Hispanic Condom Use Study: Description and Explanation of Questionnaire

Instrument

The survey instrument was based on more than 100 open- ended interview and 2 focus groups with Hispanics in San Francisco, held to identify Hispanic men's perceptions of the consequences of condom use with primary and secondary sexual partners, difficulties with condom use, and normative aspects of condom use. The instrument was developed originally in Spanish and a back-translation procedure was used to assure that the English version was equivalent in meaning. Both the Spanish and English versions were pretested with at least 20 persons. The final version of the interview required an average of 24 minutes to complete. Most interview questions had four or five-level Likert-type response scales. The reported reliabilities were for the sample of 361 Hispanic men, reporting 1 or more secondary female sexual partners, who responded to the question on condom use with a secondary partner or partners. Frequency of using and carrying condoms. The extent of condom use with a secondary sexual partner was assessed by the question, "When you had sex with someone other than your wife or primary partner in the last 12 months, how often did you use condoms?" The extent of carrying condoms was assessed by the question, "How often do you carry a condom with you?" Each item was recorded using a five-point response scale from "always" to "never." Self-efficacy to use condoms. Four questions were developed to assess perceived ability to use condoms:

• "Would you be able to refuse sex if you partner didn't want you to use a condom?"
• "Would you use condoms even if you had to stop to buy them or look for them?"
• "Would you use condoms even if you had been drinking or using drugs?" and,
• "Would you be able to use a condom with a secondary partner?"

The self-efficacy score was the mean of the four items on a four- point yes-no response scale with higher scores meaning higher efficacy (alpha = 0.55). Those with greater self-efficacy to use condoms were expected to use them more consistently with secondary partners that did those who scored lower. Negative beliefs about condoms. Sixteen items measured beliefs about the consequences of using condoms. Beliefs included "the condom might break," "the condom might come off inside your partner," and "you would feel less sexual pleasure." Responses were "yes" "probably yes," "probably no," and "no" (alpha = 0.70). Depression scale. Ten of the 20 items of the Center of Epidemiologic Studies Depression Scale (CES-D) were selected for the questionnaire, based on their factor loading for Hispanics (alpha = 0.88). The items measure sadness in the 7 days prior to the interview and have been shown to assess depression in community samples. We expected those men who reported the most depressive symptoms to report more risky behaviors than those who reported the least depressive symptoms. The scale score was a continuous variable ranging from 0 to 30, with high scores meaning more depressive symptoms. Sexual comfort. Three items were used to assess sexual comfort: being naked in front of a partner, having sex with the lights on, and having sex with a new partner. The sexual comfort score was the mean of the three items on a four-point scale ranging from "very comfortable" to "very uncomfortable" (alpha = 0.62). Persons with high levels of sexual comfort have been shown to exhibit sexual behavior that is more self-protective than persons with low levels of sexual comfort. Number of friends using or carrying condoms. Two items assessed the proportion of the respondent's close friends who carried condoms and used them with secondary partners, a measure of perceived normative condom use behavior among peers. Responses ranged on a five-point scale from "almost all" to "almost none." Myths about HIV transmission. A measure of beliefs about the casual transmission of HIV was computed by adding responses to three items, such as the likelihood of getting HIV from using public toilets. Total scores could range from 3 to 12, with higher scores representing less accurate beliefs. Demographics. Age, education, marital status, and ethnic origin were determined for each respondent. Acculturation. Acculturation, the process by which a person learns a new culture, was assessed using four language-related items. That scale has been previously shown to have good reliability and validity. Mean scores ranged from 1 to 5, with higher scores indicating more use of English, hence higher levels of acculturation (alpha = 0.90). Other variables. Positive attitude toward condom use with a secondary partner was measured with a six-level Likert-type scale ranging from "dislike a lot" to "like a lot." Knowing someone with HIV infection or AIDS and previous use of condoms to prevent disease were assessed through single items with "yes" or "no" responses.

This text is excerpted from the article "Condom use among Hispanic men with secondary female sexual partners." Marin, Barbara VanOss; Gomez, Cynthia A.; Tschann, Jeanne M.; Public Health Reports v108, n6 (Nov-Dec, 1993):742-750. COPYRIGHT U.S. Department of Health and Human Services 1993