A randomised controlled trial of computer-assisted interviewing in sexual health clinics

Research Department of Infection and Population Health, University College London, London, UK.
Sexually transmitted infections (Impact Factor: 3.4). 08/2010; 86(4):310-4. DOI: 10.1136/sti.2010.043422
Source: PubMed


To assess the impact of computer-assisted interview compared with pen and paper on disclosure of sexual behaviour, diagnostic testing by clinicians, infections diagnosed and referral for counselling.
Two-centre parallel three-arm randomised controlled open trial. Computer-generated randomisation with allocation concealment using sealed envelopes.
Two London teaching hospital sexual health clinics.
2351 clinic attenders over the age of 16 years.
Computer-assisted self-interview (CASI). Computer-assisted personal interview (CAPI). Pen and paper interview (PAPI).
Diagnostic tests ordered, sexually transmitted infections (STI).
Disclosure of sexual risk, referral for counselling.
801, 763 and 787 patients randomly allocated to receive CASI, CAPI and PAPI. 795, 744 and 779 were available for intention-to-treat analysis. Significantly more diagnostic testing for hepatitis B and C and rectal samples in the CAPI arm (odds for more testing relative to PAPI 1.32; 95% CI 1.09 to 1.59). This pattern was not seen among CASI patients. HIV testing was significantly lower among CASI patients (odds for less testing relative to PAPI 0.73; 95% CI 0.59 to 0.90). STI diagnoses were not significantly different by trial arm. A summary measure of seven prespecified sensitive behaviours found greater reporting with CASI (OR 1.4; 95% CI 1.2 to 1.6) and CAPI (OR 1.4; 95% CI 1.2 to 1.7) compared with PAPI.
CASI and CAPI can generate greater recording of risky behaviour than traditional PAPI. Increased disclosure did not increase STI diagnoses. Safeguards may be needed to ensure that clinicians are prompted to act upon disclosures made during self-interview.

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    • "The pervasive use of cell phones and other electronic devices in the study population may make protocol training and data entry easier for participants [29,30]. Electronic platforms can time-stamp all data, from reminders to start/finish diaries, to actual initiation and completion, allows a precise analysis of participant compliance [4,8,14,18]. Moreover, researchers can standardize measures across participants and have increased flexibility, including using branching/contingency questions, or multilingual versions of instruments [4,12,18,19]. "
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    • "Finally, we used in-person pen and paper interviews to collect data related to sexual risk behaviors. Although evidence is compelling that computer-assisted interviewing is preferable when asking for sensitive personal information such as sex risk (Fairley et al. 2010; Richens et al. 2010), we were unable to bring computers into the prison setting. "
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