Appendix B - State Program Manager Interview Guide
I'd like to start by asking some background questions about you.
Would you tell me a bit about yourself, your current position,
and other work you've done with STD prevention?
Next, I'd like to ask you some general questions about the people
or groups of people who you think are at the greatest risk for
syphilis in [state, city or county].
Who do you think is at the greatest risk for syphilis in
(STATE)? Why? [PROBE FOR AGE GROUPS, DIFFERENCES BETWEEN MEN AND WOMEN, PEOPLE
IN CERTAIN RACIAL AND ETHNIC GROUPS]
Do you think that people who live in certain areas are at
greater risk? Which areas and why? [PROBE FOR URBAN/RURAL
DIFFERENCES]
Have you noticed any changes in the groups of people infected
with syphilis in (STATE)? Since when? What are the changes?
The Centers for Disease Control uses the term "core
transmitters" to describe a group of people who are at the greatest
risk for syphilis and are also likely to transmit it to other people.
One of the main objectives of our research is learn more about
characteristics of core transmitters, the people who you think are
at the greatest risk of syphilis, in (STATE).
Is that also a term you use? [IF NO] Do you think that such a group exists? [Skip question 6] [IF YES] Do you use any particular term to describe them? What is
it?
You mentioned that people who live in (areas mentioned
previously) may be at greater risk of developing syphilis. Can you
tell me more about those areas?
I'm also interested in where people in this area get together,
what types of events do they get together for, as well as formal and
informal social groups that exist in the area.
I'd like to ask you a little bit about how patterns of STD infection
in (STATE) reflect patterns that have been reported elsewhere in the
professional literature.
For example, a relationship between syphilis and substance
abuse has been suggested. In your view, is there an association
between syphilis and substance abuse in [STATE]? Why do you think
this is so?
A relationship between commercial sex work or prostitution and
syphilis has also been reported. In your view, is prostitution
associated with syphilis in [STATE]? Why do you think this is
so?
In your view, are people at the greatest risk for syphilis
also at risk for HIV and other sexually transmitted disease? [IF
YES], How does this affect the kind of outreach prevention or
control efforts your target to this population?
What other health care facilities, aside from the public STD
clinic, do people at the greatest risk for syphilis use? What is
your sense of how accessible these health care services are to
people at the greatest risk?
11a. Are these health care facilities able to diagnose and treat
syphilis adequately?
11b. Do they provide counseling services?
11c. What is the relationship between the state STD program and
these facilities? Do they notify the state of new cases? [PROBE FOR
HOW CLOSELY FACILITIES FOLLOW REPORTING REQUIREMENTS]
Next, I'd like to learn more about the organizations in (STATE) that
provide services to people at the greatest risk for syphilis.
Specifically, I'd like to know what types of organizations exist and
what types of services do they provide. I'm interested in private as
well as public organizations.
Do you think that syphilis is perceived as a public health
problem in the (STATE)? By public health officials? By health care
providers? By community leaders?
Can we get a copy of the official public health policies and
procedures for syphilis control in (STATE)? [DO NOT ASK IF
INFORMATION WAS OBTAINED PRIOR TO THE INTERVIEW]
Have any new programs for STD prevention been initiated in the
past three years? Five years? Please describe. [PROBE FOR COMMUNITY OUTREACH, LIAISON WITH PRIVATE AND
COMMUNITY-BASED PROVIDERS, TARGETING TO SPECIFIC GROUPS OF PEOPLE.]
Are these programs integrated with any other prevention
programs in the [state, city, county]?
In your view, to what extent are organizations in this area
working together to prevent syphilis? [PROBE FOR INVOLVEMENT BY CHURCHES, SCHOOLS, CRIMINAL JUSTICE,
PUBLIC HEALTH AND OTHER SOURCES OF HEALTH CARE]
Before we finish, would you please describe what your ideal
syphilis prevention and control strategy would be?
17a. Is there any community, organization or group of
organizations that uses this strategy? Can you tell me more about
them?
17b. Do you think that people in the community would be open to
this type of strategy? Why or why not?
17c. What barriers prevent implementation of this strategy?
Have there been any changes in funding and other resources for
STD prevention and control in the past few years?
18a. Were any resources targeted specifically to syphilis
prevention and control?
18b. Were there any other effects of the funding changes on
syphilis prevention and control?
That's all the questions I [we] have for today. Thank you for taking
the time to answer my [our] questions about syphilis prevention in your
area. Do you have any questions for me [us]? Is there anything else you
would like to add that we didn't ask about during the interview? [RECORD
BELOW] If we have any other questions, would it be okay for us to get
back in touch with your offices? Thanks again.
STD Program Staff Interview Guide
I'd like to start by asking some background questions about you.
Would you tell me a bit about your current position? Have you
done any other work done with STD prevention? [PROBE FOR PAST
POSITIONS, VOLUNTEER, HIV-RELATED]
1a. What proportion of your time is spent in the field? and what
proportion in the clinic?
Next, I'd like to ask you some general questions about the people or
groups of people who you think are at the greatest risk for syphilis in
[state, city or county].
Who do you think is at the greatest risk for syphilis in
[state, city, county]? Why? [PROBE FOR AGE GROUPS, DIFFERENCES
BETWEEN MEN AND WOMEN, PEOPLE IN CERTAIN RACIAL AND ETHNIC GROUPS]
Do you think that people who live in certain areas are at
greater risk? Which areas and why? [PROBE FOR URBAN/RURAL
DIFFERENCES] [If no, skip question 4]
You mentioned that people who live in (areas mentioned
previously) may be at greater risk. Can you tell me more about those
areas?
I'm also interested in where people in this area get together,
what types of events do they get together for, as well as formal and
informal social groups that exist in the area.
Have you noticed any changes in the groups of people infected
with syphilis in [state, city, county]? Since when? What are the
changes?
The Centers for Disease Control uses the term "core
transmitters" to describe a group of people who are at the
greatest risk for syphilis and are also likely to transmit it to other
people. One of the main objectives of our research is learn more about
characteristics of core transmitters, the people who you think are at
the greatest risk of syphilis, in [state, city, county].
Is that also a term you use?
[IF NO] Do you think that such a group exists?
[IF YES] Do you use any particular term to describe them? What is it?
I'd like to ask you a little bit about how patterns of STD infection
in [state, city, county] reflect patterns that have been reported
elsewhere in the professional literature.
For example, a relationship between syphilis and
substance abuse has been suggested. In your view, is there an
association between syphilis and substance abuse in [state, city,
county]? In the areas you mentioned previously? Why do you think
this is so?
A relationship between commercial sex work or
prostitution and syphilis has also been reported. In your view, is
prostitution associated with syphilis in [state, city, county]? Why
do you think this is so?
In your view, are people at the greatest risk
for syphilis also at risk for HIV and other sexually transmitted
disease?
[IF YES] How is this reflected in prevention
activities? counseling activities? outreach activities?
What proportion of the client population that
you see would you characterize as "repeaters" [PEOPLE WHO
RETURN WITH AN STD SOON AFTER BEING TREATED FOR THE LAST ONE]? Of
those, what proportion would you say have syphilis?
11a. What have you found to be the most effective
methods for preventing so-called repeaters from becoming
re-infected? What are some of the barriers to preventing repeated
infection?
What is the average number of contacts per
syphilis patient? Is this different than it is for other STDs? How?
I'd like to ask some questions about the impact of STD care and
health care on the prevalence of syphilis.
To begin with, do you ever receive complaints from patients
about the treatment and services available at this clinic? What
complaints do you hear most often? [PROBE FOR HOURS, LOCATION,
STAFF] [IF RESPONDENT IS NOT ASSOCIATED WITH A CLINIC] At the
publicly funded STD clinic in this county.
Do patients complain about access to other health care
services? Please give examples.
In your opinion, are there adequate services for STD patients
in this county? Why or why not?
Next, I'd like to talk about syphilis or STD prevention programs in
this community.
In your view, to what extent are organizations in this area
working together to prevent syphilis? [PROBE FOR INVOLVEMENT BY CHURCHES, SCHOOLS, CRIMINAL JUSTICE,
PUBLIC HEALTH AND OTHER SOURCES OF HEALTH CARE]
16a. What other community groups have you worked with? What have you done with them? [PROBE FOR INITIAL CONTACT]
What do you think is the best way of getting out messages to prevent STDs? Does that happen here? Please describe.
What do you think are some of the barriers to getting out effective prevention messages? What are some of the things that make it easier to get out prevention messages in this community?
Are there any populations within the community that are particularly difficult to reach out to? Why?
19a. What programs or interventions have you tried with these
populations? How did they go? [PROBE FOR CONTENT]
Are there particular members of hard-to-reach groups who form
a bridge with the community at large? How are they accessed? Are
these members seen as leaders by the hard-to-reach group?
Before we finish, I'd like to know what you think an ideal
syphilis prevention and control strategy would be.
21a. Is there any community, organization or group of
organizations that uses this strategy? Can you tell me more
about them?
21b. Do you think that people in the community would be open
to this type of strategy? Why or why not?
21c. What barriers prevent implementation of this strategy?
That's all the questions I [we] have for today. Thank you for taking
the time to answer my [our] questions about syphilis prevention in your
area. Do you have any questions for me [us]? Is there anything else you
would like to add that we didn't ask about during the interview? [RECORD
BELOW] If we have any other questions, would it be okay for us to get
back in touch with your offices? Thanks again.
STD Clinic Staff and Health Care Provider Interview
Guide
I'd like to start by asking some background questions about you.
Would you tell me a bit about, your current position? Does this
include STD prevention, counseling and care? Have you done any
(other) work with STD prevention? [PROBE FOR PAID OR VOLUNTEER, HIV]
Next, I'd like to ask you questions about your experience providing
medical care to people at risk for STDs.
What services are most frequently sought at this clinic?
Do patients need to have appointments to be seen here? Always, sometimes or never?
[IF SOMETIMES] Under what circumstances?
3a. Has this always been the policy? What effect do you think this policy has on clinicians and patients?
What proportion of the client population that you see would you
characterize as "repeaters" [PEOPLE WHO RETURN WITH AN STD
SOON AFTER BEING TREATED FOR THE LAST ONE]? Of those, what
proportion would you say have syphilis?
4a. What have you found to be the most effective methods for
preventing repeaters from becoming re-infected? What are some of
the barriers to preventing repeated infection?
When you diagnose a patient with syphilis, how do you report
the diagnosis to the state or county? [PROBE FOR FOLLOW-UP
PROCEDURES]
Now I have a few questions about health care in general in this community.
What do you see as the most pressing health care need for members of this community?
Is there a sufficient number of health care providers in this county? Are their hours accessible to most people?
7a. Do different sectors of the community frequent different health care providers? Who goes where?
Is there any group which you believe does not get adequate health care? Who? Why?
8a. What are some of the things that make it more difficult for
certain groups of people to obtain health care than others?
Do you think there are particular barriers for patients with
STDs? With syphilis in particular?
I'd like to ask some questions about the impact of STD care and
health care on the prevalence of syphilis.
To begin with, do you ever receive complaints from patients about the treatment and services available at this clinic? What complaints do you hear most often? [PROBE FOR HOURS, LOCATION, STAFF]
Do patients complain about access to other health care services? Please give examples.
In your opinion, are there adequate services for STD patients in this [state, city, county]? Why or why not?
Do you know of other STD diagnosis and treatment services in this community? Do these facilities provide services to the same population as this facility? If different, in what ways are they different?
Next, I'd like to ask you some general questions about the people
or groups of people who you think are at the greatest risk for
syphilis in [state, city or county].
Do you think that syphilis is a problem for any people in this community?
[IF RESPONDENT ANSWER "NO", SKIP TO LAST PAGE AND READ
THE FINAL BLURB]
Who do you think is at the greatest risk for syphilis in
[state, city, county]? Why? [PROBE FOR AGE GROUPS, DIFFERENCES BETWEEN MEN AND WOMEN, PEOPLE
IN CERTAIN RACIAL AND ETHNIC GROUPS]
Do you think that people who live in certain areas are at greater risk? Which areas and why? [PROBE FOR URBAN/RURAL DIFFERENCES]
Have you noticed any changes in the groups of people infected with syphilis in [state, city, county]? Since when? What are the changes?
I'd like to ask you a little bit about how patterns of STD infection in [state, city, county] reflect patterns that have been reported elsewhere in the professional literature.
For example, many people report a relationship between
syphilis and substance abuse. In your view, is there a relationship
between substance abuse and syphilis in [state, city, county]? In
the areas you mentioned previously? Why do you think this is so?
[PROBE FOR TYPES OF SUBSTANCES]
People report a relationship between commercial sex work or
prostitution and syphilis. In your view, is prostitution associated
with syphilis in [state, city, county]? Why do you think this is so?
In your view, are people at the greatest risk for syphilis
also at risk for HIV and other sexually transmitted disease? Why or
why not?
Next, I'd like to talk about syphilis or STD prevention programs in
this community.
In your view, to what extent are organizations in this area working together to prevent syphilis? [PROBE for involvement by churches, schools, criminal justice, public health and other sources of health care]
21a. Have you worked with other community groups or STD clinics? What have you done?
What do you think is the best way of getting out messages to
prevent STDs? Does that happen here? Please describe.
What do you think are some of the barriers to getting out
effective prevention messages? What are some of the things that make
it easier to get out prevention messages in this community?
Are there any populations within the community that are
particularly difficult to reach out to? Why?
24a. What programs or interventions have you tried with these
populations? How did they go? [PROBE FOR CONTENT]
Are there particular members of hard-to-reach groups who form
a bridge with the community at large? How are they accessed? Are
these members seen as leaders by the hard-to-reach group?
Before we finish, I'd like to know what you feel is an ideal
syphilis prevention and control strategy would be.
26a. Is there any community, organization or group of organizations that uses this strategy? Can you tell me more about them?
26b. Do you think that people in the community would be open to this type of strategy? Why or why not?
26c. What
barriers prevent implementation of this strategy?
That's all the questions I [we] have for today. Thank you for taking
the time to answer my [our] questions about syphilis prevention in your
area. Do you have any questions for me [us]? Is there anything else you
would like to add that we didn't ask about during the interview? [RECORD
BELOW] If we have any other questions, would it be okay for us to get
back in touch with your offices? Thanks again.
Community Leaders Interview Guide
I'd like to start by asking some background questions about you.
Would you tell me about your current position? Have you done any work in STD prevention, either here or as a volunteer, or in a previous position? [DOES THIS INCLUDE HIV? IS THIS ONLY WITH HIV?]
Now I have a few questions about health care in general in this
community.
What do you see as the most pressing health care need for
members of this community?
Is there a sufficient number of health care providers in this
county? Are their hours accessible to most people?
3a. Do different sectors of the community frequent different
health care providers? Who goes where?
Is there any group which you believe does not get adequate health care? Who? Why?
4a. What are some of the things that make it more difficult for
certain groups of people to obtain health care than others?
Do you think there are particular barriers for patients with STDs? With syphilis in particular?
Do you think that sexually transmitted disease is a problem for
any people in this community? [DOES THIS INCLUDE HIV? IS THIS ONLY
WITH HIV?] [IF RESPONDENT ANSWER "NO", PLEASE ASK
QUESTIONS 17, 18 AND 21 TO THE END]
Next, I'd like to ask you some general questions about the people or
groups of people who you think are at the greatest risk for STDs like
syphilis in [state, city or county].
Who do you think is at the greatest risk for STDs like syphilis
in [state, city, county]? Why? [PROBE FOR AGE GROUPS, DIFFERENCES
BETWEEN MEN AND WOMEN, PEOPLE IN CERTAIN RACIAL AND ETHNIC GROUPS]
Do you think that people who live in certain areas are at
greater risk? Which areas and why? [PROBE FOR URBAN/RURAL
DIFFERENCES]
Where do people in your locality get together for formal social
activities? Informal social activities? [PROBE FOR DIFFERENCES BY
AGE, GENDER AND SEX]
I'd like to ask you a little bit about how patterns of STD infection
in [state, city, county] reflect patterns that have been reported
elsewhere in the professional literature.
For
example, there are reports of an association between STDs like
syphilis and substance abuse. In your view, is there an association
between syphilis and substance abuse in your community? Why do you
think so?
Also, a
relationship between commercial sex work or prostitution and
syphilis has been reported. In your view, is there a relationship
between syphilis and prostitution in your community? Why do you
think this is so?
In your
view, are people at the greatest risk for syphilis also at risk for
HIV and other sexually transmitted disease? [IF YES], Do your know
of any programs that address this issues? Which ones?
Where do
you think people at the greatest risk for STDs like syphilis go to
get health care? What is your sense of how accessible these health
care services are to the people at greatest risk?
Do you
think there is a difference in how men and women seek health care?
Next, I'd like to talk about STD prevention programs in this
community.
Do you think there should be special programs to prevent STDs
like syphilis? Why or why not?
Are any of your agency's programs concerned with the
prevention of STD in general or syphilis in particular? Please
describe them.
16a. Have you worked with any other community groups on these
kinds of programs? What other community groups do you work with?
Tell us about some of the things you do together.
16b. Have you ever worked with the public STD program on a
prevention or outreach program? How did that happen? [PROBE FOR
WHO MADE THE INITIAL APPROACH - STD STAFF OR CBO] What was the
content of the program? What was its effect?
What
do you think is the best way of getting out messages to prevent
STDs? Does that happen here? Please describe.
What do you think are some of the barriers to getting out
effective prevention messages? What are some of the things that make
it easier to get out prevention messages in this community?
Are there any populations within the community that are
particularly difficult to reach out to? Why?
19a. What programs or interventions have you tried with these
populations? How did they go?
19b. What was the content of the program? What effect do you
think it had?
Are there particular members of hard-to-reach groups who form
a bridge with the community at large? How are they accessed? Are
these members seen as leaders by the hard-to-reach group?
Do you think that organizations in this area are working
together to prevent STDs like syphilis? To what extent do the
various sectors work together including churches, schools, criminal
justice, public health and other sources of health care?
Before we finish, could you describe what
your ideal syphilis prevention and control strategy would be?
[IF RESPONDENT HAS
DIFFICULTY WITH THIS QUESTION, RE-PHRASE AS "IDEAL STD
PREVENTION AND CONTROL ..."]
22a. Is there any community, organization or group of
organizations that uses this strategy? Can you tell me more
about them?
22b. What barriers prevent implementation of this strategy?
22c. Do you think that people in the community would be open
to this type of strategy? Why or why not?
That's all the questions I [we] have for today. Thank you for
taking the time to answer my [our] questions about STDs like syphilis
prevention in your area. Do you have any questions for me [us]? Is there
anything else you would like to add that we didn't ask about during the
interview? [RECORD BELOW] If we have any other questions, would it be
okay for us to get back in touch with your offices? Thanks again.
Local Researcher Interview Guide
I'd like to start by asking some background questions about you.
Would you tell me about your current position? How did you come
to this position? (Training, experience, expertise). What work do
you do related to STDs? [Depending on type of work, probe for more
details of work relevant to syphilis]
What do you see as the most pressing health care need for
members of this community?
Are there a sufficient number of health care providers in this
[Location]? Are these providers accessible to most people? [Probe
for accessibility of hours, location, services, payment].
3a. Do different sectors of the community frequent different
health care providers? Who goes where?
Is there any group which you believe does not get adequate
health care? Who? Why?
4a. What are some of the things that make it more difficult
for certain groups of people to obtain health care than others?
Do you think that sexually transmitted disease is a problem for
any people in this community? [DOES THIS INCLUDE HIV? IS THIS ONLY
WITH HIV?]
The Centers for Disease Control uses the term "core
transmitters" to describe a group of people who are at the greatest
risk for getting and transmitting syphilis. One of the main objectives
of our research is to learn more about the characteristics of core
transmitters.
Is core transmitter a term that you use?
[If no] What term do you use to describe that group?
Next, I'd like to ask you some general questions about the people or
groups of people who you think are at the greatest risk for STDs like
syphilis in [state, city or county].
Who do you think is at the greatest risk for syphilis in
[state, city, county]? Why? [PROBE FOR AGE GROUPS, DIFFERENCES
BETWEEN MEN AND WOMEN, PEOPLE IN CERTAIN RACIAL AND ETHNIC GROUPS,
PARTICULAR BEHAVIORS].
There are reports of an association between STDs like syphilis
and substance abuse. In your view, is there an association between
syphilis and substance abuse in [Location]? Why do you think this is
so?
A relationship between commercial sex work or prostitution and
syphilis has alsobeen reported. In your view, is prostitution and
syphilis associated in [Location]? Why do you think this is so?
Do you think that people who live in certain areas are at
greater risk? Which areas and why? [PROBE FOR URBAN/RURAL
DIFFERENCES]. [If necessary], Can you tell me more about those
areas?
Have you noticed any changes in the groups of people infected
with syphilis in (Location)? Since when? What are the changes?
In your view, are people at the greatest risk for syphilis
also at risk for HIV and other sexually transmitted disease? [IF
YES], How does this affect the kind of outreach prevention or
control efforts to target this population?
Where do you think people at the greatest risk for STDs like
syphilis go to get health care? What is your sense of how accessible
and effective these health care services are for the people at
greatest risk?
Do you think there is a difference in how men and women seek
health care?
Next, I'd like to talk about STD prevention programs in this
community.
Do you think there should be special programs to prevent STDs
like syphilis? Why or why not?
Are any of the projects that you work on concerned with the
prevention of STD in general or syphilis in particular? Please
describe them.
16a. Have you worked with any other community groups on these
kinds of programs? What other community groups do you work with?
Tell us about some of the things you do together.
16b. Have you ever worked with the public STD program on a
prevention or outreach program? How did that happen? [PROBE FOR
WHO MADE THE INITIAL APPROACH - STD STAFF OR CBO] What was the
content of the program? What was its effect?
What do you think is the best way of getting out messages to
prevent STDs? Does that happen here? Please describe.
What do you think are some of the barriers to getting out
effective prevention messages? What are some of the things that make
it easier to get out prevention messages in this community?
Are there any populations within the community that are
particularly difficult to reach out to? Why?
19a. What programs or interventions have you tried with these
populations? How did they go?
19b. What was the content of the program? What effect do you think
it had?
Are there particular members of hard-to-reach groups who form
a bridge with the community at large? How are they accessed? Are
these members seen as leaders by the hard-to-reach group?
Do you think that organizations in this area are working
together to prevent STDs like syphilis? To what extent do the
various sectors work together including churches, schools, criminal
justice, public health and other sources of health care?
Before we finish, could you describe what
your ideal syphilis prevention and control strategy would be?
[IF RESPONDENT HAS
DIFFICULTY WITH THIS QUESTION, RE-PHRASE AS "IDEAL STD
PREVENTION AND CONTROL ..."]
22a. Is there any community, organization or group of
organizations that uses this strategy? Can you tell me more
about them?
22b. What barriers prevent implementation of this strategy?
22c. Do you think that people in the community would be open
to this type of strategy? Why or why not?
That's all the questions I [we] have for today. Thank you for taking
the time to answer my [our] questions. Do you have any questions for me
[us]? Is there anything else you would like to add that we didn't ask
about during the interview? [RECORD BELOW] If we have any other
questions, would it be okay for us to get back in touch with you? Thanks
again.