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PubMed2002

Improving the assessment of outcomes in stroke: use of a structured interview to assign grades on the modified Rankin Scale.

BACKGROUND AND PURPOSE: The modified Rankin Scale is widely used to assess changes in activity and lifestyle after stroke, but it has been criticized for its subjectivity. The purpose of the present study was to compare conventional assessment on the modified Rankin Scale with assessment through a structured interview. METHODS: Sixty-three patients with stroke 6 to 24 months previously were interviewed and graded independently on the modified Rankin Scale by 2 observers. These observers then underwent training in use of a structured interview for the scale that covered 5 areas of everyday function. Eight weeks after the first assessment, the same observers reassessed 58 of these patients using the structured interview. RESULTS: Interrater reliability was measured with the kappa statistic (weighted with quadratic weights). For the scale applied conventionally, overall agreement between the 2 raters was 57% (kappa(w)=0.78); 1 rater assigned significantly lower grades than the other (P=0.048). On the structured interview, the overall agreement between raters was 78% (kappa(w)=0.93), and there was no overall difference between raters in grades assigned (P=0.17). Rankin grades from the conventional assessment and the structured interview were highly correlated, but there was significantly less disagreement between raters when the structured interview was used (P=0.004). CONCLUSIONS: Variability and bias between raters in assigning patients to Rankin grades may be reduced by use of a structured interview. Use of a structured interview for the scale could potentially improve the quality of results from clinical studies in stroke.

Activities of Daily Living↗
PubMed2005

Clinical tasks of the dynamic interview.

We examined psychodynamic interview tasks and techniques to identify clinical actions that improve or impede exploration of subjects' emotional responses, conflicts, defenses, and central relationship themes. This article extends previous quantitative studies (Perry, Fowler, & Greif, unpublished; Perry, Fowler, & Semeniuk, 2005) by examining interview vignettes in 50-minute psychodynamic research interviews. We conducted qualitative analyses on 72 dynamic research interviews given by 26 subjects to delineate categories of tasks and interventions. Results indicated five broad tasks of the dynamic interview: 1) Frame Setting; 2) Offering Support; 3) Exploring Affect; 4) Offering Trial Interpretations; and 5) Providing a Formulation and Feedback of relationship themes and conflicts. We further selected two interviews each from 10 subjects, in which there was a difference of one standard deviation or greater on the Overall Dynamic Interview Adequacy scale (Perry, 1999), and interviewer errors from the Therapeutic Alliance Analogue scale (Perry, Brysk, & Cooper, 1989). We utilized excerpts from these interviews to highlight the importance of these tasks and techniques in deepening discussion of dynamically meaningful material.

Adult↗
PubMed2003

Factors affecting the validity of a Timeline Follow-Back interview.

OBJECTIVE: The Timeline Follow-Back (TLFB) interview is a calendar-prompted, retrospective measure of alcohol consumption. This report examines limitations of the TLFB's validity by examining change in reported consumption going back in time. METHOD: This report analyzes data from a case-control study. Cases (N = 2,517; 56.9% men) were patients presenting for care of an acute injury to one of three emergency departments in Boone County, MO. Two control groups were recruited. Community controls (N = 1,856; 51.1% men) were recruited by random-digit dialing and interviewed by telephone (response rate, 46.5%); medical patients (N = 2,103; 50.9% men) presenting for care of a noninjury illness were interviewed in person and, a few months later, by telephone (complete data obtained on 2,082). A 28-day TLFB interview was conducted with cases and community controls and an 8-day TLFB was done twice with medical controls. RESULTS: A linear regression analysis was done on each individual's drinking over the 28 or 8 days. Averaging participants' regression slopes, cases as a group showed a significant decay in self-reported consumption (0.011 drink per day for each day going back in time). Among community controls, the decay was significantly greater (0.018 drink per day). Analyzing only the 8 days prior to the day of interview, medical controls showed more evidence of bias than either cases or community controls. CONCLUSIONS: The smaller decay in cases' reporting is consistent with an effect of motivation (e.g., engagement in the interview process). Whether the interview is conducted in person (cases and first interviews with medical controls) or by telephone (community controls and second interviews with medical controls) may be relatively less important.

Adolescent↗
PubMed2002

Telephone interviewing: is it compatible with interpretive phenomenological research?

The telephone has long been used as a medium of communication. In more recent years the telephone has become a legitimate tool in marketing and survey research (Barriball et al. 1996). Telephone interviewing is becoming an increasingly popular form of interview for qualitative research (Carr & Worth 2001). Whilst there have been discussions in the literature on logistical advantages and disadvantages of telephone interviewing, there has been little debate as to whether this form of interview is compatible with qualitative health research. Much of the literature reporting this interview method is based on quantitative or structured questionnaire style research under the guise of 'qualitative' research. So the question remains: Is the telephone interview compatible with interpretive phenomenological research? This paper describes how telephone interviewing was used in a recently conducted interpretive phenomenological study, and argues that this is a methodologically and economically valuable data collection technique in qualitative research. Qualitative researchers should not rely exclusively on the face-to-face interview, as the telephone interview can be an equally valuable data collection approach.

Breast Feeding↗
PubMedDate not supplied

Selecting specialist registrars by station interview.

Appointments to the specialist registrar (SpR) grade depend almost entirely on performance at interview, yet standard panel interviews do not directly assess the competences required of a medical trainee. In this study, station interviews were used to select neurology SpRs. Eighteen candidates were assessed in three interviews, each involving three stations: a curriculum vitae (CV)-based interview, an interview with a simulated patient, and a discussion of scenarios based upon teaching, audit and research. Two or three assessors at each station ranked candidates independently before discussing the pooled rankings and reading written references. The CV-based interview rankings (resembling a traditional panel interview) correlated less well with the overall rankings (r=0.54) than did research (r=0.83), information giving (r=0.75), audit (r=0.70) or teaching presentation (r=0.59). Station interviews appear fairer (providing more time, more independent examiners, fresh starts at each station), although they require more planning and expense. Competency-based assessments should be more widely used in selecting medical trainees.

Clinical Competence↗
PubMed2005

Motivational interviewing: a systematic review and meta-analysis.

BACKGROUND: Motivational Interviewing is a well-known, scientifically tested method of counselling clients developed by Miller and Rollnick and viewed as a useful intervention strategy in the treatment of lifestyle problems and disease. AIM: To evaluate the effectiveness of motivational interviewing in different areas of disease and to identify factors shaping outcomes. DESIGN OF STUDY: A systematic review and meta-analysis of randomised controlled trials using motivational interviewing as the intervention. METHOD: After selection criteria a systematic literature search in 16 databases produced 72 randomised controlled trials the first of which was published in 1991. A quality assessment was made with a validated scale. A meta-analysis was performed as a generic inverse variance meta-analysis. RESULTS: Meta-analysis showed a significant effect (95% confidence interval) for motivational interviewing for combined effect estimates for body mass index, total blood cholesterol, systolic blood pressure, blood alcohol concentration and standard ethanol content, while combined effect estimates for cigarettes per day and for HbA(1c) were not significant. Motivational interviewing had a significant and clinically relevant effect in approximately three out of four studies, with an equal effect on physiological (72%) and psychological (75%) diseases. Psychologists and physicians obtained an effect in approximately 80% of the studies, while other healthcare providers obtained an effect in 46% of the studies. When using motivational interviewing in brief encounters of 15 minutes, 64% of the studies showed an effect. More than one encounter with the patient ensures the effectiveness of motivational interviewing. CONCLUSION: Motivational interviewing in a scientific setting outperforms traditional advice giving in the treatment of a broad range of behavioural problems and diseases. Large-scale studies are now needed to prove that motivational interviewing can be implemented into daily clinical work in primary and secondary health care.

Data Collection↗
PubMed1991

[Morbidity among kibbutz children determined by health interview].

Morbidity in 1,565 children up to the age of 6 years on 28 kibbutzim over a period of 6 days was examined. The data reported in a health interview were compared with those reported to the kibbutz clinics. The health interview gave a morbidity of 38% during the 6 days studied, equivalent to a mean of 23.1 episodes per child per year. Of these sick children, 300 were reported as having visited the clinic, compared with 240 actually recorded as having symptoms/complaints, or 9.3 events per child per year. Nearly all of the morbidity (95%) fell into 4 major categories: respiratory, nervous system and sensory infections and digestive diseases. As reported in the health interview, the clinic was visited in 50% of the episodes; the frequency and types of diseases reported were similar for both the clinic records and the health interviews. The most clinic visits were for acute infectious diseases (100%); the least for chronic diseases (none). According to the health interview, 62% of those visiting the clinic were referred to a physician and 38% to a nurse. The corresponding percentages from the clinic records were 60 and 40, respectively. In general, the relative distribution by disease categories was similar in both health interviews and clinic records. The only significant differences were for respiratory diseases, in which a higher incidence was reported in the health interview. In the matching test between health interviews and records of clinic visits, only partial matching was found. There was 34% corroboration of dates of visit according to the health interview compared with the clinic records. With regard to diagnoses, the rate of match was only 29%.

Child Health Services↗
PubMedDate not supplied

[A semi-structured psychopathological interview conceived for the AMDP-3 scale and time-blind evaluation of videotapes (author's transl)].

In the process of adapting the German AMDP Psychopathology Scale into French and of analyzing its interrater-reliability, free AMDP interviews were tape-recorded and played back. It became rapidly evident that such interviews are incompatible with a comprehensive and reliable evaluation of psychopathology: the collected information is incomplete and variable from one interviewer to the other and even from one interview to the other by the same interviewer, which is particularly invalidating in case of video ratings. The present semi-structured interview is based on 140 videotaped recordings of non-psychiatric patients, of depressives and psychotics. Formulation of questions is seldom imperative; their sequence is only suggested and may be modified according to the interviewer's style and to the patient's pathology. Have been avoided questions too dependent on setting (community, hospital) or likely to disclose the first-interview or retest nature of the recording, thus allowing time-blind evaluations. The mean duration of the interview is 28 mn (less than 30 mn in 70% of the cases) for 126 items.

Ethics, Medical↗
PubMed2000

A comparison of diagnostic interviews for depression in the Stirling County study: challenges for psychiatric epidemiology.

BACKGROUND: High prevalence rates in psychiatric epidemiologic studies raise questions about whether data-gathering procedures identify transient responses rather than clinical disorders. This issue is explored relevant to depression using data from the Stirling County Study. METHODS: The study's customary method, the DPAX (DP for depression and AX for anxiety) was compared with the Diagnostic Interview Schedule (DIS), both of which were administered to a sample of 1396 subjects selected in 1992. Reasons for discordance were analyzed, and demographic correlates of responses to questions about dysphoria were examined. These lay-administered interviews were then compared with clinician-administered interviews that used the Structured Clinical Interview for DSM-III-R (SCID) with 139 subjects. The kappa statistic and logistic regression were used for statistical assessment. RESULTS: For the level of agreement between the DPAX and the DIS for current and lifetime depression, kappa = 0.40 and kappa = 0.33, respectively. Subjects diagnosed only by the DPAX tended to have less education than those diagnosed only by the DIS. Some idioms for dysphoria seemed to work better than others. Using SCID interviews as a clinical standard, the DPAX had 15% sensitivity and 96% specificity and the DIS had 25% sensitivity and 98% specificity. CONCLUSIONS: Comprehension of an interview can be improved by using multiple questions for dysphoria and a simpler mode of inquiry. Clinician-administered interviews tend to corroborate disorders identified in lay-administered interviews but suggest that survey methods underestimate prevalence. Further research is needed to evaluate the validity of both types of interviews, but evidence from a 16-year follow-up evaluation indicates that depression diagnosed by the DPAX is a serious disorder in terms of morbidity and mortality.

Adult↗
PubMed1984

Is there a short-cut? An investigation into the life event interview.

Forty-two men and 53 women patients at the Edinburgh Regional Poisoning Treatment Centre were interviewed, usually within 8-12 h of admission. The interview covered life events and difficulties from 6 months before admission. For 43 patients it was in 3 stages: 1) a list of life events and difficulties to be ticked, 2) standard probing questions about each situation ticked, 3) free flowing unstructured interviewing eliciting fuller contextual data about the situations. An independent rater scored the situations after each of the three stages, at each point being blind to information contained in subsequent stages. Four variables were scored designed to indicate the total number of life situations present, the number of situations containing either a long-term threat or personal loss element, an overall threat score and the total number of characteristics (1). The remaining 52 patients had a similar interview but containing an extra stage at the start. In this stage the patients were invited to tell the interviewer about any problems they had had in the last 6 months. Anything volunteered was probed freely before administration of the other three stages. The raters scored all four stages separately. No important differences in results from the two types of interview were found. For individual patients more than 80% of the life situation information found after the final free flow stage had been obtained by the end of the probe stage. Furthermore, the final stage took something between a third and a half the interview time. On the other hand, it was clear that it would be unreasonable to end the interview after either the first free flow or the list stages, and the gain in information from probe to final stage was highly significant and potentially important. For individual life situations 75% underwent no further change in rating after the probe stage. High though this figure is, it would not, in our view, warrant shortening the interview.

Adjustment Disorders↗
PubMed1993

Test-retest reliability and validity of the Structured Interview for Sleep Disorders According to DSM-III-R.

OBJECTIVE: The purpose of this study was to evaluate the reliability of sleep disorder diagnoses in DSM-III-R by using a newly developed interview, the Structured Interview for Sleep Disorders According to DSM-III-R (SIS-D) and to evaluate the concordance between these diagnoses and sleep laboratory data. In addition, the sources of disagreements between two interviewers in the diagnoses given to the same patient were determined. METHOD: Two different interviewers used the SIS-D to diagnose 68 patients with complaints of sleep disorders. The concordance between these interviewers' diagnoses and polysomnographic findings was investigated by using kappa statistics. RESULTS: There were excellent reliabilities for almost all current main diagnostic categories and good concordance between diagnoses made on the basis of the structured interview and polysomnographic data. The main source of disagreement between interviewers was found in the symptom information given by the patient. CONCLUSIONS: These findings provide support for the utility of DSM-III-R sleep disorder diagnoses and for their retention in DSM-IV. These findings also accord well with a recent literature review of the DSM-III-R diagnosis of primary insomnia by the DSM-IV Work Group on Sleep Disorders. The good concordance between interview diagnoses and polysomnographic data suggests that a structured interview such as the SIS-D may be a useful screening instrument. The authors discuss the implications of these findings for the polysomnographic evaluation of chronic insomnia.

Adult↗
PubMed1995

Validity of a diagnosis of lifetime major depression obtained by personal interview versus family history.

OBJECTIVE: Diagnoses obtained by family history agree only modestly with those obtained through personal interview. If personal interview diagnoses are the "gold standard," these findings suggest that family history diagnoses have low validity. Here the authors take another perspective--to evaluate family history versus personal interview diagnoses of lifetime major depression by three independent validators. METHOD: In a large sample of female-female twin pairs and their parents (903 families) ascertained from a population-based twin register, all subjects were personally interviewed by using a modified Structured Clinical Interview for DMS-III-R. Family history diagnoses based on the Family History Research Diagnostic Criteria were obtained by questioning each participant about his or her relatives. By means of multiple regression, the powers of the personal interview and family history methods were compared to predict 1) future episodes of major depression in the twins, 2) neuroticism, and 3) familial aggregation of major depression. RESULTS: Agreement between diagnoses obtained by personal interview and family history was modest. After the presence or absence of a personal interview diagnosis of major depression was controlled for, a family history diagnosis of major depression significantly predicted future episodes of major depression, neuroticism (in five of six analyses), and familial aggregation of major depression (in four of six analyses). CONCLUSIONS: Although agreeing relatively poorly, diagnoses of lifetime major depression obtained by personal interview and family history both contained useful information about future episodes, personality, and familial liability to illness. A multimethod approach to assessment of psychiatric illness may maximize the validity of psychiatric diagnoses.

Adult↗
PubMed2005

Patient satisfaction and information gain after the preanesthetic visit: a comparison of face-to-face interview, brochure, and video.

In this study we compared 3 methods of conducting the preanesthetic visit. We prospectively studied 197 consecutive surgical patients who were to undergo general anesthesia. The patients were randomized to a routine preanesthetic interview, a brochure plus an interview, or a self-made documentary video plus an interview. After the preanesthetic visit, the degree of patient satisfaction and information gain was quantified by a questionnaire for each method. The questions on patient satisfaction were assessed on a six-point scale, and those on information gain were assessed on a multiple-choice basis. The video plus interview group showed the highest point scores (98% of the possible maximum sum point score in patient satisfaction and 93% of the maximum sum score in information gain). In contrast, the patients of the brochure plus interview group revealed 93% for patient satisfaction and 80% for information gain, and in the standard interview group, the corresponding figures were 91% and 72%, respectively. The maximum sum scores in patient satisfaction and information gain were significantly different between the interview and the video groups, but not between the interview and the brochure groups. Therefore, these data suggest that the use of a documentary video to supplement a preoperative interview may enhance patient satisfaction and maximize information gain.

Anesthesia, General↗
PubMedDate not supplied

The impact of T-ACASI interviewing on reported drug use among men who have sex with men.

Measurements of drug use and other illicit or stigmatized behaviors are subject to nontrivial underreporting biases. During in-person surveys, respondents are more likely to report such behaviors when interviewed using techniques that maximize interviewee privacy, e.g., use of paper SAQs and audio-CASI rather than questioning by human interviewers. Until recently, respondents in telephone surveys could not be offered similar privacy. A new technology, telephone audio computer-assisted self-interviewing (T-ACASI) overcomes this limitation of telephone surveys by allowing respondents to respond to a computer. A randomized experimental test of T-ACASI was embedded in the Urban Men's Health Study (UMHS). UMHS surveyed a probability sample of 2,881 men from four United States cities and who reported having sex with men. Respondents interviewed using T-ACASI reported a higher prevalence of drug use and drug-related behaviors than respondents interviewed by human interviewers. However, survey respondents were more likely to break off an interview when the interview was conducted by a T-ACASI computer rather than by a human interviewer.

Adolescent↗
PubMed2003

The patient-computer interview: a neglected tool that can aid the clinician.

In this article, I (1) review the process of interviewing patients by computer, (2) summarize computer-interviewing work done in 1968, (3) address the weaknesses of collecting information with the traditional history-taking methods or paper questionnaires, (4) discuss commercial software designed for computer interviewing, and (5) focus on the strengths and weaknesses of interviewing patients with a computer. The strengths of this process compared with traditional interviewing are that computer interviewing allows the physician to gather more data; gives the patient more time to complete an interview; uncovers more sensitive information; provides more adaptability to non-English-speaking patients, patients with hearing impairment, or patients who are illiterate; and provides structured information for research. The weaknesses of computer interviewing are that it generates false-positive responses, is not accepted by a minority of patients, is unable to detect nonverbal behavior, and requires changes in work flow. With the advent of an electronic medical record and the financial rewards for comprehensive history recording, the gathering of history and documentation from patients is increasingly important and favors adaptation to computer interviewing.

Computers↗
PubMed2006

Participants' experiences of being interviewed about an emotive topic.

AIM: The aim of this paper was to report the experience of in-depth interviewing about emotive topics from the perspectives of participants. BACKGROUND: We both undertook qualitative, longitudinal studies investigating emotive topics using repeated in-depth interviews as the data collection method. Recruitment and some of the interviews took place at a potentially distressing time for participants, which raised concerns for us about issues relating to consent and the impact of the interviews on participants' emotional well-being. METHOD: At the end of the two studies, 55 participants were asked about their experiences of the recruitment and interview processes. The tape-recorded responses were transcribed verbatim. We both independently analysed the data before agreeing on the final thematic framework arising from participants' accounts. The data were collected in 1998 and 1999 (Study 1) and 2003 and 2005 (Study 2). FINDINGS: Some participants had initial reservations about participating in the studies. The primary reason for consenting was altruism, i.e. a belief that their participation might somehow help other families. Many participants often found it difficult to discuss emotive issues, particularly soon after the actual event, but all found it helpful to be given the opportunity to talk about their experiences to someone interested in what they had to say. None of the participants had concerns about, or regretted, being interviewed. CONCLUSION: Participants can find in-depth interviewing about emotive topics a helpful, even 'therapeutic', experience. However, the purpose of the research interview is not to intentionally offer any form of therapy and researchers need to recognize and carefully consider this potential outcome at an early stage of the research process. Researchers studying emotive topics should also be aware of the possible impact of participants' experiences on their own emotional well-being.

Communication↗
PubMed1999

Interview versus questionnaire for assessing physical loads in the population-based MUSIC-Norrtälje Study.

BACKGROUND: MUSIC-Norrtälje study is a case-referent study, the aim of which is to find risk and health factors for low back and neck/shoulder disorders. In this part of the study, the interview technique and the self-administered questionnaire used for assessment of physical loads are described and the inter-method reliability of parts of the self-administered questionnaire is estimated. The distribution of exposure levels in a general population is also described. METHODS: The study period was three years from November 1993 to November 1996, and the study subjects totaled 2,480 persons (813 female and 610 male referents, 380 female and 315 male low back cases, 252 female and 106 male neck/shoulder cases). The interview concerned "a typical working day" during the preceding 12 months and comprised assessment of energy expenditure, work postures, and manual materials handling for work and leisure time, including regular sport activities. The self-administered questionnaire comprised 18 questions, each covering 5 different points of time: right now, 5, 10, 15, 20 years ago. The answers to eight of the questions about current conditions were compared to corresponding interview responses. The interview was considered as the "gold standard." RESULTS: Ninety-eight percent of the subjects completed the interview without any great difficulties. According to the interview, the distributions of different exposure levels were generally positively skewed, i.e., the frequency of highly exposed subjects was low in the study base. The correlation between interview and questionnaire responses among the referents was high for time spent "sitting at work" (r = 0.82), "VDU work" (r = 0.87), and work related "motor vehicle driving" (r = 0.80). The correlation was moderate for work-related "hands above shoulder level" (rs = 0.63), and "hands below knee level (trunk flexion)" (rs = 0.66). The correlation was lower for leisure time activities such as "domestic work" (r = 0.55), "time for own activities" (r = 0.39), and "sitting during leisure time" (r = 0.38). Subjects seeking care for low back or neck/shoulder disorder estimated equally correctly or not, as had the referents. However, non-differential misclassification was present in all questions, which will attenuate observed estimates of the relative risk. CONCLUSIONS: Even though interview data are preferable, questionnaire data may be useful for assessing well-defined work tasks and for "sitting at work."

Adult↗
PubMed2006

Strategic use of evidence during police interviews: when training to detect deception works.

Research on deception detection in legal contexts has neglected the question of how the use of evidence can affect deception detection accuracy. In this study, police trainees (N=82) either were or were not trained in strategically using the evidence when interviewing lying or truth telling mock suspects (N=82). The trainees' strategies as well as liars' and truth tellers' counter-strategies were analyzed. Trained interviewers applied different strategies than did untrained. As a consequence of this, liars interviewed by trained interviewers were more inconsistent with the evidence compared to liars interviewed by untrained interviewers. Trained interviewers created and utilized the statement-evidence consistency cue, and obtained a considerably higher deception detection accuracy rate (85.4%) than untrained interviewers (56.1%).

Adult↗