A comparison of privileged access interviewing and traditional interviewing methods when studying drug users in treatment

Abstract

Aims: Privileged access interviewing (PAI) has traditionally been used to reach illicit drug users and other ‘hidden’ populations. How PAI data compare to other self-reported data have seldom been discussed. We compare data from patients in opioid substitution treatment (OST), gathered through PAI and researcher interviews, respectively, to investigate whether PAIs and researchers are reaching comparable populations, and whether differences in answers are due to the sensitive nature of the questions.

Methods: Structured interviews were conducted with 368 patients from nine OST clinics in three Swedish cities. 237 interviews were carried out by researchers, and 131 by nine PAIs (OST patients). Data were analyzed with χ² test, Fisher’s exact test, t-test and logistic regression analysis.

Results: PAIs and researchers recruited comparable populations, with few differences in terms of individual, treatment and social factors. However, self-reported behaviors revealed several significant differences. Alcohol consumption and drinking to intoxication was more commonly reported among patients interviewed through PAI (p < 0.001 and p = 0.001, respectively). Furthermore, the PAI group reported selling medication (p < 0.001 last month, p < 0.001 during treatment episode) and snorting buprenorphine (p = 0.010 last month, p = 0.001 during treatment episode) more frequently.

Conclusions: PAI is a useful method in studies of illicit drug use and a valuable complement to more traditional interviewing methods. Specifically as regards revelations of a sensitive or controversial nature, PAI seems to produce different results than researcher interviews, and possibly also more truthful responses. PAI may have considerable potential as a data-gathering method also when studying other, more easily accessible populations.

Keywords:

• Privileged access interviewing
• hidden populations
• drug use
• self-report method
• opioid substitution treatment

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Notes

1 According to Swedish regulations, all new patients are required to take their medication under supervision every day for the first six months of treatment, which most likely is a contributing factor to the slight over-representation of new patients in the researcher group.

2 Logistical regression analysis was also performed for the other variables where significant bivariate connections were established for the ‘interviewer type’ variable (see Table 3). The connections remained significant in all analyses performed.

3 We have studied this in a multivariate analysis (binary logistical regression, n = 366) with a dichotomized variable for the social network (primarily associating with individuals with current drug problems, n = 71 versus primarily associating with individuals without current drug problems/single, n = 295) as the dependent variable. As independent variables we used three dichotomous variables: interviewers (researchers vs. PAIs), current illicit drug use (‘Yes/No’, ‘Last month’, index with six drugs), and current alcohol use (‘Yes/No,’ ‘Last month’).Step 1 (method: Enter)Interviewer (PAI):OR: 2.199, 95% CI: 1.300–3.721 (p = 0.003)Step 2 (method: Enter)Interviewer (PAI):OR: 1.995, 95% CI: 1.151–3.456 (p = 0.014)Current illicit drug use:OR 2.454, 95% CI: 1.395–4.316 (p = 0.002)Current alcohol use:OR: 2.364, 95% CI: 1.308–4.271 (p = 0.004)The multivariate analysis indicates that the interviewer effect is distinct, and independent of illicit drug use and alcohol consumption.