摘要：Objectives. This study assessed the differential effects of face-to-face interviewing and audio-computer assisted self-interviewing (audio-CASI) on categories of questions. Methods. Syringe exchange program participants (n = 1417) completed face-to-face interviews or audio-CASI. The questionnaire was categorized into the groups “stigmatized behaviors,” “neutral behaviors,” and “psychological distress.” Interview modes were compared for questions from each category. Results. Audio-CASI elicited more frequent reporting of “stigmatized behaviors” than face-to-face interviews. Face-to-face interviewing elicited more frequent reporting of “psychological distress” than audio-CASI. Conclusions. Responding to potentially sensitive questions should not be seen as merely “providing data,” but rather as an activity with complex motivations. These motivations can include maintaining social respect, obtaining social support, and altruism. Ideally, procedures for collecting self-report data would maximize altruistic motivation while accommodating the other motives. Many areas of health and behavioral research rely on self-report data, despite the knowledge that such data may not always be accurate and complete. Factors that motivate participation in research are complex 1 and may lead to differential responding within different interview modes. For example, response bias can occur as a result of respondents' desire to present themselves in a favorable light. 2 There is substantial evidence that selfreports of drug use and other stigmatized behaviors vary by mode of interview. 3– 5 Studies have shown that the level of information revealed by a respondent is positively related to the level of privacy of the interview. Methodological problems regarding self-report questionnaires can have a profound impact in fields such as HIV/AIDS research, where such questionnaires are the primary means of obtaining information on risk behaviors. New interview methods are being developed to improve the quality of self-report data. One such innovation is computer assisted self-interviewing (CASI), in which respondents read survey questions on a computer screen and then directly enter their responses into the computer. In audio-CASI, the questions are presented on the computer screen and read to the respondent through headphones, facilitating use by respondents who are not literate in the interview language. Several studies have addressed the effects of CASI, generating complex and, at times, contradictory findings. Comparisons of CASI with face-to-face interviewing have concluded that subjects completing computer interviews disclose more socially undesirable attitudes, facts, and behaviors. 6– 9 Others have reported contrary information, finding that respondents reported more socially undesirable behavior in the face-to-face interview modes than with CASI. 10 Little or no difference between CASI and face-to-face interviews also has been reported. 11– 13 A recent study by Williams et al. 14 comparing the reliability of self-reports of risk behaviors using CASI and face-to-face interviewing underscores the complexity of mode effects. The investigators did not find that CASI elicited more reporting of risk behaviors—the 2 modes were comparable in terms of the reliability of self-reports of HIV risk behaviors—but biases were detected in the reported number of times participants engaged in risk behavior. Additionally, there may be some circumstances in which respondents find answering to a computer to be “impersonal,” and this may affect reporting of specific attitudes and behaviors. In one study, individuals interviewed face-to-face were more likely to report psychiatric symptoms and depression than individuals interviewed by telephone—which, like audio-CASI, is a more anonymous mode. 15 Increased disclosure of psychiatric symptoms in a face-to-face interview may demonstrate the use of the interview process by patients as a “cry for help.” 16, 17 Respondents may use the interview as an opportunity to garner sympathy or social support for their emotional problems. 18, 19 Thus, the interview process may, in fact, serve as a medium for interpersonal connection, motivating respondents to express their true problems. Reducing the role of the human interviewer may therefore make the interview process “impersonal” for respondents and may reduce the likelihood that they will disclose the types of psychological distress for which sympathy or social support might be expected. No study to date, however, has addressed the effects of audio-CASI on distress questions. We examined the effects of interview mode on self-disclosure for heavily “stigmatized behaviors,” for which embarrassment would be very likely and social support unlikely, and for “psychological distress,” for which social support would be likely and embarrassment less likely.
