Emotional risks to respondents in survey research

Navigating distress: Exploring factors affecting adolescent girls' wellbeing during and after a violence-focused survey in Maharashtra, India

BACKGROUND

Ensuring the emotional wellbeing of participants in violence-focused research is a paramount ethical requirement. While previous research suggests that most participants in violence-focused studies do not report harmful consequences, little is known about the experiences of adolescent participants in low- and middle-income countries.

OBJECTIVE

This study, conducted in Maharashtra, India, aims at assessing how participant, contextual, and interviewer characteristics affect the level of distress that adolescent girls experience after participation in a violence survey.

METHODS

A total of 3049 13-18-year-old girls were interviewed on their experiences of family and intimate partner violence. Following the interview, both girls and interviewers completed a 5-item questionnaire on perceived participant distress. Linear regression analyses were conducted to identify possible correlates of girls' distress.

RESULTS

Less than 10 % of participants reported feelings of distress upon completion of the interview. Higher levels of interviewers' empathy were significantly associated with decreased levels of participants' distress (standardised beta: -0.25, p < 0.001). Reported distress was also lower if girls had opted for an audio- and mobile-assisted self-interview (ACASI) format (standardised beta: -0.05, p < 0.01) and if the interview was conducted by someone older (standardised beta: -0.22, p < 0.001). Conversely, if interviews were conducted in participants' homes and by interviewers with higher education levels, reported distress was significantly higher (standardised beta: 0.06, p < 0.01 and 0.12, p < 0.001, respectively).

CONCLUSIONS

Our findings suggest that incorporating empathetic interviewing and trust-building techniques into interviewer training, offering ACASI interviews, and choosing interview locations that ensure confidentiality can help protect the wellbeing of participants in violence research.

Validation of the shortened version of the Canine Behavioral Assessment and Research Questionnaire (C-BARQ) using participants from the Dog Aging Project

The Canine Behavioral Assessment and Research Questionnaire (C-BARQ) is a 100-item owner-completed survey instrument used for assessing behavior and temperament of companion dogs. The shortened version of the C-BARQ (C-BARQ(S)) consists of 42 items of the long C-BARQ. We aimed to validate the shortened C-BARQ(S) by comparing it with the long questionnaire in the same human-dog pair. We examined data from a nationwide cohort of companion dogs enrolled in the large-scale longitudinal Dog Aging Project (DAP) study. Among 435 participating owners who completed both the long and shortened versions of the C-BARQ within 60 days of each other, agreement between individual questions of the long and shortened C-BARQ using an unweighted kappa statistic and percent agreement was examined. Associations between the two questionnaires for mean behavior and temperament domain scores and mean miscellaneous category scores were assessed using Pearson correlation coefficients. Of 435 dogs in the study, the mean (SD) age was 7.3 (4.3) years and 216 (50%) were female. Kappa values between the long and shortened C-BARQ for individual questions within the 14 behavior and temperament domains and a miscellaneous category ranged from fair to moderate (0.23 to 0.40 for 21 items and 0.41 to 0.58 for 26 items, respectively). Pearson correlation coefficients above 0.60 between both questionnaires for 12 of the 14 mean behavior and temperament domain scores and a category of miscellaneous items were observed. Kappa values for individual questions between the long and shortened C-BARQ ranged from fair to moderate and correlations between mean domain scores ranged from moderate to strong.

Mental Health Screening for Korean Ukrainian Refugee Minors in the Republic of Korea: A Cross Sectional Pilot Study

Since February 2022, the Ukrainian refugee crisis has been highlighting mental health problems associated with trauma and distress. This study aimed to evaluate the mental health status of twenty-seven refugee minors (10 to 18 years old) who fled Ukraine and temporarily settled in the Republic of Korea (ROK). This cross-sectional survey study aimed to evaluate the mental health status of ethnic Korean Ukrainian refugee minors. The Child and Adolescent Trauma Screen—Youth Report (CATS), generalized anxiety disorder seven-item scale (GAD-7), and subjective unit of distress scale (SUDs) were used for assessment. A preliminary analysis indicated that 77% Ukrainian refugee minors were exposed to and experienced war-related trauma. They are at a relatively low risk of trauma symptoms, anxiety, and distress due to stable family and visa status and a comparably better environment in the ROK. Meanwhile, refugee teenagers showed higher rates of psychological distress compared with refugee children. This finding suggests that an early psychological interventions in a host country may be beneficial to prevent mental health issues in refugee minors.

A COVID-19 self-isolation monitoring module for FMUI undergraduate medical students: Linking learning and service needs during the pandemic surge in Indonesia

To ensure that students continued receiving adequate yet safe clinical exposure during the COVID-19 pandemic, the Faculty of Medicine at Universitas Indonesia (FMUI) created the Module of COVID-19 Self-Isolation Monitoring which aims to equip students with the knowledge and skill to monitor confirmed and close contact cases of COVID-19. Module development, divided into four phases: preparation, orientation, implementation, and evaluation phase, started as soon as the delta wave of COVID-19 cases forced medical students to halt their offline clinical rotations. A quantitative secondary data were obtained from student and patient satisfaction questionnaires and on students' performance and reflection. We analyzed the distribution of module evaluation, the student's discussion score during the module, the students' interest in participating as Covid-19 volunteers before and after the module's deployment, and the correlation between learning outcomes and satisfaction. A total of 372 patients were monitored by 208 students during the 4-week module. The response rates were above 80%, with the majority agreeing that students found this module well-organized and fulfilled their expectations. There was a significant increase in discussion scores from weeks 1 to 4, a significant difference in the proportion of students interested in COVID-19 volunteering before and after the module completion as well as a significant low correlation between the patient's monitoring score sheet and the reflection essay towards the patient's satisfaction. We should still improve tutors' time management, tutors' provision of triggering questions for critical thinking skills, and tutors' feedback for students. The module met patient expectations and is expected to assist tutors in providing feedback and examples of doctor-patient communication, thus accelerating students' competence in patient interaction. Further evaluation is needed regarding knowledge transfer, the impact on community health, and the faculty development program, especially regarding how tutors fulfill their roles as medical educators.

Experiences of participation in a population-based survey on violence: Emotional discomfort, disclosure concerns, and the perceived value of participation among adolescents and young adults

The accurate measurement of violence depends on high-quality data collected using methods that ensure participant confidentiality, privacy, and safety. To assess survey participants' emotional distress, discomfort, and self-perceived value of participating in the Honduras (2017), El Salvador (2017), Cote d'Ivoire (2018), and Lesotho (2018) Violence Against Children and Youth Surveys, which include sensitive topics such as sexual, physical, and emotional violence, we investigated individual self-reported distress and perceived value of participation by age, sex, and other demographic factors. We also examined the associations between past experiences of violence and both self-reported distress and perceived value of survey participation. Few individuals reported distress or concerns about disclosure. Across countries, 82.9% (Cote d'Ivoire) to 96.1% (Honduras) of participants indicated they were not afraid that someone might overhear their answers, 82.5% (Cote d'Ivoire) to 98.0% (El Salvador) said participation was not upsetting or stressful, and 93.3% (Cote d'Ivoire) to 98.6% (Honduras) said participation was worthwhile. The value of these interviews may exceed the negative feelings that some questions potentially elicit and can contribute to improved responses to victims.

Caregiver decision-making on young child schooling/care in the face of COVID-19: The influence of child, caregiver, and systemic factors

In March 2020, U.S. schools and daycares largely shut down to manage the novel COVID-19 pandemic. As the country made efforts to reopen the economy, American parents faced difficult decisions regarding returning to work and securing schooling and care for their young children. During the summer and fall of 2020, caregivers (N = 1655) of children (N = 2408; ages 0 - 12 years) completed questionnaires assessing their decision-making process regarding their children's daycare or schooling situation. A mixed method approach (i.e., qualitative, quantitative assessments) was utilized. Outcomes indicated three main themes that impacted caregivers' choices: child factors, caregiver factors, and systemic factors. Caregivers experienced high levels of stress while worrying about their child's and family's health, job responsibilities, and risk of COVID-19 infection rates in their areas. Continued assessment of families and children during this time is warranted.

COVID-19 Impacts on Beaches and Coastal Water Pollution at Selected Sites in Ecuador, and Management Proposals Post-pandemic

The COVID-19 pandemic has obliged Governments all around the world to implement confinement and social distancing measures. Leisure and business activities on beaches and in ports have restricted direct and indirect contamination from, for example, plastics, hydrocarbon spillage, microbiological loads, and noise levels. This has led to temporarily improved environmental conditions, and the beaches having conditions closer to Marine Protected Areas. Here we report some impacts that have been studied using local surveys and qualitative observations in Ecuador at the popular beaches and ports of Salinas, Manta, and Galapagos. Satellite data support this information. Online surveys were carried out at critical moments of the pandemic: May (15th) and just after when measures were relaxed a little, but within lockdown in July (21st) 2020. Respondents were asked to compare conditions before and during the pandemic lockdown. Most (97–99%) suggested that beaches had significantly improved from visual observations during confinement. On a scale from 1 (worst) to 5 (best), the beaches of Salinas and Manta respectively were rated 2.2 and 2.8 (less than acceptable) before quarantine, and 4.5 and 4.3 after; results from the second survey (after 18 weeks of restrictions) were much the same. Replies from Galapagos showed a similar trend but with less marked differences. In addition to the beaches having less plastic and garbage, more fish, and large marine organisms, including humpback whales (Megaptera novaeangliae), dolphin (bottlenose, Tursiops truncatus), and manta ray (Manta sp.) were observed near to shore. At Galapagos beaches, turtles, sea lions, and sharks were observed many more times than pre COVID. Quantitative satellite data on Chlorophyl and attenuation coefficient (Kd, 490 nm) support the qualitative survey data that there is an improvement in coastal environment quality. Here we recommend that this unique opportunity resulting from the COVID-19 pandemic is used locally, regionally and globally to construct baseline data sets that include information on physical, chemical, biological, and microbiological factors in coastal zones. These parameters can then help establish an effective Coastal Zone Management Plan based on beach description and quality (water standards, noise pollution), as well as the human dimension (tourist load, cultural heritage, and economic value indices). This data and information gathering ideally should be done before the beaches become more heavily used again as the pandemic recedes.

Psychosocial consequences of invitation to colorectal cancer screening: a matched cohort study

Background

Psychosocial consequences of colorectal cancer (CRC) screening can arise anywhere in the screening cascade. Previous studies have investigated the consequences of participating in CRC screening; however, we have not identified any studies investigating the psychosocial consequences of receiving the invitation. Therefore, the objective of this study was to investigate psychosocial consequences of invitation to CRC screening.

Methods

The study was a longitudinal study performed in Region Zealand, Denmark. Participants included in this study were a random sample of 1000 CRC screening invitees and 1000 control persons, not invited to screening, matched in a 1:1 design on sex, age and municipality. We assessed psychosocial consequences before and after invitation in both study groups concurrently. The primary outcomes were psychosocial consequences measured with the condition-specific questionnaire Consequences of Screening in ColoRectal Cancer.

Results

Preinvitation response rates were 575 (57.5%) and 610 (61.0%) for the invitation group and control group, respectively. Postinvitation response rates were 442 (44.2%) for the invitation group and 561 (56.1%) for the control group.

No differences in mean change in scale score were seen except for the scale ‘Change in body perception’. The invitation group had a 0.39 lower change (99% CI (−0.78 to −0.004), p=0.009) in mean score than the control group in the direction of a less negative body perception after invitation.

Conclusions

This study did not identify an association between invitation to CRC screening and negative psychosocial consequences.

A Portrait of Self-Reported Health and Distress in Parents Whose Child Died of Cancer

Grieving a child following cancer is a substantially difficult task. The objectives of this research were: 1) to describe current quality of life (QoL), psychological distress and symptoms of grief of bereaved parents, and 2) to explore the role of possible contributors of QoL and psychological distress. Forty-six parents (32 mothers) of children who died of cancer were surveyed on their QoL, distress, and complicated grief. Data were analyzed using multiple linear regression. Parents had a high frequency of grieving symptoms (58%). Mothers reported more retrospective grief symptoms than fathers when describing the year after child death. Current lower mental well-being was associated with experiencing higher retrospective grief symptoms, a shorter period since child death, and being a father. Hence, parents experienced disturbances even long after child death. Mothers and fathers may present specificities that should be considered when developing supportive activities for this vulnerable population.

Increasing the Patient-Centeredness of Health Economics and Outcomes Research Through Patient Engagement in Core Outcome Set Development

Core outcome sets (COS) are becoming increasingly popular in clinical research and can provide important inputs for further health economics and outcomes research (HEOR) studies. Use of standard, consistently reported outcomes can demonstrate and allow differentiation of the effectiveness and value of different treatments. Incorporating patient values during COS development increases the patient centeredness of evidence available across decision-making contexts. However, the approach to meaningful patient engagement in the COS process is evolving and poses both unique challenges and opportunities. We describe an approach to patient-centered COS development and discuss challenges and adaptations to improve engagement across COS projects. We provide examples from our experience in patient engagement for COS development using three completed COS projects. This approach includes patient engagement in terms of partnering with patient organizations, orientation and training, and the consensus process. Including COS in clinical development programs and HEOR will ensure that relevant, consistent outcomes are available for healthcare decision making and should result in faster access to high-value and novel therapies for patients. Patient-centered COS development increases the likelihood that further HEOR studies and decisions made using the COS are relevant to patients.

Taking the patient and the patient's perspective into account to improve outcomes of care of patients with musculoskeletal diseases

Patient-reported outcome measures are commonly used in the assessment of patients with musculoskeletal diseases. The present review provides an overview of historic and recent developments, including core set recommendations for assessing patient-reported outcomes in patients with fibromyalgia, osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. The evidence supporting commonly used patient-reported outcomes measures is reviewed. Furthermore, various methodological approaches that can be utilized to evaluate validity and measurement precision of patient reported outcomes are introduced. Commonly used methods based on the classical test theory as well as modern approaches based on item response theory will be discussed. The review finally describes the increasing use of item response theory-based approaches used in patient-reported outcomes assessment in the musculoskeletal diseases.

The Psychological Risk of Minimal Risk Activities: A Pre- and Posttest Study Using the Self-Assessment Manikin

It is difficult to apply U.S. Federal Code of Regulation's criterion for "minimal risk," because benchmarks of minimal risk have not been quantified. Our goal was to examine the psychological risks of several day-to-day activities. Using the Self-Assessment Manikin (SAM), we assessed the state valence and arousal of 432 patients and employees at a large Midwestern Department of Veterans Affairs medical facility before and after they had their blood drawn, saw their primary care physician or mental health provider, or took part in an exercise class. Exercise was associated with near-large to large salutary effects (Cohen's d = 0.76-1.17); other effects were small or moderate in positive directions (Cohen's d = 0.02-0.51). Our findings are a promising start toward establishing benchmarks and quantifying the psychological harms of minimal risk activities. Estimates such as these may help researchers determine whether their own research exceeds minimal risk.

"I Won't Out Myself Just to Do a Survey": Sexual and Gender Minority Adolescents' Perspectives on the Risks and Benefits of Sex Research

Sexual and gender minority (SGM) adolescents under age 18 are underrepresented in sexual health research. Exclusion of SGM minors from these studies has resulted in a lack of knowledge about the risks and benefits youth experience from sexual health research participation. Institutional Review Boards' (IRB) overprotective stances toward research risks and requirements for guardian consent for SGM research are significant barriers to participation, though few have investigated SGM youth's perspectives on these topics. This study aimed to empirically inform decisions about guardian consent for sexuality survey studies involving SGM youth. A total of 74 SGM youth aged 14-17 completed an online survey of sexual behavior and SGM identity, and a new measure that compared the discomfort of sexual health survey completion to everyday events and exemplars of minimal risk research (e.g., behavioral observation). Youth described survey benefits and drawbacks and perspectives on guardian permission during an online focus group. Participants felt about the same as or more comfortable completing the survey compared to other research procedures, and indicated that direct and indirect participation benefits outweighed concerns about privacy and emotional discomfort. Most would not have participated if guardian permission was required, citing negative parental attitudes about adolescent sexuality and SGM issues and not being "out" about their SGM identity. Findings suggest that sexual health survey studies meet minimal risk criteria, are appropriate for SGM youth, and that recruitment would not be possible without waivers of guardian consent. Decreasing barriers to research participation would dramatically improve our understanding of sexual health among SGM youth.

Changes in affect after completing a mailed survey about trauma: two pre- and post-test studies in former disability applicants for posttraumatic stress disorder

Background

One potential concern with using mailed surveys containing trauma-related content is the possibility of re-traumatizing survivors without a trained mental health professional present. Prior research provides insufficient guidance regarding the prevalence and magnitude of this risk because the psychological harms of trauma-related surveys have typically been estimated using single post-test observations. Post-test observations cannot quantify magnitude of change in participants’ emotional states and may over or under estimate associations between participants’ characteristics (risk factors) and post-survey upset.

Methods

We conducted two pre- and post-test studies in samples of former applicants for posttraumatic stress disorder disability benefits: 191 males who served during Gulf War I plus 639 male and 921 female Veterans who served sometime between 1955 and 1998. We used two 9-point items from the Self-Assessment Manikins to measure participants’ valence (sadness/happiness) and arousal (tenseness/calmness) before and after they completed mailed surveys asking about trauma-related symptoms or experiences. We examined the following potential predictors for post-survey sadness and tenseness: screening positive for posttraumatic stress disorder, having a serious mental illness, and history of military sexual assault or combat.

Results

After the survey, across the groups, 29.3–41.8% were sadder, 45.3–52.2% had no change in valence, and 12.9–22.5% were happier; 31.7–40.2% were tenser, 40.6–48.2% had no change in arousal, and 17.3–24.0% were calmer. The mean increase in sadness or tenseness post-survey was less than one point in all groups (SD’s < 1.7). Cohen’s d ranged from 0.07 to 0.30. Most hypothesized predictors were associated with greater baseline sadness or tenseness, but not necessarily with larger post-survey changes. Women with a history of military sexual assault had the largest net post-survey changes in sadness (mean = 0.7, SD = 1.4) and tenseness (mean = 0.6, SD = 1.6).

Conclusion

While a substantial minority of Veterans reported more sadness or tenseness post-survey, the net change in affect was small. Most hypothesized risk factors were actually associated with higher baseline sadness or tenseness scores. When receiving unsolicited, trauma-related surveys by mail, separate protections for Veterans with the risk factors studied here do not seem necessary.

Electronic supplementary material

The online version of this article (doi:10.1186/s12874-017-0357-x) contains supplementary material, which is available to authorized users.

Prevalence, contexts, and correlates of child sexual abuse in Cyprus

It is well documented that child sexual abuse (CSA) may be one of the major public health problems in the world, especially due to the co-occurrence with other types of abuse and negative developmental outcomes. The aim of the current study was the comprehensive examination of CSA with respect to its prevalence, its contexts of occurrence and its correlates. The sample included 1852 adolescents and young adults (15-25 years old; 441 males), recruited through schools, universities and other youth organizations across Cyprus. Participants were administered an online questionnaire assessing multiple forms of abuse, with a focus on sexual abuse, solicitation, and trafficking, as well as personality traits. The study's results supported previous findings in Europe that 1 in 5 children may experience sexual abuse or solicitation, with females being more likely than males to be the victim of CSA. Findings also indicated that the different types of sexual abuse were more likely to occur during adolescence than other developmental stages. In addition, perpetrators were more often identified to be adolescent or adult males who were strangers or friends/acquaintances with the victims. Moreover, findings suggested that experiences of sexual abuse and solicitation co-occur with neglect, physical, and psychological abuse. Regarding personality traits, sexual abuse was found to be specifically related to grandiosity, whereas sexual solicitation was related to both impulsivity and grandiosity. The current study has practical and policy implications for intervening with sexually maltreated individuals.

Recognizing Risk and Vulnerability in Research Ethics: Imagining the "What Ifs?"

Research ethics committees (RECs) may misunderstand the vulnerability of participants, given their distance from the field. What RECs identify as the vulnerabilities that were not adequately recognized in protocols and how they attempt to protect the perceived vulnerability of participants and mitigate risks were examined using the response letters sent to researchers by three university-based RECs. Using a critical qualitative method informed by feminist ethics, we identified an overarching theme of recognizing and responding to cascading vulnerabilities and four subthemes: identifying vulnerable groups, recognizing potentially risky research, imagining the "what ifs," and mitigating perceived risks. An ethics approach that is up-close, as opposed to distant, is needed to foster closer relationships among participants, researchers, and RECs and to understand participant vulnerability and strength better.

Do Some Students Need Special Protection From Research on Sex and Trauma? New Evidence for Young Adult Resilience in "Sensitive Topics" Research

Institutional review boards (IRBs) have expressed concerns that certain individuals or groups, such as participants who are younger, ethnic minorities, or who have certain psychological or personality traits, may be particularly distressed when participating in "sensitive topics" research. This study examined the effects of several demographic and individual difference factors (i.e., age, sex, ethnicity, religiosity, Big Five personality traits, and baseline psychological distress levels) on reactions to participation in sensitive topics research. Participants were 504 undergraduates who completed an extensive battery of either trauma/sex questionnaires or cognitive tests and rated their positive and negative emotional reactions and the perceived benefits and mental costs of participating. They also compared research participation to normal life stressors. Our findings indicated that individual difference and demographic risk factors do not increase participant distress after participating in sex/trauma research over and above that experienced after participating in traditionally minimal-risk cognitive tasks. Participants generally found research participation less distressing than normal life stressors and even enjoyable.