Impact of a Privacy-Enhancing ACASI Survey on Menstruation Stigma Response Patterns in Ghana

Last registered on March 12, 2026

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Pre-Trial

Trial Information

General Information

Title

Impact of a Privacy-Enhancing ACASI Survey on Menstruation Stigma Response Patterns in Ghana

RCT ID

AEARCTR-0018075

Initial registration date

March 11, 2026

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published

March 12, 2026, 4:48 AM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

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Primary Investigator

Name

Irene Furlani

Affiliation

University of Passau

Contact Primary Investigator

Other Primary Investigator(s)

Additional Trial Information

Status

In development

Start date

2026-03-13

End date

2026-04-03

Keywords

Health, Other

Additional Keywords

Menstruation stigma, randomized survey experiment, ACASI, CAPI, Sensitive survey methods, Ghana

JEL code(s)

C83, C88, C93, J16, O12

Secondary IDs

Prior work

This trial does not extend or rely on any prior RCTs.

Abstract

Menstruation stigma affects school participation and social inclusion. Evidence on menstruation stigma relies on face-to-face surveys collected with tablets in a Computer-Assisted Personal Interviewing (CAPI) setting. Estimates on a sensitive topic like menstruation stigma can be affected by the presence of the enumerator in a CAPI format. These biased estimates can flaw cost-effectiveness calculations for interventions addressing menstruation stigma. Policy decisions may be based on systematically biased measures.
In this study, we evaluate the effect of a privacy enhancing Audio Computer-Assisted Self-Interviewing (ACASI) survey method on reported levels of menstruation stigma. We created a new plug-in to implement the ACASI format aimed at minimizing the enumerator and third-party presence bias. The plug-in allows respondents to automatically play pre-recorded questions and select color-coded answers. Therefore, we compare the stigma levels around menstruation in surveys conducted in a CAPI format with those in our privacy-enhanced ACASI method.
We conduct a randomized survey experiment assigning senior high school girls in Northern Ghana to a stigma survey module, either in CAPI or ACASI format using SurveyCTO. This design allows us to estimate the differential effect of the privacy-enhancing ACASI format on levels of menstruation stigma, and in particular on school participation and social inclusion.
We hypothesize that our privacy-enhancing ACASI format increases the reported level of menstruation stigma, implying potentially higher cost-effectiveness for interventions addressing menstruation stigma.

External Link(s)

Registration Citation

Citation

Furlani, Irene. 2026. "Impact of a Privacy-Enhancing ACASI Survey on Menstruation Stigma Response Patterns in Ghana." AEA RCT Registry. March 12. https://doi.org/10.1257/rct.18075-1.0

Sponsors & Partners

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Experimental Details

Interventions

Intervention(s)

This is a randomized survey method design. The study analyses responses in a menstruation stigma section comparing the standard enumerator-led Computer-Assisted Personal Interviewing (CAPI) employed in the control group, to a privacy-enhancing Audio Computer-Assisted Self-Interviewing (ACASI) in the treatment group. Respondents in the treatment group can independently listen to pre-recorded questions and select color-coded answers. With the support of a software developer, I created a plug-in for SurveyCTO (the data collection platform used in this study) designed to increase respondent privacy and minimize potential bias introduced by the presence of the enumerator and third parties. The plug-in allows participants to listen to pre-recorded survey questions through headphones, instead of having the questions read aloud by an enumerator. Response options are presented using a simple color-coded interface, enabling participants to select a color rather than read or write text.

Intervention Start Date

2026-03-13

Intervention End Date

2026-04-03

Primary Outcomes

Primary Outcomes (end points)

Experienced stigma index, self-internalized stigma index, perceived societal stigma index

Primary Outcomes (explanation)

The primary outcome variables consist of three stigma indices constructed from Likert-scale survey items. The first index captures experienced stigma and is based on responses to questions regarding teasing at school or in the community, missing school during menstruation, and missing community events while menstruating. The second index captures self-internalized stigma and aggregates responses to statements reflecting respondents’ own beliefs about menstruation, including whether menstruating girls should attend school or community events and whether menstruation is perceived as shameful, disgusting, or positive. The third index captures perceived societal stigma and is based on respondents’ perceptions of community attitudes toward menstruation, measured through similar statements referring to what people in the community believe about menstruation and menstruating girls’ participation in social activities.

Each item contributing to the indices is measured on a five-point Likert scale. Prior to aggregation, responses will be coded such that higher values correspond to higher levels of stigma. For indices including positively framed statements (e.g., that menstruation is something good or that menstruating girls should attend school), responses will be reverse-coded.

Secondary Outcomes

Secondary Outcomes (end points)

In addition to the stigma indices, the analysis will consider a secondary outcome capturing respondents’ comfort with the survey process, the non-response rate, and each question of the stigma module.

Secondary Outcomes (explanation)

Experimental Design

The eligible population for this study consists of senior high school girls aged 16 years and older attending selected schools in and around Tamale in Northern Ghana. To be eligible, respondents must have experienced menstruation at least once. The study sample will be drawn from students who participate in menstrual health information campaigns conducted in participating schools prior to the survey. The study is expected to include between 20 and 24 schools located within approximately a 50 km radius of Tamale. The anticipated total sample size ranges from 480 to 576 respondents. Participants will be randomly assigned to one of two survey methods, resulting in a sample of approximately 240 to 288 respondents per treatment arm.

Individuals will be randomly assigned to one of two survey methods for the menstruation stigma section. Randomization is implemented prior to data collection through a pre-generated treatment list that determines which survey module is loaded for each respondent. Enumerators are not informed about treatment assignment in advance, ensuring that the allocation process remains independent of enumerator behavior.

Both survey methods share the same introductory questions and overall structure. The section containing the stigma-related questions is always placed at the end of the questionnaire. Enumerators introduce this section in both conditions and explain the survey procedure to respondents. The color order of the answer options in also randomized.

Experimental Design Details

Not available

Randomization Method

Randomization done in office on Stata

Randomization Unit

Individual (student)

Was the treatment clustered?

Experiment Characteristics

Sample size: planned number of clusters

No cluster but we expect between 20 and 24 schools.

Sample size: planned number of observations

Between 480 and 576

Sample size (or number of clusters) by treatment arms

Approximately 240 to 288 respondents per treatment arm.

Minimum detectable effect size for main outcomes (accounting for sample design and clustering)

With an expected sample size of 480–576 respondents and two equally sized treatment arms (240-288), the study is designed to detect moderate differences in reporting behavior across survey methods. The power calculations are based on a previous study in Tamale (unpublished) that collected a stigma score. Assuming a two-sided significance level of 0.05 and a statistical power of 0.8, the minimum detectable effect size is estimated to lie between approximately 0.24 and 0.26 standard deviations for stigma.

Supporting Documents and Materials

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IRB

Institutional Review Boards (IRBs)

IRB Name

University of Passau

IRB Approval Date

2026-03-05

IRB Approval Number

III/Jäckel\_I-07.5095/260122

Analysis Plan

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