An Approach to Reducing Problematic Data in an ACASI Sexual Behavior Assessment

ABSTRACT

Minimizing error in self-reported sexual behavior could reduce investigators’ likelihood of rejecting truly successful interventions to decrease HIV and STI transmission risk. Sexual behavior assessments can elicit problematic data. This may manifest in the form of elevated levels of non-response, inaccurate point estimates, or misclassification errors resulting in inappropriately answering or, perhaps more importantly, skipping questions. We programed conversational interviewing elements into 20 sexual behavior questions in an exit survey of gay bathhouse patrons (N = 459) administered using ACASI. Those elements, called alternate pathways, included follow-up questions to responses to confirm that operational definitions were applied in the answer (with return to the initial question if confirmation failed), and assurances of confidentiality and requests for best guesses in reaction to non-response (including “don’t know”). These elements were invoked in nearly 10% of participants, and approximately 74% of all invocations resulted in a usable numeric response, or 87% if the data need only estimate prevalence. Almost two-thirds of the problematic data issues occurred in answers to sexual contact questions, with others related to follow-up questions about specific sexual behavior. It is at this level of important filtering questions where the benefits of the approach are likely to be maximized.

Acknowledgments

The original study was funded by the National Institute of Mental Health [grant number R01 MH071159 (Binson, PI)], with additional support for finalizing the methodology study provided by funding of the CAPS Center grant [P30 MH066246 (Lightfoot, PI)]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIMH. Some of the data contained in this manuscript have been presented previously in a poster presented at the 2011 National HIV Prevention Conference, Atlanta, GA, USA, 14–17 August 2011. We wish to acknowledge the significant contributions of the late Diane Binson, PhD, who served as the Principal Investigator on the original study and contributed substantively in the early work on this paper. We want to express our deepest thanks to our project staff, Bob Siedle-Khan, Paul Cotten, Justin Bailey, Scott Carroll, Louis Cullen, Jason Euren, Trevor Hoppe, James Moser, Gabriel Ortiz, Mateo Rutherford, and Ted Tallase; and the club managers, staff and patrons, and in particular all the survey respondents. Special thanks to Tor Neilands, PhD, of the UCSF CAPS Methods Core for his support in refreshing our focus and commitment to completing this work.

Additional information

Funding

This work was supported by the National Institute of Mental Health [P30 MH066246, R01 MH071159].