Development and Psychometric Evaluation of HealthProtective Sexual Communication Measures for Young Women Aged 21-35Years Attending Selected MCH Clinics in Gaborone, Botswana for HIVPrevention Público

Abstract

Background Botswana, with 1.7 million people, ranks second highest in HIV sero-prevalence worldwide, heterosexually transmitted and affecting more women than men. Health protective sexual communication (HPSC) between sexual partners can contribute to HIV prevention, but women face difficulties with HPSC due to cultural and gender issues. Valid and reliable measures are needed to explore young women's perceptions and beliefs about HPSC for HIV prevention interventions.

Purpose The purpose this dissertation research was to develop and evaluate psychometric measures of HPSC measures to guide culturally sensitive HIV prevention interventions for young women in Gaborone, Botswana. The study was guided by the Theory of Planned Behavior (TPB).

Methods This cross-sectional multi stage multi-method dissertation study was conducted in Gaborone, Botswana among young women attending selected MCH clinics, selected through purposive sampling. Literature review of existing measures and a qualitative elicitation pilot directed apriori content validity. Eleven measures were developed, translated and evaluated for content validity. A quantitative pilot among was conducted among 10 women for administrative feasibility. A larger quantitative study among 280 young women was conducted in the 13 city clinics for reliability, validity and hypothesis testing. All women recruited met the selection criteria, consented and responded to all questions.

Results Twelve major themes and 20 sub-themes were elicited and used as items for 11 HPSC measures. Two measures were unreliable, one had spuriously low reliability due to its brevity. Eight measures were reliable, with Cronbach's alphas between 0.70 and 0.95. Underlying factors were extracted for these using principal components analysis. Some significant relationships were identified between measures.

Discussion of Findings The TPB successfully guided the instrument development process, yielded reliable and valid measures, which had some significant relationships. Theresults highlighted the importance of HPSC, the significant influece of the male sexual partners and other relatives, and the need to integrate HPSC at all levels of HIV/AIDS prevention and control, and research, focusing on the effectiveness of HPSC.

Table of Contents

TABLE OF CONTENTS Chapter Content Page Nos. 1 INTRODUCTION AND SPECIFIC AIMS

Introduction and Statement of the Problem.......................................... 1 Study Purpose and Aims............................................................... 3 Background.............................................................................. 5 Significance of the Study and Justification.......................................... 7 The Measurement Framework for HPSC Measures................................... 12 Approaches to Instruments Development............................................... 13 Conceptual Basis for the Measures................................................ 13 Components of HPSC Measures...................................................... 21 Conceptual Definitions................................................................. 23 Summary of Chapter 1.......................................................................... 25 2 BACKGROUND OF THE STUDY Introduction and Background of the Country....................................... 26 Epidemiology of HIV/AIDS and Women's Vulnerability to HIV............... 29 Some Strategies to Combat the Epidemic.............................................. 37 The Role of HPSC...................................................................... 37 Research on HPSC In Africa.......................................................... 39 Factors that Influence Women's Ability for HPSC......................................... 42 Summary of Chapter 2.......................................................................... 46 3 RESEARCH DESIGN AND METHODS Introduction and Research Design.................................................... 47 Phase 1: A Qualitative Study Pilot................................................... 47 Phase 2 and 3: Instrument Development and Expert Evaluation................. 68 Phase 4: Instrument Translation and Back Translation............................ 79

Chapter Content Page Nos.

Phase 5: Quantitative Pilot testing.................................................... 82 Phase 6: Quantitative Pilot Study: Reliability and Validity...................... 82 Study Design, Sampling and Sample Size Determination............................ 82 Setting, and Human Subjects Protection................................................. 83 Participant Recruitment and Training of Research Assistants...................... 84 Data Collection, Study Measures and Data Management.......................... 85 Data Analysis Procedures.............................................................. 86 Summary of Chapter 3.......................................................................... 91 4 RESULTS Introduction and Overview of HPSC Scales........................................... 92 Description of Sample Characteristic............................................... 92 Psychometric Properties of Scale 1, Meaning of HPSC........................... 96 Psychometric Properties of Scale 2, HPSC Content Discussed.................. 101 Psychometric Properties of Scale 3, Influence Tactics for HPSC.................... 109 Psychometric Properties of Scale 4. HPSC Influencing Factors....................... 116 Psychometric Properties of Scale 5, Attitude Towards HPSC.................... 125 Psychometric Properties of Scale 6, Perceived Subjective Norm..................... 129 Psychometric Properties of Scale 7, Perceived Partner's Response.................. 133 Psychometric Properties of Scale 8, Motivation to Comply with Wishes of 141 Significant People...................................................................... Psychometric Properties of Scale 9, Perceived Self-efficacy for HPSC........ 144 Psychometric Properties of Scale 10. Intention for HPSC........................ 147 Psychometric Properties of Scale 11, Safer Sex Practices........................ 154 Summary of Psychometric Properties of the HPSC Scales 156

Chapter Content Page Nos.

Hypothesis Testing..................................................................... 161 Summary of Hypotheses Tests........................................................ 174 5 DISCUSSION OF FINDINGS, IMPLICATIONS AND RECOMMENDATIONS Introduction and Overview of the Study............................................. 180 Discussion of the Findings-Summary of Qualitative Pilot Study Findings...... 181 Description of Quantitative Sample Characteristics............................... 181 Summary of Quantitative Study Findings.......................................... 183 Discussion of Findings in the Context of the Theory of Planned Behavior...... 184 Discussion of Individual Scales- Scale1, The Meaning of HPSC............... 187 Scale 2, HPSC Content Discussed.................................................... 188 Scale 3, Influence Tactics.................................................... 189 Scale 4, HPCS Influencing Factors............................................... 189 Scale 5, Attitude towards HPSC............................................ 190 Scale 6, Perceived Subjective Norm........................................ 191 Scale 7, Perceived Partner's Response.................................... 191 Scale 8, Motivation to Comply...................................................... 192 Scale 9 Perceived Self-efficacy.................................................... 192 Scale 10, Intention for HPSC............................................... 193 Scale 11, Safer Sex Practices......................................................... 194 Strengths of the Study.................................................................. 195 Limitations of the Study............................................................... 197 Suggestions for Modification of Measures......................................... 197 Conclusions ................................................................................ 201

About this Dissertation

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School	Laney Graduate School
Department	Nursing
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Health Sciences, Nursing
Palabra Clave	Heterosexual transmission of HIV, health protective sexual communication, safer sex, instrument development, psychometric evaluation.
Committee Chair / Thesis Advisor	Holstad, Marcia McDonnell, Emory University
Committee Members	Strickland, Ora, Emory University Lehr, Sally, Emory University Rogers, Martha, Emory University Diiorio, Colleen K, Emory University

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