Social Desirability Bias Impacts Self‐Reported Alcohol Use Among Persons With HIV in Uganda

Abstract

Background: Self-report is widely used to assess alcohol use in research and clinical practice, but may be subject to social desirability bias. We aimed to determine if social desirability impacts self-reported alcohol use.Methods: Among 751 human immunodeficiency virus (HIV)-infected patients from a clinic in southwestern Uganda, we measured social desirability using the Marlowe-Crowne Social Desirability Scale (SDS) Short Form C, self-reported alcohol use (prior 3 months) Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), and phosphatidylethanol (PEth), a biomarker of prior 3 weeks' drinking. We conducted multiple regression analyses to assess the relationship between SDS score (low, medium, and high levels) and (i) any self-reported recent alcohol use, among those who were PEth-positive (≥8 ng/ml), and (ii) continuous AUDIT-C score, among those reporting any recent alcohol use. We controlled for PEth level, age, gender, education, economic assets, marital status, religion, spirituality/religiosity, social support, and study cohort.Results: Of 751 participants, 59% were women; the median age was 31 years (interquartile range [IQR]: 26 to 39). Median SDS score was 9 (IQR: 4 to 10). Two-thirds (62%) self-reported any recent alcohol use; median AUDIT-C was 1 (IQR: 0 to 4). Among those who were PEth-positive (57%), 13% reported no recent alcohol use. Those with the highest SDS tertile had decreased odds of reporting any recent alcohol use compared to the lowest tertile, but the association did not reach statistical significance in multivariable analyses (adjusted odds ratio 0.55 [95% confidence interval (CI): 0.25, 1.23]). Among participants self-reporting recent alcohol use, SDS level was negatively associated with AUDIT-C scores (adjusted b: À0.70 [95% CI: À1.19, À0.21] for medium vs. low SDS and À1.42 [95% CI: À2.05, À0.78] for high vs. low SDS).Conclusions: While use of objective measures (e.g., alcohol biomarkers) is desirable for measuring alcohol use, SDS scores may be used to adjust self-reported drinking levels by participants' level of social desirability in HIV research studies.

Factors associated with phosphatidylethanol (PEth) sensitivity for detecting unhealthy alcohol use: An individual patient data meta‐analysis

“…These associations may have been caused by residual confounding if the level of alcohol consumption was differentially underreported by race/ethnicity. We have observed high social desirability and underreport of alcohol use by Ugandans living with HIV in prior studies (Adong et al, 2019; Bajunirwe et al, 2014; Muyindike et al, 2017) and underreport has also been reported for racial and ethnic minorities compared to whites in the United States (Johnson & Bowman, 2003; White et al, 2014).…”

“…To do so, we conducted an individual participant data meta‐analysis to leverage the statistical power of multiple studies with PEth testing and self‐reported alcohol use. Since social desirability bias suggests a tendency to underreport alcohol consumption (Adong et al, 2019), we have chosen to evaluate the sensitivity of PEth among those volunteering substantial alcohol consumption, that is, unhealthy alcohol use.…”

Overestimation of alcohol consumption norms as a driver of alcohol consumption: a whole‐population network study of men across eight villages in rural, southwestern Uganda

“…First, although the population prevalence of alcohol consumption in this parish is similar to that reported elsewhere in Uganda [9,10], personal alcohol consumption may be under‐reported [101–103]. Research using objective biomarkers to assess consumption levels would be helpful to determine actual population norms for comparison with perceived norms.…”

Effectiveness of a psychological intervention delivered by general nurses for alcohol use disorders in people living with HIV in Zimbabwe: a cluster randomized controlled trial

“…Given that the loss to follow‐up was greater in the EUC arm it is possible that the MI‐CBT intervention was more effective than EUC in promoting better engagement in care. Fourth, a limitation of our study is that alcohol use was measured with the AUDIT which is a self‐report questionnaire and subject to social desirability bias [51]. Social desirability may have led to bias in the reporting of reduced alcohol use in the intervention arm.…”