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Udvikling og initial validering af et web-baseret spørgeskema til identifikation af prædiktorer for usikker sex blandt unge danskere.

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Title 

Development and initial validation of a web-based questionnaire to identify predictors of unsafe sex among the Danish youth.

 

Introduction

The purpose of the study was to develop and perform initial validation of a questionnaire to identify predictors of unsafe sex - and thus an increased risk of sexually transmitted infections and unwanted teenage pregnancies - among the Danish youth aged 18-24 years.

Material and methods

The study was a mixed method study, consisting of a qualitative and a quantitative part. In order to identify predictors of unsafe sex, four semi-structured focus group interviews with 18 folk high school students aged 18-23 years were conducted. Subsequently, the web-based questionnaire was constructed and 13 individual cognitive interviews were conducted to pilot test the questionnaire. 224 students in their last year of high school were invited to participate in the quantitative study aiming to validate the questionnaire. 120 participants (54 %) were included in the analysis of the response rate of the questionnaire (survey) and in the analysis of the predictors of unsafe sex among the youth in Denmark. In the analysis of the test-retest reliability 54 (24 %) students were included.

Results

Four main categories of predictors of unsafe sex were identified in the focus group interviews. 1) Alcohol, which is associated with lack of condom use. 2) Nights on the town and meetings in foreign counties or at festivals, which are closely associated with one night stands and often lead to unsafe sex. 3) Low self-esteem, which may result in promiscuous sexual behavior. 4) Increased sexual experience, which is associated with lack of condom use.

Of the 120 participants in the quantitative part of the study 64 % were girls, and the age group ranged between 18 and 20 years. A high ceiling effect (>15 %) was found for the items related to the respondents' alcohol consumption throughout life and over the past year, and a high floor effect was found for the item related to alcohol consumption in the last month. Both Rosenberg's Self-Esteem scale and the condom Self-Efficacy scales showed high internal consistency (α>0,8), and the test-retest reliability of the questionnaire showed high internal consistency of the two measurements. Of the respondents, who were allocated to answer the questionnaire at home, 76 % answered, compared with only 25 % of those who were allocated to answer the questionnaire at the school (p-value = 0,0001). When no adjustment was made for the rest of the predictors, there was a statistically significantly increased risk of unsafe sex, defined as lack of condom use, if the respondents had been drinking alcohol (crude OR = 2,5 (95 % CI: 1,0-6,7)) or met their latest sexual partner on a night on the town (crude OR = 4,0 (95 % CI: 1,1-15,6). When adjustment was made for the rest of the predictors, the study found a trend toward increased risk of unsafe sex, defined as lack of condom use. The same trend was found for unsafe sex, defined as lack of prevention, e.g. birth control pills, when the respondents had been drinking alcohol before their sexual debut and latest sexual activity.

Conclusion

Alcohol, meeting places such as nights on the town and meetings in foreign counties or at festivals, self-esteem and sexual experience may influence whether or not the Danish youth engages in unsafe sex and can therefore be considered as possible predictors. Because of ceiling and floor effects of the questionnaire, items concerning the alcohol consumption of the youth can be associated with over- and/or under-reporting. Therefore, these items should be adjusted in future studies. In general, and especially after the suggested change, the developed web-based questionnaire is considered valid and useful for monitoring health and sex among the Danish youth aged 18-24 years with a special view to future preventive interventions. Such a questionnaire should be mailed to the participants for completion at home in order to achieve the highest possible response rate.

Translated title of the contributionDevelopment and initial validation of a web-based questionnaire to identify predictors of unsafe sex among the Danish youth.
Original languageDanish
Place of publicationMPH-uddannelsen
PublisherAarhus Universitet, Sundhedsvidenskabeligt Fakultet
Number of pages51
Publication statusPublished - 2011

    Research areas

  • Questionnaire, monitoring, unsafe sex, alcohol, night on the town, self-esteem, sexual experience, test-retest reliability, way of administering questionnaires, response rate.

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