How and Where Do We Ask Sensitive Questions: Self-reporting of STI-associated Symptoms Among the Iranian General Population

Abstract

Background: Reliable population-based data on sexually transmitted infections (STI) are limited in Iran and self-reporting remains the main source of indirect estimation of STI-associated symptoms in the country. However, where and how the questions are asked could influence the rate of self-reporting. In the present study, we aimed to assess what questionnaire delivery method (ie, face-to-face interview [FTFI], self-administered questionnaire [SAQ], or audio self-administered questionnaire [Audio-SAQ]) and setting (ie, street, household or hair salon) leads to more reliable estimates for the prevalence of self-reported STI-associated symptoms. Methods: This cross-sectional study was conducted in winter 2014 on a gender-balanced (50.0% men) sample of 288 individuals aged 18–59 years old in Kerman, Iran. Respondents were recruited in (a) crowded public places and streets, (b) their households, and (c) hair salons. Data was collected on history of current and 6-month (ie, past 6 months) STI-associated symptoms. Three different methods including FTFI, SAQ and or Audio-SAQ were applied randomly in households and non-randomly in streets and hair salons to collect data among the respondents. Generalized estimating equation (GEE) was used to compare the settings and methods separately. Results: A total of 2.8% of men and 9.4% of women self-reported at least one STI-associated symptom. Respondents were significantly more likely to report STI-associated symptoms when completing questionnaires on the street compared to their household (P = .0001). While women were less likely to report symptoms in FTFI compared to SAQ (P = .036), no significant differences were found between men’s responses across different methods (P = .064). Conclusion: Further research is needed to evaluate the effect of different combinations of methods and settings to find the optimal way to collect data on STI-associated symptoms.

Condom Use and its Associated Factors Among Iranian Youth: Results From a Population-Based Study

“…33 Moreover, these programs would not often cover the sexual health needs of those who might have extra marital sex, perhaps due to cultural taboos and religious values in the country. 29,34…”

“…Empirical studies in Iran have shown that cultural and religious restrictions might limit reporting sensitive information such as sexual practices or intercourses, and that people are more likely to disclose this information in the street-based surveys in comparison with telephone or home-based surveys. 28,29 As a result, participants were recruited from public places and crowded streets in urban areas. In fact, urban areas were divided in five regions (north, east, west, south and central) and two public places were selected from each region.…”

Public Stigma Toward Female and Male Opium and Heroin Users. An Experimental Test of Attribution Theory and the Familiarity Hypothesis

“…We implemented a street-based convenience sample in part because web-based services covering the general population are not available. Street-based sampling has been found to very feasible in comparison to random sampling via households, especially when investigating sensitive topics (61). Based on previous studies, we stratified Kerman based on the socio-economic status (low, medium, and high) (62,63).…”

“…While we employed a convenience street-based sampling strategy (which still yielded a high response rate) due to its feasibility in the study context (61), future research should aim for national samples to counteract potential sampling biases.…”

Awareness and Attitude Towards Opioid and Stimulant Use and Lifetime Prevalence of the Drugs: A Study in 5 Large Cities of Iran

“…However, our previous experiences suggested that street-based sampling was the optimum approach in the case of sensitive characteristics in Iran. 55,56…”