'I was honest, but not that much': A qualitative investigation of acceptability of ACASI and self-reports of honesty in a simulated microbicide trial
Poster presentation at the XVIII International AIDS Conference, Vienna, 22 July
Abbott,Sharon; Mensch,Barbara S.; Katzen,Lauren L.
Publication date: 2010
Audio computer-assisted self-interviewing (ACASI), developed to improve accuracy in the reporting of sensitive behaviors, has been used increasingly in HIV prevention research. While ACASI has been found to be feasible in low-literacy settings and acceptable to participants, few studies have explored users' perceptions with regard to confidentiality and honesty.
A qualitative exploration of two interview modes was integrated into a simulated microbicide trial, designed to determine whether ACASI produces better reporting of adherence. A total of 849 women were enrolled in three clinics in South Africa. Participants were given placebo gels to use before sex and randomly assigned to either face-to-face interviews (FTFI) or ACASI for monthly behavioral interviews. At closing, in-depth interviews were conducted with 75 women to explore perceptions of confidentiality, self-reports of honesty, and for those in the ACASI arm, comfort using the computer.
Women preferred the interview method to which they were randomly assigned, although this was nearly unanimous in the ACASI arm (92% ACASI and 58% FTFI). Participants in the FTFI arm reported personal contact and the opportunity to ask questions as desirable, while those in the ACASI arm cited confidentiality, lack of judgment, and decreased embarrassment. Frequency of anal and oral sex, number of sex partners, and use of the gel were reported as the most sensitive questions. Questions about condom use and prior STIs were expected, and thus caused little discomfort. Although ACASI users believed that their responses were confidential, reluctance to be completely honest was attributed to a sense of embarrassment or offense at the question. Participants in the FTFI arm also listed fear of judgment and difficulties in recall.
Cultural norms continue to influence self-reporting, even with the anonymity provided by ACASI. To increase accurate reporting, efforts should be made to soothe participants' discomfort while providing direct relevance for difficult topics.