A randomised controlled trial of computer-assisted interviewing in sexual health clinics.
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.
Richens
John
J
Research Department of Infection and Population Health, University College London, London, UK. jrichens@gum.ucl.ac.uk
Copas
Andrew
A
Sadiq
Syed Tariq
ST
Kingori
Patricia
P
McCarthy
Ona
O
Jones
Victoria
V
Hay
Philip
P
Miles
Kevin
K
Gilson
Richard
R
Imrie
John
J
Pakianathan
Mark
M
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