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Audio computer assisted self interview and face to face interview modes in assessing response bias among STD clinic patients
  1. K G Ghanem1,
  2. H E Hutton1,
  3. J M Zenilman1,
  4. R Zimba2,
  5. E J Erbelding1,3
  1. 1Johns Hopkins University School of Medicine, Baltimore, MD, USA
  2. 2New York City Department of Health and Mental Hygiene, New York, NY, USA
  3. 3Baltimore City Health Department, Baltimore, MD, USA
  1. Correspondence to:
 Khalil G Ghanem
 MD, Johns Hopkins University, Bayview Medical Center, Division of Infectious Diseases, 4940 Eastern Avenue, B3 North, Suite 352, Baltimore, MD 21224, USA;


Background: Audio computer assisted self interview (ACASI) may minimise social desirability bias in the ascertainment of sensitive behaviours. The aim of this study was to describe the difference in reporting risk behaviour in ACASI compared to a face to face interview (FFI) among public sexually transmitted diseases (STD) clinic attendees.

Study design: Randomly selected patients attending a public STD clinic in Baltimore, Maryland, sequentially took an ACASI formatted risk behaviour assessment followed by an FFI conducted by a single clinician, with both interview modalities surveying sexual and drug use behaviours. Binary responses were compared using the sign test, and categorical responses were compared using the Wilcoxon signed rank test to account for repeated measures.

Results: 671 (52% men, mean age 30 years, 95% African American) of 795 clinic attendees screened consented to participate. Subjects affirmed sensitive sexual behaviours such as same sex contact (p = 0.012), receptive rectal sexual exposure (p<0.001), orogenital contact (p<0.001), and a greater number of sex partners in the past month (p<0.001) more frequently with ACASI than with an FFI. However, there were no differences in participant responses to questions on use of illicit drugs or needle sharing.

Conclusions: Among STD clinic patients, reporting of sensitive sexual risk behaviours to clinicians was much more susceptible to social desirability bias than was reporting of illegal drug use behaviours. In STD clinics where screening of sexual risk is an essential component of STD prevention, the use of ACASI may be a more reliable assessment method than traditional FFI.

  • ACASI, audio computer assisted self interview
  • FFI, face to face interview
  • IDU, injection drug users
  • STD, sexually transmitted diseases
  • audio computer assisted self interview
  • sexually transmitted diseases clinics

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  • Financial support: NIH R01 MH60066-01A1 (EJE), NIH K24 A101663 (JMZ) and Association of Teachers for Preventive Medicine (KGG). Portions of this paper were presented in poster format at the International Society for Sexually Transmitted Diseases Research (ISSTDR), Ottawa, Canada, July 2003.

  • Conflict of interest: None of the authors report any conflicts of interest.

  • Human subject considerations: The study was approved by the institutional review boards of the Johns Hopkins Medical Institutions and the Baltimore City Health Department. Informed consent was obtained from all participants. The consent explicitly stated that study data were protected from outside disclosures by a Certificate of Confidentiality issued by the Department of Health and Human Services.