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Hypothesis-Generating Interviews. Goals . Discuss the uses of hypothesis-generating interviews Present information on case-patient selection, questions to ask and when and where to conduct hypothesis-generating interviews. Provide useful tips on how to conduct an interview during an outbreak.

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Hypothesis-Generating Interviews

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  • Discuss the uses of hypothesis-generating interviews
  • Present information on case-patient selection, questions to ask and when and where to conduct hypothesis-generating interviews.
  • Provide useful tips on how to conduct an interview during an outbreak.
why use hypothesis generating interviews
Why use hypothesis-generating interviews?
  • To obtain initial clues on possible sources of exposure
  • To develop a hypotheses-testing questionnaire
  • To identify signs and symptoms of the disease
why use hypothesis generating interviews4
Why use hypothesis-generating interviews?
  • To help develop or refine the case definition
  • To develop a develop a demographic profile and identify the population at risk
  • To develop a list of potential exposures
who do we interview
Who Do We Interview?
  • Case-patients
    • 8 to 10
    • Differing demographic profiles
    • Typical clinical presentation
    • Occurring in the middle of the outbreak
  • Family member or friend if case-patient is unavailable
  • Parent or guardian if case-patient is a child
  • Health care providers, lab workers, clinical staff
who do we interview6
Who Do We Interview?
  • Examples:
    • 1984-1985 Minnesota outbreak of Thyrotoxicosis
    • 1997 Michigan and Virginia Salmonella outbreaks
what do we ask
What Do We Ask?
  • Use existing hypothesis-generating resources as a template and guide
    • However, each outbreak is unique and questions should meet the needs of the investigation at hand
  • Contact others who have investigated similar outbreaks
    • Adapt the questionnaires used to the particular setting
what do we ask8
What Do We Ask?
  • Basic demographic information
  • Clinical details
  • Activities
  • Food consumption
what do we ask9
What Do We Ask?
  • Known or suspected agent
    • Likely exposures
    • Known reservoirs
    • Modes of transmission
    • Activities occurring during a specific period based on known incubation period and date of onset
  • Unknown agent
    • Broad, less specific questions
    • Activities, clinical signs and symptoms
when and where do we conduct the interview
When And Where Do We Conduct The Interview
  • Early in the investigation
  • Case-patients’ homes or health care setting
  • Other settings
    • e.g. the local health department, if several case-patients need to be brought together
  • Unusual approaches may be required
    • 1981 epidemic of listeriosis in Canada
    • 1983 epidemic of listeriosis in Massachusetts
how do we conduct the interview
How Do We Conduct The Interview?
  • Face to face
    • Telephone (under special circumstances)
  • Language considerations
    • Age, level of education, and other case-patient characteristics
    • Culturally sensitive wording
    • Mindful of uncomfortable topic areas
    • Avoid jargon and abbreviations
how do we conduct the interview12
How Do We Conduct The Interview?
  • Standardized forms
  • Types of questions
    • Closed-ended
    • Open-ended
how do we conduct the interview13
How Do We Conduct The Interview?
  • Tips:
    • Review the literature
    • Obtain background information
    • Enhance interviewing and people skills
    • Act friendly and professional
    • Use memory aids
how do we conduct the interview14
How Do We Conduct The Interview?
  • Tips:
    • Introduce yourself and give your credentials
    • Explain the purpose of the interview and tell the case-patient how long the interview will take
    • Be systematic but flexible when questioning
    • Provide contact information
    • Thank the interviewee for participating
    • Acknowledge his or her contribution to the investigation
  • Hypothesis-generating interviews increase efficiency of outbreak investigations by
    • helping confirm the existence of an outbreak
    • providing insights on potential causative agents
    • identifying potential sources of exposure and modes of transmission
  • From the information obtained, investigators
    • create case definitions
    • construct epi-curves
    • proceed to test hypotheses through analytic studies

1. Reingold, A. Outbreak investigations—a perspective. Emerg Infect Dis. Jan-Mar 1998;4:21-27.

2. Cummings SR, Stewart AL, Hulley SB. Designing questionnaires and data collection instruments. In Hulley SB, Cummings SR, Browner WS et al, eds. Designing clinical research. 2nd ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2001:231-245.

3. CDC Epidemiology Program Office. Case studies in applied epidemiology. No 873-703. An epidemic of Thyrotoxicosis. Available at: http://www.cdc.gov/eis/casestudies/Xthyrotox.instruct.873-703.pdf.


4. Breuer T, Benkel DH, Shapiro RL, et al. A multistate outbreak of Escherichia coli O157:H7 infections linked to alfalfa sprouts grown from contaminated seeds.  Emerg Infect Dis. 2001;7(6):977-982. Available from http://wwwcdc.gov/ncidod/eid/vol7no6/breuer.htm.

5. US Department of Health and Human Services. Principles of epidemiology. An introduction to applied epidemiology and biostatistics. 2nd ed. Self-study course 3030-G. Lesson 6: Investigating an outbreak. Available at http://www.phppo.cdc.gov/PHTN/catalog/pdf-file/Epi_Course.pdf.  


6. Schlech WF, Lavigne PM, Bortolussi RA, et al. Epidemic listeriosis—evidence for transmission by food. N Engl J Med. 1983;308:203-206.

7. Fleming DW, Cochi SL, MacDonald KL, et al. Pasteurized milk as a vehicle of infection in an outbreak of listeriosis. N Engl J Med. 1985;312:404-407.