Audio computer-assisted self-interviewing (ACASI) may avert socially desirable responses about infant feeding in the context of HIV

BACKGROUND: Understanding infant feeding practices in the context of HIV and factors that put mothers at risk of HIV infection is an important step towards prevention of mother to child transmission of HIV (PMTCT). Face-to-face (FTF) interviewing may not be a suitable way of ascertaining this information because respondents may report what is socially desirable. Audio computer-assisted self-interviewing (ACASI) is thought to increase privacy, reporting of sensitive issues and to eliminate socially desirable responses. We compared ACASI with FTF interviewing and explored its feasibility, usability, and acceptability in a PMTCT program in Kenya. METHODS: A graphic user interface (GUI) was developed using Macromedia Authorware(® )and questions and instructions recorded in local languages Kikuyu and Kiswahili. Eighty mothers enrolled in the PMTCT program were interviewed with each of the interviewing mode (ACASI and FTF) and responses obtained in FTF interviews and ACASI compared using McNemar's χ(2 )for paired proportions. A paired Student's t-test was used to compare means of age, marital-time and parity when measuring interview mode effect and two-sample Student's t-test to compare means for samples stratified by education level – determined during the exit interview. A Chi-Square (χ(2)test) was used to compare ability to use ACASI by education level. RESULTS: Mean ages for intended time for breastfeeding as reported by ACASI were 11 months by ACASI and 19 months by FTF interviewing (p < 0.001). Introduction of complementary foods at ≤3 months was reported more frequently by respondents in ACASI compared to FTF interviews for 7 of 13 complementary food items commonly utilized in the study area (p < 0.05). More respondents reported use of unsuitable utensils for infant feeding in ACASI than in FTF interviewing (p = 0.001). In other sensitive questions, 7% more respondents reported unstable relationships with ACASI than when interviewed FTF (p = 0.039). Regardless of education level, respondents used ACASI similarly and majority (65%) preferred it to FTF interviewing mainly due to enhanced usability and privacy. Most respondents (79%) preferred ACASI to FTF for future interviewing. CONCLUSION: ACASI seems to improve quality of information by increasing response to sensitive questions, decreasing socially desirable responses, and by preventing null responses and was suitable for collecting data in a setting where formal education is low

Coparenting and Sexual Partner Concurrency Among White, Black, and Hispanic Men in the United States

Concurrent sexual partnerships (partnerships that overlap in time) increase the spread of infection through a network. Different patterns of concurrent partnerships may be associated with varying STI risk depending on the partnership type (primary vs. non-primary) and the likelihood of condom use with each concurrent partner. We sought to evaluate co-parenting concurrency, overlapping partnerships in which at least one concurrent partner is a co-parent with the respondent, which may promote the spread of sexually transmitted infections (STIs)

Usability testing of a monitoring and feedback tool to stimulate physical activity

Introduction: A monitoring and feedback tool to stimulate physical activity, consisting of an activity sensor, smartphone application (app), and website for patients and their practice nurses, has been developed: the 'It's LiFe!' tool. In this study the usability of the tool was evaluated by technology experts and end users (people with chronic obstructive pulmonary disease or type 2 diabetes, with ages from 40-70 years), to improve the user interfaces and content of the tool. Patients and methods: The study had four phases: 1) a heuristic evaluation with six technology experts; 2) a usability test in a laboratory by five patients; 3) a pilot in real life wherein 20 patients used the tool for 3 months; and 4) a final lab test by five patients. In both lab tests (phases 2 and 4) qualitative data were collected through a thinking-aloud procedure and video recordings, and quantitative data through questions about task complexity, text comprehensiveness, and readability. In addition, the post-study system usability questionnaire (PSSUQ) was completed for the app and the website. In the pilot test (phase 3), all patients were interviewed three times and the Software Usability Measurement Inventory (SUMI) was completed. Results: After each phase, improvements were made, mainly to the layout and text. The main improvement was a refresh button for active data synchronization between activity sensor, app, and server, implemented after connectivity problems in the pilot test. The mean score on the PSSUQ for the website improved from 5.6 (standard deviation [SD] 1.3) to 6.5 (SD 0.5), and for the app from 5.4 (SD 1.5) to 6.2 (SD 1.1). Satisfaction in the pilot was not very high according to the SUMI. Discussion: The use of laboratory versus real-life tests and expert-based versus user-based tests revealed a wide range of usability issues. The usability of the It's LiFe! tool improved considerably during the study

Acceptance, Communication Mode and Use of Audio Computer- Assisted Self Interview Using Touchscreen to Identify Risk Factors among Pregnant Minority Women

This paper evaluates the acceptability, communication mode and use of audio computer-assisted self-interview (A-CASI) among minority pregnant women receiving prenatal care in six Washington, DC sites. A total of 2,913 women were screened for demographic eligibility (18+ years old,gestation, Black/African-American or Hispanic) and risk (smoking, environmental tobacco smoke exposure, depression, intimate partner violence). Questions were displayed on touch screen laptop monitors and heard through earphones. The mean length of time to complete the screener was almost 6 minutes. A-CASI experience, which included difficulty in using the computer, acceptability (enjoyment), and preferred communication mode, was compared across sites, the eligibility and risk groups and a subset of 878 enrolled women for whom educational attainment and receipt of WIC (a proxy for income) were available. Respondents thought A-CASI was not difficult to use and liked using the computer. Black/African-American or Hispanic respondents enjoyed it significantly more than did respondents of other race/ethnicities. Respondents who were demographically eligible, Black/ African-American or Hispanic, or with lower education levels listened to questions significantly more than did their counterparts. Mainly listening or listening and reading does not impact burden in terms of the length of time it took to complete the screener. The acceptance of A-CASI as a screening tool opens the door for more uses of this technology in health-related fields. The laptop computer and headphones provide privacy and mobility so the technology can be used to ask sensitive questions in almost any locale, including busy clinic settings

Int J STD AIDS

BackgroundWhile laboratory aetiological diagnosis is considered the gold standard for diagnosis and management of sexually transmitted infections, syndromic management has been presented as a simplified and affordable approach for sexually transmitted infection management in limited resource settings.MethodsSexually transmitted infection signs and symptoms were collected using staff-administered computer-assisted personal interview and audio computer-assisted self-interview. Participants underwent a medical examination and laboratory testing for common sexually transmitted infections. The performance of syndromic management was assessed on the agreement between interviewing methods as well as accurate diagnosis.ResultsWe screened 846 participants, of whom 88 (10.4%) received syndromic sexually transmitted infection diagnosis while 272 (32.2%) received an aetiological diagnosis. Agreement between syndromic and aetiological diagnoses was very poor (overall kappa = 0.09). The most prevalent sexually transmitted infection was herpes simplex virus type 2 and the percentage of persons with any sexually transmitted infection was higher among women (48.6%) than men (15.6%, p <0.0001). Agreement between audio computer-assisted self-interview and computer-assisted personal interview interviewing methods for syndromic diagnosis of sexually transmitted infections ranged from poor to good.ConclusionOur findings suggest that syndromic management of sexually transmitted infections is not a sufficient tool for sexually transmitted infection diagnosis in this setting; development and improvement of sexually transmitted infection diagnostic capabilities through laboratory confirmation is needed in resource-limited settings.20142015-10-01T00:00:00ZCC999999/Intramural CDC HHS/United States24516075PMC4586058785

Low adherence to exclusive breastfeeding in Eastern Uganda: A community-based cross-sectional study comparing dietary recall since birth with 24-hour recall

BACKGROUND: Exclusive breastfeeding is recommended as the best feeding alternative for infants up to six months and has a protective effect against mortality and morbidity. It also seems to lower HIV-1 transmission compared to mixed feeding. We studied infant feeding practices comparing dietary recall since birth with 24-hour dietary recall. METHODS: A cross-sectional survey on infant feeding practices was performed in Mbale District, Eastern Uganda in 2003 and 727 mother-infant (0–11 months) pairs were analysed. Four feeding categories were made based on WHO's definitions: 1) exclusive breastfeeding, 2) predominant breastfeeding, 3) complementary feeding and 4) replacement feeding. We analyzed when the infant fell into another feeding category for the first time. This was based on the recall since birth. Life-table analysis was made for the different feeding categories and Cox regression analysis was done to control for potential associated factors with the different practices. Prelacteal feeding practices were also addressed. RESULTS: Breastfeeding was practiced by 99% of the mothers. Dietary recall since birth showed that 7% and 0% practiced exclusive breastfeeding by 3 and 6 months, respectively, while 30% and 3% practiced predominant breastfeeding and had not started complementary feeding at the same points in time. The difference between the 24-hour recall and the recall since birth for the introduction of complementary feeds was 46 percentage points at two months and 59 percentage points at four months. Prelacteal feeding was given to 57% of the children. High education and formal marriage were protective factors against prelacteal feeding (adjusted OR 0.5, 0.2 – 1.0 and 0.5, 0.3 – 0.8, respectively). CONCLUSION: Even if breastfeeding is practiced at a very high rate, the use of prelacteal feeding and early introduction of other food items is the norm. The 24-hour recall gives a higher estimate of exclusive breastfeeding and predominant breastfeeding than the recall since birth. The 24-hour recall also detected improper infant feeding practices especially in the second half year of life. The dietary recall since birth might be a feasible alternative to monitor infant feeding practices in resource-poor settings. Our study reemphasizes the need for improving infant feeding practices in Eastern Uganda

Perceptions of Audio Computer-Assisted Self-Interviewing (ACASI) among Women in an HIV-Positive Prevention Program

Background: Audio Computer-Assisted Self Interviewing (ACASI) has improved the reliability and accuracy of self-reported HIV health and risk behavior data, yet few studies account for how participants experience the data collection process. Methodology/Principal Findings: This exploratory qualitative analysis aimed to better understand the experience and implications of using ACASI among HIV-positive women participating in sexual risk reduction interventions in Chicago (n = 12) and Philadelphia (n = 18). Strategies of Grounded Theory were used to explore participants ’ ACASI experiences. Conclusion/Significance: Key themes we identified included themes that could be attributed to the ACASI and other methods of data collection (e.g., paper-based self-administered questionnaire or face-to-face interviews). The key themes were usability; privacy and honesty; socially desirable responses and avoiding judgment; and unintentional discomfort resulting from recalling risky behavior using the ACASI. Despite both positive and negative findings about the ACASI experience, we conclude that ACASI is in general an appropriate method for collecting sensitive data about HIV/AIDS risk behaviors among HIV-positive women because it seemed to ensure privacy in the study population allowing for mor

Eliciting Maternal Subjective Expectations about the Technology of Cognitive Skill Formation

In this paper, we formulate a model of early childhood development in which mothers have subjective expectations about the technology of skill formation. The model is useful for understanding how maternal knowledge about child development affects the maternal choices of investments in the human capital of children. Unfortunately, the model is not identified from data that are usually available to econometricians. To solve this problem, we conduct a study where mothers were interviewed to elicit maternal expectations about the technology of skill formation. We interviewed a sample of socioeconomically disadvantaged African‐American women. We find that the median subjective expectation about the elasticity of child development with respect to investments is between 4% and 19%. In comparison, when we estimate the technology of skill formation from the CNLSY/79 data, we find that the elasticity is between 18% and 26%. We use the model and our unique data to answer a simple but important question: What would happen to investments and child development if we implemented a policy that moved expectations from the median to the objective estimates that we obtain from the CNLSY/79 data? According to our estimates, maternal investments would go up by between 4% and 24% and the stocks of cognitive skills at age 24 months would subsequently increase between 1% and 5%. Needless to say, the impacts of such a policy would be even higher for mothers whose expectations were below the median

Understanding concurrent sexual partnerships among US men: examining relationship characteristics and racial differences

Racial and ethnic minorities continue to be disproportionately affected by sexually transmitted infections (STIs), including Human Immunodeficiency Virus (HIV), in the United States. Concurrent sexual partnerships, those that overlap in time, have been associated with increased STI prevalence and increase the spread of infection through a network. Different patterns of concurrent partnerships may be associated with varying STI risk depending on the partnership type (primary vs. non-primary) and the likelihood of condom use with each concurrent partner. One pattern potentially associated with high STI risk involves concurrency in the context of a co-parenting relationship, one in which a man and woman are the joint biological parents of a child. We examined the relationship between co-parenting and concurrency using data from 4,928 male respondents age 15-44 in the National Survey of Family Growth Cycle 6. Among men engaging in concurrency in the past 12 months, 18% included a co-parent as at least one of the concurrent sex partners. One third of black men involved in co-parenting concurrency were <25 years, compared to 23% of Hispanics and 6% of whites. Young black men (age 15-24) were more likely to engage in co-parenting concurrency than white men, adjusting for socio-demographic characteristics, sexual and other high-risk behaviors, and relationship quality. The largest racial differences in co-parenting concurrency prevalence were observed among men age 15-24. In the second aim, concurrent partnerships were further classified based on pattern of overlap. Compared to men engaging in non-co-parenting concurrency, men engaging in co-parenting concurrency were more likely to report inconsistent condom use during the last month and less likely to have used a condom with either concurrent partner at last sexual intercourse in bivariable analyses. In multivariable analyses, concurrency duration was longer for men engaging in co-parenting concurrency than for men engaging in non-co-parenting concurrency, but there were no differences in STI preventive/protective behaviors. These findings show that co-parenting concurrency is more common among young black and Hispanic men and suggest that concurrency involving co-parents could be associated with a high risk of STI transmission. A comprehensive understanding of the types of concurrent sexual partnerships and the contexts in which they occur is necessary

Comparison of the unmatched count technique, face to face interview and the self-report questionnaire in estimating base rates of sensitive behaviour : unprotected sex and concurrent sexual partners.

Thesis (M.A.)-University of KwaZulu-Natal, Pietermaritzburg, 2014.There is a high rate of HIV/AIDS in the country and getting an estimate of the underlying contributing factors will help in creating interventions that will contribute towards reducing the high HIV rate. This study aimed to compare three methods the Unmatched Count Technique, Face to Face Interview and Self Report Questionnaire to explore which one yields higher rates of disclosure to questions about sensitive behavior. It aimed to get an estimate of people that engage in unprotected sex as well as those that have concurrent sexual partners amongst students. This study used a quantitative experimental survey design to compare the three methods. The study used convenience sampling and the questionnaires were randomised using the random number generator. A total of 283 questionnaires were analyzed. The study found mixed results. The Unmatched Count Technique did not produce higher base rates than the Self Report Questionnaire and Face to Face Interview on all the sensitive questions as there were instances in which more respondents in the SRQ and FTFI endorsed the sensitive statement than in the UCT. The UCT produced negative numbers and it yielded lower levels of disclosure than the SRQ and FTFI on some of the sensitive statements. The SRQ was expected to elicit higher base rate estimates than the FTFI but instead the study found that the SRQ only elicited higher reporting for one sensitive statement out of five. No statistically significant results were obtained for differences in disclosure levels of unprotected sex and multiple concurrent partners between the UCT, SRQ and FTFI on most of the questions. Accurate reporting of sexual behaviour is crucial especially in contexts where the major route of HIV transmission is through sexual intercourse. It is crucial in the creation of interventions that will respond directly to the problem. With the study having produced mixed results further research needs to be conducted in this area