Value of audio-enhanced handheld computers over paper surveys with adolescents.

Early adolescence is increasingly seen as an appropriate time to introduce interventions aimed at preventing risky behaviors such as drug and alcohol use, violence, and unprotected sexual activity.1,2 As adolescents spend a majority of their time at school, the classroom becomes a natural venue for implementing these interventions.3 Researchers often use survey methodology to assess the effectiveness of these interventions. Due to the highly sensitive nature of some targeted behaviors, researchers use questionnaires involving sophisticated branching patterns. Yet, the level of reading competency and command of the English language required to navigate such questionnaires is not always prevalent among students in diverse urban school settings. Researchers have sought to address this issue, and others, in their development of different data collection methods. A common and economical method for collecting data from a large number of students is the paper-based self-administered questionnaire (SAQ). This technique is much more likely to yield increased reports of sensitive behaviors when compared with interviewer-administered methods.4–10 However, the SAQ requires moderate reading skills, often requires students to navigate sophisticated skip patterns, and necessitates large testing areas to guarantee privacy. Also, school administration and parents oftentimes reject SAQs because exposure to detailed and sensitive questions (eg, types of sexual behavior) is not easily limited to only students for whom it applies – thus potentially exposing other students to developmentally inappropriate questions. Computer-assisted self-interview (CASI) systems address many of the limitations of the SAQ. CASI systems may be used with both desktop and laptop computer systems, allowing for transportability.4,11 These systems provide computer-controlled navigation of sophisticated branching patterns (to skip nonapplicable questions), programmed consistency checks, and automatic data entry.4,12 They also help reduce missing data by ensuring that respondents address all relevant questions.11,13,14 Audio-enhancement features may be added to CASI programs (ie, A-CASI), allowing survey respondents to listen to questions through headphones while concurrently reading questions on the computer, thereby potentially reducing issues related to literacy and comprehension.7,8 However, the cost, resources and staffing requirements of this method reduce its feasibility in school-based research where space and resources are limited. A third self-administered data collection option is the small, handheld personal digital assistant (PDA), which benefits from the advantages of the CASI approach, but is cheaper and more portable than the desktop- or laptop-based systems. Over the past several years, more studies have been published examining the use of PDAs and other handheld devices, particularly in school-based or adolescent health research.15–20 Although this line of research has developed similarly to the body of research related to CASI, little research has been conducted examining the effects of adding audio-enhancement to PDAs for survey-based data collection (similar to A-CASI).21,22 Trapl and colleagues demonstrated the feasibility of an audio-enhanced PDA-based data collection system and successfully used this method to collect baseline data on middle school adolescents.21,23 However, the study did not address questions of comparability or improvement over existing methods of data collection. To our knowledge no comparative literature examining the potential benefits or limitations of the use of audio-enhanced PDAs (APDA) in any survey research exists. Hence, this study aims to examine the differential effects of 3 different data collection modes (SAQ, PDA, APDA) on the number of questions answered, data quality, and student survey mode preference.