Audio computer-assisted self-interviewing (ACASI) may avert socially desirable responses about infant feeding in the context of HIV

Abstract

BackgroundUnderstanding infant feeding practices in the context of HIV and factors that put mothers at risk of HIV infection is an important step towards prevention of mother to child transmission of HIV (PMTCT). Face-to-face (FTF) interviewing may not be a suitable way of ascertaining this information because respondents may report what is socially desirable. Audio computer-assisted self-interviewing (ACASI) is thought to increase privacy, reporting of sensitive issues and to eliminate socially desirable responses. We compared ACASI with FTF interviewing and explored its feasibility, usability, and acceptability in a PMTCT program in Kenya.MethodsA graphic user interface (GUI) was developed using Macromedia Authorware® and questions and instructions recorded in local languages Kikuyu and Kiswahili. Eighty mothers enrolled in the PMTCT program were interviewed with each of the interviewing mode (ACASI and FTF) and responses obtained in FTF interviews and ACASI compared using McNemar's χ2 for paired proportions. A paired Student's t-test was used to compare means of age, marital-time and parity when measuring interview mode effect and two-sample Student's t-test to compare means for samples stratified by education level – determined during the exit interview. A Chi-Square (χ2test) was used to compare ability to use ACASI by education level.ResultsMean ages for intended time for breastfeeding as reported by ACASI were 11 months by ACASI and 19 months by FTF interviewing (p < 0.001). Introduction of complementary foods at ≤3 months was reported more frequently by respondents in ACASI compared to FTF interviews for 7 of 13 complementary food items commonly utilized in the study area (p < 0.05). More respondents reported use of unsuitable utensils for infant feeding in ACASI than in FTF interviewing (p = 0.001). In other sensitive questions, 7% more respondents reported unstable relationships with ACASI than when interviewed FTF (p = 0.039). Regardless of education level, respondents used ACASI similarly and majority (65%) preferred it to FTF interviewing mainly due to enhanced usability and privacy. Most respondents (79%) preferred ACASI to FTF for future interviewing.ConclusionACASI seems to improve quality of information by increasing response to sensitive questions, decreasing socially desirable responses, and by preventing null responses and was suitable for collecting data in a setting where formal education is low.

High Rates of Exclusive Breastfeeding in Both Arms of a Peer Counseling Study Promoting EBF Among HIV-Infected Kenyan Women

“…This phenomena has been observed in Kenya with mothers reporting higher proportions of EBF when interviewed face-to-face than with audio computerassisted self-interviewing (ACASI). 38 However, the magnitude of this problem in the present study is not clear, and the majority of breastfeeding studies and health surveys in sub-Saharan Africa have utilized face-to-face interviews. Nevertheless, future studies should consider using ACASI to mitigate social desirability bias.…”

A Randomized Trial on Screening for Social Determinants of Health: the iScreen Study

“…41,42 Computer-based surveys have been shown to be acceptable to adults and to elicit more truthful responses on some sensitive health issues than in-person interviews. [43][44][45][46] Though providers may hesitate to use electronic surveys to elicit information on what could be sensitive topics, research in health care settings has shown greater disclosure by adolescents, adults, and adult caregivers via computer-based screenings versus face-to-face interviews on highly sensitive items surrounding substance use, sexual behavior, and intimate partner violence, [46][47][48][49][50][51][52][53][54][55][56][57] with some of this work done in ED settings. 50,58 In line with results from the current study, other studies have found little difference in reporting rates for less sensitive items across these formats.…”

Impact of counselling on exclusive breast-feeding practices in a poor urban setting in Kenya: a randomized controlled trial

“…One limitation of the present study was the higher number of interviews conducted in the HBICG compared with the FBSICG and the CG. The interview process can act as a prompt for compliance with the required practice and may be associated with increased reporting of the socially desirable behaviour (29) . The purpose of the higher number of interviews was to monitor breastfeeding challenges experienced by the mothers for timely intervention by the research team.…”