Abstract
BackgroundSelf-reports of sensitive, socially stigmatized or illegal behavior are common in STI/HIV research, but can raise challenges in terms of data reliability and validity. The use of electronic data collection tools, including ecological momentary assessment (EMA), can increase the accuracy of this information by allowing a participant to self-administer a survey or diary entry, in their own environment, as close to the occurrence of the behavior as possible. In this paper, we evaluate the feasibility of using cell phone-based EMA as a tool for understanding sexual risk and STI among adult men and women.MethodsAs part of a larger prospective clinical study on sexual risk behavior and incident STI in clinically recruited adult men and women, using study-provided cell phones, participants (N = 243) completed thrice–daily EMA diaries monitoring individual and partner-specific emotional attributes, non-sexual activities, non-coital or coital sexual behaviors, and contraceptive behaviors. Using these data, we assess feasibility in terms of participant compliance, behavior reactivity, general method acceptability and method efficacy for capturing behaviors.ResultsParticipants were highly compliant with diary entry protocol and schedule: over the entire 12 study weeks, participants submitted 89.7% (54,914/61,236) of the expected diary entries, with an average of 18.86 of the 21 expected diaries (85.7%) each week. Submission did not differ substantially across gender, race/ethnicity and baseline sexually transmitted infection status. A sufficient volume and range of sexual behaviors were captured, with reporting trends in different legal and illegal behaviors showing small variation over time. Participants found the methodology to be acceptable, enjoyed and felt comfortable participating in the study.ConclusionAchieving the correct medium of data collection can drastically improve, or degrade, the timeliness and quality of an individual’s self-reported sexual risk behavior, which in turn, is a key factor in the success of intervention or education programs relying on this information. Our findings demonstrate that completion of electronic diaries via cellular phone is feasible way to describe STI/HIV risk among clinically recruited adult men and women.
Highlights
Self-reports of sensitive, socially stigmatized or illegal behavior are common in STI/HIV research, but can raise challenges in terms of data reliability and validity
Obtaining participant self-reports is common in STI/ HIV research, because it is difficult to directly observe sexual risk behavior [1], and because it is important to understand how an individual’s own circumstances and subjective experiences may increase or decrease the likelihood of a given behavior [2,3]
We evaluate the use of cell-phone based, thrice-daily ecological momentary assessment (EMA) over 12 weeks as a means of prospectively studying sexual risk behavior and incident STI among a sample of clinically recruited adult men and women at high risk for HIV/STI
Summary
Self-reports of sensitive, socially stigmatized or illegal behavior are common in STI/HIV research, but can raise challenges in terms of data reliability and validity. The use of electronic data collection tools, including ecological momentary assessment (EMA), can increase the accuracy of this information by allowing a participant to self-administer a survey or diary entry, in their own environment, as close to the occurrence of the behavior as possible. Is one such tool, in which participants respond to preprogrammed signals on an electronic device (e.g., a PDA or cellular phone) prompting them to complete diaries, in various within-day frequencies, related to recent or immediate social environment and behavior [13,14] This arrangement allows joint assessment of a risk behavior, and the context in which it occurs, in near real time [15]. EMA strengthens the security of sensitive or stigmatizing information, allowing information to be vacated from the device immediately upon data entry for storage on a remote server, increasing participant valued privacy [20]
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