Measuring Behavioural Outcomes with Polling Booth Surveys

1

Measuring Behavioural Outcomes with Polling Booth

Surveys B.M. Ramesh, PhD

Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada

&Karnataka Health Promotion Trust, Bangalore,

India

2

Background

• Focused HIV prevention program in 6 high prevalence states in India– KSAPS implementing the program in 9 districts

of Karnataka– KHPT implementing the program in 16 districts

in Karnataka and 3 districts in Maharashtra.

• Main objective is to reduce the incidence of HIV and STIs.

• Monitor changes in condom use and other sexual behaviours

• Polling Booth Surveys (PBS) among FSWs

3

What is polling booth survey?

• Polling booth survey is:– A group interview method

– Where the individuals give their responses through a ballot box

– Where the individual responses are anonymous and unlinked

4

Polling booth survey: Advantages

• More suitable to collect information on sensitive and personal issues

• Reduces social desirability bias• Respondent remains anonymous• Easy to administer among the illiterate• Increases sense of confidentiality among

participants• Simple to analyze• Not individualized face to face interview, but a

group approach using a moderator giving instructions

5

Comparison of face-to-face interviews with PBS

• Among FSWs– The FTFI tends to overestimate the condom

use behaviour– The PBS tends to minimize the exaggeration of

reported condom use

• Among the general population– The FTFI tends to underestimate the risky

sexual behaviours– The PBS tends to give a relatively higher

reporting of risky sexual behaviours

6

Comparison of FTFI and PBS for eliciting sensitive behaviours among unmarried

subjects in Mysore GPS

Unmarried women Unmarried men

Year – 2005/06 FTFI(n=534)

PBS(n=545)

FTFI(n=882)

PBS(n=484

)

Ever taken HIV test* 0.6% 2.5% 2.5% 4.5%

Vaginal (urethral) discharge last year

3.4% 20.9% 0.5% 7.9%

Genital ulcer last year 0.6% 7.7% 0.3% 7.6%

Ever seen a condom 30.3% 47.9% 67.5% 76.0%

Ever had heterosexual sex 0.6% 2.4% 8.3% 20.9%

Ever been paid / paid for sex 0.0% 0.6% 1.8% 6.2%

Ever had anal sex with a man 0.0% 0.6% 0.8% 6.6%*Among those who have heard of HIV/AIDS

7

Comparison of FTFI and PBS for eliciting sensitive behaviours among married subjects

in Mysore GPS 

Married women Married men

Year – 2005/06 FTFI(n=2036

)

PBS(n=575)

FTFI(n=1201

)

PBS(n=409)

Ever taken HIV test* 6.1% 14.6% 3.1% 6.0%

Vaginal (urethral) discharge last year 3.5% 27.5% 0.1% 10.5%

Genital ulcer last year 0.8% 17.6% 0.1% 6.1%

Pre-/extra-marital sex ever 0.8% 10.3% 18.7% 35.9%

Ever been paid / paid for sex 0.3% 3.1% 2.3% 7.6%

Husband (wife) ever had extra-marital sex

10.3% 29.9% 0.5% 2.7%

Husband ever had sex with FSW 1.9% 12.4% NA

Ever had heterosexual anal sex 0.5% 4.4% 3.0% 5.6%

Ever had homosexual anal sex NA 0.5% 5.4%

*Among those who have heard of HIV/AIDS

8

Comparison of FTFI and PBS for eliciting sensitive behaviours among unmarried

subjects in Belgaum

Unmarried women

Unmarried men

Year - 2007 FTFI(n=464)

PBS(n=631)

FTFI(n=947)

PBS(n=750

)

Ever taken HIV test* 3.4% 3.0% 2.6% 8.3%

Vaginal (urethral) discharge last year

0.7% 17.1% 1.9% 16.5%

Genital ulcer last year 0.0% 5.4% 1.2% 13.2%

Ever seen a condom 17.0% 19.0% 75.7% 79.7%

Ever had heterosexual sex 1.1% 2.7% 5.6% 19.9%

Ever been paid / paid for sex 0.0% 0.2% 0.8% 8.5%

Ever had anal sex with a man 0.0% 0.5% 0.6% 4.9%*Among those who have heard of HIV/AIDS

9

Comparison of FTFI and PBS for eliciting sensitive behaviours among married subjects

in the Belgaum

Married women Married men

Year - 2007 FTFI(n=2055

)

PBS(n=715)

FTFI(n=1456)

PBS(n=707)

Ever taken HIV test* 19.5% 20.9% 8.5% 15.9%

Vaginal (urethral) discharge last year 2.3% 19.9% 0.6% 17.7%

Genital ulcer last year 0.2% 14.5% 0.4% 11.0%

Pre-/extra-marital sex ever 0.2% 9.1% 11.7% 35.1%

Ever been paid / paid for sex 0.2% 3.6% 2.1% 12.9%

Husband (wife) ever had extra-marital sex

5.9% 15.5% 0.1% 3.7%

Husband ever had sex with FSW 0.9% 7.3% NA

Ever had heterosexual anal sex 1.4% 7.8% 1.0% 5.4%

Ever had homosexual anal sex NA 0.2% 5.9%

*:Among those who have heard of HIV/AIDS

10

PBS methods (1)• Members are separated from

each other in a polling booth environment

• Each participant is given 3 boxes (Red, Green and White) and a pack of cards

• Cards are numbered corresponding to the number of questions asked

• Cards are stacked in serial order

• Responses– Card with the number corresponding

to the question asked is put into the Green box if the response to the question is YES

– Card is put into the Red box if the response is NO

– Card is put into the White box if the question is NOT APPLICABLE

– Card is kept outside these boxes if the participant does not want to respond to that question

11

PBS Method (2)

• The moderator explains the PBS method with an example and a practice session

• Questions are read one by one• The moderator needs to

– Make the exercise lively– Ask each question clearly,

slowly and loudly so that every participant hears the question clearly, repeating the question as required

– Use situations/stories while asking the question

– Use local terms– Give sufficient pause, and

not to hurry

12

PBS Method (3)

• At the end of administering the questions:– Collect the cards separately:

the ones that are in the Green boxes, the ones that are in Red boxes and the ones that are in the White boxes

– Count the number of cards in each box for each question and record the tallies in the reporting form

• Share and discuss the group responses with the participants

• Document group discussion points

13

Sampling in PBS

• The subjects for the PBS may be recruited using any of the probability sampling methods

15

Polling booth questions

• Only the questions that have a definitive YES or NO as answers are suitable to be canvassed in PBS– How often do you use condoms with your

regular clients? (Not suitable for PBS)

16

Challenges/Limitations

• Non-response could be higher as not all selected individuals are able to participate in a group at the designated time and place

• Can include only the questions that have a YES or NO answers

• Can ask only a limited number of questions – questionnaire cannot be as long as the one that could be used in a face-to-face interview

• Can get only the group-aggregated data, and cannot be analyzed with linkages to individual characteristics

17

For more information

Dr. B.M. Ramesh, Director, Monitoring and Evaluation Karnataka Health Promotion TrustIT Park, 5th Floor, #1-4Rajajinagar Industrial AreaRajajinagar, Bangalore – 560 044, INDIAPh: +91-80-40400209Email: [email protected]