Abstract
Background:
Screening for sensitive and stigmatised conditions such as mental health or experience of violence is challenging. Audio computer-assisted self-interviewing (ACASI), administered using a tablet and headphones, may be more sensitive for this purpose than paper-based self-administered questionnaires (SAQ) handed in to project staff. We conducted a methodological cluster-randomised trial in Zimbabwe to compare two methods of screening for common mental disorder (CMD) and intimate partner violence (IPV): ACASI versus SAQ.
Methods:
Trial participants were health workers receiving occupational health checks at hospitals and primary health clinics. The unit of randomisation was a working day. CMD was measured with the Shona Symptom Questionnaire, anxiety with the Generalised Anxiety Disorder-7 (GAD-7) and IPV with the WHO screening questionnaire. The co-primary outcomes were CMD prevalence and prevalence of any IPV, compared by arm at cluster level, adjusting for gender and weekend. Secondary outcomes were prevalence of anxiety and of physical, emotional, severe physical and sexual IPV.
Results:
Between 20 February and 10 June 2022, 1240 participants were enrolled in 71 clusters (workdays); 77.0% female and 66.4% in clinical-facing roles. The cluster-level geometric mean prevalence of CMD was 19.4% using ACASI and 14.1% using SAQ (adjusted risk ratio (aRR) 1.37 [95% CI 0.99, 1.89]; p=0.056). ACASI yielded a higher prevalence of overall IPV than the SAQ (cluster-level geometric mean prevalence 40.6% compared to 22.4%, aRR 1.81 [95%CI 1.40, 2.35; p<0.001), of emotional IPV (aRR 1.66 [95%CI 1.27, 2.17]; p<0.001) and of physical IPV (aRR 1.61 [95%CI 1.16, 2.25]; p=0.005). No differences were seen in prevalence of severe physical or sexual IPV, or anxiety across trial arms.
Conclusion:
Screening for CMD and IPV using a confidential ACASI method identifies more people who may benefit from care than screening using SAQ handed in to clinic staff. This may be explained by under-reporting on the SAQ. ACASI is a promising screening method for sensitive issues in health care settings.
Screening for sensitive and stigmatised conditions such as mental health or experience of violence is challenging. Audio computer-assisted self-interviewing (ACASI), administered using a tablet and headphones, may be more sensitive for this purpose than paper-based self-administered questionnaires (SAQ) handed in to project staff. We conducted a methodological cluster-randomised trial in Zimbabwe to compare two methods of screening for common mental disorder (CMD) and intimate partner violence (IPV): ACASI versus SAQ.
Methods:
Trial participants were health workers receiving occupational health checks at hospitals and primary health clinics. The unit of randomisation was a working day. CMD was measured with the Shona Symptom Questionnaire, anxiety with the Generalised Anxiety Disorder-7 (GAD-7) and IPV with the WHO screening questionnaire. The co-primary outcomes were CMD prevalence and prevalence of any IPV, compared by arm at cluster level, adjusting for gender and weekend. Secondary outcomes were prevalence of anxiety and of physical, emotional, severe physical and sexual IPV.
Results:
Between 20 February and 10 June 2022, 1240 participants were enrolled in 71 clusters (workdays); 77.0% female and 66.4% in clinical-facing roles. The cluster-level geometric mean prevalence of CMD was 19.4% using ACASI and 14.1% using SAQ (adjusted risk ratio (aRR) 1.37 [95% CI 0.99, 1.89]; p=0.056). ACASI yielded a higher prevalence of overall IPV than the SAQ (cluster-level geometric mean prevalence 40.6% compared to 22.4%, aRR 1.81 [95%CI 1.40, 2.35; p<0.001), of emotional IPV (aRR 1.66 [95%CI 1.27, 2.17]; p<0.001) and of physical IPV (aRR 1.61 [95%CI 1.16, 2.25]; p=0.005). No differences were seen in prevalence of severe physical or sexual IPV, or anxiety across trial arms.
Conclusion:
Screening for CMD and IPV using a confidential ACASI method identifies more people who may benefit from care than screening using SAQ handed in to clinic staff. This may be explained by under-reporting on the SAQ. ACASI is a promising screening method for sensitive issues in health care settings.
| Original language | English |
|---|---|
| Journal | International Journal of Epidemiology |
| Publication status | Accepted/In press - 16 Oct 2025 |
