Computer-assisted self-interviews (CASI) have been successfully employed as components of studies of sensitive and risk behaviours. Surveys that depend solely on CASI are a relatively new departure, used mainly in Internet-based studies. This paper discusses the effectiveness of using computer-assisted self-interviews in a clinic-based case-control study investigating sexual behaviour among gay and bisexual men who HIV test (the INSIGHT study).
The INSIGHT study was established to investigate the current risk factors for HIV seroconversion in gay and bisexual men, which remain the group at greatest risk of HIV infection in the UK. CASI was chosen as a means of data collection for the case-control component of the study because it shares many of the advantages of a ‘face to face’ interview (e.g. interaction and validation) whilst preserving the patient’s anonymity and standardising interviewer bias.
The CASI program was developed at the Communicable Disease Surveillance Centre (CDSC) using SNAP Version 6 software. The questionnaire is administered using computers located in eight Sexual Health clinics in Manchester, Brighton and London. Patients complete the CASI having received the result of their most recent HIV test and responses are submitted via email to the INSIGHT team at the CDSC. Recruitment began in September 2002 and will continue for two years, collecting data on patients’ sexual behaviour and lifestyles during the interval between their last two HIV tests. Data from subjects that test HIV positive (cases) will be compared to that from subjects who remain HIV negative (controls).
A study of this nature poses a number of challenges. The introduction of Computer Survey technology in to Sexual Health clinics and convincing health care workers of the merits of this technology has been a major advance. Implementing the study has placed further demands on services that were already stretched to capacity by increasing numbers of patients.
Self reported sexual behaviour is notoriously difficult to measure. We rely on the patient’s ability to remember their sexual practices and risk behaviours between their HIV tests and to feel confident that they can report this behaviour without fear of judgment and recrimination. The CASI uses extensive routing, text substitution and validation to capture data on sexual behaviour and lifestyles. Clinic staff do not have access to the patient’s responses and no personally identifiable data is sought. At the outset of the study patients and clinic staff were interviewed about the recruitment process and experience of the CASI to allow improvements in design and to provide guidance for the interpretation of the results.
The interviews with patients used cognitive interviewing techniques to explore the process of navigating and completing the CASI. Qualitative techniques were used to explore perceptions of confidentiality of electronically submitted interview data. This paper will, assess the efficacy of using CASI in a clinic based setting to collect, sensitive, detailed and complex data from a specific, yet diverse population group.
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