Psychometric evaluation of HIV risk behavior assessments using Audio Computer Assisted Self-Interviewing (ACASI) among orphans and vulnerable children in Zambia

Abstract

Social desirability bias and underreporting of HIV risk behaviors are significant challenges to the accurate evaluation of HIV prevention programs for orphans and vulnerable children (OVC) in sub-Saharan Africa. Valid and reliable HIV risk behavior instruments are critical to address these challenges. We assessed the psychometric properties of two risk behavior measures, the World Aids Foundation Survey (WAF) and the Peer HIV Risk Behavior Screener (PHRBS), administered to 210 OVC in Zambia using Audio Computer Assisted Self-Interviewing. All WAF subscales exhibited good internal reliability (α > .80); only the Sexual Behavior Practices subscale strongly distinguished (P < .01) adolescents who engaged in HIV risk behaviors ("cases") from those who did not ("non-cases"). An 8-item version of the PHRBS, refined using exploratory factor analysis, demonstrated good internal reliability (α = 87), differentiated "cases" from "non-cases" (P < .01), and correlated strongly with the Sexual Behavior Practices subcale (r = .34, P < .01). Results suggest that report of peers' sexual behaviors can serve as a proxy for OVCs' own behavior in contexts where social desirability bias affects reporting.

When less is more: reducing redundancy in mental health and psychosocial instruments using Item Response Theory

“…Using the other half of the instrument validation study data (Murray et al ., 2018 b ), we compared the performance of a shortened CPSS to the original version across a number of psychometrics: (1) Cronbach's α ; (2) score distributions (i.e. means and standard deviations); (3) criterion validity comparing average scores on the original CPSS and short CPSS for PTSD cases and non-cases (Kane et al ., 2018; Murray et al ., 2018 b ); and (4) clinical utility comparing Area Under the Curves (AUCs) using our criterion. We tested the shortened CPSS performance in the baseline RCT data by comparing the relative strength of correlations between the shortened CPSS version and the full version with three external measures: a locally-developed scale of functional impairment (Murray et al ., 2015), and the Youth Self Report (YSR), which includes sub-scales of both internalizing and externalizing symptoms (Achenbach, 1991).…”

“…We used IRT to generate shortened scales and then tested how well the shortened scales measured change over time in the enrolled sample ( N = 347). The second source of data is from HIV-affected adolescents (ages 13–17) in Zambia who completed assessments either as part of a cross-sectional instrument development study ( N = 210) (Kane et al ., 2018; Murray et al ., 2018 b ) or during screening for an RCT of trauma-focused cognitive behavioral therapy ( N = 610; NCT02054780) that used the measures tested in the instrument development study. These samples were selected due to their purposive sampling approach, which was intended to include people with and without mental health problems representing a range of underlying disease severity.…”

“…For Zambia, participants in each study were distinct but drawn from the same source population of adolescents who exhibited HIV risk behaviors and met the WHO criteria for orphan or vulnerable child (Kane et al ., 2018; Murray et al ., 2018 b ). Item selection for the CPSS based on GRMs was conducted with a random sample of 50% of the data from the instrument validation study.…”

Measuring Symptoms of Psychopathology in Zambian Orphans and Vulnerable Children: Scale Validation and Psychometric Evaluation

“…The eligibility screening consisted of asking the HBCW, the adolescent, and his or her caregiver separately whether they considered the adolescent to fall into any of the four eligibility categories described above, based on the presence or absence of psychosocial and HIV-risk behaviors (see Kane et al, 2018). Each participant was asked to respond “yes” or ‘‘no” to the following four questions (when asking adolescents to respond, the language was modified from “is/does the adolescent” to “are/do you”):…”

Efficacy of the Common Elements Treatment Approach (CETA) for Unhealthy Alcohol Use Among Adults with HIV in Zambia: Results from a Pilot Randomized Controlled Trial

“…A participant could also be eligible without having a comorbidity if they met criteria for a more severe alcohol use problem (AUDIT score ≥ 16 among men; ≥ 12 among women) [24,26]. The screening, which also served as the baseline assessment, was administered via audio computer assisted self-interviewing (ACASI) [16,[27][28][29][30], in one of three languages: English, Bemba, or Nyanja. Exclusion criteria were: currently psychotic, actively suicidal and needing immediate hospitalization, or unable to provide informed consent.…”