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Chapter 2: Methods
Headlines from this chapter
- The National Needle Exchange Survey was designed to gather information from those responsible for planning and commissioning needle exchange services, and those responsible for delivering those services.
- A combination of qualitative and quantitative methods were used. The quantitative element consisted of three postal questionnaire surveys. These were sent to:
- DAT partnership / joint commissioning managers or their equivalent
- Non-pharmacy needle exchange providers
- Pharmacy needle exchange co-ordinators
- The qualitative element consisted of three focus groups - one with each of the three groups listed above.
- In addition, a complete directory of needle exchange services in Scotland was compiled.
- Scottish survey response rates were excellent:
- 22 DATs were surveyed; 19 responded (86%)
- 50 services were surveyed; 45 responded (90%)
- 12 pharmacy co-ordinators were surveyed; 10 responded (83%)
- Data quality in relation to some questions was poor. In particular, there were incomplete or missing responses in relation to many of the questions on needle exchange activity ( i.e., number of transactions, number of clients, number of syringes distributed and returned).
The Needle Exchange Survey was designed to gather information both from people responsible for planning and commissioning needle exchange services, and those who were responsible for delivering those services (both pharmacy and non-pharmacy providers). 5
Both qualitative and quantitative methods were used. The quantitative element consisted of three postal questionnaire surveys:
- A survey of DAT partnership / joint commissioning managers or their equivalent
- A survey of non-pharmacy needle exchange services
- A survey of pharmacy needle exchange co-ordinators.
Most questions required a tick-box or short written response. In addition, at the end of each questionnaire, there was space for respondents to give examples of good practice and provide details of problems and impediments in commissioning and delivering needle exchange services. The questionnaires were piloted and the surveys administered in Scotland by staff in the Scottish Executive. Copies of the questionnaires are available from the first author upon request.
The qualitative element of the study consisted of three focus groups - one with each of the three groups listed above. The qualitative work in Scotland was carried out by Griesbach & Associates under contract to the NTA. Assistance and support in organising the focus groups was provided by staff in the Scottish Executive.
Compiling a needle exchange directory
Prior to undertaking this study, there was no comprehensive list of needle exchange services in Scotland. Information was available from the 2003-04 Corporate Action Plans on the names (but not the addresses) of non-pharmacy exchanges and the Scottish Drugs Forum helpfully provided a list of the members of the Scottish Needle Exchange Workers Forum along with their contact details. However, taken together, these lists were far from complete.
Therefore, a decision was taken to ask the co-ordinators of each of Scotland's 22 DATs for the name(s) of one or more contact persons who could provide a comprehensive list of all pharmacy and non-pharmacy needle exchange services in their area. The resulting list was then circulated to DAT co-ordinators for checking and correction if necessary. By this means, it was possible to compile a complete directory of needle exchange services in Scotland by DAT area.
Analysis
Descriptive analysis of the Scottish survey results was undertaken by staff at the NTA using SPSS and Griesbach & Associates using Excel.
Analysis of the focus group discussions was undertaken by Griesbach & Associates. Key themes were identified, and these will be reported at relevant points throughout this document as a way of explaining, or providing a context for, the survey results.
In Scotland, DAT partnerships have responsibility for planning local drug services. However, needle exchange services are generally funded and commissioned by NHS Boards. 6 Therefore, where appropriate, comparisons will be made between NHS Boards and in some cases, comparisons will also be made between DATs. However, because of the small numbers of services involved, meaningful statistical comparison between Scottish NHS Boards or DATs was not possible.
On the other hand, the data did allow comparisons to be made between needle exchange services in Scotland and England, and some of these comparisons will be presented in Chapter 8 of this report.
All data presented in this report relates to the period April 2004 to March 2005.
Survey response rates
Response rates to the surveys are shown in Table 2.1 below.
Table 2.1: Survey response rates
| Total number available | Number surveyed | Number responding | Response rate |
|---|
DATs | 22 | 22 | 19 | 86% |
|---|
Non-pharmacy services | 52 | 50 | 45 | 90% |
|---|
Pharmacy co-ordinators | 15 | 12 | 10 | 83% |
|---|
All 22 of Scotland's DATs were invited to participate in the DAT survey. Responses were received from 19.
Fifty of the 52 non-pharmacy services identified in Scotland were surveyed. The specialist services in Orkney and the Western Isles were not surveyed because it was discovered in the DAT survey that these services had not been used in the previous year.
Pharmacy co-ordinators in 12 of the 15 Scottish NHS Board areas were surveyed. Western Isles was not surveyed because there is no pharmacy needle exchange scheme in the Western Isles. In the case of Dumfries & Galloway and Shetland, it had not been possible to identify a pharmacy co-ordinator.
It should be noted that pharmacy needle exchange schemes are co-ordinated at the level of NHS Boards. However, pharmacy co-ordinators were asked to complete separate questionnaires for each of the DAT areas they covered. As a result, the co-ordinators from Grampian, Lothian and Tayside completed multiple questionnaires. A total of 17 questionnaires were received from pharmacy co-ordinators throughout Scotland.
Further details of respondents are provided in Appendix 1.
A note about data quality
It must be noted that in any survey, the information reported can only be as accurate as the information that was provided. This study involved three surveys - a survey of DATs, a survey of non-pharmacy services and a survey of pharmacy co-ordinators. The three questionnaires focused on different issues, but also asked similar questions, particularly in relation to needle exchange activity ( i.e., number of transactions, number of clients, number of syringes distributed and returned). This was done deliberately to allow for the triangulation of the data.
As it turned out, the lack of robust monitoring systems in needle exchange services was especially apparent in relation to these questions on needle exchange activity. For example, nearly every DAT respondent said that services in their area collected data on the number of transactions (or contacts) that took place in needle exchange services, and many said that they also collected data on the number of clients. However, when asked for these numbers, DATs found it very difficult to provide complete and accurate figures. In some cases, it transpired that the data was available from only some of the services in the DAT area. Other DATs reported that data was routinely collected, but it was not held electronically, and therefore, it was impossible to obtain a report of this information. Others stated that data collection systems had only recently been introduced, and so the information was unavailable for the period requested.
Where figures were provided, it must be pointed out that there was reasonably good correspondence between the figures provided by DATs and those provided by pharmacy co-ordinators for pharmacy services - at least with respect to needle exchange transactions. However, there were often quite substantial differences between the DAT figures and those provided by respondents from the non-pharmacy services in that DAT area. For example, one DAT respondent reported a figure for total transactions in non-pharmacy services that was nearly three times the figure reported by the services in that area. Another DAT respondent reported a figure for transactions that was about one-fifth of what the services in that area reported.
As much as possible, the findings presented in this report are based on the best data that was available. However, the issue of poor data quality must be kept in mind throughout this report - but especially in relation to the findings presented in Chapter 5.
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