The influence of interviewers on survey responses among female sex workers in Zambia.
Adult
Cluster Analysis
Effect Modifier, Epidemiologic
Female
HIV Infections
/ diagnosis
HIV-1
/ pathogenicity
Health Knowledge, Attitudes, Practice
Humans
Male
Mass Screening
/ methods
Patient Acceptance of Health Care
/ statistics & numerical data
Sex Factors
Sex Workers
/ statistics & numerical data
Surveys and Questionnaires
Zambia
/ epidemiology
Female sex workers
Gender
Gender-based violence
Interviewer
Validity
Zambia
Journal
BMC medical research methodology
ISSN: 1471-2288
Titre abrégé: BMC Med Res Methodol
Pays: England
ID NLM: 100968545
Informations de publication
Date de publication:
15 03 2019
15 03 2019
Historique:
received:
16
03
2018
accepted:
06
03
2019
entrez:
17
3
2019
pubmed:
17
3
2019
medline:
11
2
2020
Statut:
epublish
Résumé
Interviewers can substantially affect self-reported data. This may be due to random variation in interviewers' ability to put respondents at ease or in how they frame questions. It may also be due to systematic differences such as social distance between interviewer and respondent (e.g., by age, gender, ethnicity) or different perceptions of what interviewers consider socially desirable responses. Exploration of such variation is limited, especially in stigmatized populations. We analyzed data from a randomized controlled trial of HIV self-testing amongst 965 female sex workers (FSWs) in Zambian towns. In the trial, 16 interviewers were randomly assigned to respondents. We used hierarchical regression models to examine how interviewers may both affect responses on more and less sensitive topics, and confound associations between key risk factors and HIV self-test use. Model variance (ICC) at the interviewer level was over 15% for most topics. ICC was lower for socio-demographic and cognitively simple questions, and highest for sexual behaviour, substance use, violence and psychosocial wellbeing questions. Respondents reported significantly lower socioeconomic status and more sex-work related violence to female interviewers. Not accounting for interviewer identity in regressions predicting HIV self-test behaviour led to coefficients moving from non-significant to significant. We found substantial interviewer-level effects for prevalence and associational outcomes among Zambian FSWs, particularly for sensitive questions. Our findings highlight the importance of careful training and response monitoring to minimize inter-interviewer variation, of considering social distance when selecting interviewers and of evaluating whether interviewers are driving key findings in self-reported data. clinicaltrials.gov NCT02827240 . Registered 11 July 2016.
Sections du résumé
BACKGROUND
Interviewers can substantially affect self-reported data. This may be due to random variation in interviewers' ability to put respondents at ease or in how they frame questions. It may also be due to systematic differences such as social distance between interviewer and respondent (e.g., by age, gender, ethnicity) or different perceptions of what interviewers consider socially desirable responses. Exploration of such variation is limited, especially in stigmatized populations.
METHODS
We analyzed data from a randomized controlled trial of HIV self-testing amongst 965 female sex workers (FSWs) in Zambian towns. In the trial, 16 interviewers were randomly assigned to respondents. We used hierarchical regression models to examine how interviewers may both affect responses on more and less sensitive topics, and confound associations between key risk factors and HIV self-test use.
RESULTS
Model variance (ICC) at the interviewer level was over 15% for most topics. ICC was lower for socio-demographic and cognitively simple questions, and highest for sexual behaviour, substance use, violence and psychosocial wellbeing questions. Respondents reported significantly lower socioeconomic status and more sex-work related violence to female interviewers. Not accounting for interviewer identity in regressions predicting HIV self-test behaviour led to coefficients moving from non-significant to significant.
CONCLUSIONS
We found substantial interviewer-level effects for prevalence and associational outcomes among Zambian FSWs, particularly for sensitive questions. Our findings highlight the importance of careful training and response monitoring to minimize inter-interviewer variation, of considering social distance when selecting interviewers and of evaluating whether interviewers are driving key findings in self-reported data.
TRIAL REGISTRATION
clinicaltrials.gov NCT02827240 . Registered 11 July 2016.
Identifiants
pubmed: 30876402
doi: 10.1186/s12874-019-0703-2
pii: 10.1186/s12874-019-0703-2
pmc: PMC6419821
doi:
Banques de données
ClinicalTrials.gov
['NCT02827240']
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
60Subventions
Organisme : NIMH NIH HHS
ID : R25 MH083620
Pays : United States
Organisme : NIAID NIH HHS
ID : T32 AI007535
Pays : United States
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