Self-report sexual risk behaviors

Self-report sexual risk behaviors are a cornerstone of sexual health-related research, particularly when related to assessing risk-related outcomes such as pregnancy or acquisition of sexually transmitted infections (STIs) such as HIV. Despite their frequency of use, the utility of self-report measures to provide an accurate account of actual behavior are questioned and ways to enhance their accuracy should be a critical focus when administering such measures.

Self-reported assessments of sexual behavior are prone to a number of measurement concerns that could affect the reliability and validity of a measure ranging from participants literacy level and comprehension of behavioral terminology to recall biases and self-presentation or confidentiality concerns resulting form stigmatization of the behavior in question.

Thus, the decision to incorporate a self-report measure of sexual risk behaviors is often one of practicality. Self-report measures are both inexpensive and more feasible than behavioral observation given the private nature of most sexual risk behaviors. To this end, the validity of self-reported sexual risk measures can be strengthened by the level of concordant answers obtained from sexual partners or obtained from sexual partners or through more objective measures of risk such as incidence of pregnancy, HIV or other STIs.

It is important to consider the way in which measures of self-reported sexual risk behaviors will be collected during the research development phase. Frequently self-report measures are self administered, but can also be elicited from an interviewer either face-to-face or over the phone; such modalities help to address literacy and comprehension confounds but may increase potential for self-presentation bias (2-3). The delivery of risk behavior assessments via the internet or computer can increase a sense of privacy and may reduce self-presentation biases.

Similarly, it is important to select a self-report sexual risk measure that meets the studies assessment needs. Dichotomous (yes/no) evaluation of engagement in risk behaviors (Risk Screening), assessing the level of risk via frequency of engagement in risk behaviors (Risk Assessments), and detailed event-level data related to the co-occurrence of other factors (e.g., alcohol use or primary vs. secondary partners) that may facilitate engaging in risk behaviors (Risk-event Data) are non-equivocal serving very distinct functions in evaluating self-reported risk behavior.

Attention should also be paid to the period of time in which self-reported risk measures ask individuals to recall the occurrence/frequency of engaging in risk behavior, generally recalling frequency of risk behaviors over a period of approximately 3 months supports recall accuracy.