Assessments of understanding (AoUs) in clinical trials are often composed of true/false multiple choice questions, however, these tools can be difficult for volunteers with limited education or without prior testing experience

Allen, S

Bekker, L

Chomba, E

Fast, P

Kilembe, W

Lindegger, G

Mark, D

Mwananyanda, L

Priddy, F

Quayle, M

Roux, S

Singh, S

Wallace, M

Welsh, S

Retrovirology

English

PubMed

G Lindegger

M Quayle

S Singh

S Welsh

D Mark

M Wallace

S Roux

L Bekker

L Mwananyanda

W Kilembe

E Chomba

S Allen

F Priddy

P Fast

Springer - Publisher Connector

POSTER PRESENTATION Open Access
A mixed-methods assessment of understanding
(AoU) tool for AIDS vaccine trials in sub-Saharan
Africa: results from a pilot study
G Lindegger1, M Quayle1, S Singh2, S Welsh7, D Mark3, M Wallace3, S Roux3, L Bekker3, L Mwananyanda4,
W Kilembe4, E Chomba5, S Allen6, F Priddy7*, P Fast7
From AIDS Vaccine 2012
Boston, MA, USA. 9-12 September 2012
Background
Assessments of understanding (AoUs) in clinical trials are
often composed of true/false multiple choice questions,
however, these tools can be difficult for volunteers with
limited education or without prior testing experience.
Methods
35 adults were recruited at two research centers in
Southern Africa. A within-subjects, repeated measures
design was used, whereby each volunteer served as his/
her own control. An AoU tool with closed- and open-
ended questions was administered within a hypothetical
AIDS vaccine trial setting. Performance on closed- and
open-ended questions was compared using correlations
and repeated-measure t-tests, limited to 4 complex con-
cepts: false sense of security, risk of false positive test,
need for contraception, and potentially enhanced
susceptibility.
Results
Mean scores of understanding for each concept assessed
by closed-ended questions ranged from 0.73 (need for
contraception) to 0.84 (risk of false positive test); and by
open-ended questions from 0.4 (risk of false positive
test) – 0.6 (need for contraception). Scores for the
open-ended measure were all lower than the equivalent
closed-ended measure. Correlations between the closed-
and open-ended measures were generally low, achieving
significance for false sense of security (r=0.377), poten-
tially enhanced susceptibility (r=0.393), and total score
across concepts (r=0.617). Volunteers’ understanding as
assessed by the closed- and open-ended methods dif-
fered significantly: false sense of security= -3.862; risk of
false positive test= -7.210; need for contraception=
-2.303; and potentially enhanced susceptibility= -8.007.
The correlation with years of education was consistently
and significantly higher for the open-ended measure
than the true/false questionnaire with the exception of
need for contraception.
Conclusion
The results suggest the qualitative measure better assesses
understanding than the quantitative measure. The scores
from the two assessment methods have limited interchan-
geability. The standard closed-ended questions appear to
provide an inflated measure of volunteers’ understanding.
An assessment tool with closed- and open-ended ques-
tions is better suited to determine genuine understanding.
Author details
1School of Psychology, University of Kwa-Zulu Natal, Pietermaritzburg, South
Africa. 2GHAR Consulting Inc, New York, NY, USA. 3Desmond Tutu HIV
Foundation, University of Cape Town, Cape Town, South Africa. 4Zambia-
Emory HIV Research Project, Lusaka, Zambia. 5Zambia-Emory HIV Reseach
Project, Lusaka, Zambia. 6Emory University, Atlanta, GA, USA. 7International
AIDS Vaccine Initiative, New York, NY, USA.
Published: 13 September 2012
doi:10.1186/1742-4690-9-S2-P135
Cite this article as: Lindegger et al.: A mixed-methods assessment of
understanding (AoU) tool for AIDS vaccine trials in sub-Saharan Africa:
results from a pilot study. Retrovirology 2012 9(Suppl 2):P135.
7International AIDS Vaccine Initiative, New York, NY, USA
Full list of author information is available at the end of the article
Lindegger et al. Retrovirology 2012, 9(Suppl 2):P135
http://www.retrovirology.com/content/9/S2/P135
© 2012 Lindegger et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.


A mixed-methods assessment of understanding (AoU) tool for AIDS vaccine trials in sub-Saharan Africa: results from a pilot study

Cape Town University OpenUCT

POSTER PRESENTATION Open AccessA mixed-methods assessment of understanding(AoU) tool for AIDS vaccine trials in sub-SaharanAfrica: results from a pilot studyG Lindegger1, M Quayle1, S Singh2, S Welsh7, D Mark3, M Wallace3, S Roux3, L Bekker3, L Mwananyanda4,W Kilembe4, E Chomba5, S Allen6, F Priddy7*, P Fast7From AIDS Vaccine 2012Boston, MA, USA. 9-12 September 2012BackgroundAssessments of understanding (AoUs) in clinical trials areoften composed of true/false multiple choice questions,however, these tools can be difficult for volunteers withlimited education or without prior testing experience.Methods35 adults were recruited at two research centers inSouthern Africa. A within-subjects, repeated measuresdesign was used, whereby each volunteer served as his/her own control. An AoU tool with closed- and open-ended questions was administered within a hypotheticalAIDS vaccine trial setting. Performance on closed- andopen-ended questions was compared using correlationsand repeated-measure t-tests, limited to 4 complex con-cepts: false sense of security, risk of false positive test,need for contraception, and potentially enhancedsusceptibility.ResultsMean scores of understanding for each concept assessedby closed-ended questions ranged from 0.73 (need forcontraception) to 0.84 (risk of false positive test); and byopen-ended questions from 0.4 (risk of false positivetest) – 0.6 (need for contraception). Scores for theopen-ended measure were all lower than the equivalentclosed-ended measure. Correlations between the closed-and open-ended measures were generally low, achievingsignificance for false sense of security (r=0.377), poten-tially enhanced susceptibility (r=0.393), and total scoreacross concepts (r=0.617). Volunteers’ understanding asassessed by the closed- and open-ended methods dif-fered significantly: false sense of security= -3.862; risk offalse positive test= -7.210; need for contraception=-2.303; and potentially enhanced susceptibility= -8.007.The correlation with years of education was consistentlyand significantly higher for the open-ended measurethan the true/false questionnaire with the exception ofneed for contraception.ConclusionThe results suggest the qualitative measure better assessesunderstanding than the quantitative measure. The scoresfrom the two assessment methods have limited interchan-geability. The standard closed-ended questions appear toprovide an inflated measure of volunteers’ understanding.An assessment tool with closed- and open-ended ques-tions is better suited to determine genuine understanding.Author details1School of Psychology, University of Kwa-Zulu Natal, Pietermaritzburg, SouthAfrica. 2GHAR Consulting Inc, New York, NY, USA. 3Desmond Tutu HIVFoundation, University of Cape Town, Cape Town, South Africa. 4Zambia-Emory HIV Research Project, Lusaka, Zambia. 5Zambia-Emory HIV ReseachProject, Lusaka, Zambia. 6Emory University, Atlanta, GA, USA. 7InternationalAIDS Vaccine Initiative, New York, NY, USA.Published: 13 September 2012doi:10.1186/1742-4690-9-S2-P135Cite this article as: Lindegger et al.: A mixed-methods assessment ofunderstanding (AoU) tool for AIDS vaccine trials in sub-Saharan Africa:results from a pilot study. Retrovirology 2012 9(Suppl 2):P135.7International AIDS Vaccine Initiative, New York, NY, USAFull list of author information is available at the end of the articleLindegger et al. Retrovirology 2012, 9(Suppl 2):P135http://www.retrovirology.com/content/9/S2/P135© 2012 Lindegger et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the CreativeCommons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited.

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A mixed-methods assessment of understanding (AoU) tool for AIDS vaccine trials in sub-Saharan Africa: results from a pilot study

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