POLLING BOOTH SURVEY: A SOLUTION TO ASSESS THE BEHAVIORAL IMPACT OF TARGETED INTERVENTIONS IN CONDOM USAGE AMONG FSWS AND MSMS

[BEST PRACTICE DOCUMENTATION UNIT OF KSACS]

POLLING BOOTH SURVEY: A SOLUTION TO ASSESS THE BEHAVIORAL IMPACT OF
TARGETED INTERVENTIONS IN CONDOM USAGE AMONG FSWS AND MSMS
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After a much awaited wait, the TI Division and Technical Support Unit
of KSACS has come out with a scientific solution for assessing
behavioral impact of Suraksha Projects in condom usage and safe sex
practices among FSWs and MSMs to reduce the risk of getting HIV and
STI. Condom promotion is one of the core components of targeted
interventions implemented under the National AIDS Control Programme,
Phase -III (NACP-III). Since the beginning of 1997, Targeted
Interventions in Kerala have been measuring the level of condom usage
among the target group members through physical verification of number
of condoms distributed or through irrational and unempirical methods
like counting the number of used condoms in activity places, asking
about condom usage during one-to-one/group interactions, etc.

Kerala State AIDS Control Society is implementing 53 Targeted
interventions in the State through Non Governmental Organizations and
stakeholder owned Community Based Organizations. Out of this, 19
interventions are exclusively working for female sex workers and 13
for MSMs. It is observed that all these projects are unskilled at
assessing the behavioral impact caused by their interventions among
the primary stakeholders. Periodical evidence-based empirical
assessment of behavioral outcomes produced by the interventions is
essential to revise the ongoing behavior change communication
strategies. Accurate scientific assessment of condom usage and other
service utilization by target group members is indispensable in
behavioral outcome assessment.

Sexual health, particularly condom use is a very sensitive and
personal issue that always creates a stumbling block before collecting
genuine data to assess the impact of allied services implemented by
the Suraksha Projects. The scope of “Polling Booth Surveys (PBS)”
reclines here and hence the Technical Support Unit of KSACS (TSU of
KSACS) suggests it as a solution to resolve this difficulty. Polling
Booth Survey is a kind data collection methodology like group
interview method, where respondents give their responses through a
ballot box anonymously, and in an unlinked manner.

During the current phase of intervention, TSU has facilitated Polling
Booth Surveys in the FSW/MSM projects with the purpose of evaluating
the behavior patterns of MSMs and FSWs in Condom use, risky sexual
activities and assess the utilization of services such as STI
services, ICTC, etc. The information gathered from the Polling Booth
Surveys can be used to monitor some of the behavioral outcomes of TI
Programmes by understanding the level of condom use with different
partners, STI/HIV Risk perception, high-risk sexual acts like anal sex
and experience of violence by the members of high-risk groups.

For the well conduct of the Polling Booth Survey, TSU has developed
separate questionnaires for MSMs and FSWs that contain systematically
furnished scientific closed ended questions in the local language,
covering areas like condom usage in last encounter with various
partners (viz. paying clients, occasional clients, regular clients,
lover, husband/co-habiting partner, etc.,), sex without condom,
incidences of condom breakage, barriers in condom usage (Partner’s
resistance, Influence of alcohol, Non-availability of condom, and
covetousness for more money), risk perception, experience of violence
and audit of services availed. The number of PBS in each district is
determined proportionately based on the number of FSWs/MSMs line
listed. One booth is arranged for the 20 samples selected from every
240 primary stakeholders. Systematic sampling method has been adopted
to select the samples from the peer communication units. Stakeholder
registration details available at the projects are used to select the
required samples.

During the Survey, the selected respondents/samples are separated from
each other in a polling booth environment created by sheets or
cardboards. Each participant is given three glasses as ballot boxes
specified with responses to the question like ‘YES, No, Not
Applicable’ and a pack of cards stacked in serial order. The Cards are
numbered corresponding to the number of questions in the
questionnaire. The Facilitator explains the Polling Booth Survey
method with an example and a practice session. She/he reads out the
questions one by one, slowly and loudly in local language, so that
every participant hears the question clearly. The participants
answered each question by dropping the card carrying the question
number into any of the three glasses. The card is kept outside the
glasses, if the participant does not want to respond the question.
After administering the questions, the answer cards are collected
separately and the number of cards in each box for each question is
counted and the tallies are recorded in the reporting form. The group
responses are shared with the participants and the discussion points
were documented.

The exercise is found to be excellent in assessing the behavioral
outcomes of the targeted intervention initiatives implemented by the
project. Since the process offers anonymity to the respondents, it
reduces the social desirability bias. It is an efficient and easy tool
to administer among both the literate and illiterate respondents by
the project functionaries. It provides exact information on condom
usage and risk behavior so as to equip the functionaries to analyze
the outcome and impact of the intervention. KSACS/TSU is planning to
use the method every year to analyze the impact of intervention and to
make necessary strategy shifts in the behavior change communication
process. It is certain that the process will improve the quality of
Suraksha Projects in Kerala which in turn will support NACP to halt
and reverse the epidemic by saturated coverage among core high risk
groups.