Assessment of self-reported sexual behavior and condom use among female sex workers in India using a polling box approach: a preliminary report.
BACKGROUND
The accuracy of behavioral data related to risk for HIV and other sexually transmitted infections is prone to misreporting because of social desirability effects. Because computer-assisted approaches are not always feasible, a noncomputerized interview method for reducing social desirability effects is needed. The previous performance of alternative methods has been limited to aggregate data or constrained by the simplicity of dichotomous-only responses. We designed and tested a "polling box" method for case-attributable, multiple-response survey items in a low literacy population.


METHODS
A cross-sectional survey was conducted with 812 female sex workers in Andhra Pradesh, India. For a subset of questions embedded in a face-to-face survey questionnaire, every third participant was provided graphical response cards upon which to mark their answer and place in a polling box outside the view of the interviewer. Multiple logistic regression analysis was used to test for response differences to questions about socially undesirable, socially desirable, or sensitivity-neutral behaviors in the 2 interview methods.


RESULTS
Polling box participants demonstrated higher reporting of risky sexual behaviors and lower reporting of condom use, with no conclusive response patterns among sensitivity-neutral items.


CONCLUSIONS
Our findings suggest that the polling box approach provides a promising technique for improving the accurate reporting of sensitive behaviors among a low-literacy population in a resource poor setting. Additional research is needed to test logistical adaptations of the polling box approach.
Hanck
Sarah E
SE
Center for Interdisciplinary Research on AIDS (CIRA), Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut, USA. sarah.e.hanck@gmail.com
Blankenship
Kim M
KM
Irwin
Kevin S
KS
West
Brooke S
BS
Kershaw
Trace
T
D000293:Adolescent; D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D016015:Logistic Models; D011314:Preventive Health Services; D011477:Sex Work; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D011795:Surveys and Questionnaires