Auswahl der wissenschaftlichen Literatur zum Thema „Telephone surveys Evaluation“

AbstractInterviewers often assess after the interview the respondent’s ability and reluctance to participate. Prior research has shown that this evaluation is associated with next-wave response behavior in face-to-face surveys. Our study adds to this research by looking at this association in telephone surveys, where an interviewer typically has less information on which to base an assessment. We looked at next-wave participation, non-contact and refusal, as well as longer-term participation patterns. We found that interviewers were better able to anticipate refusal than non-contact relative to participation, especially in the next wave, but also in the longer term. Our findings confirm that interviewer evaluations – in particular of the respondent’s reluctance to participate – can help predict response at later waves, also after controlling for commonly used predictors of survey nonresponse. In addition to helping to predict nonresponse in the short term, interviewer evaluations provide useful information for a long-term perspective as well, which may be used to improve nonresponse adjustment and in responsive designs in longitudinal surveys.

Although the Drug-Free Schools and Communities Act of 1986 and the 1989 Amendments to the Act require states to evaluate their drug-education programs, no guidelines for conducting these evaluations have been produced, and little has been reported on how the states are conducting such evaluations. In this article, the results of a telephone survey on current state-level efforts to evaluate school programs funded under the Act are reported. Some states report studies of the implementation of the program and some report drug- and alcohol-use surveys. Together, these two types of evaluation efforts form the foundation of an approach for conducting evaluations under the Act. Reasons are presented why experimental and quasi-experimental designs might be inappropriate and impractical for the evaluations, and an evaluation approach linking program implementation findings and drug- and alcohol-use survey results is suggested.

The British Columbia Nutrition Survey was the last of ten provincial nutrition surveys completed between 1988 and 1999. A qualitative process evaluation was conducted to identify strengths and weaknesses of British Columbia Nutrition Survey procedures, as perceived by 27 public health nurses and dietitians directly involved in data collection. Data for the process evaluation were collected through in-depth telephone interviews, during which interviewers and facilitators described their experiences working for the survey. Qualitative analysis of interview transcripts identified codes that were then organized into eight categories, including issues arising from interviewer and facilitator training, challenges in recruiting survey participants, reflections on safety for survey personnel and participants, facilitators’ key role, the flexibility required to implement the protocol, and communication within the survey research team. Two final categories related to rewarding aspects of the job: insights affecting professional practice, and meeting survey participants and personnel. Evaluation findings show the importance of establishing open communication between research planners and those conducting surveys. This communication is needed to ensure that workers’ needs are met, the quality of the study is maximized, and evaluations of study protocols include the perspectives of those directly involved in data collection.

Researchers at Battelle Centers for Public Health Research and Evaluation (CPHRE) were contracted by the Centers for Disease and Prevention (CDC) to conduct a random sample survey to serve as one component of the evaluation of the Prevention Marketing Initiative (PMI) Local Site Demonstration Project, a community-based HIV prevention program for adolescents. Data were collected from 1,402 adolescents over a 23-month period. A five wave, cross-sectional design was used. A dual sampling strategy combined Random Digit Dialing (RDD) with Listed Household (LHH) samples. Particular care was devoted to ensuring the rights of teenaged participants. Data were collected anonymously and concerns about confidentiality and privacy informed design and operational decisions. Response rate goals were achieved. Factors that may have contributed to the adequacy of the response rate include the use of advance letters and a toll-free phone line as well as sensitivity to the needs and concerns of the target population, the perceived legitimacy of CDC research and the perseverance of the interviewers.

Background The increasing difficulty experienced by general practices in meeting patient demand is leading to new approaches being tried, including greater use of telephone consulting. Objectives To evaluate a ‘telephone first’ approach, in which all patients requesting a general practitioner (GP) appointment are asked to speak to a GP on the telephone first. Methods The study used a controlled before-and-after (time-series) approach using national reference data sets; it also incorporated economic and qualitative elements. There was a comparison between 146 practices using the ‘telephone first’ approach and control practices in England with regard to GP Patient Survey scores and secondary care utilisation (Hospital Episode Statistics). A practice manager survey was used in the ‘telephone first’ practices. There was an analysis of practice data and the patient surveys conducted in 20 practices using the ‘telephone first’ approach. Interviews were conducted with 43 patients and 49 primary care staff. The study also included an analysis of costs. Results Following the introduction of the ‘telephone first’ approach, the average number of face-to-face consultations in practices decreased by 38% [95% confidence interval (CI) 29% to 45%; p < 0.0001], whereas there was a 12-fold increase in telephone consultations (95% CI 6.3-fold to 22.9-fold; p < 0.0001). The average durations of consultations decreased, which, when combined with the increased number of consultations, we estimate led to an overall increase of 8% in the mean time spent consulting by GPs, although there was a large amount of uncertainty (95% CI –1% to 17%; p = 0.0883). These average workload figures mask wide variation between practices, with some practices experiencing a substantial reduction in workload. Comparing ‘telephone first’ practices with control practices in England in terms of scores in the national GP Patient Survey, there was an improvement of 20 percentage points in responses to the survey question on length of time to get to see or speak to a doctor or nurse. Other responses were slightly negative. The introduction of the ‘telephone first’ approach was followed by a small (2%) increase in hospital admissions; there was no initial change in accident and emergency (A&E) department attendance, but there was a subsequent small (2%) decrease in the rate of increase in A&E attendances. We found no evidence that the ‘telephone first’ approach would produce net reductions in secondary care costs. Patients and staff expressed a wide range of both positive and negative views in interviews. Conclusions The ‘telephone first’ approach shows that many problems in general practice can be dealt with on the telephone. However, the approach does not suit all patients and is not a panacea for meeting demand for care, and it is unlikely to reduce secondary care costs. Future research could include identifying how telephone consulting best meets the needs of different patient groups and practices in varying circumstances and how resources can be tailored to predictable patterns of demand. Limitations We acknowledge a number of limitations to our approach. We did not conduct a systematic review of the literature, data collected from clinical administrative records were not originally designed for research purposes and for one element of the study we had no control data. In the economic analysis, we relied on practice managers’ perceptions of staff changes attributed to the ‘telephone first’ approach. In our qualitative work and patient survey, we have some evidence that the practices that participated in that element of the study had a more positive patient experience than those that did not. Funding The National Institute for Health Research Health Services and Delivery Research programme.

In 1993 the SmarTraveler advanced traveler information system (ATIS) was introduced to travelers in the greater Boston area as part of an operational test jointly funded by FHWA and the Massachusetts Executive Office of Transportation and Construction. The service offers real-time, route-specific travel information by phone for major highways and public transit. During the 3-year test period from January 1993 to January 1996, service usage grew to nearly 60,000 calls per week, made by an average of more than 20,000 users. To achieve this growth, SmarTraveler was marketed to both cellular and land-line phone users using a variety of strategies over the course of the test. Evaluation and monitoring studies were commissioned to examine the degree to which users responded to SmarTraveler and the marketing program. The evaluation included extensive surveys of users and nonusers as well as tracking of calls and call frequency. The findings of the independent evaluation team on the success of various promotional efforts associated with the SmarTraveler operational test are presented. Overall, the marketing program aimed at the broad target market during the first 2 years appears to have been only partly successful in increasing the public’s level of awareness of SmarTraveler, in convincing its target market of SmarTraveler’s superiority to radio and TV travel reports, and in inducing trials. As a result of the second-year evaluation, changes were made to marketing and pricing during the third year of operation to target cellular telephone users. Further surveys were conducted to examine cellular telephone user response to these changes. SmarTraveler experienced a large increase in calls and users in the third year, especially in the cellular telephone market. Among the survey findings was that this market is quite price sensitive.

Abstract Background The Accreditation Council for Graduate Medical Education requires annual surveys of residency programs. Intervention We switched from a paper-based to a web-based survey and report on the efficiency and quality improvement gains from this change. To determine the prevalence of web-based surveys, we conducted a web-based and telephone survey of 17 internal medicine residency training programs in Southern California. Fifteen programs provided data (88% response rate). Results By making the switch, our internal medicine residency program was able to save over 50 administrative hours and over 1000 pieces of paper. A total investment of $20 for the Surveymonkey.com account (Palo Alto, CA) and approximately 15 hours to migrate the survey was made. The program administrators were able to more rapidly analyze and respond to the feedback from the residents with this system. Our survey of other programs showed that of 15 programs, 12 used a web-based survey system (80%) and 3 used a paper-based system (20%). Surveymonkey.com was the most popular system used. Conclusions We feel that the quality of response to resident feedback was enhanced by the real-time reaction to comments and assessments. Residents also appreciated the benefits of such a change. We recommend this approach to other programs that are still using paper-based surveys.

This paper evaluates the Department of the Environment's Helping the Earth Begins at Home Campaign that was carried out in the early 1990s from a global warming perception perspective. The study is based on both qualitative and quantitative research in the UK including random telephone surveys and interviews with policy makers. The study shows that the campaign largely failed for two reasons: a) the majority of the respondents did not make a link between their own energy consumption and global warming and b) the respondent's still confused global warming with the ozone hole.

AbstractIn this study, two methods of entering and accessing dairy herd records are compared: the traditional mail-in Dairy Herd Improvement (DHI) system and the Direct Access to Records by Telephone (DART) system, which provides more timely and convenient access to records. An evaluation of DART was carried out using mail survey responses from 117 DART users and telephone surveys of 40 randomly selected users. Results indicate that DART users are generally satisfied with the system and feel that it improves their herd management. Variations in use of the DART system by DART users are explained by herd, cost, and management variables. DART users and comparable non-DART, DHI users are compared with respect to gains in herd production efficiency. Results indicate that DART users made somewhat better gains in most efficiency measures but that the differences were generally not statistically significant.

As developments in communication technologies impact upon many spheres of public and private life, they influence the way in which the public sector engages citizens. While most governments have an online presence, this is mainly applied to the provision of one-way (i.e. government to citizen) information and services. However, available technologies such as the Internet and mobile telephony provide opportunities for governments to enter into a two-way dialogue with citizens, increase transparency of their operations, and encourage democratic participation outside election time. As the government closest to the people, local government is particularly well placed to use online technologies to enhance and expand participatory democracy through strategies such as e-consultation. The implementation of an e-consultation strategy by local government presents a number of challenges to local governments seeking to enhance their dialogue with constituents using information and communication technologies (ICTs). This chapter draws from an external evaluation of an Australian local government initiative, Darebin eForum.1 Conducted in 2007, this evaluation included a survey of e-consultation participants2 and interviews with Council Officers responsible for moderating the site.3 The findings provide a snapshot of some of these challenges. 4 Though modest in size and ambition, the experiences of Darebin eForum provide valuable insight into the challenges faced by governments seeking to use ICTs to engage in dialogue with their constituents.

The present study focused on evaluating the impact of Covid-19 lockdown on the agriculture system in India. A telephonic interview was conducted with farmers among various states between April to May 2020. A total of 494 farmers participated in the survey identifying the challenges they faced during the lockdown. First, the study has outlined the knowledge and perception of respondents on the Covid-19 virus and second the impact of Covid 19 induced restrictions on the agricultural system and food prices in India has been analyzed. The study classified the impact of lockdown on the agriculture system into four broad classifications - Farm Inputs, Farm Produce and Supply Chain, Agriculture and Allied Activities, Pandemic and Food prices. The detailed analysis across these four dimensions is discussed. Due to the shutdown of many supply routes, the availability of agricultural inputs such as fertilizer and seeds was disrupted, which jeopardized farmers’ investment planning. Furthermore, the seasonal migrants who would work in urban areas enter off-season and return to their native villages for farming could not carry it on. Such a rapid chain of events created massive short-run income shortages for small and marginalized farmers across the country. The special economic package for agriculture empowerment announced by the Government of India in the tune of two lakh crore rupees, equivalent to ten per cent of India’s GDP, has been the government’s first response to deal with this agricultural crisis. Finally, the chapter puts forward policy suggestions to strengthen resource-poor farmers’ capabilities plagued with a low-income-low-yield vicious cycle.

Fibromyalgia is usually a diagnosis of exclusion. Often poorly understood by some primary care physicians, the diagnosis of fibromyalgia is often delayed. Even though in one survey up to 10 percent of general medical visits involve a complaint of generalized musculoskeletal pain, the diagnosis was made only after patients saw a mean of 3.5 doctors. This chapter will take you through the workup that establishes the definitive diagnosis and eliminates other possible explanations for the patient’s complaints. Doctors who diagnose and treat fibromyalgia often cross specialty lines. Although rheumatologists tend to regard fibromyalgia as residing within their bailiwick, there are too few of us to handle all the needs of the 6 million fibromyalgia sufferers. The 5,000 rheumatologists in the United States are internal medicine subspecialists. A total of 80,000 doctors practice primary care internal medicine in the United States, and an additional 80,000 general or family practitioners are the front-line doctors for most patients. These physicians may suspect fibromyalgia and consult a rheumatologist to confirm the diagnosis. In complicated cases, the rheumatologist can take over the management of the condition. Orthopedists, neurosurgeons, and neurologists frequently diagnose fibromyalgia but generally refer patients to rheumatologists or internists for treatment. Rheumatologists may refer patients to physical medicine specialists or pain management centers when their approaches do not bear fruit. Suppose that you are suspected of having fibromyalgia, and a primary care physician has referred you to a fibromyalgia consultant (usually a rheumatologist but sometimes an internist, physiatrist, neurologist, orthopedist, or osteopath) to confirm the diagnosis and make management suggestions. Is any sort of advanced preparation advisable? Yes. Bring copies of outside records and previous test results or workups to the consultant. If you have more than a few complaints or are taking more than a few medications, a summary list is useful. The evaluation will consist of a history, physical examination, diagnostic laboratory tests, and possibly imaging studies (X-rays, scans, etc.). Once all the observations and test results are in, the doctor will discuss the findings with you—perhaps at the time of the visit, by telephone after the initial meeting, or in a follow-up visit.

1.1 Macroeconomic summary Economic recovery has consistently outperformed the technical staff’s expectations following a steep decline in activity in the second quarter of 2020. At the same time, total and core inflation rates have fallen and remain at low levels, suggesting that a significant element of the reactivation of Colombia’s economy has been related to recovery in potential GDP. This would support the technical staff’s diagnosis of weak aggregate demand and ample excess capacity. The most recently available data on 2020 growth suggests a contraction in economic activity of 6.8%, lower than estimates from January’s Monetary Policy Report (-7.2%). High-frequency indicators suggest that economic performance was significantly more dynamic than expected in January, despite mobility restrictions and quarantine measures. This has also come amid declines in total and core inflation, the latter of which was below January projections if controlling for certain relative price changes. This suggests that the unexpected strength of recent growth contains elements of demand, and that excess capacity, while significant, could be lower than previously estimated. Nevertheless, uncertainty over the measurement of excess capacity continues to be unusually high and marked both by variations in the way different economic sectors and spending components have been affected by the pandemic, and by uneven price behavior. The size of excess capacity, and in particular the evolution of the pandemic in forthcoming quarters, constitute substantial risks to the macroeconomic forecast presented in this report. Despite the unexpected strength of the recovery, the technical staff continues to project ample excess capacity that is expected to remain on the forecast horizon, alongside core inflation that will likely remain below the target. Domestic demand remains below 2019 levels amid unusually significant uncertainty over the size of excess capacity in the economy. High national unemployment (14.6% for February 2021) reflects a loose labor market, while observed total and core inflation continue to be below 2%. Inflationary pressures from the exchange rate are expected to continue to be low, with relatively little pass-through on inflation. This would be compatible with a negative output gap. Excess productive capacity and the expectation of core inflation below the 3% target on the forecast horizon provide a basis for an expansive monetary policy posture. The technical staff’s assessment of certain shocks and their expected effects on the economy, as well as the presence of several sources of uncertainty and related assumptions about their potential macroeconomic impacts, remain a feature of this report. The coronavirus pandemic, in particular, continues to affect the public health environment, and the reopening of Colombia’s economy remains incomplete. The technical staff’s assessment is that the COVID-19 shock has affected both aggregate demand and supply, but that the impact on demand has been deeper and more persistent. Given this persistence, the central forecast accounts for a gradual tightening of the output gap in the absence of new waves of contagion, and as vaccination campaigns progress. The central forecast continues to include an expected increase of total and core inflation rates in the second quarter of 2021, alongside the lapse of the temporary price relief measures put in place in 2020. Additional COVID-19 outbreaks (of uncertain duration and intensity) represent a significant risk factor that could affect these projections. Additionally, the forecast continues to include an upward trend in sovereign risk premiums, reflected by higher levels of public debt that in the wake of the pandemic are likely to persist on the forecast horizon, even in the context of a fiscal adjustment. At the same time, the projection accounts for the shortterm effects on private domestic demand from a fiscal adjustment along the lines of the one currently being proposed by the national government. This would be compatible with a gradual recovery of private domestic demand in 2022. The size and characteristics of the fiscal adjustment that is ultimately implemented, as well as the corresponding market response, represent another source of forecast uncertainty. Newly available information offers evidence of the potential for significant changes to the macroeconomic scenario, though without altering the general diagnosis described above. The most recent data on inflation, growth, fiscal policy, and international financial conditions suggests a more dynamic economy than previously expected. However, a third wave of the pandemic has delayed the re-opening of Colombia’s economy and brought with it a deceleration in economic activity. Detailed descriptions of these considerations and subsequent changes to the macroeconomic forecast are presented below. The expected annual decline in GDP (-0.3%) in the first quarter of 2021 appears to have been less pronounced than projected in January (-4.8%). Partial closures in January to address a second wave of COVID-19 appear to have had a less significant negative impact on the economy than previously estimated. This is reflected in figures related to mobility, energy demand, industry and retail sales, foreign trade, commercial transactions from selected banks, and the national statistics agency’s (DANE) economic tracking indicator (ISE). Output is now expected to have declined annually in the first quarter by 0.3%. Private consumption likely continued to recover, registering levels somewhat above those from the previous year, while public consumption likely increased significantly. While a recovery in investment in both housing and in other buildings and structures is expected, overall investment levels in this case likely continued to be low, and gross fixed capital formation is expected to continue to show significant annual declines. Imports likely recovered to again outpace exports, though both are expected to register significant annual declines. Economic activity that outpaced projections, an increase in oil prices and other export products, and an expected increase in public spending this year account for the upward revision to the 2021 growth forecast (from 4.6% with a range between 2% and 6% in January, to 6.0% with a range between 3% and 7% in April). As a result, the output gap is expected to be smaller and to tighten more rapidly than projected in the previous report, though it is still expected to remain in negative territory on the forecast horizon. Wide forecast intervals reflect the fact that the future evolution of the COVID-19 pandemic remains a significant source of uncertainty on these projections. The delay in the recovery of economic activity as a result of the resurgence of COVID-19 in the first quarter appears to have been less significant than projected in the January report. The central forecast scenario expects this improved performance to continue in 2021 alongside increased consumer and business confidence. Low real interest rates and an active credit supply would also support this dynamic, and the overall conditions would be expected to spur a recovery in consumption and investment. Increased growth in public spending and public works based on the national government’s spending plan (Plan Financiero del Gobierno) are other factors to consider. Additionally, an expected recovery in global demand and higher projected prices for oil and coffee would further contribute to improved external revenues and would favor investment, in particular in the oil sector. Given the above, the technical staff’s 2021 growth forecast has been revised upward from 4.6% in January (range from 2% to 6%) to 6.0% in April (range from 3% to 7%). These projections account for the potential for the third wave of COVID-19 to have a larger and more persistent effect on the economy than the previous wave, while also supposing that there will not be any additional significant waves of the pandemic and that mobility restrictions will be relaxed as a result. Economic growth in 2022 is expected to be 3%, with a range between 1% and 5%. This figure would be lower than projected in the January report (3.6% with a range between 2% and 6%), due to a higher base of comparison given the upward revision to expected GDP in 2021. This forecast also takes into account the likely effects on private demand of a fiscal adjustment of the size currently being proposed by the national government, and which would come into effect in 2022. Excess in productive capacity is now expected to be lower than estimated in January but continues to be significant and affected by high levels of uncertainty, as reflected in the wide forecast intervals. The possibility of new waves of the virus (of uncertain intensity and duration) represents a significant downward risk to projected GDP growth, and is signaled by the lower limits of the ranges provided in this report. Inflation (1.51%) and inflation excluding food and regulated items (0.94%) declined in March compared to December, continuing below the 3% target. The decline in inflation in this period was below projections, explained in large part by unanticipated increases in the costs of certain foods (3.92%) and regulated items (1.52%). An increase in international food and shipping prices, increased foreign demand for beef, and specific upward pressures on perishable food supplies appear to explain a lower-than-expected deceleration in the consumer price index (CPI) for foods. An unexpected increase in regulated items prices came amid unanticipated increases in international fuel prices, on some utilities rates, and for regulated education prices. The decline in annual inflation excluding food and regulated items between December and March was in line with projections from January, though this included downward pressure from a significant reduction in telecommunications rates due to the imminent entry of a new operator. When controlling for the effects of this relative price change, inflation excluding food and regulated items exceeds levels forecast in the previous report. Within this indicator of core inflation, the CPI for goods (1.05%) accelerated due to a reversion of the effects of the VAT-free day in November, which was largely accounted for in February, and possibly by the transmission of a recent depreciation of the peso on domestic prices for certain items (electric and household appliances). For their part, services prices decelerated and showed the lowest rate of annual growth (0.89%) among the large consumer baskets in the CPI. Within the services basket, the annual change in rental prices continued to decline, while those services that continue to experience the most significant restrictions on returning to normal operations (tourism, cinemas, nightlife, etc.) continued to register significant price declines. As previously mentioned, telephone rates also fell significantly due to increased competition in the market. Total inflation is expected to continue to be affected by ample excesses in productive capacity for the remainder of 2021 and 2022, though less so than projected in January. As a result, convergence to the inflation target is now expected to be somewhat faster than estimated in the previous report, assuming the absence of significant additional outbreaks of COVID-19. The technical staff’s year-end inflation projections for 2021 and 2022 have increased, suggesting figures around 3% due largely to variation in food and regulated items prices. The projection for inflation excluding food and regulated items also increased, but remains below 3%. Price relief measures on indirect taxes implemented in 2020 are expected to lapse in the second quarter of 2021, generating a one-off effect on prices and temporarily affecting inflation excluding food and regulated items. However, indexation to low levels of past inflation, weak demand, and ample excess productive capacity are expected to keep core inflation below the target, near 2.3% at the end of 2021 (previously 2.1%). The reversion in 2021 of the effects of some price relief measures on utility rates from 2020 should lead to an increase in the CPI for regulated items in the second half of this year. Annual price changes are now expected to be higher than estimated in the January report due to an increased expected path for fuel prices and unanticipated increases in regulated education prices. The projection for the CPI for foods has increased compared to the previous report, taking into account certain factors that were not anticipated in January (a less favorable agricultural cycle, increased pressure from international prices, and transport costs). Given the above, year-end annual inflation for 2021 and 2022 is now expected to be 3% and 2.8%, respectively, which would be above projections from January (2.3% and 2,7%). For its part, expected inflation based on analyst surveys suggests year-end inflation in 2021 and 2022 of 2.8% and 3.1%, respectively. There remains significant uncertainty surrounding the inflation forecasts included in this report due to several factors: 1) the evolution of the pandemic; 2) the difficulty in evaluating the size and persistence of excess productive capacity; 3) the timing and manner in which price relief measures will lapse; and 4) the future behavior of food prices. Projected 2021 growth in foreign demand (4.4% to 5.2%) and the supposed average oil price (USD 53 to USD 61 per Brent benchmark barrel) were both revised upward. An increase in long-term international interest rates has been reflected in a depreciation of the peso and could result in relatively tighter external financial conditions for emerging market economies, including Colombia. Average growth among Colombia’s trade partners was greater than expected in the fourth quarter of 2020. This, together with a sizable fiscal stimulus approved in the United States and the onset of a massive global vaccination campaign, largely explains the projected increase in foreign demand growth in 2021. The resilience of the goods market in the face of global crisis and an expected normalization in international trade are additional factors. These considerations and the expected continuation of a gradual reduction of mobility restrictions abroad suggest that Colombia’s trade partners could grow on average by 5.2% in 2021 and around 3.4% in 2022. The improved prospects for global economic growth have led to an increase in current and expected oil prices. Production interruptions due to a heavy winter, reduced inventories, and increased supply restrictions instituted by producing countries have also contributed to the increase. Meanwhile, market forecasts and recent Federal Reserve pronouncements suggest that the benchmark interest rate in the U.S. will remain stable for the next two years. Nevertheless, a significant increase in public spending in the country has fostered expectations for greater growth and inflation, as well as increased uncertainty over the moment in which a normalization of monetary policy might begin. This has been reflected in an increase in long-term interest rates. In this context, emerging market economies in the region, including Colombia, have registered increases in sovereign risk premiums and long-term domestic interest rates, and a depreciation of local currencies against the dollar. Recent outbreaks of COVID-19 in several of these economies; limits on vaccine supply and the slow pace of immunization campaigns in some countries; a significant increase in public debt; and tensions between the United States and China, among other factors, all add to a high level of uncertainty surrounding interest rate spreads, external financing conditions, and the future performance of risk premiums. The impact that this environment could have on the exchange rate and on domestic financing conditions represent risks to the macroeconomic and monetary policy forecasts. Domestic financial conditions continue to favor recovery in economic activity. The transmission of reductions to the policy interest rate on credit rates has been significant. The banking portfolio continues to recover amid circumstances that have affected both the supply and demand for loans, and in which some credit risks have materialized. Preferential and ordinary commercial interest rates have fallen to a similar degree as the benchmark interest rate. As is generally the case, this transmission has come at a slower pace for consumer credit rates, and has been further delayed in the case of mortgage rates. Commercial credit levels stabilized above pre-pandemic levels in March, following an increase resulting from significant liquidity requirements for businesses in the second quarter of 2020. The consumer credit portfolio continued to recover and has now surpassed February 2020 levels, though overall growth in the portfolio remains low. At the same time, portfolio projections and default indicators have increased, and credit establishment earnings have come down. Despite this, credit disbursements continue to recover and solvency indicators remain well above regulatory minimums. 1.2 Monetary policy decision In its meetings in March and April the BDBR left the benchmark interest rate unchanged at 1.75%.