Cognitive strategies affecting recall of sexual behavior among high-risk men and women.

OBJECTIVE Most sexual health research depends on self-reported information, but little is known about the ways in which individuals arrive at their responses to sexual behavior questions. The purpose of the present research was to investigate the cognitive strategies and contextual cues used to recall sexual behaviors among men and women at high risk for HIV. DESIGN 102 men and 106 women were recruited from a public health sexually transmitted disease clinic (mean age = 31 years; 45% African American, 50% White) and asked to think aloud as they responded to questions about number of lifetime sexual partners and frequency of vaginal and oral sex (in the past 2 weeks or 3 months). MAIN OUTCOME MEASURES Transcripts of participant interviews were coded for the different types of cognitive strategies and contextual cues that were used to recall counts of sexual partners and behaviors. RESULTS Multivariate logistic regressions indicated that respondents tended to enumerate each instance of behavior when recalling low frequencies of behavior and small numbers of partners and to use rate-based estimates or general impression strategies when recalling high frequencies and numbers. Most respondents did not use self-generated contextual cues. CONCLUSION Results suggest that reports of high frequencies of sexual behavior or large numbers of partners are approximations. For valid and reliable assessment, researchers should direct respondents to recall sexual behavior in small, manageable chunks through the use of interviewer prompts.