Validity and utility of community health workers' estimation of kava use

Aust N Z J Public Health. 2002 Feb;26(1):52-7. doi: 10.1111/j.1467-842x.2002.tb00271.x.


Objective: Estimating illicit substance use in epidemiological studies is challenging, particularly across ethical, cultural and language barriers. While developing the methods for a case-control study of the effects of heavy kava consumption among Aboriginal people in remote Northern Territory (NT), we examined the validity and utility of alternative methods for estimating exposure.

Methods: We assessed the level of agreement between a consensus of Aboriginal health workers in two different communities using interviews conducted with community members and health workers and individuals' self-reported kava consumption. Exposure measures included history of kava use, current kava use and history of heavy use. Agreement between a health worker consensus classification and individuals' self-report was analysed and agreement among several health workers in a consensus classification without self-report was assessed.

Results: Health workers concurred about an individual's history of kava use (k=0.83), current use (k=0.43) and also level of use (k=0.33). There was very good agreement between health workers' consensus and self-reported history of use (k=0.77). Agreement among health workers about current kava use was poor (k=0.08), while there was fair agreement between health workers and self-reported heavy kava users (k=0.36). Data from review of clinic patient notes supported agreement between consensus classification and self-reported history and level of use (k=0.39).

Conclusions: Self-reported kava use may be a poor estimate of current use especially when obtained from interviews away from a confidential clinic setting. Consensus classification by knowledgeable Aboriginal health workers provided comprehensive coverage, efficiently and with greater reliability and assisted to identify 'excessive' kava use.

Publication types

  • Comparative Study
  • Validation Study

MeSH terms

  • Community Health Workers*
  • Cross-Sectional Studies
  • Data Collection / methods
  • Data Interpretation, Statistical
  • Female
  • Humans
  • Illicit Drugs / supply & distribution*
  • Interviews as Topic
  • Kava* / adverse effects
  • Male
  • Native Hawaiian or Other Pacific Islander* / statistics & numerical data*
  • Northern Territory / epidemiology
  • Reproducibility of Results
  • Self Disclosure
  • Substance-Related Disorders / epidemiology*


  • Illicit Drugs