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Overview on the use of hand-held devices for data collection in Thailand: From science to implementation. Philip Mock and Frits van Griensven Thailand MOPH – US CDC Collaboration. Background.

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Overview on the use of hand-held devices for data collection in Thailand: From science to implementation

Philip Mock and Frits van Griensven

Thailand MOPH – US CDC Collaboration

background
Background
  • Studies have shown audio-computer assisted self-interviewing to have higher reports of sensitive behaviors than traditional methods
    • Science 1998; volume 280, p867-73
    • Lancet 1999; volume 353, p1657-61
  • Control of missing and invalid data
  • Allows complex skip patterns
  • Eliminates need for data entry
audio computer aided self interviewing acasi
Audio computer-aided self interviewing (ACASI)
  • First used in1999 by CDC-Thailand with a behavioral risk survey with commercial college students (15-19 yrs) in Chiang Rai, Northern Thailand
    • Used PCs that were available at the commercial college computer training rooms
    • QDS software was used to develop the ACASI tool in Thai language
    • 300 plus questions including detailed sexual history and use of drugs
    • 1725 students interviewed
motivation for use of hand held devices
Motivation for use of hand-held devices
  • In 2001 plan to repeat the 1999 behavioral survey among students in Chiang Rai
  • Use of PCs and/or laptops was cumbersome
  • Hand-held devices were becoming available in Thailand
  • Hand-held devices appeared more cost effective and mobile than PCs/laptops
  • Greater privacy
  • How to demonstrate the technology was reliable and valid compared to ACASI ?
slide6

First Application: Randomized trial comparinghand-held self-interviewing with audio computer assisted self-interviewing (ACASI), and traditional methods (face-to face and self-interview)

  • Main study aims:
    • Non-inferiority of hand-held vs ACASI
    • Superiority of hand-held vs interviews
  • Study population: Students in Chiang Rai, Northern Thailand in November 2002.
  • Design: Four-arm randomized trial with ~300 students per arm
  • Main outcomes:
    • Sensitive behaviors, eg sex practices, illicit drug use, suicide ideation
    • Urine testing to validate self-reported drug use

Published: Frits van Griensven, Sataphana Naorat, Peter H. Kilmarx et al. Palmtop-assisted self-Interviewing for the collection of sensitive behavioral data: Randomized trial with drug use urine testing. American Journal of Epidemiology (2006); Volume 163, page 271-278.

main results handhelds
Main Results - handhelds
  • Non-inferior to ACASI for sensitive questions, eg self-reports of sexual experience, contraceptive use, buying/selling sex, genital ulcers
  • Superior to face-to-face interview – higher self-reports on sensitive questions
  • Agreement between self-reports of tobacco usage and nicotine metabolites in urine were non-inferior to ACASI, and superior to interviews
  • Same control of skip patterns as ACASI – no missing data or inconsistent responses
device tools and challenges
Device, tools and challenges
  • Palm M500 (black and white LCD)
  • Programming Tool
    • Satellite Forms (maximum 255 fields)
    • Does not require programming expertise
  • Hurdles
    • Thai language
    • Language problem solved by hiring Thai OS language support developer as a consultant
  • Other
    • Training students to use was not a problem
subsequent applications
Subsequent applications
  • 2003 – Men sex with Men (MSM) HIV prevalence survey in Bangkok conducted at venues where MSM meet, eg bars, saunas, parks
    • AIDS 2005; volume 19, p521-6
  • 2005 – post Tsunami response survey (post-traumatic stress syndrome) in Southern Thailand
    • JAMA 2006; volume 296, p537-59
  • 2005 – MSM/Transgender HIV prevalence survey #2 conducted in Bangkok, Chiang Mai, Phuket and Pattaya
    • MMWR 2006; volume 55, p844-48
issues from fieldwork
Issues from fieldwork
  • IT Support for use at remote sites for
    • Interviewer administration
    • Self-administration
  • Use of hand-held devices for interviewing in dark places, eg MSM surveys
    • Improvised lighting with “penlights”
  • Participants with poor eyesight
  • Loss of hand-held devices ?
    • In 6+ years we have not lost one device
transfer of technology to moph through gap thailand
Transfer of technology to MOPH through GAP-Thailand
  • 2004 – Transfer of technology to MOPH through the support of GAP
    • Adopted for use with Behavioral Surveillance Survey (BSS) in the Thai youth population
    • BSS is conducted in 24 of the 76 provinces in Thailand
    • In the initial 2004 pilot round 13,524 students were successfully interviewed using hand-held devices
    • In the 2005 round over 60,000 students were interviewed
    • Now used in 3 rounds of BSS demonstrating successful adoption and sustainability of the technology by the MOPH
pocket pcs windows mobile
Pocket PCs (Windows mobile)
  • In 2005 we moved to the Windows Pocket PC (PPC) platform
  • Why ?
    • Dominance of Microsoft Windows
    • Better programming tools, eg Visual Studio .NET
    • Support for greater than 255 questions
    • Other language support, apart from Thai we have developed applications with questions in Chinese, Japanese and Laotian
pocket pc 2
Pocket PC (2)
  • Audio version (Pocket ACASI)
    • Recent development (2006) has been an audio-version of the Pocket PC hand-held for respondent self-interviewing in populations with limited literacy eg sex-workers from the Hill-tribes of Northern Thailand
    • Final audio recorded at studio
    • Visual studio .NET based so same version can be used on PC or hand-held device
    • More memory required than non-audio version
applications in 2007 2008
Applications in 2007-2008
  • Successfully used for data collection in a number of different populations, field settings, study designs and sampling methodologies
    • MSM 2007 HIV prevalence survey
    • MSM HIV/STI prevalence survey in Laos
    • Female Sex Workers in Bangkok and Chiang Rai (including audio)
    • Prisoners in BKK and Phuket jails
    • Students in College Dormitories in Ubon
    • Injecting Drug Users project
    • Karen Refugee Cholera Outbreak investigation in Mae La camp, Tak
    • Randomized trial on efficacy of behavioral interventions in prevention of influenza
    • Paper replacement in a routine pneumonia surveillance system
msm survey in laos
MSM survey in Laos
  • HIV/STI prevalence survey among MSM in Laos
  • Adaptation of MSM Thailand surveys in 2003, 2005 and 2007
  • Fieldwork in Vientiane August/Sept 2007
  • Venue-Date-Time (VDT) sampling (n=545)
  • PPC application with ~200 questions
  • Laotian language display (not input)
female sex workers fsw survey
Female Sex Workers (FSW) survey
  • HIV prevalence survey (2007)
  • Respondent-driven sampling (RDS)
    • non-establishment FSWs
  • Seeds included
    • street, internet, coyote dancer
  • 3 “unsecure” sites in Bangkok and 1 site in Chiang Rai
  • ~100 questions
  • Pocket ACASI
other applications and changing technologies
Other applications and changing technologies
  • PDAs with WiFi can be used as Polling Booth devices
  • Smart Phones with 3G networks could result in even more timely data collection
  • New mini-size notebooks mean full ACASI functionality on a device not much bigger or costlier than a PDA
further information
Further Information
  • PDAs in Thailand
  • Email: pgm6@th.cdc.gov