Psychometric Evaluation of an Instrument to Measure Hispanic Mothers’ Normative Beliefs, Intentions, Past Experience and Past Behavior Related to the Discussion of Sex-Related Topics with their Adolescent Daughters

Research Article

Austin J Nurs Health Care. 2014;1(2): 1009.

Psychometric Evaluation of an Instrument to Measure Hispanic Mothers’ Normative Beliefs, Intentions, Past Experience and Past Behavior Related to the Discussion of Sex-Related Topics with their Adolescent Daughters

Rodriguez D*, Topp R and Fehring R

Department of Nursing, Marquette University, USA

*Corresponding author: Rodriguez D, Department of Nursing, Marquette University, 530 N. 16th St. Milwaukee, WI 53233, USA

Received: August 25, 2014; Accepted: September 30, 2014; Published: October 02, 2014

Abstract

Aim: The aim of this project was to describe the psychometric properties of a recently developed instrument that measures Hispanic mother normative beliefs, intentions, past experience, and past behavior regarding the Discussion of Sex-Related Topics (DSRTs) with their adolescent daughters.

Background: The DSRTs between Hispanic mothers and their adolescent daughters is important because this interaction has been found to be a protective factor against the daughter’s risk for STDs and unintended pregnancy. Hispanic mother talk less with their daughters about sex-related topics (SRTs) than other ethnic groups. The Rodriguez Normative Belief Instrument (RNBI) has been established to measure normative beliefs, normative beliefs, past behavior, and past experience regarding Hispanic mothers’ DSRTs with their adolescent daughters.

Method: The 44-item RNBI was developed based on the Theory of Planned Behavior and the Parent-Based Expansion Theory of Planned Behavior. A convenience sample of 119 Hispanic mothers of adolescent females grades 6 through 8 from two Midwestern Catholic Middle Schools was enrolled completed the instrument. Paper and pen instruments were administered in the language of the participant’s choice, English or Spanish.

Results: The entire RNBI and each of the four subscales demonstrated acceptable internal consistency (Cronbach’s alpha = .70). The overall reliability of the RNBI was .82 with the normative beliefs subscale of .85, intentions .88, past behavior .89, and past experience .88. Confirmatory factor analysis validated the four subscales.

Conclusion: Psychometric analyses indicated that the RNBI demonstrates acceptable validity and reliability for this sample.

Keywords: Hispanic mothers; Adolescent female; Discussion of sexrelated topics

Introduction

The Center for Disease Control (CDC) estimates that half of all new STIs in the United States occur among adolescent men and women ages 15-24 [1,2]. STIs cost the American healthcare system almost $16 billion each year. As well as financial considerations, STIs can lead to potentially severe physical repercussions for the affected individuals such as infertility and cervical cancer [2]. It is well established that Hispanic adolescent females have disproportionately high STIs when compared with white non-Hispanic adolescent females [3]. In addition to STIs, teen pregnancy also has unfavorable effects on society. Only about 50% of teen mothers earn their high school diploma by age 22 [4]. Despite the fact that teen birth rates have declined in the United States they still remain high, especially among Hispanic teens [5,6]. These effects can be decreased if appropriate interventions are designed and executed that reduce STIs and teen pregnancy. These interventions, while ultimately aimed at female adolescents’ intentions and behaviors, may include interventions to increase parents’ intentions and behaviors involving the discussion of Sex-Related Topics (DSRTs) with their daughters. The parent behavior of DSRTs has a direct influence on adolescent beliefs, which are directly associated with the adolescents’ intentions to do something (in this case, to engage in sexual risk behaviors). The adolescents’ intentions ultimately influence the adolescent behavior [7].

While adolescent sexual behavior is influenced by peers, media, professionals (teachers, health care professionals, religious leaders) [8] parents have the most significant influence on their adolescent children’s sex-related attitudes, intentions, and behaviors [7,9]. Although parents have the most significant influence on their child’s sex related attitudes, many parents have not discussed SRTs with their adolescent children [10-13]. Some reasons parents provide for not discussing SRTs with their adolescent children include language and cultural barriers between the parents and their children, [10] the perception the child is too young, [13] not knowing what to say, and parent or child embarrassment [12,13]. Guilamo-Ramos, Jaccard, Dittus, and Collins [12] found that the more mothers perceived important people in their lives approved of them talking about sex, and the greater the number of parents they thought did so, the more frequent were the DSRTs with their children. Despite the fact that parents are known to influence their adolescents’ intentions and decisions regarding sexual activity, studies have shown that Hispanic mothers rarely engage in DSRTs with their adolescent daughters [8,14,15]. Hispanic mothers talk less with their daughters about SRTs when compared to other ethnic groups [8]. Thus understanding the background factors and the normative beliefs affecting the intention of Hispanic mothers regarding the discussion of SRTs with their adolescent daughters is the first step toward developing an effective intervention to increase discussion of SRTs among this group.

A theoretical framework frequently used to explain behavior, including DSRTs behavior, is Ajzen’s Theory of Planned Behavior (TPB) [16]. The TPB and an expanded variation, the Parent-Based Expansion of the Theory of Planned Behavior (PBETPB) were the guiding frameworks for the study and were used to explain mothers’ intentions regarding the DSRTs with their adolescent females [7]. According to the PBETPB, parental behaviors are external influences on adolescent behaviors [7]. Behavioral beliefs, normative beliefs and control beliefs influence behavioral intentions that in turn are the best predictors of actual behavior [16]. These beliefs are influenced by background factors, which are factors that influence the beliefs people hold [17]. According to the TPB, normative beliefs are beliefs that an individual holds about performing a behavior, that important people in their life (normative referents) either approve or disapprove of, and that these important people perform or do not perform the behavior [16]. Normative beliefs are important determinants of behavioral intention and engaging in a specific behavior [17]. According to TPB, normative referents may include friends, parents, spouse, co-workers, and depending upon the behavior, physicians or others [16]. In this study, normative referents included the subject’s mother, father, sister and close female friends, husband or daughter’s father, doctor or health care provider, priest or religious advisor, and daughter’s godmother (Comadre or “co-mother”). A study performed by Askelson, et al. [18] using TPB as the framework found that mothers who reported they had important persons in their lives supporting communication were more likely to intend to communicate about SRTs, which illustrates the importance studying normative beliefs. Thus, the current study measured normative beliefs in order to understand what influence select important persons have on Hispanic mothers’ intentions to discuss SRTs with their adolescent daughters.

While numerous investigations have examined adolescents’ intentions and behaviors, there is little research utilizing the TPB framework examining Hispanic mother’s intention to discuss SRTs with their adolescent daughters. There were no instruments available based on TPB to measure intention of mothers regarding DSRTs, past experience with DSRT, past DSRT behavior, nor are their instruments to measure Hispanic mothers’ normative beliefs including reference to specific family members on DSRTs. This study aim of this project was to describe the psychometric properties of a recently developed instrument that measures Hispanic mother normative beliefs, intentions, past experience, and past behavior regarding the DSRTs with their adolescent daughters.

Instrument development

The review of the literature indicated that no established instrument exists to measure normative beliefs, intentions, past behaviors, and past experiences relevant to DSRTs among Hispanic mothers of adolescent girls. As a result, the 44-item Rodriguez Normative Beliefs Instrument (RNBI) was developed to address this need for a comprehensive instrument to evaluate Hispanic mothers’ normative beliefs, intentions, past behaviors, and past experiences related to DSRTs. The RNBI was created based on Ajzen’s Theory of Planned Behavior (TPB) [16,19] and Parent-Based Expansion of the Theory of Planned Behavior (PBETPB) [7], following the recommendations for questionnaire construction by Ajzen [20]. As recommended by Ajzen, [20] first the behavior of interest, the DSRTs, was defined in collaboration with experts in adolescent sexuality. Time elements in which SRTs were to be discussed was “within the next three months” as it is enough time for the behavior to take place but not too much time where life circumstances may cause a change in intention. The DSRTs in the current study refers to discussions about menstruation, sexual intercourse, oral sex, abstinence, pregnancy, STIs, emotional consequences of sex, religious beliefs about sex, cultural beliefs about sex, and/or beliefs about birth control.

The initial versions of the RNBI were reviewed by three doctoral prepared nurses, who were involved with the Hispanic community, for content and face validity. They were asked to read the instrument to examine whether the English and Spanish versions made sense and whether all relevant SRTs and normative referents were included. Suggestions were aggregated and the appropriate revisions were made to the instrument. Then the RNBI was reviewed by two nurses who provided suggestions in modifying the instrument to a sixth grade reading level. The RNBI was then translated to Spanish by a native Spanish speaker and subsequently reviewed by a bilingual Doctoral Student in nursing. The instrument was then back translated from Spanish to English to ensure accuracy of the initial translation. Finally the instrument was pilot tested with a small group of mothers (n=20) for face validity and study feasibility including a pilot focus group to get feedback on the instrument. Minor revisions were made based on the feedback from the focus group. This pilot study supported the feasibility of the proposed approach to gathering data and supports the face validity of the RNBI. The pilot study further demonstrated that the mothers would complete the questionnaire and that they were able to understand the questions. It also provided initial support for the content validity of the RNBI because mothers who discussed SRTs in the past exhibited higher normative beliefs. Due to the small sample size of this preliminary study, the next logical step in development of this tool was to administer it to a much larger sample in order to further evaluate the psychometric characteristics of the instrument. Thus the research questions that were addressed by the proposed methodology included:

RQ1: What is the internal consistency of the overall RNBI and the subscales?

RQ2: What is the construct validity of the four theoretically derived subscales of the RNBI?

The RNBI consists of four subscales (normative beliefs, intention, past behavior, and past experience). The 11-item RNBI normative belief subscale (items 1-11) includes a series of statements concerning what the participant believes important people in their lives would think of them engaging in DSRTs with their daughter. The first version of the normative belief subscale (items 1-10) included important people in their lives as the mother’s mother, the mother’s father, health care provider, and priest. After the pilot focus groupwas conducted it was evident an additional normative referent needed to be added, and daughter’s godmother (comadre). An 11th normative belief item was added to the normative belief subscale. The subject responds to each item on a 7-point Likert scale with 1 as strongly disagree and 7 as strongly agree. An example of an item is as follows: “My mother would approve of me talking about sexual topics with my daughter within the next three months.” The items have the same root, replacing mother with other important people (father, sister and close female friends, husband or daughter’s father, doctor or health care provider, priest or religious advisor, and daughter’s godmother (Comadre or “co-mother”)) in their lives. The item responses are then summed to result in a normative beliefs score ranging from 11-77, with greater numbers indicating a higher degree of normative beliefs.

The 11-item RNBI intention subscale (items 12-22) queries mothers’ intentions to discuss the various SRTs within the next three months with their adolescent daughter. Responses to the 11-item intention subscale are also made on 7-point Likert scale with 1 as disagree and 7 as agree and were summed with scores ranging from 11-77. An example of the items is as follows: “I plan to talk with my daughter in the next three months about menstruation (her period).” Each consecutive statement includes the same stem but replaces the italicized portion with one of the afore mentioned sexual topics. The item responses are then summed to result in an intention score ranging from 11-77, with greater numbers indicating a higher degree of intention to engage in the discussion of SRTs.

The 11-item RNBI past behavior subscale (items 23-33) asks the respondent to indicate if they have previously engaged (yes or no) in a discussion with their adolescent daughter about a variety of SRTs. The first item of the subscale is as follows, “In the past three months, have you discussed at least one sexual topic from this list with your daughter?” Then, each of the following items begin with the stem, “In the past three months, have you talked with your daughter about menstruation?” Each item substitutes the italicized portion with the same sexual topics as in the intention subscale. The responses (1=yes, 2=no) to items in the subscale were summed to arrive at a past behavior score ranging from 11-22, with higher scores indicating fewer previous attempts to engage in DSRTs with their daughter.

The 11-item RNBI past experience subscale (items 34-44) is almost identical to the past behavior subscale but asks the respondent to indicate if their own mother discussed with them (yes or no) when they were adolescents, a variety of SRTs. The responses (1=yes, 2=no) to items in the subscale were summed to arrive at a past experience score ranging from 11-22, with higher score indicating fewer discussions with their own mothers regarding SRTs.

Methods

G*Power [21] was used to calculate the sample size for a linear regression model with a medium effect size of 0.15 and 8 predictors [22]. With a significance level of 0.05 and 80% power, 109 participants were needed for the analysis. A sample size of 119 was collected to account for 10% incompletion rate. A convenience sample of Hispanic mothers of 6th to 8th grade girls was recruited from two Catholic middle schools in the Midwest. A convenience sample was appropriate because the sample sufficiently represented the target population and thus was necessary in order to address the purpose [23]. The two middle schools include an enrollment of 99% Hispanic students. Both schools are located in the inner city and serve a majority of students who are at or below the Federally designated poverty level. The schools are located within two miles of one another. The first school has 67 sixth grade girls, 64 seventh grade girls, and 52 eighth grade girls for a total of 183 potential subjects. Ninety-nine percent of the students at this school are part of the School Choice program, which means they receive a voucher from the state to utilize for the private school. Similarly, 99% percent of the students at the first school take part in the Federal Free and Reduced Lunch Program. The School Choice Program and the Free and Reduced lunch program are both indicators of the low socioeconomic status of the schools. The second middle school (grades 5th – 8th) is an all girls Catholic Middle School and has 117 students in grades 6 through 8. Ninety-four percent of the students participate in the School Choice program and 90% participate in the Free and Reduced Lunch Program. Inclusion criteria for the study was as follows: Mothers or primary female caretakers were included in the study if they identified themselves as Hispanic, if they speak Spanish or English, and if they have a daughter in grades 6th through 8th at one of the two schools. Primary female caretakers (legal guardians) were included if they live with the adolescent daughter as the primary caretaker of the child.

Procedure

Data collection occurred from October 2013 through December 2013 following written permission being obtained from school administrators. A pre-notice letter was sent home with all female students in each middle school one week prior to data collection announcing the study and asking mothers to come to the school to complete the questionnaire during the designated before or after school timeframes. A verbal announcement was made to the students the day prior to data collection by the principal encouraging the students to remind their mothers about the study.

Mothers were invited to come to school 20-30 minutes prior to the start of school or over a four-hour period after school, on a date agreed upon by school administrators to engage in the study. During this time they had the opportunity to complete the consent form and the quantitative instruments. A second date was offered a week later for mothers who were unable to attend the first date. During the scheduled data collection sessions, a research assistant (RA) who has been trained and approved by the Institutional Review Board (IRB) assisted the primary investigator in answering any questions the mothers have during the consent process. The quantitative instruments were completed in secluded rooms in the school. Eligibility for the study was determined by the investigator or the RA asking the participants two screening questions: Are you Hispanic? Are you the mother or primary caretaker of a 6th to 8th grade girl? If they met the screening criteria, they were consented and then completed the questionnaire packet.

After this initial recruitment effort elicited only 40 mothers, an addendum was added to the IRB proposal that modified the recruitment by having secretaries at the first school call mothers utilizing an IRB approved script to schedule appointments for the mothers to come and complete the data collection instruments. The script included the assurance that their participation was completely voluntary and would in no way impact their daughter’s academic success. The RA or PI was present during the appointments in order to answer questions. An additional 79 mothers were recruited in this manner.

Mothers who completed the questionnaire received a $10 gift card. Completing the questionnaire and consent took approximately 20 minutes. After the forms were completed, they were anonymously deposited into a locked survey box.

Results

Sample characteristics

Participants were 119 Hispanic mothers of 6th-8th grade adolescent girls from two inner city Catholic schools. All of the participants self-identified as Hispanic and as the primary caretaker of a 6th to 8th grade girl enrolled in one of the two schools. One hundred ten participants were recruited from the first school (92.4%) and 9 were recruited from the second school (7.6%). All of the participants from both schools self-identified as Hispanic. Since these two groups were both Hispanic mothers of middle schools girls from Catholic schools located in the same neighborhood they were both included in the total sample consisting of 119 participants.

Participants ranged in age from 28-50 (x = 37.1, SD = 5.2). Participants’ daughters’ average age was 12 years (SD =1.5). One hundred eight participants identified as Mexican (90.8%), 1.7% identified as Puerto Rican, and one participant identified as Honduran and one as Costa Rican. The rest of the participants identified as “other” (n=7). In terms country of birth, 77.8% reported they were born outside of the United States. One hundred eight participants (90.8%) chose to complete the questionnaire in Spanish while 11 (9.2%) completed it in English. Sample characteristics are described in Table 1.