Measuring sexual behaviour: methodological challenges in survey research.

Introduction The study of sexual behaviour lies at the heart of understanding the transmission dynamics of sexually transmitted infections (STIs). Academic investigation into sexual behaviour dates back to the 18th century and, over time, has employed a variety of approaches including the medical and psychiatric investigation of sexual disorders, anthropological investigations, and survey research based largely on volunteer samples. More recent studies, driven largely by the public health response to HIV/AIDS, have focused on large scale probability sample survey research. Key areas of inquiry have shifted towards describing population patterns of risk behaviours for STI/HIV transmission, understanding how epidemics of STIs are generated, and informing disease control strategies. Sexual behaviour is a largely private activity, subject to varying degrees of social, cultural, religious, moral and legal norms and constraints. A key challenge for all sex survey research is to generate unbiased and precise measures of individual and population behaviour patterns. Methods are needed to minimise measurement error which may be introduced by participation bias, recall and comprehension problems, and respondents’ willingness to report sensitive and sometimes socially censured attitudes or behaviours. 7 This paper briefly considers the role of diVerent types of study in understanding STI epidemiology. It then focuses on potential sources of measurement error in survey research and strategies for assessing and limiting them.