Factors shaping understanding and interpretation of sexual practice survey questions in south-central Uganda: A qualitative analysis of cognitive interviews

BACKGROUND: Accurate interpretation of survey questions about sensitive matters such as sexual practices is crucial for obtaining reliable data to inform effective public health interventions. Describing sexual practices involves reflecting on acts and contextually attributing meanings. However, participants in sexual behaviour studies may struggle to understand questions, affecting the validity of the data. AIM: We investigated factors that shape the understanding of survey questions on sexual practices in South Central Uganda using a survey instrument and a semi-structured cognitive interview guide. METHODOLOGY: = 24), stratified by age, sex, and community type, and including persons with disabilities, were recruited. Interviews were conducted in person, and data were analysed using thematic analysis and an analytic matrix. RESULTS: A complex interaction between awareness or knowledge of the practice, memory retrieval, denial, sexual involvement, and cultural beliefs influenced participants' understanding of survey questions on sexual activities. Specifically, awareness and knowledge of the practice facilitated spontaneous and accurate responses, while a lack of familiarity led to hesitation and confusion. Memory retrieval was easier for recent experiences, and denial slowed down the process. CONCLUSION: This study highlights the importance of considering individual, interpersonal, and community-level factors to improve the accuracy and reliability of survey research on sexual practices for effective public health interventions.