National Survey on Low-Threshold (LT) Services

Hungary, March-June 2005

Methodology: definitions of LT

1.1 Definition given by Ministry of Health and Family Affairs on LT: social services for addicts wishing to change target group: addicts, peers, relatives aims of services:

reach and consult addicts, friends, relatives reduce the use and the harms of drugs (’szerhasználat’) assist in launching changes

stimulate changes in client’s way of living prevent recurrence1.2 Definition provided by the National Drug Strategy: clear

Methodology: identification of LT

1.1 Before the survey: Book titled ’Druginfo’ used which contains names and accessibility of LTs

1.2 During and following the survey:

certain LTs found questions in the questionnaire irrelevant

responses revealed lack/deficiencies of/in LT-related services (e.g. no condoms distributed only consultation available)

Methodology: quantitative survey (self-filling questionnarire)

1.1 duration of questionnaire: 50-60 minutes

1.2 number of questions used in the questionnaire: 70

1.3 type of questions used: yes/no questions scales open questions

Methodology: thematic units

1.1 General information on forms of operation, financial details, number and type of HR

1.2 Services: type/form staff places where services are delivered concrete data on syringe exchange 1.3 Risk assessment process, decision-making process, success

criteria in treatment1.4Quality assurance: trainings attended by staff, monitoring carried

out by staff, development plans1.5 Target group: description, coverage (based on estimation or real

data), problems regarding clients1.6 Evaluation of services, future plans

Methodology: origin of questions

1.1 EMCDDA recommendations:

● Structured Questionnaire 29

● Standard Table 10 (syringe availability)

1.2 Ministry of Health and Family Affairs’ recommendations

1.3 Own ideas

Methodology: report structure on data towards EMCDDA

1. Responses to Health Correlates and Consequences1.1 Prevention of drug-related death: Overdose prevention (safer use training, first aid training, consumption rooms,

antagonists, etc.)1.2 Prevention and treatment of drug-related infectious diseases: Prevention (vaccination, syringe provision programmes, paraphernalia and

condom provision; information materials, educational approaches ‘safer use/safer sex’)

Counselling and testing Infectious disease treatment

2. Responses to social correlates and cosequences2.1 Social Reintegration: Housing Education, training, Employment Basic social assistance etc.

Methodology: pre-test

Two low-threshold services requested to make comments →

certain questions removed certain questions modified certain questions added

Methodology: responses

1.1 motivating respondents: phone calls made to services in two phases

1.2 sixty-two questionnaires sent out to organisations defining themselves as LT (see Definition of LT)

1.3 four ceased operations, fourteen did not return the questionnaire as they found questions irrelevant

1.4 an additional fifteen organisations failed to return questionnaire for unknown reason

1.5 twenty-nine responses received altogether

Methodology: data procession with SPSS

frequencies crosstables variable aggregation/reduction factor analysis

Methodology: qualitative

Structured questionnaire (interviews) for

syringe exchange LTs only

1.1 duration of interview: 1.5 hours

1.2 Number of questions used in the questionnaire: 80

1.3 type of questions used: yes/no questions open questions

Methodology: thematic units Operations: financial resources, financing

environment, level of independency Main goals Target groups: problems concerning how to reach

them, special target groups, special services offered for them

Helping process and risk assessment, decision-making process regarding clients

Informing and educating clients: modes, places Methods used at services Evaluation: own and other LTs, problems, planned

actions

Methodology: origin of questions

EMCDDA recommendations: structured questionnaire 29

Own ideas

Methodology: data procession

Atlas.ti: software package for text analysis

Experiences: difficulties, problems – terminological aspects

Definition and identification of LTs:

a. Problems with the definition provided by the related ministry:

emphasis on social services does not define taget group clearly (’addict’) fails to define ’low-threshold’: why is it low-

threshold?b. Problem: no generally accepted and agreed

protocol as regards LTs

Experiences: difficulties, problems – operational aspects

No national register on LTs Whose task would it be to set up such a

register? Who would be held responsible for operating

the register/system? National Focal Point? Would it be possible to harmonize and carry

out the operation of the register and data collection at the same time?

Experiences: difficulties, problems - practical aspects

Slow responses→ bad timing, busy staff?→ other surveys being carried out simultaneously?→ no/little interest, indifference?→ due to the lack of face-to-face situation, respondents postpone filling in the questionnaire?→ mailing?

IF slow responses are… …due to bad timing: when to time the survey?…due to simultaneous surveys: how to agree on different timing?…due to indifference: what is the reason? How to motivate respondents? Is DATA PROVISION OBLIGATION ITSELF the problem?…due to the lack of face-to-face situation: … …due to the difficulties of mailing (little time, inconvenient, money): is e-mail a possibility?

Experiences: difficulties, problems – methodological aspects

Quality of data provided is irrelevant - RELIABILITY: → Qs have been misunderstood?→ Qs do not cover LT programmes fully and properly? IF bad quality of data provision is due to…

… questions that have been misunderstood, is it because of undeveloped Qs? unclear instructions? unexperienced respondents?

... the fact that Qs do not fully cover LT programmes: how to make it suitable for everyone?

Experiences: difficulties, problems – methodological aspects

Missing or small amount of data - GENERALISATION→ indifferent respondents?→ ’secretive’ respondents (afraid of giving data)?→ no data available?

IF missing data is due to…… indifferent respondents: how to motivate them?…secretive respondents: anonymity should be insured? …no data available: how to get that data? How to increase the

chances of eliciting the data?

Experiences: difficulties, problems – methodological aspects

Problems of interpretation - VALIDITY:

who/what is meant by ‘target group’? what is meant by ‘success criteria’? How can

you operationalize it? what is meant by ’methods’ used at LTs?

How can you operationalize it?

Conclusions

1.1 Make data collection as easy as possible for users: develop questionnaire with respondents (user involvement: focus

groups? general discussions?) ask for continuous feedback provide support if needed: make yourself available

1.2 Use qualitative and quantitative methods simultaneously → different aspects can be approached the questionnaire can be further improved on the basis of

qualitative results (see problems of interpretation of terminology such as ’method’)