Antecedents of Sexual and Reproductive Health Misperceptions–Model

Abstract

The Antecedents of Sexual and Reproductive Health Misperceptions–Model, developed by Dong, Zhang, Lam, and Huang (2024), is a specialized psychological inventory designed to investigate the underlying processes that contribute to Sexual and Reproductive Health (SRH) misperceptions. This instrument integrates 22 items adapted from established research (Cunningham, 2002; Chae, 2015; Ramondt & Ramírez, 2019) across several critical antecedent factors, including Stigma Perceptions, Information Avoidance, and Information Overload.

The scale was rigorously evaluated using Structural Equation Modeling (SEM) on a sample of adult Chinese women. The resulting measurement model demonstrated strong psychometric properties. The study successfully reported robust evidence regarding the instrument’s factor structure, high internal consistency (Cronbach’s alpha ranging from .78 to .90), and adequate convergent validity, establishing it as a reliable tool for assessing the psychological and social drivers of SRH misinformation vulnerability.

Keywords

Information Avoidance, Information Overload, Misinformation Exposure, Misinformation Statements, Misperceptions, Sexual and Reproductive Health, Stigma Perceptions, Women, Stigma Management Communication, Stigma Exposure.

Authors

Dong, Yujie; Zhang, Lianshan; Lam, Chervin; Huang, Zhongwei.

Purpose

The primary purpose of the Antecedents of Sexual and Reproductive Health Misperceptions–Model is to quantitatively assess the psychological, social, and informational antecedents that predispose individuals, particularly women, to hold inaccurate or erroneous beliefs regarding Sexual and Reproductive Health (SRH).

Specifically, the instrument aims to measure how factors such as perceived social stigma, deliberate information avoidance, and exposure to overwhelming or contradictory information (Information Overload) drive the formation and maintenance of SRH misperceptions. This assessment is crucial for designing targeted public health interventions and communication strategies aimed at mitigating the spread and acceptance of health misinformation.

Construct

The scale measures five distinct, yet interrelated, latent constructs: Stigma Perceptions, Information Avoidance, Information Overload, Misinformation Exposure, and the resulting SRH Misperceptions (encompassing both sexual and reproductive health misconceptions). These constructs collectively model the process through which environmental and psychological stressors translate into false health beliefs.

The instrument operationalizes Misperceptions by assessing the degree to which respondents believe various false statements about contraception, sexually transmitted diseases (STDs), and common reproductive health issues are true, thereby quantifying the extent of their adherence to misinformation. The scale items are designed to capture the emotional and behavioral responses (such as avoidance and perceived stigma) that precede the adoption of these inaccurate health beliefs.

Validity

The validity of the measurement model was primarily established through robust evidence of convergent validity. Analysis demonstrated that the items intended to measure specific constructs converged strongly, supporting the internal structure of the scale and confirming that the items correlate highly with their respective latent factors.

Empirical findings showed that the majority of the individual measurement items exhibited factor loadings exceeding the acceptable threshold of 0.6. Furthermore, the Composite Reliability (CR) values calculated for the latent constructs consistently surpassed 0.8. These high factor loadings and CR values collectively provide strong statistical confirmation of adequate convergent validity, ensuring that the items accurately represent their intended underlying constructs.

Reliability

The reliability of the Antecedents of Sexual and Reproductive Health Misperceptions–Model was assessed using internal consistency measures across all measured constructs.

The results indicated high internal consistency, with the calculated Cronbach’s alpha coefficients ranging robustly from 0.78 to 0.90 across the five latent factors. This range demonstrates that the items within each subscale are highly correlated and reliably measure the same underlying construct, meeting or exceeding standard criteria for acceptable psychological instruments used in academic research.

Factor Analysis

The scale structure was validated through rigorous confirmatory analysis using Structural Equation Modeling (SEM). The researchers tested a measurement model featuring five distinct latent constructs, which demonstrated excellent model fit indices, confirming the theoretical delineation of the antecedents.

Key fit statistics for the model were reported as follows: the chi-square to degrees of freedom ratio (χ2/df) was 2.728, the Comparative Fit Index (CFI) was 0.941, the Root Mean Square Error of Approximation (RMSEA) was 0.05, and the Standardized Root Mean Square Residual (SRMR) was 0.043. These values meet or exceed conventional standards for a good fitting model in psychological research. It is important to note that during the refinement process, three specific items (Item 4, Item 13, and Item 14) were removed from the final instrument due to their low factor loadings (below 0.5), which did not adequately contribute to the measurement of their intended constructs.

Instrument

Test Type: Inventory/Questionnaire

Format: The instrument consists of 22 items rated using 7-point scales. Response options vary based on the specific construct being measured, ranging from “strongly disagree” to “strongly agree” (for Stigma Perceptions and Information Overload) or “very false” to “very true” (for Misinformation Statements).

Language Available: English

Population Group: Human; Female

Age Group: Adult

Population Details: The initial validation sample consisted of Adult Women located in China.

Test Methodology: Test Validity; Convergent Validity; Test Reliability; Internal Consistency; Measurement Model; Structural Equation Modeling.

Keywords

Sexual Health Misperceptions, Reproductive Health Misconceptions, Information Avoidance, Stigma Perceptions, Information Overload, Measurement Model, Adult Women, China, Psychometrics.

Authors

Author ORCID Identifier: Dong, Yujie: ORCID 0000-0001-8146-6571

Affiliation Email addresses: [email protected]

Correspondence Address: Zhang, Lianshan: Shanghai Jiao Tong University, School of Media & Communication, 800 Dongchuan Road, Minhang, Shanghai, China, 200240.

Permissions & Fee and Test Year

The scale was developed and published in 2024. It is designated as non-commercial, meaning there are no commercial rights restrictions and no associated fees required for its use in academic or research settings, pending standard citation requirements.

Reference’s

Dong, Y., Zhang, L., Lam, C., & Huang, Z. (2024). Counteracting sexual and reproductive health misperceptions: Investigating the roles of stigma, misinformation exposure, and information overload. Patient Education and Counseling, 120, Article 108098. DOI: 10.1016/j.pec.2023.108098

The scale development also drew upon prior research:

• Cunningham, A. (2002).
• Chae, J. (2015).
• Ramondt, S., & Ramírez, M. (2019).

Items of the Antecedents of Sexual and Reproductive Health Misperceptions–Model

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

Stigma Perceptions (Items 1-3) & Information Avoidance (Items 4-6)

• If a woman has sexual/reproductive disorders, people will think she is unclean.

• If a woman has sexual/reproductive disorders, people will think badly of her.

• If a woman has sexual/reproductive disorders, people will avoid her.

• I prefer not to think about sexual and reproductive health.

• I deliberately avoid information about sexual and reproductive health.

• I do not want any more information about sexual and reproductive health.

Information Overload (Items 7-9)

• There are so many recommendations about sexual and reproductive health, it’s hard to know which ones to follow.

• It has gotten to the point where I don’t even care to hear new information about sexual and reproductive health.

• I feel overloaded by the amount of information about sexual and reproductive health I am supposed to know.

Misinformation Statements (SRH Misperceptions)

1. Taking oral contraceptive pills effectively prevents the transmission of STDs.

2. Withdrawal before ejaculation prevents pregnancy.

3. Using two condoms together doubles the protection and can be more effective in preventing conception and the transmission of STDs.

4. You can’t contract an STD unless you have penetrative sex.

5. You can only transmit an STD if you have symptoms.

6. Showering or urinating after sex prevents pregnancy.

7. Having unprotected sex during the safe period (i.e., the days before and after the expected fertile window) does not lead to pregnancy.

8. Frequent sexual intercourse during the ovulation period can definitely get pregnant.

9. Menstrual cramps will cease after giving birth.

10. Drinking too much soy milk can lead to ovarian or breast cancer.

11. Traditional Chinese medicine can cure AIDS.

12. Emergency contraceptive pills are 100% successful after unprotected sex.

13. Only women need to take pre-pregnancy/preconception tests, not men.

Response Options

Construct	Scale
Stigma perceptions	1 (“strongly disagree”) to 7 (“strongly agree”)
Information Overload	1 (“strongly disagree”) to 7 (“strongly agree”)
Misinformation Exposure (Not listed above)	1 (“never”) to 7 (“very often”)
SRH Misperceptions (Misinformation Statements)	1 (“very false”) to 7 (“very true”)