We assessed the user-friendliness, privacy and truthfulness of an ACASI-based sexual behaviour survey that was administered in disadvantaged, urban communities in Cape Town, South Africa. We found that an overwhelming majority of our participants preferred ACASI on touch screen computers to other modes of inquiry and that they answered all questions truthfully, probably owing in large part to participants’ perceived ease of use and privacy.
Despite the predominately positive experience, our analysis indicates that more effort may be required to improve the user experience for certain subgroups of the South African population. For instance, respondents over the age of 40 were less likely to think ACASI was easy to use, which might explain why they were also less likely to prefer ACASI as a mode of inquiry. Indeed, others have found that older generations are often intimidated by computers . These results are not surprising given that computer literacy skills are only beginning to be taught in disadvantaged communities in South Africa. Moreover, unemployed participants found ACASI methods difficult to use probably due to the lack of computer exposure from a work environment. Since these groups of people found the survey challenging, it may have affected their recall of information due to the additional cognitive strain of navigating ACASI .
We also found that coloured participants were less likely to find our methods private. We suspect the reason for this is that a plurality of the coloured participants in our survey belonged to the oldest age group. McCallum and Peterson postulate that younger generations may find it more socially acceptable to share sensitive information due to changing views of privacy in the new technology age . In fact, among Cape Town youth, there is a high use of mobile internet for instant messaging, digital media, and social networking , making their standards for privacy different from older generations. It should also be noted that in the multivariate analysis, adjusting for all of the potential predictors, the predictors did not change, only the size of the effects.
Our results also indicate that in this context, ACASI may produce more accurate results by partially removing some of the gendered SDB. In our survey the gender gap between reported sexual behaviours for men and women was narrowed, compared to the DHS that used FTFI techniques. Additionally, all of the sexual behaviours were reported more frequently in our survey than in the DHSs. This is particularly noticeable when looking at female reports of > 2 partners in the past year and had a concurrent relationship: less than 1% of women reported these behaviors in all DHS studies. This could be due to many different confounders or cultural differences between the two populations. However, we believe such a large difference in reported behaviours is most likely due to increased perception of privacy, which made our participants feel more at ease when answering intimate questions .
Our study had some limitations, which may affect the interpretation of our results. Firstly, we recognise that the questions we asked with respect to user experience, may also be subject to forms of bias. However, we believe that the bias would be minimal because typical forms of survey bias (e.g. inaccurate recall, social desirability, etc.) were probably not factors in answering these specific questions. Secondly, the positive results from the first two parts of our analysis may have been confounded by additional mechanisms we built into the survey to reduce bias, other than the interview mode. For one, we made use of a visual timeline to help respondents recall beginning and end dates of distinct episodes within each of their relationships. These visual cues have been demonstrated to encourage internal consistency in reporting relationship histories [31, 32]. Additionally, our survey was relatively short, asking only a few questions for each reported relationship episode and partner, thus minimizing fatigue bias compared to other long surveys, such as DHSs. While these are an overall strength of the survey, they may have contributed to the positive user experience, as much or more than the ACASI itself.
The greatest strength of this study is that it is one of few sexual behaviour surveys that measured the user experience of the instrument . This allowed us not only to find a proxy for how accurate our results were, but it enabled us to quantitatively assess how appropriate our methods were for the communities where the survey was administered. By asking questions about user experience we were able to determine that old age groups and unemployed people in similar contexts may be at risk for having an adverse experience with ACASI and consequently inaccurately reporting their results. Going forward, this knowledge will allow researchers to target these at-risk groups and provide more assistance and training for them before conducting a survey with similar methods.