Original article
A pilot of audio computer-assisted self-interview for youth reproductive health research in Vietnam

https://doi.org/10.1016/j.jadohealth.2005.07.008Get rights and content

Abstract

Purpose

Several recent adolescent health studies in Vietnam have shown low levels of premarital sex among youth compared to neighboring countries and other regions of the world. One possible explanation for these findings is that adolescents in Vietnam are less willing to reveal their true behaviors. This study aims to assess the level of reporting of sensitive behaviors/events using three methods of survey data collection: face-to-face interviewer-administered (IA), paper-and-pencil self-administered (SA) and AudioComputerAssisted Self Interview (ACASI).

Methods

A randomized experiment was undertaken in Gialam, a suburb of Hanoi, among a sample of 2,394 youth ages 15 to 24 years. Respondents were randomly assigned to one of three interviewing methods, with females and males evaluated separately.

Results

ACASI showed certain advantages with regard to respondent attitudes and perceptions of sensitive topics. ACAI also revealed higher prevalence rates for sensitive and stigmatized behaviors. Among those in the pencil and paper survey group it is estimated that 12.9% of unmarried males and 3.4% of unmarried females have had premarital sex. The rate found by using ACASI is higher at 17.1% in males (95% CI: 13.5-21.4) and 4.5% in females (95% CI: 2.7-7.3). Using ACASI, unmarried males also reported higher levels of risky sexual relations. For example, 7.8% confirmed visiting sex workers compared with only 1.2% in SA group and 3.9% in IA group. Additionally, ACASI respondents reported having had more sex partners by age group, gender and marital status.

Conclusions

When coupled with the emerging data from around the world, the present findings suggest that researchers should consider using ACASI for future studies dealing with sensitive and stigmatized topics.

Section snippets

The Sample

Youth aged 15 to 24 years from Gialam district, a suburb of Hanoi, were randomized into three groups: face-to-face personal interview administration (PI), pencil-and-paper self-administered (SA), and ACASI. Each group was further analyzed by gender and marital status.

The target sample size for each analytic domain of interest was based upon the following: significance = 95%; power = 80%; difference to be detected = 10 percentage points, assuming a population proportion for premarital sexual

Sample comparability

Investigators identified 2761 potential study participants in the participating towns. Overall, 86.7% of the chosen sample (2394 young people) were interviewed, 2.3% refused to participate, and 11% of the sample were unreachable. There were no significant differences in the nonresponse and absence rates among the three data collection methods. The rate of successful interviews in the three survey methods is 88.7% for personal interview, 86.3% in self-administered interview, and 85.1% for ACASI.

Limitations

There are a number of limitations inherent in a study of this kind. First, the sample is drawn from a single community, thus, the data cannot be generalized to Vietnam as a whole. Secondly, although the three samples were randomly drawn using youth rosters, it is evident that there were some differences among the three groups; and the higher socioeconomic level of the ACASI group may have affected the results. Third, the low prevalence of some sexual behaviors limits the possibilities both in

Discussion

In Vietnam, questions about sexual behaviors and attitudes are still considered sensitive. Such sensitivity is rooted in Confucian culture, where conservative sexual mores have predominated. In such a context, discussion of sexual behaviors has, until recently, been taboo. Thus, the central hypothesis of the present study was that those responding to sensitive questions (e.g., those related to sexual attitudes and behaviors) would be more likely to provide affirmative/less traditional responses

Conclusion

Researchers, policymakers, and program planners have long feared that adolescent sexual and reproductive health interventions have been developed on less than accurate information. The evidence from the United States over the past decade has substantiated the improved response rates to sensitive questions using ACASI. Increasingly, the same is being seen in developing nations given the risks of HIV/AIDS, unplanned pregnancies, and sexually transmitted infections. ACASI offers a promising

Acknowledgments

This study was supported by the Ford Foundation under the project “Strengthening Social Sciences and Reproductive Health Training and Research Capacity at Hanoi School of Public Health.” The authors would like to thank the Hanoi School of Public Health leader board and the Gialam District Health Center.

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Copyright © 2006 Society for Adolescent Medicine. Published by Elsevier Inc. All rights reserved.