title: Methods to increase reporting of childhood sexual abuse in surveys: the sensitivity and specificity of face-to-face interviews versus a sealed envelope method in Ugandan primary school children.
abstract: Underreporting of childhood sexual abuse is a major barrier to obtaining reliable prevalence estimates. We tested the sensitivity and specificity of the face-to-face-interview (FTFI) method by comparing the number of disclosures of forced sex against a more confidential mode of data collection, the sealed-envelope method (SEM). We also report on characteristics of individuals associated with non-disclosure in FTFIs.
  
  
  
  Secondary analysis of data from a cross-sectional survey conducted in 2014, with n = 3843 children attending primary school in Luwero District, Uganda. Sensitivity and specificity were calculated, and mixed effects logistic regression models tested factors associated with disclosure in one or both modes.
  
  
  
  In the FTFI, 1.1% (n = 42) of children reported ever experiencing forced sex, compared to 7.0% (n = 268) in the SEM. The FTFI method demonstrated low sensitivity (13.1%, 95%CI 9.3-17.7%) and high specificity (99.8%, 95%CI 99.6-99.9%) in detecting cases of forced sex, when compared to the SEM. Boys were less likely than girls to disclose in the FTFI, however there was no difference in prevalence by sex using the SEM (aOR = 0.91, 95%CI 0.7-1.2; P = 0.532). Disclosing experience of other forms of sexual violence was associated with experience of forced sex for both modes of disclosure.
  
  
  
  The SEM method was superior to FTFIs in identifying cases of forced sex amongst primary school children, particularly for boys. Reporting of other forms of sexual violence in FTFIs may indicate experience of forced sex. Future survey research, and efforts to estimate prevalence of sexual violence, should make use of more confidential disclosure methods to detect childhood sexual abuse.
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.|Department of Medicine, University of Cambridge, Cambridge, UK.
authors.forename: Anna Louise
authors.initials: AL
authors.lastname: Barr
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
authors.forename: Louise
authors.initials: L
authors.lastname: Knight
authors.affiliation: School of Public Health, University of São Paulo, State of São Paulo, Brazil.
authors.forename: Ivan
authors.initials: I
authors.lastname: Franҫa-Junior
authors.affiliation: Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Allen
authors.affiliation: Raising Voices, 16 Tufnell Drive, P.O. Box 6770, Kamwokya, Kampala, Uganda.
authors.forename: Dipak
authors.initials: D
authors.lastname: Naker
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK. karen.devries@lshtm.ac.uk.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Devries
mesh_terms: D000293:Adolescent; D002650:Child Abuse, Sexual; D003219:Confidentiality; D003430:Cross-Sectional Studies; D030881:Disclosure; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D015995:Prevalence; D012574:Schools; D011795:Surveys and Questionnaires; D014454:Uganda / Q000453:epidemiology
keywords: Africa; Child sexual abuse; Confidential methods; Disclosure; Face-to-face interviews; Methodology; Reporting; Sexual violence; Uganda; Violence