AIDS and Behavior

, Volume 17, Issue 6, pp 2260–2268

Color-Coded Audio Computer-Assisted Self-Interviews (C-ACASI) for Poorly Educated Men and Women in a Semi-rural Area of South India: “Good, Scary and Thrilling”

  • Tarun Bhatnagar
  • Joelle Brown
  • P. Sakthivel Saravanamurthy
  • Raju Mohan Kumar
  • Roger Detels
Original Paper

Abstract

It is challenging to collect accurate and complete data on sensitive issues such as sexual behaviors. Our objective was to explore experience and perceptions regarding the use of a locally programmed color-coded audio computer-assisted self interview (C-ACASI) system among men and women in a semi-rural setting in south India. We conducted a mixed-methods cross-sectional survey using semi-structured interviews among 89 truck drivers and 101 truck driver wives who had participated earlier in the C-ACASI survey across a predominantly rural district in Tamil Nadu. To assess the color-coded format used, descriptive quantitative analysis was coupled with thematic content analysis of qualitative data. Only 10 % of participants had ever used a computer before. Nearly 75 % did not report any problem in using C-ACASI. The length of the C-ACASI survey was acceptable to 98 % of participants. Overall, 87 % of wives and 73 % of truck drivers stated that C-ACASI was user-friendly and felt comfortable in responding to the sensitive questions. Nearly all (97 %) participants reported that using C-ACASI encouraged them to respond honestly compared to face-to-face personal interviews. Both the drivers and wives expressed that C-ACASI provided confidentiality, privacy, anonymity, and an easy mechanism for responding truthfully to potentially embarrassing questions about their personal sexual relationships. It is feasible and acceptable to use C-ACASI for collecting sensitive data from poorly computer-literate, non-English-speaking, predominantly rural populations of women and men. Our findings support the implementation of effective and culturally sensitive C-ACASI for data collection, albeit with additional validation.

Keywords

Color-coded ACASI Computer interview Sensitive questions Acceptability Rural India 

References

  1. 1.
    Catania JA, Gibson DR, Chitwood DD, Coates TJ. Methodological problems in AIDS behavioral research: influences on measurement error and participation bias in studies of sexual behavior. Psychol Bull. 1990;108(3):339–62.PubMedCrossRefGoogle Scholar
  2. 2.
    Turner CF, Ku L, Rogers SM, Lindberg LD, Pleck JH, Sonenstein FL. Adolescent sexual behavior, drug use, and violence: increased reporting with computer survey technology. Science. 1998;280(5365):867–73.PubMedCrossRefGoogle Scholar
  3. 3.
    Metzger DS, Koblin B, Turner C, et al. Randomized controlled trial of audio computer-assisted self-interviewing: utility and acceptability in longitudinal studies. HIVNET Vaccine Preparedness Study Protocol Team. Am J Epidemiol. 2000;152(2):99–106.PubMedCrossRefGoogle Scholar
  4. 4.
    Tourangeau R, Yan T. Sensitive questions in surveys. Psychol Bull. 2007;133(5):859–83.PubMedCrossRefGoogle Scholar
  5. 5.
    Gribble J. Interview mode and measurement of sexual behaviors: methodological issues. J Sex Res. 1999;36(1):16–24.PubMedCrossRefGoogle Scholar
  6. 6.
    Fenton KA, Johnson AM, McManus S, Erens B. Measuring sexual behaviour: methodological challenges in survey research. Sex Transm Infect. 2001;77(2):84–92.PubMedCrossRefGoogle Scholar
  7. 7.
    Mensch BS, Hewett PC, Gregory R, Helleringer S. Sexual behavior and STI/HIV status among adolescents in rural Malawi: an evaluation of the effect of interview mode on reporting. Studies Family Plan. 2008;39(4):321–34.CrossRefGoogle Scholar
  8. 8.
    NIMH Collaborative HIV/STD Prevention Trial Group. The feasibility of audio computer-assisted self-interviewing in international settings. AIDS. 2007;21(Suppl 2):S49–58.CrossRefGoogle Scholar
  9. 9.
    NIMH Multisite HIV/STD Prevention Trial for African American Couples Group. Designing an audio computer-assisted self-interview (ACASI) system in a multisite trial: a brief report. J Acquir Immune Defic Syndr. 2008;49(Suppl 1):S52–8.Google Scholar
  10. 10.
    Langhaug LF, Cheung YB, Pascoe SJS, et al. How you ask really matters: randomised comparison of four sexual behaviour questionnaire delivery modes in Zimbabwean youth. Sex Transm Infect. 2010;87(2):165–73.PubMedCrossRefGoogle Scholar
  11. 11.
    Reichmann WM, Losina E, Seage GR, et al. Does modality of survey administration impact data quality: audio computer assisted self interview (ACASI) versus self-administered pen and paper? PLoS ONE. 2010;5(1):e8728.PubMedCrossRefGoogle Scholar
  12. 12.
    Minnis AM, Muchini A, Shiboski S, et al. Audio computer-assisted self-interviewing in reproductive health research: reliability assessment among women in Harare. Zimb Contracept. 2007;75(1):59–65.CrossRefGoogle Scholar
  13. 13.
    Edwards SL, Slattery ML, Murtaugh MA, et al. Development and use of touch-screen audio computer-assisted self-interviewing in a study of American Indians. Am J Epidemiol. 2007;165(11):1336–42.PubMedCrossRefGoogle Scholar
  14. 14.
    Gribble JN, Miller HG, Cooley PC, Catania JA, Pollack L, Turner CF. The impact of T-ACASI interviewing on reported drug use among men who have sex with men. Subst Use Misuse. 2000;35(6–8):869–90.PubMedCrossRefGoogle Scholar
  15. 15.
    van de Wijgert J, Padian N, Shiboski S, Turner C. Is audio computer-assisted self-interviewing a feasible method of surveying in Zimbabwe? Int J Epidemiol. 2000;29(5):885–90.PubMedCrossRefGoogle Scholar
  16. 16.
    Hewett PC, Mensch BS, Erulkar AS. Consistency in the reporting of sexual behaviour by adolescent girls in Kenya: a comparison of interviewing methods. Sex Transm Infect. 2004;80(Suppl 2):43–8.Google Scholar
  17. 17.
    Mensch BS, Hewett PC, Abbott S, et al. Assessing the reporting of adherence and sexual activity in a simulated microbicide trial in South Africa: an interview mode experiment using a placebo gel. AIDS Behav. 2011;15(2):407–21.PubMedCrossRefGoogle Scholar
  18. 18.
    Potdar R, Koenig MA. Does Audio-CASI improve reports of risky behavior? Evidence from a randomized field trial among young urban men in India. Studies Family Plan. 2005;36(2):107–16.CrossRefGoogle Scholar
  19. 19.
    Le LC, Blum RW, Magnani R, Hewett PC, Do HM. A pilot of audio computer-assisted self-interview for youth reproductive health research in Vietnam. J Adolesc Hlth. 2006;38(6):740–7.CrossRefGoogle Scholar
  20. 20.
    van Griensven F, Naorat S, Kilmarx PH, et al. Palmtop-assisted self-interviewing for the collection of sensitive behavioral data: randomized trial with drug use urine testing. Am J Epidemiol. 2006;163(3):271–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Jaya J, Hindin MJ, Ahmed S. Differences in young people’s reports of sexual behaviors according to interview methodology: a randomized trial in India. Am J Pub Hlth. 2008;98(1):169–74.CrossRefGoogle Scholar
  22. 22.
    Gutierrez JP, Torres-Pereda P. Acceptability and reliability of an adolescent risk behavior questionnaire administered with audio and computer support. Rev Panam Salud Publica. 2009;25(5):418–22.PubMedCrossRefGoogle Scholar
  23. 23.
    Judd A, Rhodes T, Johnston LG, et al. Improving survey methods in sero-epidemiological studies of injecting drug users: a case example of two cross sectional surveys in Serbia and Montenegro. BMC Infect Dis. 2009;9:14.PubMedCrossRefGoogle Scholar
  24. 24.
    Pluhar E. McDonnell Holstad M, et al. Implementation of audio computer-assisted interviewing software in HIV/AIDS research. J Assoc Nurses AIDS Care. 2007;18(4):51–63.PubMedCrossRefGoogle Scholar
  25. 25.
    Plummer ML, Ross DA, Wight D, et al. “A bit more truthful”: the validity of adolescent sexual behaviour data collected in rural northern Tanzania using five methods. Sex Transm Infect. 2004;80(Suppl 2):49–56.Google Scholar
  26. 26.
    Plummer ML, Wight D, Ross DA, et al. Asking semi-literate adolescents about sexual behaviour: the validity of assisted self-completion questionnaire (ASCQ) data in rural Tanzania. Trop Med Int Hlth. 2004;9(6):737–54.CrossRefGoogle Scholar
  27. 27.
    Jaspan HB, Flisher AJ, Myer L, et al. Brief report: methods for collecting sexual behaviour information from South African adolescents—a comparison of paper versus personal digital assistant questionnaires. J Adolesc. 2007;30(2):353–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Bernabe-Ortiz A, Curioso WH, Gonzales MA, et al. Handheld computers for self-administered sensitive data collection: a comparative study in Peru. BMC Med Inform Decis Mak. 2008;8:11.PubMedCrossRefGoogle Scholar
  29. 29.
    van der Elst EM, Okuku HS, Nakamya P, et al. Is audio computer-assisted self-interview (ACASI) useful in risk behaviour assessment of female and male sex workers, Mombasa, Kenya? PLoS ONE. 2009;4(5):e5340.PubMedCrossRefGoogle Scholar
  30. 30.
    Simoes AA, Bastos FI, Moreira RI, Lynch KG, Metzger DS. Acceptability of audio computer-assisted self-interview (ACASI) among substance abusers seeking treatment in Rio de Janeiro. Brazil Drug Alcohol Depend. 2006;82(Suppl 1):S103–7.CrossRefGoogle Scholar
  31. 31.
    Hewett PC, Mensch BS, Ribeiro MC, et al. Using sexually transmitted infection biomarkers to validate reporting of sexual behavior within a randomized, experimental evaluation of interviewing methods. Am J Epidemiol. 2008;168(2):202–11.PubMedCrossRefGoogle Scholar
  32. 32.
    Rathod SD, Minnis AM, Subbiah K, Krishnan S. ACASI and face-to-face interviews yield inconsistent estimates of domestic violence among women in India: The Samata Health Study 2005–2009. J Interpers Violence. 2011;26(12):2437–56.PubMedCrossRefGoogle Scholar
  33. 33.
    Census of India. Population Totals of Namakkal District New Delhi: Registrar General of India; 2001. http://www.namakkal.tn.nic.in/census.htm#2. Accessed 18 Dec 2007.
  34. 34.
    Kissinger P, Rice J, Farley T, et al. Application of computer-assisted interviews to sexual behavior research. Am J Epidemiol. 1999;149(10):950–4.PubMedCrossRefGoogle Scholar
  35. 35.
    Substance Abuse and Mental Health Services Administration. Executive Summary: Development of Computer-Assisted Interviewing Procedures for the National Household Survey on Drug Abuse, 2008. http://www.oas.samhsa.gov/nhsda/CompAssistInterview/es.htm. Accessed 16 May 2011.
  36. 36.
    Estes LJ, Lloyd LE, Teti M, et al. Perceptions of audio computer-assisted self-interviewing (ACASI) among women in an HIV-positive prevention program. PLoS ONE. 2010;5(2):e9149.PubMedCrossRefGoogle Scholar
  37. 37.
    Jones R. Relationships of sexual imposition, dyadic trust, and sensation seeking with sexual risk behavior in young urban women. Res Nurs Hlth. 2004;27(3):185–97.CrossRefGoogle Scholar
  38. 38.
    Verma RK, Collumbien M. Homosexual activity among rural Indian men: implications for HIV interventions. AIDS. 2004;18(13):1845–7.PubMedCrossRefGoogle Scholar
  39. 39.
    Asthana S, Oostvogels R. The social construction of male ‘homosexuality’ in India: implications for HIV transmission and prevention. Soc Sci Med. 2001;52(5):707–21.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Tarun Bhatnagar
    • 1
    • 2
  • Joelle Brown
    • 3
  • P. Sakthivel Saravanamurthy
    • 4
  • Raju Mohan Kumar
    • 5
  • Roger Detels
    • 2
  1. 1.National Institute of Epidemiology, Indian Council of Medical ResearchChennaiIndia
  2. 2.Department of EpidemiologyUCLA Fielding School of Public HealthLos AngelesUSA
  3. 3.Department of Obstetrics and GynecologyUniversity of California, San FranciscoSan FranciscoUSA
  4. 4.Voluntary Health Services – CHARTEREDChennaiIndia
  5. 5.State Health SocietyNational Rural Health Mission, Government of Tamil NaduChennaiIndia

Personalised recommendations