title: A focus group study of enteric disease case investigation: successful techniques utilized and barriers experienced from the perspective of expert disease investigators.
abstract: BACKGROUND
  In Ontario, Canada, enteric case investigators perform a number of functions when conducting telephone interviews including providing health education, collecting data for regulatory purposes ultimately to prevent further illness, enforcement, illness source attribution and outbreak detection. Information collected must be of high quality as it may be used to inform decisions about public health actions that could have significant consequences such as excluding a person from work, recalling a food item that is deemed to be a health hazard, and/or litigations. The purpose of this study was to describe, from the perspectives of expert investigators, barriers experienced and the techniques used to overcome these barriers during investigation of enteric disease cases.
  
  
  METHODS
  Twenty eight expert enteric investigators participated in one of four focus groups via teleconference. Expert investigators were identified based on their ability to 1) consistently obtain high quality data from cases 2) achieve a high rate of completion of case investigation questionnaires, 3) identify the most likely source of the disease-causing agent, and 4) identify any possible links between cases. Qualitative data analysis was used to identify themes pertaining to successful techniques used and barriers experienced in interviewing enteric cases.
  
  
  RESULTS
  Numerous barriers and strategies were identified under the following categories: case investigation preparation and case communication, establishing rapport, source identification, education to prevent disease transmission, exclusion, and linking cases. Unique challenges experienced by interviewers were how to collect accurate exposure data and educate cases in the face of misconceptions about enteric illness, as well as how to address tensions created by their enforcement role. Various strategies were used by interviewers to build rapport and to enhance the quality of data collected.
  
  
  CONCLUSIONS
  To our knowledge, this is the first study to examine the perspectives of expert enteric disease case investigators on successful interview techniques and barriers experienced during enteric case investigation. A number of recommendations could improve the process of enteric case investigation in the Ontario context which include formal training and development of resource materials pertaining to interviewing, standardized interviewing tools, strategies to address cultural and language barriers, and the implementation of the single interviewer approach.
authors.forename: Stanley
authors.initials: S
authors.lastname: Ing
authors.forename: Christina
authors.initials: C
authors.lastname: Lee
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Sciences Building, 6th Floor, Toronto, Ontario M5T 3M7, Canada. Dean.Middleton@oahpp.ca.
authors.forename: Dean
authors.initials: D
authors.lastname: Middleton
authors.forename: Rachel D
authors.initials: RD
authors.lastname: Savage
authors.forename: Stephen
authors.initials: S
authors.lastname: Moore
authors.forename: Doug
authors.initials: D
authors.lastname: Sider
mesh_terms: D003142:Communication; D003219:Confidentiality; D004196:Disease Outbreaks; D004812:Epidemiologic Methods; D017144:Focus Groups; D005767:Gastrointestinal Diseases / Q000453:epidemiology*; D006266:Health Education; D006801:Humans; D007407:Interviews as Topic; D011939:Mental Recall; D009864:Ontario; D011634:Public Health; D011637:Public Health Nursing; D011795:Surveys and Questionnaires