Institute for Global Health, University College London, London, United Kingdom; Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa; Department of Epidemiology, Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; MRC/WITS Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso.
J Adolesc Health. 2021 May;68(5):914-921. doi: 10.1016/j.jadohealth.2020.09.006. Epub 2020 Oct 21.
Accurate measures of violence are difficult to obtain from self-reported data because of stigmatization and social undesirability of the topic. Most methods that attempt to reduce such biases require literacy and either remove the benefits of interviewer guidance or do not give individual-level results. We tested a low-tech nonverbal response card that avoids revealing interviewees' responses to interviewers while retaining interviewer support among adolescents in communities with very low educational attainment.
As part of a broader health questionnaire, we asked a sample of 1,644 adolescents, aged 12-20 years, in northwestern Burkina Faso about their experiences of physical and sexual violence. We randomized participants to either a conventional verbal response arm or a nonverbal response card arm where respondents' answers were unspoken and not displayed to interviewers. We first evaluated response validity and reliability in each arm, then compared prevalence rates across arms and evaluated whether any differences varied by respondent characteristics using regression models.
The level of internal reliability of responses among nonverbal respondents was similar to or greater than that of verbal respondents. Nonverbal respondents reported similar patterns of physical assault and sexual debut as verbal respondents but significantly higher levels of sexual assault and forced sex. These differences were broadly similar across sample subgroups defined by age, gender, proneness to social desirability, and mental health.
Nonverbal response cards offer a practical and beneficial method for reducing underreporting of stigmatized and traumatic experiences while maintaining data quality in low-literacy populations.
由于暴力行为这一话题具有污名化和社会不可取性，因此很难从自我报告数据中获得准确的衡量。大多数试图减少这种偏差的方法都需要读写能力，要么消除了访谈者指导的好处，要么无法提供个人层面的结果。我们测试了一种低技术的非言语反应卡，该卡片可以避免向访谈者暴露受访者的回答，同时在受教育程度非常低的社区中保留青少年访谈者的支持。
作为更广泛的健康问卷的一部分，我们询问了来自布基纳法索西北部的 1644 名 12-20 岁的青少年，了解他们在身体和性暴力方面的经历。我们将参与者随机分配到传统的口头反应组或非言语反应卡组，在非言语反应卡组中，受访者的回答是无声的，不会显示给访谈者。我们首先在每个组中评估反应的有效性和可靠性，然后比较组之间的流行率，并使用回归模型评估任何差异是否因受访者特征而异。
非言语受访者的反应内部可靠性与口头受访者相似或更高。非言语受访者报告的身体攻击和性初体验模式与口头受访者相似，但性侵犯和强迫性性行为的报告水平明显更高。这些差异在按年龄、性别、易受社会期望影响程度和心理健康划分的样本亚组中基本相似。
非言语反应卡提供了一种实用且有益的方法，可以减少污名化和创伤性经历的漏报，同时保持低识字率人群的数据质量。
