Skip Ribbon Commands
Skip to main content


How to improve the validity of sexual behaviour reporting: systematic review of questionnaire delivery modes in developing countries


L. Langhaug, L. Sherr, and F. Cowan

Network Affiliation




Journal Name

Tropical Medicine and International Health

Publication Date


PubMed Search


Link to full-text







objectives To systematically review comparative research from developing countries on the effects of
questionnaire delivery mode.
methods We searched Medline, EMbase and PsychINFO and ISSTDR conference proceedings.
Randomized control trials and quasi-experimental studies were included if they compared two or more
questionnaire delivery modes, were conducted in a developing country, reported on sexual behaviours
and occurred after 1980.
results A total of 28 articles reporting on 26 studies met the inclusion criteria. Heterogeneity of
reported trial outcomes between studies made it inappropriate to combine trial outcomes. Eighteen
studies compared audio computer-assisted survey instruments (ACASI) or its derivatives [personal digital
assistant (PDA) or computer-assisted personal interview (CAPI)] against another self-administered
questionnaires, face-to-face interviews or random response technique. Despite wide variation in geography
and populations sampled, there was strong evidence that computer-assisted interviews lowered
item-response rates and raised rates of reporting sensitive behaviours. ACASI also improved data entry
quality. A wide range of sexual behaviours were reported including vaginal, oral, anal and or forced sex,
age of sexual debut, condom use at first and or last sex. Validation of self-reports using biomarkers was
conclusions These data reaffirm that questionnaire delivery modes do affect self-reported sexual
behaviours and that use of ACASI can significantly reduce reporting bias. Its acceptability and feasibility
in developing country settings should encourage researchers to consider its use when conducting sexual
health research. Triangulation of self-reported data using biomarkers is recommended. Standardizing
sexual behaviour measures would allow for meta-analysis.










Created at 9/13/2011 11:53 AM by Davis, Gregory P
Last modified at 9/13/2011 11:53 AM by Davis, Gregory P