title: A randomised controlled trial of computer-assisted interviewing in sexual health clinics.
abstract: OBJECTIVE
  To assess the impact of computer-assisted interview compared with pen and paper on disclosure of sexual behaviour, diagnostic testing by clinicians, infections diagnosed and referral for counselling.
  
  
  METHODS
  Two-centre parallel three-arm randomised controlled open trial. Computer-generated randomisation with allocation concealment using sealed envelopes.
  
  
  METHODS
  Two London teaching hospital sexual health clinics.
  
  
  METHODS
  2351 clinic attenders over the age of 16 years.
  
  
  METHODS
  Computer-assisted self-interview (CASI). Computer-assisted personal interview (CAPI). Pen and paper interview (PAPI).
  
  
  METHODS
  Diagnostic tests ordered, sexually transmitted infections (STI).
  
  
  RESULTS
  Disclosure of sexual risk, referral for counselling.
  
  
  RESULTS
  801, 763 and 787 patients randomly allocated to receive CASI, CAPI and PAPI. 795, 744 and 779 were available for intention-to-treat analysis. Significantly more diagnostic testing for hepatitis B and C and rectal samples in the CAPI arm (odds for more testing relative to PAPI 1.32; 95% CI 1.09 to 1.59). This pattern was not seen among CASI patients. HIV testing was significantly lower among CASI patients (odds for less testing relative to PAPI 0.73; 95% CI 0.59 to 0.90). STI diagnoses were not significantly different by trial arm. A summary measure of seven prespecified sensitive behaviours found greater reporting with CASI (OR 1.4; 95% CI 1.2 to 1.6) and CAPI (OR 1.4; 95% CI 1.2 to 1.7) compared with PAPI.
  
  
  CONCLUSIONS
  CASI and CAPI can generate greater recording of risky behaviour than traditional PAPI. Increased disclosure did not increase STI diagnoses. Safeguards may be needed to ensure that clinicians are prompted to act upon disclosures made during self-interview.
authors.affiliation: Research Department of Infection and Population Health, University College London, London, UK. jrichens@gum.ucl.ac.uk
authors.forename: John
authors.initials: J
authors.lastname: Richens
authors.forename: Andrew
authors.initials: A
authors.lastname: Copas
authors.forename: Syed Tariq
authors.initials: ST
authors.lastname: Sadiq
authors.forename: Patricia
authors.initials: P
authors.lastname: Kingori
authors.forename: Ona
authors.initials: O
authors.lastname: McCarthy
authors.forename: Victoria
authors.initials: V
authors.lastname: Jones
authors.forename: Philip
authors.initials: P
authors.lastname: Hay
authors.forename: Kevin
authors.initials: K
authors.lastname: Miles
authors.forename: Richard
authors.initials: R
authors.lastname: Gilson
authors.forename: John
authors.initials: J
authors.lastname: Imrie
authors.forename: Mark
authors.initials: M
authors.lastname: Pakianathan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000554:Ambulatory Care Facilities; D003376:Counseling; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D005260:Female; D006801:Humans; D007407:Interviews as Topic / Q000379:methods*; D008131:London; D008297:Male; D008875:Middle Aged; D012650:Self Disclosure; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000517:prevention & control*; D055815:Young Adult