Looking at the PREPARE data or “How (not) to open Pandora’s box” S.M. Eggers

Factors (Dar) # items Response formatBaselineFollow-up HIV knowledge Condom knowledge Myths HIV Myths condoms Risk susceptibility sti Risk severity sti Attitude: -Pros delaying sex -Cons delaying sex -Pros condom use -Cons condom use Subjective norms delaying sex Subjective norms condom use Self-efficacy delaying sex Self-efficacy condom use Action planning delaying sex Action planning condom use Yes, no, I don’t know a Yes, no, I don’t know a Strongly disagree-Strongly agree Strongly disagree-Strongly agree Very low-Very high Not serious-Very serious Strongly disagree-Strongly agree Strongly disagree-Strongly agree Strongly disagree-Strongly agree Strongly disagree-Strongly agree Very difficult-Very easy Very difficult-Very easy Strongly disagree-Strongly agree Strongly disagree-Strongly agree 0.50 (0.28) 0.25 (0.24) 2.19 (0.73) 2.31 (0.80) 3.47 (0.98) 3.98 (1.08) 3.44 (0.90) 2.29 (0.86) 3.21 (0.82) 2.60 (0.69) 3.50 (0.93) 3.44 (0.97) 2.61 (0.91) 2.49 (0.82) 3.23 (0.83) 3.42 (0.96) 0.46 (0.29) 0.24 (0.24) 2.17 (0.73) 2.39 (0.79) 3.57 (0.96) 4.03 (1.04) 3.48 (0.92) 2.29 (0.80) 3.28 (0.81) 2.60 (0.73) 3.48 (0.96) 3.33 (0.98) 2.70 (0.92) 2.54 (0.83) 3.24 (0.81) 3.28 (1.00)

Factors (Dar) # items Response format Cronbachs alpha Test-Retest ICC HIV knowledge Condom knowledge Myths HIV Myths condoms Risk susceptibility sti Risk severity sti Attitude: -Pros delaying sex -Cons delaying sex -Pros condom use -Cons condom use Subjective norms delaying sex Subjective norms condom use Self-efficacy delaying sex Self-efficacy condom use Action planning delaying sex Action planning condom use Yes, no, I don’t know a Yes, no, I don’t know a Strongly disagree-Strongly agree Strongly disagree-Strongly agree Very low-Very high Not serious-Very serious Strongly disagree-Strongly agree Strongly disagree-Strongly agree Strongly disagree-Strongly agree Strongly disagree-Strongly agree Very difficult-Very easy Very difficult-Very easy Strongly disagree-Strongly agree Strongly disagree-Strongly agree

Factors (CT) # items Response formatBaselineFollow-up HIV knowledge Condom knowledge Myths HIV Myths condoms Risk susceptibility sti Risk severity sti Attitude: -Pros delaying sex -Cons delaying sex -Pros condom use -Cons condom use Subjective norms delaying sex Subjective norms condom use Self-efficacy delaying sex Self-efficacy condom use Action planning delaying sex Action planning condom use Yes, no, I don’t know a Yes, no, I don’t know a Strongly disagree-Strongly agree Strongly disagree-Strongly agree Very low-Very high Not serious-Very serious Strongly disagree-Strongly agree Strongly disagree-Strongly agree Strongly disagree-Strongly agree Strongly disagree-Strongly agree Very difficult-Very easy Very difficult-Very easy Strongly disagree-Strongly agree Strongly disagree-Strongly agree 0.56 (0.28) 0.28 (0.24) (1.18) 4.03 (1.14) 3.99 (0.84) 2.56 (1.02) 3.83 (0.77) 2.77 (0.90) 4.34 (0.74) 4.26 (0.84) 3.08 (1.07) 2.96 (0.89) 3.67 (1.18) 4.14 (0.91) 0.57 (0.28) 0.29 (0.25) (1.09) 4.13 (1.04) 4.06 (0.81) 2.38 (0.99) 3.87 (0.73) 2.62 (0.89) 4.37 (0.73) 4.36 (0.75) 3.25 (1.04) (1.15) 4.18 (0.84)

Factors (CT) # items Response format Cronbachs alpha Test-Retest ICC HIV knowledge Condom knowledge Myths HIV Myths condoms Risk susceptibility sti Risk severity sti Attitude: -Pros delaying sex -Cons delaying sex -Pros condom use -Cons condom use Subjective norms delaying sex Subjective norms condom use Self-efficacy delaying sex Self-efficacy condom use Action planning delaying sex Action planning condom use Yes, no, I don’t know a Yes, no, I don’t know a Strongly disagree-Strongly agree Strongly disagree-Strongly agree Very low-Very high Not serious-Very serious Strongly disagree-Strongly agree Strongly disagree-Strongly agree Strongly disagree-Strongly agree Strongly disagree-Strongly agree Very difficult-Very easy Very difficult-Very easy Strongly disagree-Strongly agree Strongly disagree-Strongly agree

Outcome variables Dar es Salaam Baseline Dar es Salaam Follow-up Cape Town Baseline Cape Town Follow-up I intend to have sex in the next 6 months When I have a boyfriend or girlfriend, I intent to stay faithful and not have sex with somebody else I intend to use a condom the next time I have sex Have you ever had vaginal sex? Have you ever had oral sex? Have you ever had anal sex? Have you ever used a condom? a Did you use a condom the last time you had sex? a In the past 6 months, how often did you use a condom when having sex? b -Never -Sometimes -Everytime 2.28 (1.13) 2.31 (1.16) 2.71 (1.29) 9.4% (223) - 6.4% (151) 36.7% (81) 27.7% (59) 85.4% (163) 14.6% (28) 0% 2.21 (1.10) 2.32 (1.16) 2.64 (1.26) 15.9% (379) % (257) 39.9% (116) 22.3% (48) 72.5% (142) 27.5% (54) 0% 1.76 (1.17) (1.45) 14.5% (201) 10.9% (139) 10.7% (152) 47.8% (153) 75.5% (256) 50.2% (122) 30.8% (75) 19.0% (46) 1.79 (1.16) (1.32) 23.7% (364) 13.6% (194) 14.9% (217) 55.7% (256) 49.4% (244) 48.1% (161) 28.6% (96) 23.3% (78

Health Promotion So far, so good…

Health Promotion Another example: Gender FemaleMale Baseline (T1)49.6% (2227)50.4% (2262) FemaleMale Follow-up (T2)49.4% (2218)50.6% (2271)

Health Promotion Gender at baseline and at follow-up Female (T2)Male (T2) Female (T1)95.6%4.4% (97) Male (T1)3.9% (88)96.1%

Health Promotion Next, age difference between T1 and T2 Δ Age%N

Health Promotion I plan to use a condom when I have a steady partner % Definitely yes30 Probably yes10 Not sure49 Probably no4 Definitely no7 I plan to always keep a condom in a safe place at home % Definitely yes31 Probably yes11 Not sure42 Probably no5 Definitely no10

Health Promotion I intend to use a condom the next time I have sex % Definitely no28 Probably no9 Not sure42 Probably yes8 Definitely yes12 I intend to only have sex with my boy or girlfriend and not with somebody else % Definitely no38 Probably no9 Not sure45 Probably yes3 Definitely yes5

Health Promotion Next, have you ever had vaginal sex? YesNo Baseline (T1)9.7% (430)90.3% (3981) YesNo Follow-up (T2)9.5% (419)90.5% (3992)

Health Promotion Yes (T2)No (T2) Yes (T1)30.9% (133)69.1% (297) No (T1)7.2% (286)92.8% (3695) Next, have you ever had vaginal sex?

Health Promotion Also in Cape Town! Vaginal or anal or oral sex (combined) Condom use at last intercourse Never sexSex Condom use (T1)65.0% (1006)35.0% (541) Never sexSex Condom use (T2)31.3% (211)68.7% (463)

Health Promotion

211 instead of 1006 inconsistent answers Never sexSex Condom use (T1)65.0% (1006)35.0% (541) Never sexSex Condom use (T2)31.3% (211)68.7% (463)

Dar es Salaam Gender Age Ever sex Condom use First exp Pregnant Frequency sex Ever sex Intention Different gender at follow-up Became younger or more than 1 year older at follow-up Indicated to ever had sex at baseline, but not at follow-up Indicated to ever used a condom at baseline, but not at follow-up Indicated to ever had sex, but indicated no first experience (T1) Indicated to ever had sex, but indicated no first experience (T2) Indicated to not have had sex, but indicated to have been or made someone pregnant (T1) Indicated to not have had sex, but indicated to have been or made someone pregnant (T2) Indicated to not have had sex in the last 6 months, but indicated to have had sexual partners in that time (T1) Indicated to not have had sex in the last 6 months, but indicated to have had sexual partners in that time (T2) Indicated to never have had sex, but indicated to have had sexual partners (T1) Indicated to never have had sex, but indicated to have had sexual partners (T2) Indicated to ‘definitely’ plan to use a condom with steady partner, but indicated ‘definitely not’ intending to use a condom the next time they have sex (T1) Indicated to ‘definitely’ plan to use a condom with steady partner, but indicated ‘definitely not’ intending to use a condom the next time they have sex (T2) 4.1% (185) 7.8% (359) 63.7% (305) 20.4% (28) 0.7% (4) 27.5% (103) 2.9% (104) 1.0% (33) 45.2% (33) 45.7% (86) 10.3% (275) 0% (0) 8.3% (386) 7.0% (293)

Dar es Salaam: No of participants that scored inconsistently: 30.9% (1575) No of participants that had more than one inconsistency: 7.9% (401) No of participants that had more than two inconsistencies: 1.9% (96)

Dar es Salaam: Are these inconsistencies randomly distributed? Self-efficacy to talk about sex (r =.15) Communicating with peers about sex (r =.19) No other variables CONCLUSIONS: The inconsistencies seem to be mainly caused by ‘mistakes’. Perhaps improving the instructions could help future surveys. We need to cross-validate these outcome variables before running analyses.

Cape Town Gender Age Ever sex Condom use First exp Pregnant Sex partners Condom use Intention Different gender at follow-up Became younger or more than 1 year older at follow-up Indicated to ever had sex at baseline, but not at follow-up Indicated to ever used a condom at baseline, but not at follow-up Indicated to ever had sex, but indicated no first experience (T1) or vice versa Indicated to ever had sex, but indicated no first experience (T2) or vice versa Indicated to not have had sex, but indicated to have been or made someone pregnant (T1) Indicated to not have had sex, but indicated to have been or made someone pregnant (T2) Indicated to never have had sex, but indicated to have had sexual partners (T1) Indicated to never have had sex, but indicated to have had sexual partners (T2) Indicated condom use, but indicated to never have had sex (T1) Indicated condom use, but indicated to never have had sex (T2) Indicated to ‘definitely’ plan to use a condom with steady partner, but indicated ‘definitely not’ intending to use a condom the next time they have sex (T1) Indicated to ‘definitely’ plan to use a condom with steady partner, but indicated ‘definitely not’ intending to use a condom the next time they have sex (T2) 1.4% (45) n/a 36.2% (165) 47.7% (195) 17.0% (254) 12.7% (229) 0.7% (13) n/a 14.1% (203) 10.4% (158) 41.9% (1045) 11.8% (284) 5.3% (152) 3.0% (85)

Cape Town: No of participants that scored inconsistently: 49.7% (1762) No of participants that had more than one inconsistency: 21.6% (757) No of participants that had more than two inconsistencies: 9.6% (337)

Cape Town: Are these inconsistencies randomly distributed? Being male (r =.15)* Being older (r =.23)* Lower SES (r = -.16) Less risk perception: perceived susceptibility (r = -.14) and severity (r = -.18) No other variables CONCLUSIONS: The inconsistencies seem to be mainly caused by ‘mistakes’. Perhaps improving the instructions could help future surveys. We need to cross-validate these outcome variables before running analyses.

Health Promotion CONCLUSIONS: -Internal consistency & test-retest reliability: OK -Amount of inconsistencies: OK(-ish)?

Health Promotion CONCLUSIONS: -Internal consistency & test-retest reliability: OK -Amount of inconsistencies: OK(-ish)? -Avoid reversed framing of questions?  Including reversely framed questions can also be useful

Health Promotion CONCLUSIONS: -Internal consistency & test-retest reliability: OK -Amount of inconsistencies: OK(-ish)? -Avoid reversed framing of questions?  Including reversely framed questions can also be useful -Raw data entering is essential to trace these issues

Health Promotion CONCLUSIONS: -Internal consistency & test-retest reliability: OK -Amount of inconsistencies: OK(-ish)? -Avoid reversed framing of questions?  Including reversely framed questions can also be useful -Raw data entering is essential to trace these issues -Tablets/PDA’s can be programmed to detect (and not to accept) invalid codes, inconsistent combinations and illogical time sequences

Health Promotion CONCLUSIONS: -Internal consistency & test-retest reliability: OK -Amount of inconsistencies: OK(-ish)? -Avoid reversed framing of questions?  Including reversely framed questions can also be useful -Raw data entering is essential to trace these issues -Tablets/PDA’s can be programmed to detect (and not to accept) invalid codes, inconsistent combinations and illogical time sequences -Always try to cross-validate your variables before you trust your results ! ! !

Health Promotion Big thanks to: -CT team: Cathy, Joy, Petra, Tracy -Dar team: Sylvia, Lusajo, Mrema, Elia -Limpopo team: Hans, Susan -Kampala team: Anne, Cecily