Visual Versus Written Cues: A Comparison of Drug Injectors’ Responses. Have Surveys Using the Written Word Underestimated Risk Behaviors for Hepatitis C?

Abstract

We examined differences in responses of injecting drug users (IDUs) about sharing injecting paraphernalia using written questions (“written cues”) versus video recordings of IDUs engaged in sharing behaviors (“visual cues”). Data were collected in 2007 in cities Liverpool, England and Glasgow, Scotland (N = 204). Participants completed a computer-assisted questionnaire with questions about sharing asked using visual and written cues. McNemar's chi-squared tests and logistic regression models were used. Respondents provided significantly different responses to questions about sharing when asked using visual versus written cues; a considerable proportion of IDUs said they had never shared via front/back loading and via sharing water/bleach for flushing out injecting equipment using written cues but confirmed they had participated in these behaviors when asked using visual cues. Implications and future research are discussed.

RÉSUMÉ

Les signaux visuels contre les signaux écrits: une comparaison des réponses des toxicomanes par injection. Les études qui utilisent les questions écrites, ont-elles sous-estimé le comportement à risque pour l’hépatite C?

Nous avons étudié les différences entre les réponses des toxicomanes par injection sur le partage du matériel d’injection, en utilisant des questions écrites (‘les signaux écrits’) contre des enregistrements vidéo (‘les signaux visuels’) des toxicomanes ayant des comportements de partage. Des données ont été collectées en 2007 à Liverpool en Angleterre et à Glasgow en Ecosse (n = 204). Les participants ont rempli un questionnaire informatisé au sujet du partage en répondant aux signaux visuels et écrits. Le test du Chi 2 de McNemar et des modèles de régression ont été utilisés. Les participants ont donné des réponses différentes sur le partage du matériel d’injection selon qu’elles soient posées par des signaux visuels ou par des signaux écrits; une proportion considérable des toxicomanes a dit qu’elle n’avait jamais partagé «par un chargement devant/derrière» ou de partager de l’eau de javel pour rincer le matériel d’injection en utilisant les signaux écrits alors qu’elle a confirmé avoir participé à des comportements de partage quand ils ont répondu aux signaux visuels. Les implications et les recherches à venir vont être abordées. Financement: Liverpool Drug and Alcohol Action Team et NHS Greater Glasgow.

RESUMEN

Instrucciones escritas vs. visuales: comparación de respuestas de usuarios de droga inyectada. ¿Están las investigaciones basadas en la palabra escrita subestimando las conductas de riesgo de infección por hepatitis C?

Hemos examinado las diferentes respuestas que los usuarios de droga inyectada (UDI) proporcionan sobre el intercambio de parafernalia para la inyección de drogas mediante el uso de preguntas escritas (“instrucciones escritas”) vs. grabaciones de video en las cuales se capta a UDI en conducta de compartir (“instrucciones visuales”). Los datos fueron recogidos en las ciudades de Liverpool, Inglaterra y Glasgow, Escocia (N = 204). Los participantes completaron un cuestionario informático con preguntas referentes al intercambio de parafernalia para la inyección mediante la utilización de instrucciones escritas y visuales. Se utilizó el test de la Chi-cuadrado de McNemar y el análisis de regresión logística. Los participantes proporcionaron respuestas significativamente diferentes a las preguntas referentes a la practica del compartir en función de que se les preguntase mediante las instrucciones visuales o escritas; una considerable proporción de individuos que afirmaron no haber compartido parafernalia para la inyección mediante la practica del front/back loading o bien el uso compartido de agua/lejía para la limpieza del material de inyección con las instrucciones escritas, confirmaron haber participado en este tipo de practicas cuando fueron preguntados mediante las instrucciones visuales. Se tratan las implicaciones y futuras investigaciones. Financiación: Liverpool Drug and Alcohol Action Team y NHS Greater Glasgow.

Keywords :

• hepatitis C
• injectingdrug use
• harm reduction
• risk behavior
• visual data

THE AUTHORS

Dr. Caryl Beynon is a Reader in Substance Use Epidemiology at the Centre for Public Health in Liverpool John Moores University, UK. Her research interests are focused upon reducing the harm associated with substance use, in particular reducing drug-related deaths and drug-related infections. In relation to this, she recently sat on the Advisory Council on the Misuse of Drugs Working Party on the prevention of hepatitis C and other blood-borne viruses among injecting drug users. More recently, Caryl has initiated research on substance use among older populations and the challenges this change in demography presents.

Professor Avril Taylor holds the Chair in Public Health and is the Director of the Institute for Applied Social and Health Research in the School of Social Sciences at the University of the West of Scotland. Her work on risk behaviors for blood-borne virus infections led to her being part of the Scottish Executive's Effective Interventions Unit Hepatitis C Research Group (2001–2002) which was responsible for compiling the Scottish Executive's research strategy for the following three years, and also the Scottish Government's current Hepatitis C Action Plan. Most recently, Professor Taylor was Chair of the Hepatitis C Action Plan for Scotland's Prevention Working Group and is currently Chair of the Needle Exchange Guidelines Working Group to develop guidelines for needle exchange services in Scotland.

Elizabeth Allen is a senior researcher for the Institute for Applied Social and Health Research at the University of the West of Scotland. She has successfully worked on a variety of research studies as lead researcher and project manager. This has included several collaborative studies on hepatitis C prevention and risk behaviors associated with injecting drug use. She currently manages the Needle Exchange Surveillance Initiative (NESI). NESI is an annual survey looking at the prevalence and incidence of hepatitis C, and associated risk behaviors, among needle exchange attendees in Scotland. Elizabeth is enrolled as an M.Phil./Ph.D. student at the University of the West of Scotland and her research explores stigma and hepatitis C.

Professor Mark Bellis is Director of the Centre for Public Health, the North West Public Health Observatory (www.nwpho.org.uk) and the World Health Organization Collaborating Centre for Violence Prevention at Liverpool John Moores University (www.cph.org.uk), UK. He leads a team of academics and health professionals on national and international projects addressing alcohol and drug use, sexual behavior, violence, and public health intelligence. Mark is a member of the Medical Research Council's College of Public Health Experts and an expert advisor on drug prevention to both the United Nations (UNODC) and European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).