Behavioural Surveillance Surveys - The Wisdom of Whores

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Using the chi-square test for trend, it turns out that both trend lines are statistically significant. The chi-square test statistic for the trucker’s condom use trend is 67.84, with a p-value of
Changes in sampling methodology over time are almost certain to result in selection bias, making trends over time much more difficult to interpret than when a consistent methodology is used. Even if sampling methodology remains the same, changes in the political or social climate may have important influences on who is included in a survey. A crackdown on illegal immigrants may completely change the profile of the sex worker population between one survey and the next, for example. Differences in risk behavior over time may not reflect behavior change in this case, but may simply mean the population measured is no longer the same. It should be noted that rapid population turnover is typical of many of the sub-populations of interest to HIV prevention programmes. As long as the population sampled relates in the same way to the wider population to which results will be extrapolated, this will not increase sampling error. It will, however, affect the interpretation of trends over time. One important potential source of selection bias is refusal bias. BSS asks people about personal and often illegal behaviors. It is absolutely essential, therefore, that the purpose of the study be carefully explained to selected respondents, and that their full consent to participate be obtained before questioning begins. Refusal bias arises when those who refuse to participate have different behaviors than those who agree. In the case of BSS, refusal bias may well underestimate true levels of risk behavior, because people may avoid participating because they do not want to admit to behaviors that they recognize are risky. Survey reports should always state what proportion of the selected sample refused participation, and should give socio-demographic profiles of refusers where available. One way of attempting to gauge the importance of selection bias is to collect some basic socio-demographic variables from selected participants, including those who refuse to participate in the study. These variables can be compared with the same variables in respondents in earlier survey rounds (as well as in those who refuse to take part) to see if any systematic differences are discernable. Variables that will help judge the likely magnitude of selection bias will depend on the local situation but may include nationality, province of origin, length of time associated with the site, etc. Measurement bias Another source of potential error in surveys is error in the measurement of the variables. This can arise when survey forms are not clear, for example when the meaning of a question in the local language is open to different interpretations. Interviewer bias can also affect the correct measurement of behavior. Some interviewers are more judgmental than others, and people may be more or less willing to report stigmatized behaviors to an interviewer depending on their attitude. Indeed people’s unwillingness to tell the truth about their sexual or drug-taking behavior may be the most important source of measurement bias. It is not clear to what extent this is likely to change over time. Where an interviewer has to turn a verbal answer into one that fits in to a coded category, they may also influence results, by consistently preferring one category over another when answers are ambiguous. Many of the difficulties associated with measurement bias can be minimized through comprehensive training of interviewers and survey staff, and active supervision. 84 C H A PTER 7 B EHAV I OR A L S U R V EI L L A NC E S U R V EY S
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BEHAVIORAL SURVEILLANCE SURVEYS GUI
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Family Health International (FHI) H
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Chapter 7 Analysis and interpretati
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3. Choosing populations for behavio
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G UIDELINES FOR REPEATED BEHAVIORAL
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Recognizing that HIV surveillance d
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Different approaches to collecting
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The principal rationale for focusin
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It is not possible to validate data
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GUIDELINES FOR REPEATED BEHAVIORAL
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The process of building partnership
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Funders of HIV prevention activitie
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What is to be measured ? Indicators
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Step 7 : Constructing a sampling fr
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Step 12 : Data collection and super
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choosing population groups GUIDELIN
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the spread of HIV. For this reason,
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In some circumstances, public healt
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GUIDELINES FOR REPEATED BEHAVIORAL
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The majority of sub-populations of
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In the end, the issue boils down to
Page 43 and 44: In looking at behaviors of hard-to-
Page 45 and 46: Maps derived from program planning
Page 47 and 48: Selecting primary sampling units (c
Page 49 and 50: ...when measures of size are not av
Page 51 and 52: If there is no reason to believe th
Page 53 and 54: Figure 3 : Decision tree for first-
Page 55 and 56: Implications of alternative samplin
Page 57 and 58: Table 5 : Values of Z 1-α and Z 1-
Page 59 and 60: Table 6 : Sample size requirements
Page 61 and 62: equired. In this case, the pros and
Page 63 and 64: Should one- or two-tailed z-score v
Page 65 and 66: Other measurement issues for BSS Th
Page 67 and 68: A “low-tech” solution to the pr
Page 69 and 70: 5 Weighting in multi-stage sampling
Page 71 and 72: Figure 6 : Procedures for calculati
Page 73 and 74: Calculating weights from sampling p
Page 75 and 76: Calculating standard errors with mu
Page 77 and 78: 6 Adapting and using questionnaires
Page 79 and 80: Some attempts have in the past been
Page 81 and 82: Informed consent Confidentiality an
Page 83 and 84: GUIDELINES FOR REPEATED BEHAVIORAL
Page 85 and 86: Recommended Methods of Statistical
Page 87 and 88: where n is the sample size in the d
Page 89 and 90: Table 2 : Reported number of non-re
Page 91 and 92: False conclusions: the danger of co
Page 93: Analysis of trends in behavior over
Page 97 and 98: 8 Using the data collected to impro
Page 99 and 100: Improving prevention programs As a
Page 101 and 102: Finally, information about HIV and
Page 103 and 104: Figure 9 : HIV and STD prevalence,
Page 105 and 106: 9 Indicators This guide identifies
Page 107 and 108: The standard questionnaires are acc
Page 109 and 110: INDICATORS Page INDICATORS FOR YOUT
Page 111 and 112: INDICATORS Page INDICATORS FOR MEN
Page 113 and 114: KEY INDICATORS What follows is a fu
Page 115 and 116: The indicator uses promoted data. O
Page 117 and 118: To be counted the numerator for thi
Page 119 and 120: Strengths and limitations Some meas
Page 121 and 122: Adult Indicator 5 Consistent condom
Page 123 and 124: Adult Indicator 7 (men only) Number
Page 125 and 126: Adult Indicator 9 Consistent condom
Page 127 and 128: Adult Indicator 11 Population seeki
Page 129 and 130: Adult Indicator 12 Exposure to inte
Page 131 and 132: Youth Indicator 2 No incorrect beli
Page 133 and 134: Youth Indicator 4 Youth sexually ac
Page 135 and 136: Youth Indicator 6 Number of sexual
Page 137 and 138: Youth Indicator 8 Consistent condom
Page 139 and 140: Youth Indicator 10 Commercial sex a
Page 141 and 142: Youth Indicator 14 Exposure to inte
Page 143 and 144: Female Sex Worker Indicator 2 No in
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Female Sex Worker Indicator 5 Sex w
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Indicators for men who have sex wit
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Men Who Have Sex With Men Indicator
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Men who have sex with men Indicator
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Indicators for injecting drug users
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Injecting Drug User Indicator 3 Inj
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Injecting Drug User Indicator 8 Dru
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Injecting Drug User Indicator 10 Dr
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Suggested Reading Brown T, Sittitra
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QUESTIONNAIRE For Adult Target Grou
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The ADULT questionnaire includes th
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FHI 1999 HIV/AIDS/STD BEHAVIORAL SU
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POSSIBLE ADDITIONAL QUESTIONS Commu
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STD Treatment seeking behaviors No.
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STD Treatment seeking behaviors (co
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QUESTIONNAIRE For Unmarried Male An
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The YOUTH questionnaire includes th
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No. Questions and filters Coding ca
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Stigma and Discrimination No. Quest
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FAMILY HEALTH INTERNATIONAL (FHI) H
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STD Treatment seeking behaviors No.
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STD Treatment seeking behaviors (co
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QUESTIONNAIRE For Men Who Have Sex
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The MSM questionnaire includes the
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STD Treatment seeking behaviours No
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No. Questions and filters Coding ca
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QUESTIONNAIRE For Injecting Drug Us
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This questionnaire includes the fol
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EXAMPLE OF SUPERVISORS’ AND INTER
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A “take-all” approach is to be
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• To probe for additional informa
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Part B: How to use the Long Distanc
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An example of a question for which
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Part C: Section-by-section review o
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Q109. If the respondent says he/she
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it is asking if the respondent has
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Section 5 : Non-regular partners Q5
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Q706 : This question determines the
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Q910 - Q912 : Knowledge of maternal
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in riskier behavior (i.e., not usin
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Section 5 : Non-paying partners Que
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3 APPENDIX WORKING EXAMPLES OF SAMP
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For the purposes of the BSS, the ke
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The second stage sampling procedure
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Notes: 1. It may not always be poss
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The information from the mapping ex
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In Figure 3, clusters were chosen b
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Fieldwork assignments when the “t
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Figure 4 : Example of targeted snow
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In some settings it may not be acce
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Figure 6 : Steps in using the segme
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Figure 9 : Map of hypothetical samp
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In-class sampling of school youth T
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Alternative to “in-class” sampl
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found at the various locations at d
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What should be done if, even after
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FIELDWORK FORMS The following set o
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Form I Cluster Selection Sheet (Pro
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Form 2 Cluster Selection Sheet (Equ
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Form 3 Assignment Information Sheet
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Form 4 Cluster Information Sheet Su
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TABLE OF CHI-SQUARE STATISTICS AND
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Step 2 : Calculate the expected num
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