摘要：Objectives. We compared reports of sexual behaviors given in standard face-to-face interviews with reports given in audio computer-assisted self-interviews (ACASIs) and culturally specific interactive interviews among adolescents in India. We sought to determine which of the interview methods leads to higher reporting of sexual behaviors among economically disadvantaged 15–19-year-olds in urban India. Methods. We conducted a randomized trial in which each participant (583 boys and 475 girls) was assigned to 2 interview methods: face-to-face interview and ACASI or interactive interview. We used matched case–control analyses to assess differences in the individual’s reporting on the 2 methods. Results. Female participants consistently reported fewer sexual behaviors in ACASIs than in face-to-face interviews, whereas male participants’ reports differed according to type of sexual behavior and interview mode. Both male and female participants reported more sexual behaviors during interactive interviews than during face-to-face interviews. Twenty-eight percent of male participants reported having engaged in heterosexual intercourse in interactive interviews, as compared with 20% in face-to-face interviews ( P < .01); the corresponding percentages for female participants were 7% and 2% ( P <.01). Conclusions. Our results showed that young people were more likely to report sexual behaviors in culturally specific interactive interviews than in face-to-face interviews. By contrast, ACASIs did not uniformly lead to higher reporting levels than did face-to-face interviews. Sexual health issues can be intensely private and at the same time circumscribed by strict social norms. Understandably, it is often difficult to gather accurate information on sexual behaviors, 1 and this is especially the case with young people in settings where premarital sexual experience is taboo. However, such information is essential if reproductive health programs aimed at young people are to be effective. Given that the global population of 10- to 19-year-olds is 1.2 billion, 2 there is an urgent need for initiatives targeting the needs of this group. In India, adolescent health issues have been largely neglected, even though the country is home to 230 million adolescents. 3 – 5 The sexual health of young men and young women has gained attention in India only recently, and this attention has been the result of concern that adolescents will be the group worst hit by the country’s AIDS epidemic. 6 , 7 Face-to-face interviews are the most frequently used method of obtaining information on adolescents’ sexual behaviors. However, they may lead to underreporting because of concerns about privacy and confidentiality, fear of judgment on the part of interviewers, and social desirability bias (i.e., the desire to present oneself in a manner that will be viewed favorably by others). 8 – 10 Audio computer-assisted self-interviews (ACASIs) have been suggested as an effective alternative that will encourage honest reporting of sensitive behaviors. 1 , 11 – 15 ACASIs involve a standardized measurement system in which all respondents answer the same questions; as a result, interviewer biases are limited. Also, ACASIs feature quality checks (e.g., monitoring of response consistency) and efficient multilingual administration, and they create an automatic data set that can be used immediately. 1 , 12 – 16 However, the ACASI format does not provide an opportunity to probe or clarify potentially misunderstood or unclear questions. Respondents can skip questions, or they can respond to questions without according them a sufficient amount of thought. 9 The ACASI format has not been used extensively in developing countries. However, in a recent Brazilian study in which biomarkers for sexually transmitted infections were used to validate interview-based reports of sexual behaviors among literate women aged 18 to 40 years, results showed that ACASIs led to significantly higher reporting rates than did face-to-face interviews. 17 The results of a methodological experiment conducted in Kenya 18 showed a mixed pattern. ACASIs produced a more diverse picture of adolescent sexual activity than did face-to-face interviews. However, adolescent girls were significantly more likely to report having had sexual intercourse in face-to-face interviews than in ACASIs or self-administered interviews. 18 , 19 In another study, designed to assess the feasibility of ACASI in Zimbabwe, 86% of women preferred ACASIs to face-to-face interviews. However, 53% of women with a primary school education or less reported problems with computer use (as compared with only 10%–12% of women in higher educational groups). 16 Finally, a randomized trial conducted in Pune, India, 20 that involved 1500 unmarried men aged 18 to 22 years compared reports of stigmatized sexual behaviors in ACASIs, face-to-face interviews, and self-administered interviews. Results showed that respondents more frequently reported behaviors such as masturbation, oral sex, and homosexual activity in ACASIs than in face-to-face interviews. Although ACASIs were successful in eliciting information among computer-literate college students, results from less-educated men living in economically disadvantaged neighborhoods were mixed. Men living in these neighborhoods more often reported having sexual intercourse in face-to-face interviews than in ACASIs (35% vs 11%; P = .001). We conducted a randomized crossover study in Delhi, India, in which we compared young people’s reports of their sexual behaviors in standard face-to-face interviews with their reports in ACASIs and interactive interviews. We hypothesized that, in comparison with face-to-face interviews, ACASIs and interactive interviews would produce less social desirability bias and would encourage more-honest reporting of sexual behaviors and experiences.
