Academic journal article International Public Health Journal

Condom Use Measurement in Adolescent HIV Prevention Research: Is Briefer Better?

Academic journal article International Public Health Journal

Condom Use Measurement in Adolescent HIV Prevention Research: Is Briefer Better?

Article excerpt

Introduction

Other than abstinence, correct and consistent condom use is the most effective method for preventing HIV/AIDS. Increasing condom use among adolescents is a target of many HIV prevention interventions, and demonstrating the efficacy of these interventions often relies on establishing condom use behavior change. However, there is no "gold standard" for condom use measurement and all such measures are subject to threats to validity and reliability. A review of the literature identified more than 70 measures of condom use in studies that correlated condom use with sexual risk behavior (1). Among the studies reviewed, the most common formats were ordinal frequency measures asking how often condoms were used (36%), dichotomous formats with yes/no questions about condom use (28%), and proportional measures calculated from the number of protected sexual occasions divided by the total number of sexual occasions (21%).

Little is known about which condom use measurement formats yield the most reliable and valid data among adolescents. One study found that although adolescent reports of sexual behaviors such as engaging in vaginal sex in the last three months (kappa = .72) and number of lifetime sexual partners (intraclass correlation (ICC) = .81) were moderately to highly consistent when test-retest reliability was measured over a two-week period, consistency regarding use of condoms during last sex (kappa = .62) and participant counts of unprotected vaginal sex acts in a three-month period (ICC = .44) were lower, suggesting that condom use measures may be more vulnerable to threats to reliability (2). Another study found significant inconsistencies among college students in their responses on two measures of condom use (3). Sixty-three percent of respondents indicated that using condoms 18-19 out of 20 times represented "always" using a condom; however, one or two unprotected sex acts represents significantly greater risk than zero. Similar results have been found among high-risk heterosexually active adults (4). Together, these studies suggest that condom use measures are also subject to threats to validity.

Little is known about adolescent participant characteristics associated with unreliable reports on measures of condom use. Other literatures provide clues regarding patterns of unreliable responding. From the substance use literature, Farrell and colleagues (5) found that 33% of adolescents provided inconsistent responses between drug use measured dichotomously (yes/no) and continuously (days used in past month). Those who inconsistently responded reported higher rates of nearly half of the drugs measured than those who were consistent, suggesting that inconsistency in response may be associated with more risk behavior. From the adult sexual risk literature, discrepancies in reports of sexual risk behavior based on data collection method are common, such that the average magnitude of combined underreporting and overreporting discrepancies in unprotected sex was 54% when retrospective surveys were compared to a daily diary method (6). Participants, however, tended to underreport with the retrospective measure relative to the daily diary measure, suggesting that responses may vary depending on the type of measure used to collect data. Gender and sexual orientation were related to accuracy of report, such that MSM were more accurate than heterosexual men or women.

Accurate condom use measurement has direct implications for preventing HIV and other STIs and for public health policies. However, researchers often face dilemmas deciding which condom use measures to use with adolescents. The apparent accuracy of partner-by-partner measures of condom use that yield proportion data may be appealing. However, the burden placed on participants, poor recall accuracy for those with many sexual occasions, and participant frustration that may result from being asked many similar questions may be undesirable. Single items that ask respondents to estimate the frequency of condom use may be appealing for their simplicity, yet researchers may be concerned about the accuracy of data collected by this format because of cognitive biases that may influence responses, such as emphasizing recent or salient events or poor estimating skills. …

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