Sexual Health Survey

Abstract

The Sexual Health Survey (SHS) is a comprehensive psychological instrument developed to measure critical aspects of sexual health among students enrolled in institutions of higher education. The survey targets three primary constructs: Sexual Health Knowledge (SHK), Sexual Health Attitudes (SHA), and Sexual Health Behaviors (SHB). The development process involved an extensive literature review, focus group construct explication, and refinement through a pilot study involving 600 university students, resulting in a finalized instrument consisting of 127 items. The SHS assesses five key areas: contraception, pregnancy prevention, sexual health communication, sexual behavior, and sexually transmitted infections (STI) and barriers to testing.

Keywords

Sexual health, Sexual Health Survey (SHS), university students, attitudes, behaviors, knowledge, contraception, STIs, rape myths, psychometric evaluation

Authors

Heather Eastman-Mueller, Deborah Carr, Steve Osterlind

Purpose

The primary purpose of the Sexual Health Survey (SHS) is to provide a robust and multidimensional assessment of sexual health factors pertinent to the college student population. By measuring knowledge, attitudes, and behaviors, the SHS allows researchers and health promotion professionals to identify specific deficits or strengths within student populations regarding responsible sexual practices and health awareness.

The instrument covers a wide array of topics crucial for promoting safe sexual practices, including knowledge about STI transmission and prevention, efficacy of barrier methods, comfort level in communicating with partners about sexual history, and perceptions surrounding sexual violence and abstinence. This comprehensive approach ensures that interventions can be tailored accurately based on objective data gathered across these domains.

Construct

The SHS is structured around three core psychological constructs central to sexual health: Sexual Health Knowledge (SHK), Sexual Health Attitudes (SHA), and Sexual Health Behaviors (SHB). The final instrument, totaling 127 items, is designed to capture variability across five specific content areas:

• Contraception and pregnancy prevention.
• Knowledge and prevention of Sexually Transmitted Infections (STIs) and testing barriers.
• Sexual health communication comfort and practices.
• Sexual behavior patterns (including alcohol use impact).
• Beliefs related to sexual violence (e.g., rape myths).

The scale items were rigorously developed based on an extensive literature review and refined through focus group data to ensure construct explication aligned with priority areas relevant to the university environment. This foundational work ensures the scale measures the intended theoretical constructs accurately.

Validity

Content validity of the SHS was established through a thorough review by a panel of five experts representing diverse fields, including a counseling psychologist, a registered nurse, a statistician, an expert on human sexuality, and a specialist in sexual violence and LGBTQ issues. This panel assessed the items for quality, clarity, sensitivity to culture, and gender relevance.

Construct validity was further evaluated using Principal Axis Factoring. The factorability of the data was confirmed by the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy (0.784) and the Bartlett’s test of sphericity (p < 0.001). The resulting five-factor solution, confirmed by a scree plot and accounting for 71.46% of the variance, demonstrated a clear underlying structure, supporting the dimensionality of the constructs being measured. All retained items exhibited loadings of 0.30 or greater.

Reliability

Internal consistency reliability was assessed using Cronbach’s alpha for each subscale and the combined factor model. The results indicate strong to acceptable reliability across all measured factors:

• Factor 1 (Perceived Sexual Readiness, 5 items): Cronbach’s alpha = 0.88.
• Factor 2 (Comfort Sexual Communication, 3 items): Cronbach’s alpha = 0.91.
• Factor 3 (Comfort with Barrier Methods, 3 items): Cronbach’s alpha = 0.79.
• Factor 4 (Latex Barrier Effectiveness, 3 items): Cronbach’s alpha = 0.79.
• Factor 5 (Belief in Rape Myths, 3 items): Cronbach’s alpha = 0.74.

For the 17 items included across all five combined subscales, the overall Cronbach’s alpha was 0.79, with corrected item-total correlations ranging from 0.23 to 0.54, confirming the internal consistency of the instrument.

Factor Analysis

Principal axis factoring was employed to explore the underlying structure and dimensionality of the survey variables. The strong factorability indices (KMO = 0.784 and significant Bartlett’s test) confirmed the suitability of the data for factor analysis.

A varimax rotation was utilized, based on the finding that the majority of variables were uncorrelated (loadings below 0.32). The analysis yielded a stable five-factor solution, characterized by eigenvalues greater than 1.0, which collectively accounted for 71.46% of the total variance. This solution was independently verified using a scree plot, ensuring the robustness of the factor structure. The five factors identified were Perceived Sexual Readiness, Comfort Sexual Communication, Comfort with Barrier Methods, Latex Barrier Effectiveness, and Belief in Rape Myths.

Instrument

Test Type: Self-report survey / Psychometric scale

Format: Mixed format, including 6-point Likert-type scales (for Knowledge and Attitudes), multiple-choice items, and dichotomous (Yes/No) items (for Behaviors).

Language Available: English

Population Group: Students enrolled in institutes of higher education (university/college students).

Age Group: Late adolescence to young adulthood (typical university student age range).

Population Details: The pilot study involved 600 randomly sampled university students. The demographic section of the survey captures age, year in school, sexual orientation, relationship status, ethnicity, residential arrangements, and Greek community membership.

Test Methodology: The SHS consists of 127 items organized into three main sections: Sexual Health Knowledge (24 items), Sexual Health Attitudes (48 items), and Sexual Health Behavior (33 items), plus demographic questions. Completion time is approximately 20 minutes. Scoring involves summing items by construct or factor; for Knowledge (SHK), the maximum score is 120 (Items 1–24).

Keywords

Sexual Health Knowledge (SHK), Sexual Health Attitudes (SHA), Sexual Health Behaviors (SHB), psychometrics, college students, Likert scale, principal axis factoring, university health

Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: [email protected]

Correspondence Address: Heather Eastman-Mueller, Student Health Center, 1101 Hospital Drive, Health Promotion Department, University of Missouri, Columbia, MO 65212

Permissions & Fee and Test Year

The Sexual Health Survey (SHS) instrument was copyrighted in 2006. Permission must be explicitly granted by the primary author, Heather Eastman-Mueller, prior to its use in research or clinical settings. Information regarding usage fees is not detailed in the source content, but contact with the primary author is required for permission protocols.

Reference’s

• Heck, R. H. (2000). Factor analysis: Exploratory and confirmatory approaches. Mahwah, NJ: Lawrence Erlbaum.
• Tabachnick, B. G., & Fidell, L. S. (2001). Using multivariate statistics (4th ed.). Needham Heights, MA: Allyn & Bacon.

Items of the Sexual Health Survey

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Sexual Health Survey (Sample Items)

Knowledge Section

The following questions are intended to access your sexual health knowledge. Please answer each question to the best of your ability by indicating to what extent you agree or disagree with the following statements. If you feel uncomfortable answering any of the questions you may skip them.

K10) Women can become pregnant the first time they engage in vaginal-penile intercourse.

Strongly Disagree a Moderately Disagree Mildly Disagree Mildly Agree Moderately Agree Strongly Agree

For each of the following questions, please indicate the level of effectiveness that each behavior provides in preventing sexually transmitted diseases. Select the option that best corresponds with your answer.

K13) Giving and receiving oral sex without any form of barrier protection (condom or dental dam).

Very Effective b Moderately Effective Slightly Effective Slightly Ineffective Moderately Ineffective Strongly Ineffective

K15) Wearing (or having a partner wear) a condom that contains spermicidal cream.

K16) Using (or having a partner use) a dental dam or any latex barrier used to help prevent the exchange of fluids, during oral sex.

Attitude Section

The following questions are intended to access your attitudes towards sexual health topics. Please answer each question to the best of your ability by selecting one of the following options. If you feel uncomfortable answering any of the questions you may skip them.

To what extent do you feel comfortable or uncomfortable when engaging in the following behaviors? Please indicate your answer for each behavior by selecting the corresponding option.

A6) Speaking with a partner about using birth control (any method).

• Very Comfortablec Moderately Comfortable Slightly Comfortable Slightly Uncomfortable Moderately Uncomfortable Strongly Uncomfortable

A7) Asking a partner about their past sexual history.

A10) Engaging in unprotected (no condom or dental dam) sexual activity with a partner.

• For the following statements, please indicate your level of concern if you were trying to decide whether or not to get tested for a sexually transmitted disease, including HIV (the virus that causes AIDS).

A19) Having unprotected sex (sex without a condom or dental dam) is not worth the risk of contracting a sexually transmitted disease.

Behavior Section

• In this survey, the definition of sexual activity refers to oral, anal, and vaginal sex. This does not include massage, touching, or mutual masturbation.

B1) Have you ever had consensual sex (oral, anal, or vaginal)?

• Yes No

B8) In the last 30 DAYS, what type of sex did you have? Check all that apply.

• Oral Anal Vaginal Other

B10) If you did NOT use a form of barrier protection such as a condom/dental dam (a latex covering used to prevent the exchange of bodily fluids) in the last 30 DAYS you had sex please indicate the reason. Check all that apply.

• I just knew my partner was safe.
• It was a spontaneous, unplanned event.
• I was under the influence of alcohol or drugs.
• I did not feel comfortable discussing the matter with my partner.
• I did not feel I needed to because I was involved in a long-term relationship at the time. I was using another form of birth control.
• There was not any form of protection method available. The sex was nonconsensual (sex against my will).
• Other          (Must fill in the blank)

B15) Which of the following barrier and/or birth control methods do you use 30 DAYS? Check all that apply.

• Condom/dental dams (latex covering used to prevent the exchange of bodily fluids)
• Combination hormonal methods (such as birth control pills, Ortho Evra—the Patch, NUVA—intravaginal ring—the Ring). Depo-Provera (the Shot)
• Calendar method (rhythm or having sex only during the “safe” times of the month) Withdrawal or “pulling out”
• Diaphragm Nothing
• Other              (Must fill in the blank)

Demographics

D2) Which of the following do you consider yourself?

• Male Female
• Transgender

D5) What is your current relationship status?

• Single (not in a relationship)
• Committed relationship (only dating one person) Non-committed relationship (casual) Cohabitating (living together)
• Married or partnered

D6) Which of the following commonly used terms best describes you?

• Heterosexual Gay or lesbian Bisexual Transgender Questioning

D7) Where do you currently live?

• Campus residence halls Greek housing
• Other university housing Off-campus housing Parent’s or guardian’s house

a The responses are repeated for Questions K1 through K11.

b The responses are repeated for Questions K12 through K24.

c The responses are repeated for Questions A1 through A10.