Asking questions about women's reproductive health: validity and reliability of survey findings from Istanbul

Abstract

SummaryIn countries where population-based data on health problems are scarce, the extent of reproductive morbidity can be estimated from replies in structured interviews as a complement or as an alternative to reports from physician's examination and laboratory tests. We examined the sensitivity and specificity of detected morbidity based on these replies as compared to medical diagnoses and explored the consistency of replies when the questionnaire was administered twice, by two types of interviewers in different environments. Data were collected in a cross-sectional survey in Istanbul. The presence or absence of five morbidities, reproductive and urinary tract infections (RTI and UTI), menstrual disorders, pelvic relaxation and anaemia was determined by algorithms based on the replies, and by the physician's diagnosis. Except with anaemia, questionnaire replies were more specific than sensitive in detecting morbidity, probably partly due to many morbid conditions being accepted as normal. Specificity exceeded 80% for home reports of menstrual disorders (93.0%), pelvic relaxation (95.7%), RTI (abnormal discharge and pain) (81.2%) and UTI (80.7%), with the corresponding figure for anaemia at 41.7%; the best sensitivity results were for anaemia (58.3%), RTI (abnormal discharge only) (49.3%) and menstrual disorders (45.4%) with figures for pelvic relaxation and UTI reaching only 17.3 and 13.0%. Reliability between the interviews (assessed by the coefficient), was highest at 66.1% for pelvic relaxation and lowest at 39.9% for menstrual disorders. Reliability varied between the two lay interviewers, suggesting the interviewer and the interview conditions are important. Questionnaire-based information on this type of morbidity is most useful for ascertaining perceived ill-health and only of limited use for the corresponding medically defined conditions. keywords reproductive health, health interview surveys, Turkey correspondence Véronique Filippi, Maternal and Child Epidemiology Unit,

Menstrual Problems and Health Seeking in Sri Lanka

“…Although several studies have described the prevalence of menstrual problems among women in South Asia, including in Sri Lanka (Montgomery, 1974;Ferro-Luzzi, 1980;Bang et al, 1989;Bhatia et al, 1997;Bulut, Filippi, & Marshall, 1997;Fillippi et al, 1997;Walraven et al, 2002;Deeb et al, 2003;Kumarapeli, 2006), information on dysfunctions, such as amenorrhea, dysmenorrhea, and menorrhagia, is scarce. The ''culture of silence'' associated with menstruation (Bang et al, 1989;Rani & Bonu, 2003;Schooler et al, 2005;Cooper and Koch, 2007;Johnston-Robledo et al, 2007) and the sensitive and personal nature of the information from women's perspectives, suggested the special value of using qualitative methods to gather information (LeCompte and Schensul, 1999).…”

Surveys on sexual health: recent developments and future directions

“…A major limitation of social research is its reliance on self reports of symptoms of infection, which correlate poorly with laboratory evidence. [2][3][4][5] At the same time, surveillance systems (where they exist) exclude cases diagnosed and treated outside the GUM service (notably in primary care and the private sector), and provide no measure of the burden of untreated STIs in the community. Sentinel surveillance-for instance, of antenatal clinic attenders or military conscripts, is invaluable in monitoring HIV epidemics but is unable to illuminate the underlying behavioural dynamics of disease transmission, the forces that sustain unsafe sex, the barriers to treatment seeking, or the consequences of infection for individuals and families.…”

Measuring Gynecological Morbidity: Evaluating Two Different Data Sources From Beirut

“…Population-based health examination surveys have the potential to provide the best quality data. Some population-based health examination surveys of reproductive morbidity have been done using medical examinations, sometimes accompanied by laboratory testing (Bang et al, 1989;Bhatia, Cleland, Bhagavan, & Rao, 1997;Filippi, Marshall, Bulut, Graham, & Yolsal, 1997;Wasserheit, Harris, Chakraborty, Kay, & Mason, 1989;Younis et al, 1993). These produce population-based point prevalences of medically defined morbidity.…”

“…Such surveys usually interview women by using a symptom checklist and/or asking for spontaneous complaints (Bang et al, 1989;Wasserheit et al, 1989;Younis et al, 1993, Filippi et al, 1997Bhatia & Cleland, 1995;Stewart, Stanton, Festin, & Jacobson, 1996). Alternatively, they may ask about a condition diagnosed during a recent visit to a health facility.…”

“…Several studies have compared women's perceived/reported morbidity and clinical and/or laboratory tests. These comparisons show poor agreement, and results can be difficult to interpret (Bang et al, 1989;Filippi et al, 1997;Zurayk, Khattab, Younis, Kamal, & El-Mouelhy, 1995). However, to our knowledge there are few studies (Bulut, Yosal, Fillippi, & Graham, 1995;Filippi et al, 1997) that attempt to pool information from different data sources while discussing the practical limitations encountered and suggesting possible alternatives.…”