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List experiments (LEs) are an increasingly popular survey research tool for measuring sensitive attitudes and behaviors. However, there is evidence that list experiments sometimes produce unreasonable estimates. Why do list experiments "fail," and how can the performance of the list experiment be improved? Using evidence from Kenya, we hypothesize that the length and complexity of the LE format make them costlier for respondents to complete and thus prone to comprehension and reporting errors. First, we show that list experiments encounter difficulties with simple, nonsensitive lists about food consumption and daily activities: over 40 percent of respondents provide inconsistent responses between list experiment and direct question formats. These errors are concentrated among less numerate and less educated respondents, offering evidence that the errors are driven by the complexity and difficulty of list experiments. Second, we examine list experiments measuring attitudes about political violence. The standard list experiment reveals lower rates of support for political violence compared to simply asking directly about this sensitive attitude, which we interpret as list experiment breakdown. We evaluate two modifications to the list experiment designed to reduce its complexity: private tabulation and cartoon visual aids. Both modifications greatly enhance list experiment performance, especially among respondent subgroups where the standard procedure is most problematic. The paper makes two key contributions: (1) showing that techniques such as the list experiment, which have promise for reducing response bias, can introduce different forms of error associated with question complexity and difficulty; and (2) demonstrating the effectiveness of easy-to-implement solutions to the problem. [ABSTRACT FROM AUTHOR]

Electronic games delivered via smartphones have the potential to become valuable tools in HIV prevention in high-prevalence and low-resource international settings. To ground theoretical elaboration around novel mHealth interventions in contextual realities, it is important to understand the mechanisms of their effects as perceived by local populations. Such perspectives are particularly important when working cross-culturally. 'Tumaini' is an interactive narrative-based smartphone game that uses a 'choose-your-own-adventure' format. It is designed to prevent HIV among young African adolescents (aged 11–14) by increasing age and condom use at first sex. It was developed with a US-based commercial game developer and is grounded in social behavioral theory, evidence-based practice and contextually relevant scenarios. In a 2017 randomized pilot study (n  = 60) in Western Kenya, 'Tumaini' showed promising effects on behavioral mediators of sexual debut. In subsequent focus group discussions, adolescent participants and their parents shared their perceptions of the game's mechanisms of effect, which included motivation to play, future orientation, decision-making, relationship to a diverse range of characters and a bridging of the virtual and real worlds. These findings align with our theoretical framework, confirm its successful translation into the intervention and will inform mediation analyses in an upcoming efficacy trial. [ABSTRACT FROM AUTHOR]

Current WHO guidelines recommend lifelong antiretroviral therapy (ART) for all HIV-positive individuals, including pregnant and breastfeeding women (Option B+) in settings with generalized HIV epidemics. While Option B+ is scaled-up in Kenya, insufficient adherence and retention to care could undermine the expected positive impact of Option B+. To explore challenges to the provision of Option B+ at the health facility level, we conducted forty individual gender-matched in-depth interviews with HIV-positive pregnant/postpartum women and their male partners, and four focus groups with thirty health care providers at four health facilities in western Kenya between September-November 2014. Transcripts were coded with the Dedoose software using a coding framework based on the literature, topics from interview guides, and emerging themes from transcripts. Excerpts from broad codes were then fine-coded using an inductive approach. Three major themes emerged: 1) Option B+ specific challenges (same-day initiation into treatment, health care providers unconvinced of the benefits of Option B+, insufficient training); 2) facility resource constraints (staff and drug shortages, long queues, space limitations); and 3) lack of client-friendly services (scolding of patients, inconvenient operating hours, lack of integration of services, administrative requirements). This study highlights important challenges at the health facility level related to Option B+ rollout in western Kenya. Addressing these specific challenges may increase linkage, retention and adherence to life-long ART treatment for pregnant HIV-positive women in Kenya, contribute towards elimination of mother-to-child HIV transmission, and improve maternal and child outcomes. [ABSTRACT FROM AUTHOR]