‘He said, she said’: assessing dyadic agreement of reported sexual behaviour and decision-making among an HIV sero-discordant couples cohort in Uganda Katherine A Muldoon, 1 Steve Kanters, 2 Josephine Birungi, 3 Rachel L King, 4,5 Maureen Nyonyintono, 6 Sarah Khanakwa, 7 David M Moore 8 For numbered affiliations see end of article. Correspondence to Dr David M Moore, Department of Medicine, University of British Columbia, Research Scientist, BC Centre for Excellence in HIV/ AIDS, St Paul’s Hospital, 608–1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; dmoore@cfenet.ubc.ca Received 5 August 2015 Revised 26 February 2016 Accepted 26 February 2016 Published Online First 30 March 2016 To cite: Muldoon KA, Kanters S, Birungi J, et al. J Fam Plann Reprod Health Care 2017;43:142–146. ABSTRACT Background The intimate nature of sexuality makes it challenging to accurately measure sexual behaviour. To assess response reliability, we examined agreement between couples in heterosexual HIV sero-discordant partnership on survey questions regarding condom use and sexual decision-making. Methods Data for this analysis come from baseline data from a cohort study of HIV sero- discordant couples in Jinja, Uganda. We examined the degree of agreement between male and female partners on standard measures of sexual behaviour using the kappa (κ) statistic and 95% confidence intervals (95% CIs). Results Among 409 couples, the median age for the male partner was 41 [interquartile range (IQR) 35–48] years and the female partner was 35 (IQR 30–40) years. Among 58.2% of the couples, the male was the HIV-positive partner. Questions with high or substantial couple agreement included condom use at last sex (κ=0.635, 95% CI 0.551–0.718) and frequency of condom use (κ=0.625, 95% CI 0.551–0.698). Questions with low or fair couple agreement included decision-making regarding condom use (κ=0.385, 95% CI 0.319–0.451), wanting more biological children (κ=0.375, 95% CI 0.301– 0.449) and deciding when to have sex (κ=0.236, 95% CI 0.167–0.306). Conclusions Survey questions assessing condom use had the highest level of couple agreement and questions regarding sexual decision-making and fertility desire had low couple agreement. Questions with high agreement have increased reliability and reduced measurement bias; however, questions with low agreement between couples identify important areas for further investigation, particularly perceived relationship control and gender differences. INTRODUCTION Reporting and social desirability biases are common threats to validity within research involving stigmatising topics such as sexuality. Accurate reporting of condom use and partnership-level factors such as sexual decision-making play an important role in preventing the trans- mission of HIV. Within Uganda, it is esti- mated that 50% of people living with HIV/AIDS are cohabitating with a partner who is HIV-negative and there- fore are at very high risk for acquiring HIV infection. 1 Established strategies to improve ques- tionnaire item validity include test-retest Key message points ▸ Accurate information on sexual behav- iour is needed to reduce risk among HIV sero-discordant couples. ▸ Matching couples answers to sexual and reproductive health questions revealed high agreement for reported condom use and lower agreement for sexual decision-making. ▸ Questions with high agreement have increased reliability, and questions with low agreement and large discrepancies between partners identify important areas for further investigation. RESEARCH 142 Muldoon KA, et al. J Fam Plann Reprod Health Care 2017;43:142–146. doi:10.1136/jfprhc-2015-101323 copyright. on December 11, 2021 by guest. Protected by http://jfprhc.bmj.com/ J Fam Plann Reprod Health Care: first published as 10.1136/jfprhc-2015-101323 on 30 March 2016. Downloaded from