Abstract
Studies from low- and middle-income countries (LMIC) indicate that the use of audio computer-assisted self-interviewing (ACASI) is associated with more accurate reporting of sensitive behaviors (e.g. substance use and sexual risk behaviors) compared with interviewer-administered questionnaires. There is a lack of published information on the process of designing, developing, and implementing ACASI in LMIC. In this paper we describe our experience implementing an ACASI system for use with a population of orphans and vulnerable children in Zambia. A questionnaire of mental health, substance use, and HIV risk behaviors was converted into an ACASI system, tested in pilot and validity studies, and implemented for use in a randomized controlled trial. Successes, barriers, and challenges associated with each stage in the development and implementation of ACASI are described. We were able to convert a lengthy and complex survey into an ACASI system that was feasible for use in Zambia. Lessons learned include the importance of: (1) piloting the written and electronic versions; (2) proper and extensive training for study assessors to use ACASI and for those doing voice recordings; and (3) attention to logistics such as appropriate space, internet, and power. We found that ACASI was feasible and acceptable in Zambia with proper planning, training, and supervision. Given mounting evidence indicating that ACASI provides more accurate self-report data and immediate data download compared with interview-administered measures, it may be an effective and economical alternative for behavioral health research studies in LMIC.
Highlights
Studies from low- and middle-income countries (LMIC) indicate that the use of audio computer-assisted self-interviewing (ACASI) is associated with more accurate reporting of sensitive behaviors compared with interviewer-administered questionnaires
In Zambia, we found that participants were much more comfortable using a mouse compared with a touchpad
Many other studies cited in this paper have made such comparisons; our goal was to present the process of developing an Audio computer assisted self-interviewing (ACASI) for a LMIC and the challenges associated with that process
Summary
The HIV epidemic in sub-Saharan Africa has caused over 15 million children to be orphaned or made otherwise vulnerable, a number that is expected to increase in the near future (UNICEF, 2013). We recruited 210 adolescents and their caregivers from our target population in Lusaka neighborhoods who would meet criteria for the upcoming trial (exhibiting HIV risk behaviors or symptoms of psychosocial problems, ages 13–17, and meeting World Health Organization definition of an orphan or vulnerable child) This recruitment was conducted by HBCWs, similar to our previously described pilot groups. Extraction of data from field laptops to the main office-based study computer at the end of each day required meticulous attention to detail (see online Supplemental File for process of extraction) This responsibility was delegated to trained data staff in the study office and required weekly quality control checks to ensure that data transfers were accurate and complete
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