How to improve the validity of sexual behaviour reporting: systematic review of questionnaire delivery modes in developing countries

Abstract

Summary Objectives To systematically review comparative research from developing countries on the effects of questionnaire delivery mode. Methods We searched Medline, EMbase and PsychINFO and ISSTDR conference proceedings. Randomized-controlled trials and quasi-experimental studies were included if they compared two or more questionnaire delivery modes, were conducted in a developing country, reported on sexual behaviours, and occurred after 1980. Results 28 articles reporting on 26 studies met the inclusion criteria. Heterogeneity of reported trial outcomes between studies made it inappropriate to combine trial outcomes. 18 studies compared audio computer-assisted survey instruments (ACASI) or its derivatives (PDA or CAPI) against another self-administered questionnaires, face-to-face interviews, or random response technique. Despite wide variation in geography and populations sampled, there was strong evidence that computer-assisted interviews lowered item-response rates and raised rates of reporting sensitive behaviours. ACASI also improved data entry quality. A wide range of sexual behaviours were reported including vaginal, oral, anal and/or forced sex, age of sexual debut, condom use at first and/or last sex. Validation of self-reports using biomarkers was rare. Conclusions These data reaffirm that questionnaire delivery modes do affect self-reported sexual ehaviours and that use of ACASI can significantly reduce reporting bias. Its acceptability and feasibility in developing country settings should encourage researchers to consider its use when conduct ing sexual health research. Triangulation of self-reported data using biomarkers is recommended. Standardising sexual behaviour measures would allow for meta-analysis.

HIV Acquisition and Transmission Potential Among African American Men Who Have Sex with Men and Women in Three U.S. Cities

“…Additionally, the eligibility criteria included sexual risk that influenced the overall profile of the sample. Although ACASI has been shown to reduce reporting bias (Langhaug, Sherr, & Cowan, 2010), we relied on selfreport of sexual practices and HIV status with no biological markers. Desirability bias may have played a role and may have been particularly acute for HIV-positive participants reporting sex with HIV-negative or unknown status partners, since this was a felony in two of the states where the study was conducted.…”

Disclosure of sensitive behaviors across self-administered survey modes: a meta-analysis

“…Third, questions evoking answers that are in conflict with the prevalent social norm can be perceived as sensitive. Prototypical examples for sensitive topics in many Western societies are the consumption of alcohol and illicit substances (Tourangeau & Yan, 2007), sexual activities (Langhaug, Sherr, & Cowan, 2010;McCallum & Peterson, 2012), or delinquency (Kleck & Roberts, 2012). Due to the private nature of these behaviors, researchers interested in studying them usually have to rely on individuals' selfreports; objective measurements are typically rare (see van der Pol et al, 2013, for an example on drug use) or nearly impossible (e.g., in the context of sexual research).…”

Early Life Psychosocial Stressors and Housing Instability among Young Sexual Minority Men: the P18 Cohort Study

“…Participants may be more likely to underestimate or not recognize their instances of housing instability and inversely have overestimated age of sexual debut, but the use of the ACASI technology minimizes these concerns. 30 Because the parent cohort study was not designed specifically to examine housing stability, a limited number of variables with which to investigate the associations are available-for example, there were no measures addressing why participants had been unstably housed. Finally, as in all observational research, residual confounding is likely to be an issue.…”