Sexual Health Services Questionnaire

Abstract

The Sexual Health Services Questionnaire (SHSQ) is a comprehensive, 100-item, theory-based instrument designed to assess the spectrum and availability of sexuality-related services offered by college health centers. It can also be utilized for evaluating services within sexual health clinics situated in other professional settings. A primary objective of the SHSQ is to explore the relationship between the provision of these services and two key components of the Diffusion of Innovations Theory (DIT; Rogers, 2003): organizational complexity and organizational innovativeness. The instrument is divided into 13 distinct sections covering personnel, specific health products, medical procedures, and institutional demographics.

Keywords

Sexual Health Services Questionnaire, SHSQ, Diffusion of Innovations Theory, organizational innovativeness, college health, complexity, sexual health services, dichotomous scoring, public health, college health centers

Authors

Scott M. Butler, David R. Black, George H. Avery, Janice Kelly, Daniel C. Coster

Purpose

The core purpose of the Sexual Health Services Questionnaire (SHSQ) is to systematically quantify the availability of specific sexuality-related services offered by college and university health centers. This assessment is critical for understanding the scope of sexual health provision in academic environments.

Furthermore, the SHSQ serves as a research tool grounded in the Diffusion of Innovations Theory (DIT). By measuring service availability, the instrument allows researchers to analyze how organizational characteristics (specifically complexity and size) correlate with the degree of organizational innovativeness demonstrated by the health center in adopting new sexual health protocols and services.

Construct

The SHSQ is fundamentally structured around two constructs derived from the DIT, which aim to predict a health center’s adoption of innovative practices concerning sexual health.

The first key construct is Complexity, which is assessed primarily through the first two sections of the questionnaire (employees and peer helpers). Complexity, as defined by Rogers (2003), refers to the level of knowledge and expertise possessed by an organization’s members, typically measured by their range of occupational specialties and degree of professionalism through formal training. The DIT posits that higher organizational complexity is positively related to overall organizational innovativeness.

The second construct, Organizational Innovativeness, is derived from summing the scores across Sections 3 through 11, which cover the breadth of specific services and products offered (e.g., contraceptives, STI testing, vaccinations, and specialized exams). This score measures the extent to which the health center has adopted a wide range of sexual health innovations. The SHSQ also allows for assessing the relationship between organizational innovativeness and institutional size (total employees or student population).

Validity

The development and implementation of the SHSQ utilized a comprehensive strategy to establish its validity, particularly focusing on face and content validity.

The initial phases involved an extensive review of extant literature concerning sexuality-related services offered at college health centers, alongside a review of contemporary contraceptive and sexually transmitted infection literature. To establish face and content validity, six expert panelists were selected to review the instrument. These panelists included doctoral-level specialists in health promotion and psychology, as well as a doctoral student experienced in collegiate sexual health programming. Following initial feedback via email, three one-on-one meetings were conducted with field experts, including a director of a comprehensive health center, further refining the final version of the SHSQ.

Additionally, an assessment of response bias was conducted on participants who completed the test-retest reliability portion. Evaluators were asked about item clarity, comprehensiveness adequacy, and whether participants would respond honestly. Results strongly supported the instrument’s clarity (91%) and perceived honesty of responses (98%), though only 64% felt the sections were fully adequate in terms of comprehensiveness.

Reliability

Reliability assessments were performed using data collected from 358 returned questionnaires (29.83% response rate) from a geographically representative sample of U.S. colleges/universities.

Internal Consistency: Internal consistency was assessed using Cronbach’s alpha, with items categorized by their respective sections. Because of service similarity, Sections 6 and 7 (STI testing and vaccinations) were merged, as were Sections 8–10 (gynecological/sexual assault/testicular exams). Section 12 (CLIA certificate) was excluded from this analysis. Cronbach’s alpha scores for individual sections ranged from .62 to .93, demonstrating acceptable to strong internal consistency. The reliability for the entire questionnaire was highly robust, yielding an alpha score of .94.

Test-Retest Reliability: To establish stability over time, a subsample of 50 participants received a second copy of the SHSQ, resulting in 28 recompleted questionnaires (56% response rate). Demographic analysis confirmed that this subsample adequately represented the overall population. The results showed a high overall rate of 87.37% consistency on service-related items between the two administrations.

Factor Analysis

The provided source material does not detail a formal factor analysis (such as exploratory or confirmatory factor analysis) for the Sexual Health Services Questionnaire. The structure and scoring methods are based on theoretical divisions derived from the Diffusion of Innovations Theory (DIT), rather than purely empirical factor loadings. The two main psychological constructs—Complexity and Organizational Innovativeness—are defined by summing pre-determined, theoretically related sections of the instrument.

Instrument

Test Type: Organizational Assessment Questionnaire / Self-Report Survey

Format: 100 items divided into 13 sections. The majority of items utilize a dichotomous (Yes/No or X/Blank) response mode. Three items allow for open-ended “other” responses, and one item requires a ratio-based numerical response (condoms distributed per year).

Language Available: English (Original)

Population Group: College/University Health Centers and Sexual Health Clinics

Age Group: Not applicable (Organizational measure)

Population Details: The instrument is designed to be completed by the Director of the health center or another appropriate administrative representative knowledgeable about the center’s services and staffing. Completion time is approximately 15 minutes.

Test Methodology: The scoring involves dichotomous coding (1 or 0). Specific summation methods are applied to create composite scores for the Complexity Scale (sum of Section 1 scores plus utilization of peer helpers) and the Organizational Innovativeness Scale (sum of dichotomous scores from Sections 3–11). Currently, no normative data are available for the services scored on the SHSQ.

Keywords

Organizational complexity, college services, STI testing, contraception, health promotion, peer education, CLIA certificate, survey methodology, Cronbach’s alpha, test-retest reliability

Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: [email protected] (Scott M. Butler)

Correspondence Address: Scott M. Butler, Department of Kinesiology, Georgia College & State University, Campus Box 065, Milledgeville, GA 31061

Permissions & Fee and Test Year

The Sexual Health Services Questionnaire is copyrighted © 2008 by Scott M. Butler, David R. Black, George H. Avery, Janice Kelly, and Daniel C. Coster. Information regarding specific usage fees or detailed permission requirements beyond the copyright notice is not provided in the source material.

Reference’s

Gunning, R. (1952). The technique of clear writing. New York: McGraw-Hill.

Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York: Free Press.

Items of the Sexual Health Services Questionnaire

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

The following questionnaire inquires about the sexual health services your student health center currently offers. If you have any questions please do not hesitate to contact the investigators.

Directions: The items below inquire about your current employment of staff involved with sexual health programs and types of sexual health services offered by your campus health center. Please mark an “X” next to all that apply.

Employees who deal with student sexual health concerns and/or problems as their primary job responsibility at your health center include:

• Sexuality Program Coordinator
• Sexuality Educator
• Physician
• Physician Assistant
• Nurse
• Nurse Practitioner
• Sexual Assault Nurse Examiner (SANE)
• Health Educator
• Psychologist
• Psychiatrist
• Social Worker
• Mental Health Counselor

Other (please identify):                                           

Employees that deal with student sexual health concerns and/or problems on a regular basis but do not consider sexual health their primary job responsibility include:

• Physician
• Physician Assistant
• Nurse
• Nurse Practitioner
• Sexual Assault Nurse Examiner (SANE)
• Health Educator
• Psychologist
• Psychiatrist
• Social Worker
• Mental Health Counselor

Other (please identify):                                           

Some health centers house volunteer or paid student peer educators/health advocates. Please mark an “X” next to all of the following that apply to your college health center.

Do you use student peers . . .

• To organize sexuality-related events on campus (e.g., presentations at residence halls/Greek housing)
• To conduct counseling on relationship issues
• To conduct sexual health outreach
• To conduct contraceptive counseling
• To conduct STD testing counseling
• To conduct counseling on sexual orientation issues
• To conduct counseling on other sexuality issues
• To give away condoms at campus bars/restaurants

Other (please identify):                                           

Please mark an “X” next to any of the following safer-sex products your health center distributes to students.

• Male latex condoms
• Flavored condoms
• Non-latex male condoms
• Specialty condoms (e.g., those above or below average size)
• Female condoms
• Sexual lubricants
• Latex dams (i.e., dental dams)

**On average how many condoms does your institution distribute to students per year? (If you do NOT distribute condoms please write in 0. If you are unsure about how many condoms you distribute please write in 999 for coding purposes)               #

Please mark an “X” next to any methods in which your health center distributes condoms (includes both selling and giving away condoms for free).

• At the pharmacy
• During after-hours
• Through appointment with health care provider
• Through educational outreach
• At campus events
• At bars and restaurants near campus

Please mark an “X” next to any of the following contraceptive methods that are available through your health center.

• Oral contraceptive pill
• Oral contraceptive pill (progestin only)
• Hormonal transdermal skin patch
• Hormonal vaginal ring
• Intrauterine device (IUD) hormonal
• Intrauterine device (IUD) copper
• Progestin-only injection
• Instruction for fertility awareness method (FAM)
• Emergency contraception pills (ECP) by prescription
• Emergency contraception pills (ECP) over the counter
• Diaphragm
• Cervical cap
• Hormonal implant

Please mark an “X” next to any of the sexually transmitted infections (STIs) that your health center currently offers testing for.

• HIV
• HIV “quick” blood test
• HIV oral swab test
• Chlamydia
• Gonorrhea
• Hepatitis B
• Hepatitis A
• Herpes simplex virus (HSV)
• Syphilis
• HPV DNA test for women
• Trichomonas

Please mark an “X” next to any of the following infections that your health center currently provides a vaccine for.

• HPV vaccine
• Hepatitis B vaccine

Please mark an “X” next to any of the following services that your health center currently provides.

• Pap test
• Bimanual uterine/ovarian exam
• Colposcopy

Please mark an “X” if your health center provides the service listed below. Clinical breast exam

Please mark an “X” if your health center provides the service listed below. Testicular exam

Please mark an “X” if your health center provides the service listed below. Post-sexual assault exam

Please mark an “X” next to any of the following counseling services that your health center currently provides.

• Individual counseling on general sexual health issues
• Group counseling on general sexual health issues
• Relationship issues
• Sexual orientation issues
• Contraceptive methods
• Service for survivors of sexual assault

Does your health center have a Clinical Laboratory Improvement Amendment (CLIA) certificate? Please mark an “X” next to your response.

• Yes
• No
• Unsure

Directions: The items below ask about your personal demographics and how long you have been a college health center director. Please respond by writing in your response or by placing an “X” in the space provided.

Your age:                             

Your race/ethnicity:

• Asian         
• Black/African American         
• Caucasian White         
• Hispanic         
• American Indian         
• Other         

Your gender:

• Male         
• Female         

How many total years have you been the director of a college health center? If you have been the director of more than one health center, please combine your total years of experience.                years

Your education:

Please mark an “X” next to all of the degrees you have earned

• Bachelor’s
• Master’s
• PhD
• MD
• Other

Total number of employees at your health center:               

Total student population at your college/university:               

What state is your college/university located in?               

Directions: The items below are based upon your college/university’s demographics; please respond by placing an “X” in the space provided.

Type of Academic Institution

• Public
• Private

Setting of Your Institution:

• Urban
• Small Town
• Suburban
• Rural

Student Population:

• Primarily Residential         
• Primarily Commuter         
• Equal Numbers Residential and Commuter         

Degrees Awarded at Your Institution (check all that apply)

• Associate
• Baccalaureate
• Master’s
• Doctorate
• Professional (e.g., MD, JD)
• Other Degrees

Does your institution have a medical school?

• Yes         
• No         

Additional Demographic Characteristics (Please check all that apply)

• Historically Black College or University         
• Faith-Based Institution         
• All-Male Institution         
• All-Female Institution         

Thank You for Participating in Our Study!

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