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Assessment of Self-Reported Sexual Behavior and Condom Use Among Female Sex Workers in India Using a Polling Box Approach: A Preliminary Report

Hanck, Sarah E. MPH; Blankenship, Kim M. PhD; Irwin, Kevin S. MA; West, Brooke S. MA; Kershaw, Trace PhD

Sexually Transmitted Diseases: May 2008 - Volume 35 - Issue 5 - p 489-494
doi: 10.1097/OLQ.0b013e3181653433

Background: The accuracy of behavioral data related to risk for HIV and other sexually transmitted infections is prone to misreporting because of social desirability effects. Because computer-assisted approaches are not always feasible, a noncomputerized interview method for reducing social desirability effects is needed. The previous performance of alternative methods has been limited to aggregate data or constrained by the simplicity of dichotomous-only responses. We designed and tested a “polling box” method for case-attributable, multiple-response survey items in a low literacy population.

Methods: A cross-sectional survey was conducted with 812 female sex workers in Andhra Pradesh, India. For a subset of questions embedded in a face-to-face survey questionnaire, every third participant was provided graphical response cards upon which to mark their answer and place in a polling box outside the view of the interviewer. Multiple logistic regression analysis was used to test for response differences to questions about socially undesirable, socially desirable, or sensitivity-neutral behaviors in the 2 interview methods.

Results: Polling box participants demonstrated higher reporting of risky sexual behaviors and lower reporting of condom use, with no conclusive response patterns among sensitivity-neutral items.

Conclusion: Our findings suggest that the polling box approach provides a promising technique for improving the accurate reporting of sensitive behaviors among a low-literacy population in a resource poor setting. Additional research is needed to test logistical adaptations of the polling box approach.

We report the design and testing of the “polling box,” a noncomputerized, interviewer-administered interview method for reducing social desirability effects in the collection of sensitive information among low-literacy participants.

From Project Parivartan, Center for Interdisciplinary Research on AIDS (CIRA), Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut

The authors thank all of the women who participated in the cross-sectional survey, as well as numerous Project Parivartan team members for their contributions in implementing and/or designing the survey and polling box method.

Supported by the Bill & Melinda Gates Foundation through Avahan, its India AIDS Initiative, and the Center for Interdisciplinary Research on AIDS (P30 MH 62,294, P. Cleary, PI).

The views expressed herein are those of the authors and do not necessarily reflect the official policy or position of the Bill & Melinda Gates Foundation and Avahan.

Correspondence: Sarah E. Hanck, MPH, Doctors of the World–USA, 80 Maiden Lane, 6th Floor, New York, NY 10038. E-mail:

Received for publication August 20, 2007, and accepted December 13, 2007.

© Copyright 2008 American Sexually Transmitted Diseases Association