Reducing under-reporting of stigmatized health events using the List Experiment: results from a randomized, population-based study of abortion in Liberia
Reducing under-reporting of stigmatized health events using the List Experiment: results from a randomized, population-based study of abortion in Liberia
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DOI：
10.1093/ije/dyv174
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发表时间：
2015-12-01
影响因子：
7.7
通讯作者：
Gerdts, Caitlin
中科院分区：
文献类型：
--
作者：
Moseson, Heidi;Massaquoi, Moses;Gerdts, Caitlin
背景：由于耻辱感和对隐私的担忧，敏感健康事件的直接测量往往受到高度漏报的限制。特别是堕胎，众所周知，很难衡量。本研究实施了一种新的方法来估计人工流产在利比里亚的累积终生发病率。方法：在随机选择的样本3219名妇女年龄在15-49岁，2013年6月在利比里亚，我们实施了“双名单实验”。为了测量流产发生率，每个妇女都读了两个列表：（A）非敏感项目列表和（B）与流产相关的非敏感项目列表。敏感项目堕胎被随机添加到每个答复者的清单A或清单B中。受访者报告了她所经历的每个列表上的选项的简单计数，但没有说明哪些选项。然后对每个列表的平均计数之间的平均值计算的差异进行平均，以提供已经流产的人口比例的估计。结果：列表实验估计32% [95%置信区间（CI）：0.29-0.34）的受访者曾经堕胎（城市地区妇女为26%，农村地区妇女为36%，差异P值< 0.001），答复率为95%。名单实验产生的估计数比利比里亚以前唯一有代表性的堕胎估计数高出五倍，表明这一方法在减少堕胎计量中报告不足的情况方面的潜在效用。这一方法可广泛用于衡量其他被污名化的健康问题，包括性行为、性攻击或家庭暴力。
Background: Direct measurement of sensitive health events is often limited by high levels of under-reporting due to stigma and concerns about privacy. Abortion in particular is notoriously difficult to measure. This study implements a novel method to estimate the cumulative lifetime incidence of induced abortion in Liberia.Methods: In a randomly selected sample of 3219 women ages 15-49 years in June 2013 in Liberia, we implemented the 'Double List Experiment'. To measure abortion incidence, each woman was read two lists: (A) a list of non-sensitive items and (B) a list of correlated non-sensitive items with abortion added. The sensitive item, abortion, was randomly added to either List A or List B for each respondent. The respondent reported a simple count of the options on each list that she had experienced, without indicating which options. Difference in means calculations between the average counts for each list were then averaged to provide an estimate of the population proportion that has had an abortion.Results: The list experiment estimates that 32% [95% confidence interval (CI): 0.29-0.34) of respondents surveyed had ever had an abortion (26% of women in urban areas, and 36% of women in rural areas, P-value for difference < 0.001), with a 95% response rate.Conclusions: The list experiment generated an estimate five times greater than the only previous representative estimate of abortion in Liberia, indicating the potential utility of this method to reduce under-reporting in the measurement of abortion. The method could be widely applied to measure other stigmatized health topics, including sexual behaviours, sexual assault or domestic violence.