Collecting accurate data on the sexual behaviour of adolescents can be difficult.  Respondents may give inaccurate answers for a variety of reasons. Many young people find it difficult to speak openly about their sexual health and behaviour. In rural Tanzania, where the standard of education is low, poor literacy is also a barrier to completion of questionnaires. Methods of data collection must be responsive to young people's particular circumstances.

Researchers from the London School of Hygiene and Tropical Medicine tested the usefulness of assisted self-completion questionnaires (ASCQs).  These are considered a compromise between face-to-face interviews and self-completion questionnaires (SQAs). In the former, adolescents may be more inclined to give answers that they believe are socially acceptable, whether true or not. Whilst SQAs guarantee more privacy, they demand a standard of literacy adequate to read and understand the questions. 

Each question and possible answer from an ASCQ is read aloud by a researcher. To fill in their answers, the respondents only need to follow the question numbers and the letters for each answer option.

The researchers compared the results of a 1998 ASCQ survey of 6,079 primary school students with those of three overlapping sub-groups: 4,958 students in a 1998 face-to-face interview (FFQ); 4,424 students in an ASCQ conducted 18 months later; and a relatively small number of young people who participated in qualitative research (i.e. in-depth interviews, focus group sessions and participant observation. Answers to questions asked in both the 1998 ASCQ and FFQ were compared assess consistency during the same time period.

The 1998 and 2000 ASCQ results were compared to assess consistency over time, for example if an individual reported a higher total number of partners in the 1998 survey than in 2000. Qualitative findings were used to assess the plausibility of the quantitative results. The analysis found that:

• The 1998 ASCQ socio-demographic characteristics and some of the sexual and reproductive knowledge, attitudes and behaviour results seemed plausible.  However some of the sexual behaviour results were problematic, due to bias related to answer order or inconsistencies between answers.
• A minority of ASCQ respondents selected only first or only last answer options in sections for which this was illogical. This may have related to poor comprehension, unease with the sexual topic, and/or frustration with questionnaire length.
• In 1998 and 2000, the majority of respondents did not appear to have difficulty completing the ASCQ, suggesting this method has promise.  Screening of respondents who could not or would not answer logically and consistently was generally effective.
• Reports of sensitive behaviour were sometimes higher in the 1998 ASCQ than in the FFQ. Overall the 1998 surveys had similar results, but comparison at an individual level showed some great inconsistencies.
• The high proportion of respondents who unreliably reported vaginal intercourse in two surveys raises questions about the validity of sexual behaviour data collected in surveys in general.

Implications for future ASCQ surveys include:

• This method in an African setting has most potential among older, male and/or more educated adolescents.
• Biases may decrease with shorter questionnaires and random allocation of answer order.  Many questions should be repeated to assess internal consistency.
• Careful screening should be done to exclude individuals who cannot or do not complete the questionnaire correctly. This should take place both before administering the questionnaire, and during data analysis.   

Source(s):
‘Asking semi-literate adolescents about sexual behaviour: the validity of assisted self-completion questionnaire (ASCQ) data in rural Tanzania’, Tropical Medicine and International Health 9(6): 737-754, by M.L. Plummer et al, 2004
HINARI subscribers can access the full-text article here. Full document.

Funded by: UK Medical Research Council; European Commission; UK Department for International Development

id21 Research Highlight: 23 March 2005

Further Information:
Mary L. Plummer
Department of Infectious and Tropical Diseases
London School of Hygiene and Tropical Medicine
Keppel St
London WC1E 7HT
UK

Tel: +44 (0) 20 7927 2302
Fax: +44 (0) 20 7612 7860
Contact the contributor: mary.plummer@lshtm.ac.uk

London School of Hygiene and Tropical Medicine, UK

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'Friends in deed – preventing HIV through peer education in South African schools'

'Adolescent sexual health in Zambia - peer interviews reveal all'

'Intergenerational deadlock? Confronting the AIDS crisis in Tanzania'

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