CONTEXT: Social desirability bias is problematic in studies that rely on self-reported sexual behavior data. Where gender norms create different expectations about socially acceptable behavior, males and females face distinct pressures in reporting certain outcomes, which can distort assessments of risk for HIV and STIs.
METHODS: In 2009, relationship and sexual behavior data were collected from 1,750 never-married males and females aged 16-18 via audio computer-assisted self-interviewing (audio-CASO during the third round of the Malawi Schooling and Adolescent Study. A comparison group of 311 youth completed an identical questionnaire in face-to-face interviews. To assess whether interview mode may have influenced participants' reporting of sensitive behavior, reports of sexual experience in the two groups were compared. Multiple logistic regression analysis was used to identify associations between interview mode and reports of these behaviors, by gender.
RESULTS: In adjusted regression models, males were less likely to report ever having had a girlfriend in audio-CASI than in face-to-face interviews (odds ratio, 0.4), but they were more likely to report having had sex with a relative or teacher (3.5). For females, reports of ever having had a boyfriend or having had sex did not differ between modes. A small proportion of females reported ever having had sex with a relative or teacher in audio-CASI, while none did so in face-to-face interviews.
CONCLUSIONS: The method used for collecting relationship and sexual behavior data may influence the reported prevalence of some key behaviors, particularly among males. Further research is needed to improve methods of collecting sensitive data.
International Perspectives on Sexual and Reproductive Health, 2013, 39(1):14-21, doi: 10.1363/3901413
Collection of accurate behavioral data is critical for understanding the transmission dynamics of HIV and other STIs and for designing and evaluating interventions aimed at containing their spread. Researchers usually rely on self-reported data, which are subject to participants' recall bias, question misinterpretation and reluctance to respond truthfully when asked about private behavior. (1) Social desirability bias is particularly problematic in studies involving sexual behavior, as respondents may deliberately answer questions inaccurately, either by underreporting stigmatized activities or by overreporting normative ones, if their actual behavior would be considered socially unacceptable. (2)
Potential respondent biases may be reduced or exacerbated by the method of questionnaire delivery. Surveys administered via face-to-face interviews, for instance, can be influenced by interviewers' inaccurate rewording of questions, directive probes, nonverbal cues or inappropriate feedback. (3) Real or perceived judgment on the part of the interviewer, or concerns participants have about the privacy of their responses, may prevent them from providing honest answers to sensitive questions.
Although the bulk of survey data from developing countries--including Demographic and Health Survey (DHS) data sets--is traditionally collected in face-to-face interviews, increasing use has been made of technology-based alternatives, such as audio computer-assisted self-interviewing (audio-CASI). (4) With this method, participants listen to questions through headphones and enter responses using an electronic device, such as a laptop or handheld computer. This technique provides greater standardization than other interview methods by administering an identical script to each respondent and by eliminating interviewer effects. Audio-CAM also affords greater privacy to participants than other modes, and thus has the potential to reduce social desirability bias in the reporting of sensitive or stigmatized behaviors.
Use of audio-CASI has been shown to be feasible in low-resource settings (e. …