Modeling response rates in surveys of female sexual difficulty and dysfunction

INTRODUCTION: Studies that address sensitive topics, such as female sexual difficulty and dysfunction, often achieve poor response rates that can bias  results. Factors that affect response rates to studies in this area are not well characterized.
AIM: To model the response rate in studies investigating the prevalence of female sexual difficulty and dysfunction.
METHODS: Databases were searched for English-language, prevalence studies using the search terms: sexual difficulties/dysfunction, woman/women/female, prevalence, and cross-sectional. Studies that did not report response rates or were clinic-based were excluded. A multiple linear regression model was constructed.
MAIN OUTCOME MEASURES: Published response rates.
RESULTS: A total of 1,380 publications were identified, and 54 of these met our inclusion criteria. Our model explained 58% of the variance in response rates of studies investigating the prevalence of difficulty with desire, arousal, orgasm, or sexual pain (R(2) = 0.581, P = 0.027). This model was based on study design variables, study year, location, and the reported prevalence of each type of sexual difficulty. More recent studies (beta = -1.05, P = 0.037) and studies that only included women over 50 years of age (beta = -31.11, P = 0.007) had lower response rates. The use of face-to-face interviews was associated with a higher response rate (beta = 20.51, P = 0.036). Studies that did not include questions regarding desire difficulties achieved higher response rates than those that did include questions on desire difficulty (beta = 23.70, P = 0.034).
CONCLUSION: Response rates in prevalence studies addressing female sexual difficulty and dysfunction are frequently low and have decreased by an average of just over 1% per anum since the late 60s. Participation may improve by conducting interviews in person. Studies that investigate a broad range of ages may be less representative of older women, due to a poorer response in older age groups. Lower response rates in studies that investigate desire difficulty suggest that sexual desire is a particularly sensitive topic.

Taxpayer beliefs and views : two new surveys

The importance of behavioural economics in supplementing and extending the neoclassical analysis of taxpayer behaviour has been recognised for some time. This paper summarises contributions to date and outlines a way forward for integrating the behavioural and neoclassical approaches and developing a more coherent strategy of encouraging taxpayer compliance.The paper then provides significant further evidence relating to taxpayer behaviour by reporting some of the main results of two substantial surveys (N =2,040 and 2,374) of Australian citizens' beliefs, attitudes, values and motivations with respect to the tax system, widely defined. It is concluded that the behaviour of Australian taxpayers is not determined only by considerations of narrow economic rationality based on the expected financial costs and benefits of compliance or non-compliance but is also influenced by a much wider range of factors. Examination of the importance of these other factors might be the most fruitful way of improving tax compliance in the future.

Should capillary blood glucose measurements be used in population surveys?

Objective
To determine the accuracy and appropriateness of capillary blood glucose testing in population surveys.
Materials and methods
Capillary blood glucose using the Rochec ACCU-CHEK instrument and Advantage 11 Test Strips was compared to a laboratory instrument. Three independent cross-sectional risk factor surveys (n=1432) and baseline individuals from the Greater Green Triangle Diabetes Prevention Project (n=341) provided both fasting plasma and capillary blood glucose measurements. Accuracy of capillary glucoses was assessed using the ISO 15197 standard. The median age of the participants was 71years, ranging from 25 to 84years. There were 799 males and 974 females.
Results
Capillary glucose method had poorer precision at lower concentrations (CV: 9.50%, mean=3.09mmol/L, CV: 4.90%, mean=16.78mmol/L, n=233 replicates). Individual discrepancies were seen across the measuring range (2.8–19.9mmol/L, n=1773). In total, 94.5% of results fell within the minimum acceptable accuracy standards. This was slightly short of the 95% of results required to meet the ISO 15197 standard. The prevalence of diabetes in the study population using glucose 7.0mmol/L was 2.4% (95%CI 1.8–3.3%) according to fasting plasma glucose and 2.8% (2.1–3.8%) according to fasting capillary glucose. The lower WHO-defined cut-off of 6.1mmol/L for capillary blood glucose testing gave a prevalence of 10.7% (9.0–12.5%).
Conclusions
This study of matched capillary and plasma glucose results concludes that while it is appropriate to use fasting capillary glucose levels to determine the prevalence of diabetes in populations, it should not be used to reliably diagnose diabetes in individuals.

Investigation into the diffusion of innovation in technical and further education : implementing e-mail through action research

This research project examined the diffusion of change within one Victorian TAFE Institute by engaging action research to facilitate implementation of e-mail technology. The theoretical framework involving the concepts of technology innovation and action research was enhanced with the aid of Rogers's (1983) model of the diffusion of the innovation process. Political and cultural factors made up the initiation phase of innovation, enabling the research to concentrate on the implementation phase of e-mail Roger's (1983) model also provided adopter categories that related to the findings of a Computer Attitude Survey that was conducted at The School of Mines and Industries Ballarat (SMB), now the University of Ballarat—TAFE Division since amalgamation on 1st January 1998. Despite management rhetoric about the need to utilise e-mail, Institute teaching staff lacked individual computers in their work areas and most were waiting to become connected to the Internet as late as 1997. According to the action research reports, many staff were resistant to the new e-mail facilities despite having access to personal computers whose numbers doubled annually. The action research project became focussed when action researchers realised that e-mail workshop training was ineffective and that staff required improved access. Improvement to processes within education through collaborative action research had earlier been achieved (McTaggart 1994), and this project actively engaged practitioners to facilitate decentralised e-mail training in the workplace through the action research spiral of planning, acting, observing and reflecting, before replanning. The action researchers * task was to find ways to improve the diffusion of e-mail throughout the Institute and to develop theoretical constructs. My research task was to determine whether action research could successfully facilitate e-mail throughout the Institute. A rich literature existed about technology use in education, technology teaching, gender issues, less about computerphobia, and none about 'e-mailphobia \ It seemed appropriate to pursue the issue of e-mailphobia since it was marginalised, or ignored in the literature. The major political and cultural influences on the technologising of SMB and e-mail introduction were complex, making it impossible to ascertain the relative degrees of influence held by Federal and State Governments, SMB's leadership or the local community, Nonetheless, with the implementation of e-mail, traditional ways were challenged as SMB's culture changed. E-mail training was identified as a staff professional development activity that had been largely unsuccessful. Action research is critical collaborative inquiry by reflective practitioners who are accountable for making the results of their inquiry public and who are self-evaluating of their practice while engaging participative problem-solving and continuing professional development (Zuber-Skerritt 1992, 1993). Action research was the methodology employed in researching e-mail implementation into SMB because it involved collaborative inquiry with colleagues as reflective practitioners. Thoughtful questions could best be explored using deconstructivist philosophy, in asking about the noise of silence, which issues were not addressed, what were the contradictions and who was being marginalised with e-mail usage within SMB. Reviewing literature on action research was complicated by its broad definition and by the variability of research (King & Lonnquist 1992), and yet action research as a research methodology was well represented in educational research literature, and provided a systematic and recognisable way for practitioners to conduct their research. On the basis of this study, it could be stated that action research facilitated the diffusion of e-mail technology into one TAFE Institute, despite the process being disappointingly slow. While the process in establishing the action research group was problematic, action researchers showed that a window of opportunity existed for decentralised diffusion of e-mail training,in preference to bureaucratically motivated 'workshops. Eight major findings, grouped under two broad headings were identified: the process of diffusion (planning, nature of the process, culture, politics) and outcomes of diffusion (categorising, e-mailphobia, the survey device and technology in education). The findings indicated that staff had little experience with e-mail and appeared not to recognise its benefits. While 54.1% did not agree that electronic means could be the preferred way to receive Institute memost some 13.7% admitted to problems with using the voice answering service on telephones. Some 43.3% thought e-mail would not improve their connectedness (how they related) to the Institute. A small percentage of staff had trouble with telephone voice-mail and a number of these were anxious computer users. Individualised tuition and peer support proved helpful to individual staff whom action researchers believed to be 'at risk', as determined from the results of a Computer Attitude Survey. An instructional strategy that fostered the development of self-regulation and peer support was valuable, but there was no measure of the effects of this action research program, other than in qualitative terms. Nevertheless, action research gave space to reflect on the nature of the underlying processes in adopting e-mail. Challenges faced by TAFE action researchers are integrally affected by the values within TAFE, which change constantly and have recently been extensive enough to be considered as a 'new paradigm'. The influence of competition policy, the training reform agenda and technologisation of training have challenged traditional TAFE values. Action research reported that many staff had little immediate professional reason to use e-mail Theoretical answers were submerged beneath practical professional concerns, which related back to how much time teachers had and whether they could benefit from e-mail. A need for the development of principles for the sound educational uses of e-mail increases with the internationalisation of education and an increasing awareness of cultural differences. The implications for conducting action research in TAFE are addressed under the two broad issues of power and pedagogy. Issues of power included gaining access, management's inability to overcome staff resistance to technology, changing TAFE values and using technology for conducting action research. Pedagogical issues included the recognition of educational above technological issues and training staff in action research. Finally, seventeen steps are suggested to overcome power and pedagogical impediments to the conduct of action research within TAFE. This action research project has provided greater insight into the difficulties of successfully introducing one culture-specific technology into one TAFE Institute. TAFE Institutes need to encourage more action research into their operations, and it is only then that -we can expect to answer the unanswered questions raised in this research project.

Review of prevalence data in, and evaluation of methods for cross cultural adaptation of, UK surveys on tobacco and alcohol in ethnic minority groups

Objective To assess the adequacy of cross cultural adaptations of survey questions on self reported tobacco and alcohol consumption in the United Kingdom.

Design Assessment of consistency of data between studies identified through literature review. Studies evaluated with 12 guidelines developed from the research literature on achieving cross cultural comparability.

Results The literature review identified 18 key studies, five of them on national samples. Survey instruments were obtained for 15 of these. The comparison of prevalence data in national surveys showed some important discrepancies, greater for tobacco than for alcohol. For example, prevalence of cigarette smoking in Bangladeshi women was 6% in a national survey in 1994 and 1% in a national survey in 1999; in Chinese men it was 31% in a survey in 1993-4 and 17% in one in 1999; in African-Caribbean men it was 29% in a 1992 survey and 42% in one in 1993-4. The most guidelines met by any study was three, although one study partly met a fourth. Two studies met no guidelines. Only four studies consulted with ethnic minority communities in developing the questionnaire, none checked each language version with all others, and two stated the questionnaire had not been validated.

Conclusions Surveys have not followed best practice in relation to measurement of risk factors in cross cultural settings. There is inconsistency in the prevalence data on smoking provided by different major national UK studies. Users of such data should be aware of their limitations. Research is needed to help achieve linguistic equivalence of survey questions in cross cultural research.

Chronic disease risk factors in rural Australia : results from the Greater Green Triangle risk factor surveys

The aim of this article was to assess the level and prevalence of major chronic disease risk factors among rural adults. Two cross-sectional surveys were carried out in 2004 and 2005 in the southeast of South Australia and the southwest of Victoria. Altogether 891 randomly selected persons aged 25 to 74 years participated in the studies. Surveys included a self-administered questionnaire, physical measurements, and a venous blood specimen for lipid analyses. Two thirds of participants had cholesterol levels ≥5.0 mmol/L. The prevalence of high diastolic blood pressure (≥90 mm Hg) was 22% for men and 10% for women in southeast of South Australia, and less than 10% for both sexes in southwest of Victoria. Two thirds of participants were overweight or obese (body mass index ≥25 kg/m2). About 15% of men and slightly less women were daily smokers. The abnormal risk factor levels underline the need for targeted prevention activities in the Greater Green Triangle region. Continuing surveillance of levels and patterns of risk factors is fundamentally important for planning and evaluating preventive activities.

The efficacy of using e-mail when researching inclusive teaching practices used by male academics

The paper describes work-in-progress and reflects upon a small research project, ‘A Small Study of Male Academics and Their Inclusive Teaching Strategies’, in which the author trialed the use of e-mail communication as a medium for having repeated conversations with a number of male academics about their inclusive teaching practices. This forms a small part of a larger study concentrating on the non-mainstream leadership practices of male academics.

The study met with mixed results: on one hand, it provided an opportunity for the respondents to express how they teach inclusively; on the other, the study made it apparent that the use of e-mails alone did not facilitate communication with the respondents. The implication for research of a sensitive nature is to ensure that the communication is primarily of a personal, face-to-face nature with the use of e-mails providing a complementary, rather than a primary, means of data gathering.

Trends in food intake in French children from 1999 to 2007 : results from the INCA (étude Individuelle Nationale des Consommations Alimentaires) dietary surveys

The objectives of the present study were to assess the intake of different food groups in French children aged 3–17 years (n 1455), and to analyse trends since a dietary survey undertaken 8 years ago. Dietary intake was evaluated using data from the 2006–7 cross-sectional INCA2 national dietary survey (étude Individuelle Nationale sur les Consommations Alimentaires), based on a 7 d food record. Dietary intake (percentage of subjects consuming the food group and amount eaten) was assessed for thirty-nine food categories. We observed variations in food consumption by age, sex, North–South regional gradient, seasonal period and educational level of the responding parent. Trends in dietary intake between 1999 and 2007 were determined by comparing the INCA1 (n 1126) and the INCA2 surveys. Both surveys had been carried out using the same methodology. The findings showed a decrease in energy intake in children aged 3–14 years, due to a reduction in the consumption of foods of animal origin and sweetened products. In adolescents aged 15–17 years, energy intake remained rather stable; during this 8-year period, the consumption of meat decreased, whereas the consumption of savoury snacks such as sandwiches and hamburgers significantly increased. These trends occurred during a time of growing concern about overweight and the associated co-morbidities in France. A number of public health measures were implemented over this period to improve dietary habits and physical activity patterns in children and adults. The periodic monitoring of dietary patterns through the INCA surveys is an essential part of the surveillance network in France.

Trends in food and nutritional intakes of French adults from 1999 to 2007 : results from the INCA surveys

Two independent cross-sectional dietary surveys (the Individual and National Food Consumption Surveys, INCA), performed in 1998–99 (INCA1) and in 2006–07 (INCA2) on nationally representative samples of French people, were used to analyse trends in the dietary habits and nutritional intake of French adults. Food consumption was recorded through 7-d dietary records, and nutritional intakes were assessed using the French food composition database. After exclusion of under-reporters, analyses were performed on 3267 adults, aged 18–79 years: 1345 from INCA1 and 1922 from INCA2. The trends highlighted over the 8-year period showed a decrease in consumption of dairy products, meat, bread, potatoes, pastries/croissant-like pastries/cakes/biscuits and sugar/confectionery. In contrast, the consumption of fruits and vegetables, rice, ice cream and chocolate increased. Other food groups, like fish and snacking foods, remained stable. Food choices were mostly age specific. These age differences remained consistent over the years and underlined two opposite dietary trends: a ‘traditional’ one mainly followed by the elderly, and a ‘snacking and convenience’ one mainly adopted by young adults. The overall trends in food consumption did not influence the mean energy intake, but did slightly modify the contribution of each macronutrient to energy intake. These repeated surveys highlighted the fact that trends in French food habits have moved towards an average European diet at the crossroads between Mediterranean and Northern diets, and that food consumption changes impacted, to a lesser extent, nutritional intake.