Audio-computerized self-interviewing versus face-to-face interviewing for research data collection at drug abuse treatment programs

Safer choices 2: rationale, design issues, and baseline results in evaluating school-based health promotion for alternative school students

BACKGROUND

Students attending 'alternative' high schools form relatively small, highly mobile high-risk populations, presenting challenges for the design and implementation of HIV-, other STI-, and pregnancy-prevention interventions. This paper describes the rationale, study design, and baseline results for the Safer Choices 2 program.

STUDY DESIGN

Modified group-randomized intervention trial with cross-over of schools but not of students. The study cohort was defined a priori as those who completed the baseline measures and were still enrolled at the time of first follow-up. DESIGN RESULTS: Of 940 students initially enrolled in the study, 711 (76%) formed the study cohort. There were significant demographic differences between those included and those excluded from the study cohort in sex, age, sexual experience, experience with pregnancy, drug use, and some psychosocial measures. There were no significant differences between the intervention and control groups within the study cohort. The only significant difference between those students excluded from the intervention group and those excluded from the control group was reported age at first intercourse. BASELINE DATA RESULTS: Students (n=940) enrolled were predominately African-American (29.7%) and Hispanic (61.3%); 57.3% were female; 66% had ever had sex; and reported drug use in the previous 30 days ran from 4.3% (cocaine) to 26.9% (marijuana). Of the 627 sexually experienced, 41.8% reported their age at first intercourse as 13 years or younger; 28.5% reported ever being or having gotten someone pregnant; 74% reported sex in the past 3 months. Of the 464 sexually active in the last 3 months, 55.4% reported unprotected intercourse and 31.3% reported using drugs beforehand.

CONCLUSION

The cross-over design will provide a rigorous test of the intervention; however, loss to follow-up of this population can result in some selection bias. Students attending dropout prevention and recovery schools are at high risk for HIV, STIs, and pregnancy, and are in need of interventions.

Development and use of touch-screen audio computer-assisted self-interviewing in a study of American Indians

This article describes the development and usability of an audio computer-assisted self-interviewing (ACASI) questionnaire created to collect dietary, physical activity, medical history, and other lifestyle data in a population of American Indians. Study participants were part of a cohort of American Indians living in the southwestern United States. Data were collected between March 2004 and July 2005. Information for evaluating questionnaire usability and acceptability was collected from three different sources: baseline study data, auxiliary background data, and a short questionnaire administered to a subset of study participants. For the subset of participants, 39.6% reported not having used a computer in the past year. The ACASI questionnaires were well accepted: 96.0% of the subset of participants reported finding them enjoyable to use, 97.2% reported that they were easy to use, and 82.6% preferred them for future questionnaires. A lower educational level and infrequent computer use in the past year were predictors of having usability trouble. These results indicate that the ACASI questionnaire is both an acceptable and a preferable mode of data collection in this population.

Self reported risk behaviour among injecting drug users: Self versus assisted questionnaire completion

The current study aimed to compare self-reported injecting and sexual risk behaviour among Needle and Syringe Program (NSP) attendees who self-completed a questionnaire to that of those who received assistance in completing the questionnaire. Information on demographic, injecting and sexual risk behaviour was collected via a self-completed questionnaire for an annual cross-sectional survey of injecting drug users (IDUs) recruited from sentinel NSPs around Australia. Assistance was provided when necessary and recorded. Of 2,035 participants, 1,452 (71%) reported completing the questionnaire without assistance. Being male and nominating a language other than English spoken at home was independently associated with receiving assistance with questionnaire completion. Participants who reported heroin as the drug last injected were also more likely to receive assistance. Multivariate analyses revealed those who received assistance with questionnaire completion were less likely to report re-using a syringe after someone else and less likely to report sex work in the past month. The current findings suggest self-completion of risk behaviour questionnaires should be considered as an alternative to interviewer administered questionnaires to maximise accuracy of self-reports.

The feasibility of audio computer-assisted self-interviewing in international settings

OBJECTIVE

To determine the feasibility of using audio computer-assisted self-interviewing (ACASI) for data collection in developing countries, and to compare responses to questions eliciting sensitive information about sexual behavior using ACASI versus computer-assisted personal interviewing (CAPI) in five developing countries.

DESIGN

A feasibility study determined whether ACASI could be used in populations in developing countries. A follow-up, randomized crossover study compared responses to questions eliciting sensitive information about sexual behavior using ACASI versus CAPI.

METHODS

The NIMH Collaborative HIV/STD Prevention Trial conducted a feasibility study of ACASI in convenience samples in China, India, Peru, and Russia, then a randomized crossover ACASI versus CAPI study among volunteers in these countries plus Zimbabwe.

RESULTS

Approximately equal numbers of men and women completed the feasibility study; the results suggested a high comfort level among participants. Married respondents in China and India appeared to give unreliable responses on sexual activity. In the crossover study, the pattern of responses to sensitive questions showed few differences. In China, higher rates of sexual risk were reported on CAPI. In Peru and Russia, differences by mode were found in the number of partners in the past year.

CONCLUSION

Despite variable computer experience and literacy, feasibility study participants reported ease in completing ACASI, and preferred a computer to an interviewer for answering sensitive questions, or had no preference. In the crossover study, most participants gave similar responses on both modes of survey administration. ACASI appears to be feasible in these settings, although low literacy may pose problems if participants cannot clarify questions.

Brief report: Methods for collecting sexual behaviour information from South African adolescents—a comparison of paper versus personal digital assistant questionnaires

Reporting bias in adolescent behavioural research may be overcome with the use of personal digital assistants (PDA) or other computer based technologies. However, there is little insight into the use of these tools among adolescents in low resource settings. We compared self-administered paper questionnaires with PDA questionnaires to collect sexual behaviour data from a sample of 11-19 year olds living in a periurban, Xhosa-speaking community in South Africa. There was a high level of agreement between sexual risk behaviour data collected via each method (kappas> or = 0.50). Data collected from the PDA questionnaires were more complete. Subjectively, adolescents found the use of PDA to be simple and confidential. PDA may be a useful method to collect sensitive, self-reported information from adolescents in resource-limited settings.

A Comparison of HIV Health Services Utilization Measures in a Marginalized Population

BACKGROUND

In studies examining the use of human immunodeficiency virus (HIV) health services, researchers often use subjects' self-reported measures. Agreement between a subject's self-reports and medical records in marginalized populations is uncertain, yet important to understand, as this population is disproportionately affected by HIV.

METHODS

We sought to examine agreement between self-report and medical record health care utilization measures. Using a cross-sectional study, we studied 428 unstably housed HIV-infected adults in New York City. Self-reported data were collected from Audio Computer-Assisted Self-Interviews, and medical record data from health care providers' and facilities' ambulatory medical records. Agreement for a 6-month period was compared for ambulatory visits (0, 1, >or=2), HIV medications (antiretroviral therapy, opportunistic infection prophylaxis), whether CD4 counts and viral loads were performed and their values (CD4: <200, 200-500, >500 cells/mm; Viral load: undetectable, detected).

RESULTS

Agreement between self-report and medical records was 55.2% (kappa=0.12) for visits, and 68.2-79.1% (kappa=0.27-0.48) for medications. Agreement on whether laboratory tests were performed was 62.3-65.7% (kappa=0.11-0.14), whereas agreement on laboratory values was 77.6-79.3% (kappa=0.52-0.70). Most disagreement resulted in greater number of self-reported visits, use of medications, and laboratory tests compared with medical record data.

CONCLUSIONS

Among HIV-infected marginalized individuals, agreement between self-report and medical records was poor for ambulatory visits, poor to fair for medication use, and poor for laboratory tests performed. However, agreement for CD4 count value was substantially better. These findings have implications on health services research in marginalized populations that relies only on self-report or medical record data. This study underscores the importance of understanding how self-reported and medical record data are correlated in marginalized populations.

Accuracy of audio computer-assisted self-interviewing (ACASI) and self-administered questionnaires for the assessment of sexual behavior

This study examined the accuracy of two retrospective methods and assessment intervals for recall of sexual behavior and assessed predictors of recall accuracy. Using a 2 [mode: audio-computer assisted self-interview (ACASI) vs. self-administered questionnaire (SAQ)] by 2 (frequency: monthly vs. quarterly) design, young women (N =102) were randomly assigned to one of four conditions. Participants completed baseline measures, monitored their behavior with a daily diary, and returned monthly (or quarterly) for assessments. A mixed pattern of accuracy between the four assessment methods was identified. Monthly assessments yielded more accurate recall for protected and unprotected vaginal sex but quarterly assessments yielded more accurate recall for unprotected oral sex. Mode differences were not strong, and hypothesized predictors of accuracy tended not to be associated with recall accuracy. Choice of assessment mode and frequency should be based upon the research question(s), population, resources, and context in which data collection will occur.

Examining the Effects of a National Alcohol-Free Fraternity Housing Policy

This investigation examined the effectiveness of an alcohol-free fraternity housing policy on the risky alcohol use of members of a national fraternity (N=718). Comparisons of members in chapters with fraternity housing (FH) and those in chapters without housing (NFH) over time revealed no policy-related effects on measures of alcohol use. Among FH members, comparisons of those who lived in fraternity housing and those who lived in other housing also found no effects. FH members reported that the policy was implemented moderately well; however, it may have shifted alcohol use from fraternity housing to other settings.

Patterns of sexual commerce among women at US Syringe Exchange Programs

In the USA, the majority of research on sex work has examined the experiences of women recruited from social locations commonly referred to as the 'sex industry', such as street strolls or escort services. This paper presents data from female syringe exchange participants who had sold sex in the last 30 days. The women interviewed for this study report a much broader array of commercial transactions than found in previous US studies, including selling sex to women, paying men for sex, and considerable role fluidity between buying and selling. In addition, approximately one-third of the women report only selling sex 1 day per week or less, and appear to be more socio-economically stable than women who sell sex more often. We argue that this data suggests the existence of an array of commercial sexual transactions outside of the socially recognized sex industry, and that social location may affect condom use.

A randomized trial of audio computer and in-person interview to assess HIV risk among drug and alcohol users in Rio De Janeiro, Brazil

This study compares drug patterns and prevalence of risk behaviors in a randomized trial using two methods of administration, Audio Computer-Assisted Self-Interview (ACASI) and Interviewer-Administered Questionnaire (IAQ), among drug users seeking treatment in a drug treatment center. We randomized 735 participants: 367 to ACASI and 368 to IAQ. No significant difference in sociodemographic variables were found between subjects in the two arms of the study. Those interviewed by ACASI were more likely to report use on 7 of 10 substances assessed. Rates of reporting of sexual risk behaviors (male-to-male and commercial sex) were higher among participants in the ACASI arm. ACASI seems to be a key resource in improving the reporting of sensitive data in Brazil, as it has been in prior international studies.

High prevalence of alcohol use among hepatitis C virus antibody positive injection drug users in three US cities

Injection drug users (IDUs) acquire the majority of new hepatitis C virus (HCV) infections and frequently use alcohol. Alcohol abuse accelerates liver disease among HCV-infected persons, can reduce the effectiveness of treatment for HCV infection and may be a contraindication for HCV treatment. HCV seropositive, HIV-negative IDUs aged 18-35 years in Baltimore, New York City and Seattle who were enrolled in a behavioral risk-reduction intervention trial underwent computerized self-interviews to assess baseline alcohol use and dependence and medical history. We measured problem alcohol use using the 10-item Alcohol Use Disorders Identification Test (AUDIT) scale. Of 598 participants, 84% responded "false" to: "it is safe for a person with HCV to drink alcohol". Problem drinking, defined as score > or =8 on AUDIT, was identified in 37%. Correlates of scoring > or =8 on AUDIT included homelessness, male gender, primarily injecting speedballs, having injected with used needles, prior alcohol treatment and depression. Although most HCV seropositive IDUs in our sample appear informed about their increased risk of liver disease from alcohol, two-fifths screened positive for problem alcohol use. These findings underscore the importance of referring HCV-positive persons to effective alcohol treatment programs to reduce future liver damage and improve eligibility for and effectiveness of treatment of HCV.

HIV behavioral research online

Internet access has caused a global revolution in the way people of all ages and genders interact. Many have turned to the Internet to seek love, companionship, and sex, prompting researchers to move behavioral studies online. The sexual behavior of men who have sex with men (MSM) has been more closely studied than that of any other group online given the abundance of gay-oriented websites and concerns about increasing transmission of HIV and other sexually transmitted infections. Not only does the Internet provide a new medium for the conduct of behavioral research and for participant recruitment into an array of research studies, it has the as yet unrealized potential to reach huge numbers of MSM with innovative harm reduction and prevention messages tailored to individualized needs, interests, and risk behavior. Internet-based research on sexual behavior has many advantages in rapidity of recruitment of diverse samples which include individuals unreachable through conventional methods (i.e., non-gay identified and geographically and socially isolated MSM, etc.). Internet-based research also presents some new methodologic challenges in study design, participant recruitment, survey implementation, and interpretation of results. In addition, there are ethical issues unique to online research including difficulties in verifying informed consent, obstacles to surveying minors, and the ability to assure anonymity. This paper presents a review of Internet-based research on sexual behavior in MSM, a general discussion of the methodologic and ethical challenges of Internet-based research, and recommendations for future interdisciplinary research.

The epidemiology of herpes simplex virus type 2 infection in low-income urban populations in coastal Peru

OBJECTIVE

The objective of this study was to determine the epidemiology of herpes simplex virus type 2 (HSV-2) in general and socially marginalized populations of low-income, urban, coastal Peru.

STUDY

Two low-income populations were administered an epidemiologic survey and serologic tests, determining risk behavior, HSV-2, and HIV prevalence.

RESULTS

In the socially marginalized population, HSV-2 prevalence was 72.3% in men who have sex only with men (MSOM), 42.5% in women, and 20.7% in men. In the general population, HSV-2 prevalence was 20.5% in women and 7.1% in men. In all groups except the male general population, HSV-2 prevalence increased with age or number of sexually active years (both P <0.001). HSV-2 infection was associated with HIV infection in MSOM (P <0.023) and other socially marginalized men (P <0.01).

CONCLUSION

HSV-2 was common in both low-income populations, and control programs are needed in Peru given high prevalence and association with HIV infection. Prevention of HSV-2 infection should target individuals before they become sexually active.

Obtaining sensitive information from a wary population: a comparison of telephone and face-to-face surveys of welfare recipients in the United States

Recent studies reveal the benefits of technological developments such as audio computer assisted self-interviewing (A-CASI) in interview methodology, especially for surveys of sensitive behavior and information. However, we believe that the selection of mode of administration depends not only on the technology available and the behavior of interest, but also on the specific population under study. We therefore assess survey mode effects on reported rates of alcohol and drug use among welfare recipients, an especially important group for scholars and public health agencies. The sample consisted of adult recipients of Temporary Assistance to Needy Families (TANF) in Oklahoma, January 2001. Adjusting for demographic characteristics, employment, and education, we employ odds ratios to compare 30-day, 1 year, and lifetime prevalence estimates from telephone and face-to-face surveys. Telephone methodology yields similar or higher estimates for lifetime prevalence of alcohol, marijuana, and hard drug use and abuse, though lower estimates of recent use. We discuss our findings in relation to underfunded public health agencies that must efficiently assess and respond to local levels of drug abuse and we conclude that mode selection may depend upon the population under study.