The validity of self-reported behaviors: methods for estimating underreporting of risk behaviors

Abstract

Purpose When individuals underreport risk behaviors, data gathered from public health research and practice will underestimate risk. To date, there is little guidance on if or how reports can be adjusted to better reflect true levels of a risk behavior in a given cohort, sample or, by extension, population. Methods We develop the underreporting correction factor (UCF), which can be used to correct estimates of the prevalence of a risk behavior using self-report of the behavior and a specific (but not necessarily sensitive) biomarker. The UCF rests on three assumptions: (1) there is no overreporting of the behavior (2) the biomarker can only be acquired if the person engages in the behavior, and (3) the presence of the biomarker does not affect reporting of the behavior. We investigate the sensitivity of the UCF to violation of these assumptions and develop confidence intervals for the UCF and the corrected prevalence of the behavior. Results The UCF is most sensitive to the second assumption (biomarker perfectly specific). We apply the UCF to estimates of sexual risk behaviors in various settings using a variety of biomarkers. Conclusions Implementation of the UCF corrects for underreporting and more accurately quantifies risk in cohorts.

A Prospective Cohort Study of Fertility Desire, Unprotected Sex, and Detectable Viral Load in HIV-Positive Female Sex Workers in Mombasa, Kenya

“…In this study, we found substantial underreporting of unprotected sex compared to semen detection by PSA test. This finding is consistent with our prior study comparing biologic and self-reported measures of condomless sex in this cohort [46]. Self-reported condomless sex measures recalled behavior and willingness to report it.…”

Interdental cleaning and periodontal pocketing among finnish adults

“…In addition, partial‐mouth recording yields lower prevalence and severity rates (Eke, Thornton‐Evans, Wei, Borgnakke, & Dye, ; Kingman, Susin, & Albandar, ; Susin, Kingman, & Albandar, ). Fourth, interdental cleaning and toothbrushing were assessed through self‐reports, which are prone to measurement error and weaker associations (Norwood, Hughes, & Amico, ). Misclassification of exposure could have occurred if participants reporting favourable behaviours did not have enough manual dexterity to remove plaque effectively.…”

Association between non-barrier modern contraceptive use and condomless sex among HIV-positive female sex workers in Mombasa, Kenya: A prospective cohort analysis

“…Specifically, women using non-barrier modern contraceptives appear to report condomless sex more frequently than women not using a non-barrier method. This differential reporting could be related to HIV-positive women’s experience of stigma associated with pregnancy [ 26 ] [ 27 ]. As a result, women living with HIV may be more comfortable reporting condomless sex if they are using an additional non-barrier method of contraception to reduce their risk of pregnancy.…”

“…Women were asked about self-reported condomless sex in the past week, whereas detection of PSA is most sensitive within 24 hours, and may be detected up to 48 hours after condomless sex [ 18 ]. However, despite the shorter period captured by PSA detection compared to self-reported condomless sex, PSA was detected more often than self-reported condomless sex, suggesting substantial underreporting [ 26 ]. Fourth, the observational study design limits the ability to establish causal relationships.…”