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J Adolesc Health. 2006 Apr;38(4):426-32.

Comparison of a computer-administered and paper-and-pencil-administered questionnaire on health and lifestyle behaviors.

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Department of Public Health, Ghent University, Ghent, Belgium.



The Health Behavior in School-aged Children (HBSC) study is a cross-national survey examining health and lifestyle behaviors of adolescents, traditionally administered by paper and pencil in a school setting. The purpose of the present study was to investigate if a computer format of the questionnaire would affect the responses of the adolescents in comparison with the paper and pencil format.


In 2000, the Belgian (Flemish) HBSC survey was administered in 81 secondary schools by paper and pencil (n = 4083) and in 19 schools by computer (n = 1008). Eight hundred four computer participants (aged 12-20 years) were matched with paper and pencil participants on the basis of gender, age, educational level, socioeconomic status, and type of school authority. The questionnaire included items on lifestyle behaviors (e.g., nutrition, substance use, physical inactivity, sexual behavior), psychosomatic health, and social relations.


For the majority of lifestyle behaviors, we found that mode of administration had no significant effect on adolescents' responses, whereas for several questions about feelings/affective states, more socially desirable responses were found in the paper and pencil format than in the computer format.


The present findings suggest a need for further exploration of potential mode effects on questions about feelings and affective states before transition from the paper and pencil HBSC-survey to the computer format.

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