT: Veterinary schools are most likely to offer one interview to a candidate (83%). A panel interview with between two and three interviewers is the predominant format employed (92%). The interview is of 20-45 minutes duration (88%), most commonly 30 minutes (50%). Interview questions most often address experiences in veterinary medicine, general background, and strengths and weaknesses (>or=85%). The level of interview structure is low to moderate (73%). The cold or blind interview (where interviewers are denied access to all or part of the written application) is employed by 50% of the interviewing veterinary schools. INTERVIEWERS: Interviewing veterinary schools assign interviewing to faculty veterinarians (100%). Some level of interviewer training is usually provided (87%); the most common mode of training is distribution of printed material (86%). SUMMARY AND RECOMMENDATIONS: The veterinary admissions interview is similar to that employed by schools of medicine, optometry, and dentistry, with the exception that veterinary schools are more likely to use panel interviews, to fix the interview weight in selection decisions, and to employ a cold or blind interview (these differences provide an opportunity to increase interview reliability and validity). Interview reliability and validity can be further improved by increasing interviewer training and interview structure, ensuring that the interview's format is consistent with its purpose, and identifying behavioral characteristics that are consistent with successful practice.
OBJECTIVE: In nutritional research, a growing interest in the use of computer-assisted cross-check dietary history interview methods exists in order to improve cost-effectiveness. The introduction of such a method in an ongoing longitudinal study was evaluated with special emphasis on the effect on interviewer bias. DESIGN: A study for the interviewer bias within and the agreement between a previously used paper-based face-to-face cross-check dietary history interview method and a newly developed interviewer-administered computer-assisted version of this interview method. SUBJECTS: The interviewer bias of 436 face-to-face interviews is compared with that of 352 computer-assisted interviews. A subset of 82 subjects underwent a face-to-face interview at the mean age of 27 and 32 y and a computer-assisted interview at their mean age of 36 y. Energy, three macronutrients (protein, fat and carbohydrate), two micronutrients (calcium and iron) and alcohol intakes obtained by these three measurements are compared to analyse the agreement between the two interview methods. RESULTS: ANOVA showed no interviewer bias for all seven analysed nutrients within the data from the computer-assisted interview, while for the face-to-face interview method, several nutrients varied significantly among the interviewers. Five different measures, used to analyse the agreement (differences, Pearson's correlation, ICC, square weighted kappa and Bland-Altman plots), showed no relevant differences between the two cross-check dietary history interview methods. CONCLUSIONS: It is concluded that the computer-assisted interview caused a reduction of interviewer bias and is of similar quality to the face-to-face interview method. Computerization of a paper-based interview can be implemented in a running cohort if a change in method is unavoidable.
Factors affecting outcomes of medication-history interviewing by pharmacy students were studied. Data were obtained from fourth-year pharmacy students enrolled in a required course in fall 1984. Each student conducted a medication-history interview with one of two simulated patients who presented a predetermined history; interviews were videotaped from behind a one-way mirror. Students also completed an interviewing-orientation survey and a personal report of communication apprehension (PRCA). Trained raters evaluated the videotaped interviews using measures of interview skill and interview completeness. The simulated patients completed a patient-satisfaction form after each interview. Two path models were developed that were identical except that one had completeness and one had patient satisfaction as the dependent variable. Interview skill was the final factor in each model, preceded by variables representing the student's background and orientation factors, PRCA, and simulated-patient gender. Of 112 students conducting the interview, 107 (95.5%) and 95 (84.8%) completed the PRCA and orientation surveys, respectively. The models explained 36% and 27% of the variance in patient satisfaction and completeness, respectively. Shown in parentheses are the significant direct predictors of variables in the model of patient satisfaction: satisfaction (skill, prepharmacy grade point average [preGPA], people and health-care [PHC] orientation); skill (interviewing orientation, preGPA); interviewing orientation PHC orientation, preGPA, PRCA); and (PHC orientation (student gender). All effects were positive except for PRCA on interviewing orientation. For the model of completeness, direct predictors were as follows: completeness (skill, PHC orientation, student gender, simulated-patient gender); skill (interviewing orientation, preGPA); interviewing orientation (PRCA, preGPA, PHC orientation); and PHC orientation (student gender). All effects were positive except for PRCA on interviewing orientation and PHC orientation on completeness. Results suggest that one path model reflects the patient's assessment of interviewer competence in terms of satisfaction, and the other reflects the clinician-rater's assessment of interviewer competence in terms of interview completeness. The interviewing process positively influences both patient satisfaction and interview completeness.
A case-control study of quality of life in patients with lung cancer was carried out. The investigation was conducted by means of a series of interviewer-administered instruments. As part of the study, patients' attitudes towards the interviewer-administered questionnaires were studied. Previously we reported that a high proportion of the patients found being interviewed acceptable. The present study firstly examines why patients found being interviewed acceptable and secondly investigates whether there is an association between gender, age, diagnosis, place of interview, patients' overall health status, global quality of life and patients' feelings. Two hundred and thirty-two patients attending an outpatient clinic with either lung cancer or chronic respiratory disease were interviewed by means of a short questionnaire. They were asked to indicate their feelings about interviews, and to explain the reasons why they had their particular feelings. We documented issues on communication between interviewers and patients. These include observations on interviewing cancer patients, interviewing at home, and interviewing in the clinic. Nearly all the patients (96%) indicated that they found being interviewed acceptable. A content analysis of data showed that patients' feelings can be attributed to four major themes: the interview was not disturbing, they felt relaxed and at ease, they liked to talk, and the interview was conversational. There were no significant association between gender, age, diagnosis (cases and controls), place of interview, patients' overall health status and global quality of life and the reasons expressed. Practical experience from interviewing patients at home or in the clinic reveals several issues on communication between interviewer and patients. The study results suggest that apart from communication factors, other parameters such as age, gender, diagnosis, overall health status and quality of life and interview setting do not have significant role in patients' feelings about interviews. If data on quality of life studies are to be collected by interviewers, then proper communication is essential. How to achieve this remains a major question.
OBJECTIVES: The present study was designed to explore structural differences between forensic interviews in which children made allegations and those in which children did not make allegations. METHODOLOGY: Fifty forensic interviews of 4- to 13-year-old suspected victims of abuse who did not disclose abuse during the interview were compared with the same number of forensic interviews of alleged victims who made allegations of sexual or physical abuse. Only cases in which there was substantial reason to believe that abuse had taken place were included in the study. Audiotapes of the interviews were examined with a focus on interviewer utterances and children's responses during the pre-substantive rapport-building, episodic memory training, and 'getting the allegation' phases of the interviews, which all employed the NICHD Investigative Interview Guide. FINDINGS: Forensic interviews which yielded allegations of child abuse were characterized by quite different dynamics than interviews with children who did not make allegations. When interviewing non-disclosers, interviewers made less frequent use of free recall prompts and offered fewer supportive comments than when interviewing children who made allegations of abuse. Children who did not disclose abuse were somewhat uncooperative, offered fewer details, and gave more uninformative responses, even at the very beginning of the interview, before the interviewers focused on substantive issues and before the interviewers themselves began to behave differently. CONCLUSIONS: A premature focus on substantive issues may prevent children who are not responsive in the episodic memory training phase from disclosing abuse. Identifying reluctant disclosers and making more extensive efforts to build rapport before substantive issues are broached, or interviewing such children in more than one session, may help suspected victims disclose their experiences.
Quality control is an important aspect of a study because the quality of data collected provides a foundation for the conclusions drawn from the study. For studies that include interviews, establishing quality control for interviews is critical in ascertaining whether interviews are conducted according to protocol. Despite the importance of quality control for interviews, few studies adequately document the quality control procedures used during data collection. This article reviews quality control for interviews and describes methods and results of quality control for interviews from two of our studies regarding the accuracy of children's dietary recalls; the focus is on quality control regarding interviewer performance during the interview, and examples are provided from studies with children. For our two studies, every interview was audio recorded and transcribed. The audio recording and typed transcript from one interview conducted by each research dietitian either weekly or daily were randomly selected and reviewed by another research dietitian, who completed a standardized quality control for interviews checklist.Major strengths of the methods of quality control for interviews in our two studies include: (a) interviews obtained for data collection were randomly selected for quality control for interviews, and (b) quality control for interviews was assessed on a regular basis throughout data collection. The methods of quality control for interviews described may help researchers design appropriate methods of quality control for interviews for future studies.
OBJECTIVES: To determine the reliability of scores assigned to interviews of medical students applying to an emergency medicine program. METHODS: A scoring instrument was derived based on faculty and resident input, institutional and national documents, and previous application procedures. Candidates were interviewed by four pairs of interviewers. Interviewers were asked to score the candidates on five visual analog scales (VASs) with objective anchors. Each interview assessed a unique candidate characteristic. All interviewers were given explicit instructions on scoring procedures and instrument use. The data were entered into an Excel database and transferred to SPSS, and reliabilities were measured with a two-way mixed-effect Cronbach's alpha. RESULTS: Forty applications were received for the 2002 residency entry year. Thirty-eight application packages were complete, and 16 candidates were interviewed. Data collection was complete for all 16. The average measure intraclass correlations for each individual interviewer across the five VASs ranged from 0.72 to 0.92 (mean, 0.85). The interrater reliability within the four interviews (personal characteristics, trainability, suitability for emergency medicine, and suitability for the specific training program) were low at 0.36, 0.59, 0.69, and 0.49. The overall reliability of the four interview scores was 0.83, and for the eight interviewer scores it was 0.86. CONCLUSIONS: The reliability of the overall interview scores was very high. The intraclass correlations for each interviewer's VAS scores were also high, but interrater correlations within interview teams were moderate and not higher than those across interview teams. This study suggests that an interview assessment instrument can be highly reliable overall and that interviewers base scores on an overall global impression.
Structured diagnostic interviews, which evolved along the development of classification's systems, are now widely used in adult psychiatry, in the fields of clinical trials, epidemiological studies, academic research as well as, more recently, clinical practice. These instruments improved the reliability of the data collection and interrater reliability allowing greater homogenisation of the subjects taking part in clinical research, essential factor to ensure the reproducibility of the results. The diagnostic instruments, conversely to the clinical traditional diagnostic processes allow a systematic and exhaustive exploration of disorders, diagnostic criteria but also severity levels, and duration. The format of the data collection, including the order of exploration of the symptoms, is fixed. The formulation of the questions is tested to be univocal, in order to avoid confusions. In child and adolescent, researches in pharmacology and epidemiology increased a lot in the last decade and the standardisation of diagnostic procedures is becoming a key feature. This Article aims to make an assessment, a selection, and a description of the standardized instruments helping psychiatric diagnosis currently available in the field of child and adolescent's psychiatry. Medline and PsycINFO databases were exhaustively checked and the selection of the instruments was based on the review of four main criteria: i) compatibility with international diagnostic systems (DSM IV and/or ICD-10); ii) number of disorders explored; iii) peer reviewed Journals and iv) richness of psychometric data. After the analysis of the instruments described or mentioned in the literature, 2 structured interviews [the Diagnostic Interview Schedule for Children (DISC) and the Children's Interview for Psychiatric Syndromes (ChIPS)] and 4 diagnostic semi-structured interviews [the Schedule for Affective Disorders and Schizophrenia for School-Age Children (Kiddie-SADS), the Diagnostic Interview for Children and Adolescent (DICA), the Child and Adolescent Psychiatric Assessment (CAPA) and the Interview Schedule for Children and Adolescents ISCA)] were retained according to the 3 first criteria. All can be administered by clinicians, and x out of 6 can also be administered by lay-interviewers. All include a child/adolescent version and a parent version. Two instruments evaluate the presence of DSM IV axe II disorders: The ISCA explores the criteria of the Antisocial Personality Disorder. The CAPA evaluates Borderline, Obsessional-compulsive, Histrionic and Schizotypic Personality Disorders. Regarding the psychometric quality criterion, the selection was much more difficult because of the lack of data and the weakness of the samples studied in reliability studies. Interrater reliability appeared to be good for the 6 instruments, with kappas ranging from 0.5 to 1. This is usual in such instruments. The test-retest reliability was found to vary from bad to excellent depending on the instruments, the "informant" status (child/adolescent or parent), and the disorder explored, kappas ranging from 0.32 to 1. The worst results concerned face-to-face reliability studies which showed weak concordances for the diagnoses, whatever the procedure implemented: Diagnostic interview vs. i) Another diagnostic interview, vs. ii) An expert diagnosis or vs. iii) Scales and questionnaires. Overall, the K-SADS-PL appeared to be the instrument that has the best test-retest reliability for Anxious Disorders and Affective Disorders (the value kappa showing good to excellent reliabilities). Several important methodological observations emerged from this review. Firstly, the metrological data corresponding to the diagnoses according to DSM IV or ICD-10 criteria's were lacking. The face validity was globally satisfactory, but the data concerning their face-to-face validities and their test-retest reliability, although better than in the former versions, were limited because they were tested on small sample. In fact, it appeared that the agreements depend on the informant, the sample studied, the various diagnostic categories and the instrument used. Since the studies carried out by Cohen et al., with now obsolete versions of the DISC and K-SADS, no other study establishing a comparison between two EDS have been conducted. Consequently, the clinicians must be very careful before comparing DSM or ICD diagnoses generated by different instruments. The second point was the length of the interviews that appeared sometimes longer than instruments used in adults, considering the fact that diagnostic procedure implies two independent interviews, one with the child/adolescent and one with the adult referent. The minimum duration was found to be 1 h 30 for the Chips in clinical setting, while it could reach 4 h or more for the DISC IV or the ISCA. The interviews had to be often carried out in several sessions, so the assessment became very difficult in easily tired and/or distractible subjects. The third point referred to the necessity to consider multiple data sources in young patients during the diagnostic procedure, and the weakness of the levels of agreement generally reported between sources. Empirically, it was observed that the investigator granted more weight to the report of the children than to the parent's one, when the clinical judgement was necessary to synthesize the data. On another level, studies showed a high agreement on the factual contents or on the specific events (ex: hospitalization), like on the obvious symptoms (ex: enuresis). The parents report more problems of behaviour, school and relational difficulties, whereas the children report more fear, anxiety, obsessions and compulsions, or delusional ideas. In other words, it appeared that children were better informants in describing their mental states (internalised disorders), and that adults would bring more reliable information in describing externalised disorders. Like McClellan and Werry, we think that further researches are needed to clarify if and when this is the case. The last major point concerned the problem of language. These instruments must be used in the maternal language of the interviewees and they were developed for most of them into English only. For example, there is only one instrument available into French (the Kiddie SADS). Nowadays, it remains difficult to conduct international studies in child and adolescent psychiatry and/or to compare data is this domain. To conclude, the use of the EDS and EDSS brings many benefits, in academic researches as well as in clinical practice, but a more systematic use is limited by a certain number of parameters. The instruments currently available in child and adolescent are far from being optimal in terms of quality and quantity. It seems necessary and useful to contribute to their development and their improvement. In particular, the following points should be considered: drastic reduction of the length of the interviews; simplification in the use of these instruments, during the interviews, but also in the treatment of the data collected during the final phase of diagnosis generation, the clinician having to carry out ceaseless returns to check the presence or not of each diagnostic criterion; reduction of the duration of the highly necessary training, which can be easily solved by the global simplification of the instruments; quantitative and qualitative improvements of psychometric properties, in particular in terms of sensitivity, specificity and face-to-face validity. Finally, it is highly necessary to continue to develop structured diagnostic interviews adapted to the assessment of child and adolescent psychiatric diagnoses keeping in mind simplicity, feasibility and reliability. Developing this kind of instruments is hard, expensive, and sometimes tiresome but it remains the inescapable stage to produce high quality data in the future.
BACKGROUND: Interviews are commonly used to measure noncognitive traits of medical school applicants. The present study investigated the influence of knowledge of applicants' cognitive abilities on interviewers' ratings of noncognitive traits. METHOD: Academic and demographic predictors of interview ratings of applicants' noncognitive traits were examined at the Medical University of South Carolina College of Medicine during two years: 1992, when applicants' Medical College Admission Test (MCAT) total scores and undergraduate grade-point averages (GPAs) were available to interviewers; and 1993, when MCAT and GPA data were not available. In 1992, 226 applicants met study criteria (i.e., they received ratings from three interviewers in addition to having MCAT and GPA data on file); in 1993, 245 applicants met the criteria. Step-wise regression analyses were conducted to measure the influences of seven independent variables on applicants' interview ratings. Two-way analyses of variances and t-tests were used to determine the effects of gender of applicants and interviewers. Cronbach's alpha coefficients were used as measures of interviewers' reliability. RESULTS: GPA was the best predictor for both years but accounted for double the amount of variance in interview ratings in 1992 (15.7%) compared with 1993 (7.4%). The reliability coefficients for the interviewers were .496 for 1992 and .473 for 1993. CONCLUSION: If the goal of the medical school admission interview is to assess noncognitive traits independently from academic skills, the authors recommend that MCAT and GPA data not be available to interviewers during interviews. The authors also found that gender and race influenced interview ratings in accordance with affirmative-action goals. Finally, the authors found that interview scores were only moderately reliable across different interviewers. They discuss ways to increase their reliability.