Reliability and Validity Assessment of Multi-Dimensional Sexual Self- Concept Questionnaire in Iran

Transcription

1 Iranian Journal of Military Medicine Vol. 14, No. 4, Winter 2013; Reliability and Validity Assessment of Multi-Dimensional Sexual Self- Concept Questionnaire in Iran Ramezani MA. 1,2 PhD, Ghaemmaghami A. 3 MSc, Talakar M. 3 MSC, Saadat SH. 1* PhD Zamani E. 4 MSc, Shams J. 1,2 PhD, Hadi S. MSc 1 Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran 2 Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran 3 Islamic Azad University of Marvdasht, Fars, Iran 4 Islamic Azad University of Khomeini shahr, Isfahan, Iran Neuroscience Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran Abstract Aims: Sexual self-concept is one of the most important aspects of human psychology and sexuality with several domains and dimensions. Multi-dimensional Sexual Self-Concept Questionnaire (MSSCQ), designed by Professor Snell, is commonly used to assess individuals sexual self-concept in different research studies. The present is study was an attempt to evaluate the reliability and validity of MSSCQ in Iran. Methods: The original questionnaire, after being translated into Persian and going through a detailed procedure for ensuring the accuracy of the translation, was piloted and later administered. To check its reliability, Cronbach s alpha was used. A factor analysis was performed to identify the items and subscales fitting into the questionnaire in this context. The correlation between MSSCQ and Marital Satisfaction as well as General Health questionnaire was also checked in order to ensure its criterion validity. Results: Our study showed that the reliability was good for MSSCQ α=0.89. Factor analysis has introduced 28 factors in primary questions and 4 factors for subscales analysis. There has been an appropriate correlation between GHQ-28 score and MSSCQ (r = -0.31, p = 0.008) and a significant correlation between marital satisfaction and MSSCQ (r = 0.3, p = 0.013). Conclusion: MSSCQ is a good tool for sexual self-concept assessment in Iran. It is, therefore, appropriate for research about human sexuality in an Iranian context. Key words: Multi-dimensional sexual self-concept questionnaire; Reliability; Validity; Iran; Sexual self-concept * Corresponding author: Saadat SH. Please, direct all correspondence to arash98@yahoo.com

2 Ramezani MA. et al. Introduction Research on sexual health and sexual disorders is a newly-established domain in Iran. The cultural and demographical changes, changes in the social relations between individuals and families, and the spread of diseases such as AIDS due to risky sexual behaviors are all among factors making this domain a very important one for the researchers and the research centers. The studies done in Iran on AIDS show that the pattern in getting infected with AIDS is changing from the joint use of injection tools by addicted people and the use of viruspolluted blood to risky sexual behaviors [1]. Most young people form their relations under the influence of the existing behavioral patterns and norms in the society and the phenomenon of socialization. The more recent studies in Iran show that about 20% to 30% of young people have premarital sex [2-4]. On the other hand, research shows that one of the most influential factors in conflict or even divorce between couples in Iran is sexual problems and disorders in couples []. All the above-mentioned factors indicate that people in Iran need to receive education in their sexual relationship, and individuals should develop their sexual awareness and self-concept in their sexual life so that most social disorders and sexual diseases are controlled and prevented from in the society. The first step in this regard is the evaluation of individuals mental health and their conception of sex. Next steps will be the interventions based on the results of the first step. An individual s sexual self-concept means their feelings, imagination, and beliefs regarding sex. People shape their sexual behaviors based on these feelings, imaginations, and beliefs. Evaluating people s sexual self-concept can help predict their behaviors, and improving that concept can help people in their mental and sexual health. There is no tool for measuring this concept in Iran. Therefore, most researchers tried to find or develop an apparatus to do so. The Multi- Dimensional Sexual Self-Concept Questionnaire (MSSCQ) has been used in a number of studies so far [6]. This questionnaire was developed by William Snell at the Department of Psychology in South East Missouri University in 1990s [7]. With 20 subscales, it can be regarded as the most comprehensive questionnaire evaluating different dimensions of sexual self-concept [8]. Considering its comprehensiveness and the fact that it is not culturally biased, the researchers in this study attempted to evaluate its validity and reliability in the Iranian context so that it can be used in other studies in the domain of sexual health in Iran. Methods The present study was a cross-sectional study done in order to standardize a research tool. After obtaining Professor Snell s consent, the questionnaire was downloaded from his website. It was translated into Persian by two of the researchers, and the translated versions were compared. The best version was given to a third person with a good command of English to be rendered back to English. The English version was checked with the original English version and the results were approved by the research team. As such, the Persian version could be relied on. It was also piloted with 1 participants in order to identify any possible problem with the questionnaire items. Using the sample size estimation formula, with 9% confidence interval and a maximum sampling error of 20%, the sample size was estimated at 60. Leaving a safe margin of 20% due to attrition or error, data was collected from 73 participants. The respondents were randomly selected from among the personnel of an organization in Isfahan and the patients in a hospital in

3 Reliability and Validity Assessment of Multi-Dimensional Sexual Self-Concept Questionnaire in Iran Tehran. There were 43 female and 30 male participants in the sample, and the participant s age ranged from 20 to 8 (SD = 8). The 100 item Snell s questionnaire in addition to two other questionnaires was used. The first one (GHQ28) was to check participants general health conditions. It is a standard 28 item questionnaire checking individuals mental health. It was also used by Noorbala et al. [9, 10] in Iran. This tool was used to check the validity of self-concept questionnaire. The second questionnaire was a 2 item marital satisfaction questionnaire. It was translated into Persian, and its validity and reliability was checked by Salehi et al. [11]. It had an acceptable content validity in the present study too, and its correlation with GHQ28 was also found to be high (Cronbach α =.9, 9%Confidence interval = ). For checking the reliability of MSSCQ, the internal consistency approach with a 9% confidence interval was used. Cronbach s alpha was also estimated for each subscale. Three methods were used for checking the validity of MSSCQ. For content validity, in addition to the use of experts opinion, a principal component analysis with Varimax rotation was used. This procedure can also be used for checking the construct validity. In order to check the construct validity of the questionnaire, discriminant function analysis was used. The GHQ28 was used to divide the participants into two groups; those with distress possibility and those without, and the data were compared between these two groups. Regarding the criterion validity of MSSCQ, concurrent validity procedure was used. The correlation between MSSCQ and GHQ28 was checked using Pearson-Product Moment and Spearman rho formula. Moreover, Mann-Whitney test and Kruskal- Wallis test were used with the ordinal data and ANOVA with interval data to do group comparisons. Results First the reliability of the whole MSSCQ was checked using Cronbach s alpha. It was0.89 with 9% confidence interval being Then, the reliability of each subscale was checked. The minimum acceptable index was obtained: α =0.8, with 9% confidence interval of 0.7 to0.8. Factor analysis was performed first for the 100 items in MSSCQ. The analysis presented 28 factors which could explain 84% of the variance. Figure 3 shows the obtained Scree plot. In the second run, the 20 subscales were checked using factor analysis. Four factors were obtained (see Table 1) which could explain 66.7% of the variance. Table 1. Factor Analysis for MSSCQ Subscale 1 st Factor 2 nd Factor 3 rd Factor 4 th Factor sexual problem prevention internal-sexual-control sexual-esteem 0.77 sexual-consciousness sexual self-efficacy sexual problem management sexual self-schemata motivation to avoid risky sex sexual-optimism 0.91 sexual-satisfaction 0.82 sexual-motivation sexual-preoccupation sexual problem self-blame sexual-monitoring power-other sexual control 0.733

4 Ramezani MA. et al. Subscale 1 st Factor 2 nd Factor 3 rd Factor 4 th Factor sexual-assertiveness chance/luck sexual control sexual-anxiety 0.78 sexual-depression fear-of-sex The discriminant analysis was performed for MSSCQ and its 20 subscales based on the obtained distress from GHQ28, which was statistically significant for 8 subscales. Table 2 presents the descriptive statistics for the two groups in MSSCQ. Table 2. The Comparison of MSSCQ Subscales between the 2 groups Subscale Mental Health Mean S.D P sexual-anxiety No sexual self-efficacy No sexual-consciousness No motivation to avoid risky sex No chance/luck sexual control No sexual-preoccupation No sexual-assertiveness No sexual-optimism No sexual problem self-blame No sexual-monitoring No sexual-motivation No sexual problem management No sexual-esteem No sexual-satisfaction No power-other sexual control No sexual self-schemata No fear-of-sex No sexual problem prevention No sexual-depression No internal-sexual-control No =non-significance

5 Reliability and Validity Assessment of Multi-Dimensional Sexual Self-Concept Questionnaire in Iran In the case of criterion validity, the correlation between MSSCQ and both GHQ28 and the marital satisfaction questionnaire was checked. There was a significant correlation between MSSCQ and GHQ (r = 0.31, p = 0.008). The relationship between MSSCQ and Marital satisfaction questionnaire was also significant (r = 0.3, p =0.013) Figure 1. Correlation between Marital Satisfaction & MSSCQ Discussion The literature indicates that there is a direct relationship between an individual s sexual behavior and his or her self-concept which starts being shaped at their teens. This selfconcept can shape their beliefs about their sexual behavior too. What is of importance is the effect of risky sexual behaviors in spreading AIDS in societies. This selfconcept can also have a great effect on the prevention of AIDS and even sexual disorders [12-14]. All the above factors point to the need for a precise tool for the evaluation of individuals sexual self-concept. Professor Snell s sexual self-concept questionnaire which consists of 100 items is one of the best tools for that purpose [6, 8]. Very few studies have been carried out on this subject not because of its inefficacy but because this area is a new one. There are other shorter questionnaires, but they are specifically designed for teenagers [17, 18]. The results of the standardization of the questionnaire in an Iranian context as well as the evaluation of its validity and reliability showed that this questionnaire can be a good apparatus for the evaluation of Iranians sexual self-concept. The reliability index was 0.89 which is very high, and different validity types were demonstrated for the questionnaire. Naturally, this study faced some limitations including the small sample size. Though the sample size was determined using sample size estimators, it seems that a bigger sample size could give a better picture of the subject. Another limitation of the study was the participants age. It was limited to the couples of 20 to 60 years of age. Moreover, one of the most important types of validity is predictive validity, checking which needs time. Predictive validity tries to predict future phenomena based on the present results. However, since it was a cross-sectional study, it was not possible to check its predictive validity. In future studies, this Figure 2. Correlation between GHQ & MSSCQ

6 Ramezani MA. et al. could be good point to take care of. In sum, this study showed that the MSSCQ can be a good tool to be used in an Iranian context with Iranian population. Figure 3. Scree Test for MSSCQ Items Acknowledgement: The researchers would like to thank all those who participated in or helped this study in any way. Reference 1. Nasirian M, Haghdoost AA. Modeling of new HIV infections based on exposure groups in Iran. Kerman, Iran.: Kerman University of Medical Sciences; Farahani FK, Cleland J, Mehryar AH. Associations between family factors and premarital heterosexual relationships among female college students in Tehran. Int Perspect Sex Reprod Health 2011 Mar;37(1): Malek A, Shafiee-Kandjani AR, Safaiyan A, bbasi- Shokoohi H. Sexual Knowledge among High School Students in Northwestern Iran. ISRN Pediatr 2012;2012: Mohammad K, Farahani FK, Mohammadi MR, et al. Sexual risk-taking behaviors among boys aged 1-18 years in Tehran. J Adolesc Health 2007 Oct;41(4): Kalantari A, Rooshanfekr P, Javaheri J. Review of three decade divorce cuases in Iran (Persian). Strategic Research of Women 2012;14(3): Snell WE, Fisher TD, Walters AS. The Multidimensional Sexuality questionnaire: An objective self-report measure of psychological tendencies associated with human sexuality. Ann Sex Res 1989;6: Snell WE. semo edu/snell/vita htm Snell WE. The Multidimensional Sexual Self- Concept Questionnaire. In: Davis CM, Yarber WL, Baurermen R, Schreer G, Davis SL, editors. Sexualityrelated measures :A compendium. 2nd ed. CA, Sage Pub, Noorbala AA, Bagheri Yazdi SA, Hafezi M. Trends in change of mental health status in the population of Tehran between 1998 and Arch Iran Med 2012 Apr;1(4): Noorbala AA, Bagheri Yazdi SA,Yasamy MT, Mohammad K. Mental health survey of the adult population in Iran. Br J Psychiatry 2004 Jan;184: Salehi M, Zargar A, Ramezani MA. Effects of Dextromethorphan on reducing methadone dosage in opium addicts undergoing methadone maintenance therapy: A double blind randomized clinical trial. J Res Med Sci 2011 Oct;16(10): Pai HC, Lee S. Sexual self-concept as influencing intended sexual health behaviour of young adolescent Taiwanese girls. J Clin Nurs 2012 Jul;21(13-14): Pai HC, Lee S, Yen WJ. The effect of sexual selfconcept on sexual health behavioural intentions: a test of moderating mechanisms in early adolescent girls. J Adv Nurs 2012 Jan;68(1): Pai HC, Lee S, Chang T. Sexual self-concept and intended sexual behavior of young adolescent Taiwanese girls. Nurs Res 2010 Nov;9(6): Hensel DJ, Fortenberry JD, O'Sullivan LF, Orr DP. The developmental association of sexual self-concept with sexual behavior among adolescent women. J Adolesc 2011 Aug;34(4): Steinke EE, Wright DW, Chung ML, Moser DK. Sexual self-concept, anxiety, and self-efficacy predict sexual activity in heart failure and healthy elders. Heart Lung 2008 Sep;37(): Newton DC, McCabe M. Effects of sexually transmitted infection status, relationship status, and disclosure status on sexual self-concept. J Sex Res 2008 Apr;4(2): Breakwell GM, Millward LJ. Sexual self-concept and sexual risk-taking. J Adolesc 1997 Feb;20(1):29-41