Sexual Health

Development and content validation of a survey assessing domains of sexual and reproductive health in adults with spina bifida.

TL;DR

Content validity, clarity, and functionality of a novel survey probing five domains of sexual and reproductive health in adults with spina bifida was established using a modified Delphi method and cognitive interviews.

Key Findings

A high response rate was achieved among invited expert panel members for the modified Delphi review process.

  • Of 26 potential panel members invited to participate, 22 (85%) responded and agreed to participate.
  • The panel included seven urologists (two adult, five pediatric), six developmental pediatricians, six registered nurses from spina bifida clinics, two physiatrists, and one medicine-pediatrics trained internist.
  • The panel represented national sexual health experts with diverse clinical backgrounds relevant to spina bifida care.

Consensus on 100 survey items was achieved after three rounds of iterative expert review.

  • The modified Delphi method was used to assess item clarity, relevance, and comprehensiveness across multiple rounds.
  • Following each round, items were refined through researcher consensus until the content validity index was met.
  • The content validity index threshold required agreement of 0.8–1.0 for each question.
  • All five SRH domains were confirmed as adequately represented in the final 100-item instrument.

The final survey instrument covers five distinct domains of sexual and reproductive health relevant to adults with spina bifida.

  • The five domains are: sexual knowledge/education, sexual practice, sexual safety/risk profile, history of abuse, and perceived self-efficacy.
  • Survey development was guided by social cognitive theory's self-efficacy concept, which is 'known for its predictive power in behavior change among those with physical disabilities.'
  • The initial survey was informed by a targeted literature review as well as stakeholder and expert opinions.

Cognitive interviews with adults with spina bifida confirmed the survey's acceptance and understandability.

  • Five adults with spina bifida participated in cognitive interviews of the refined instrument.
  • The cognitive interviews were conducted to analyze acceptance and understanding of the survey items.
  • This step followed the expert Delphi panel rounds and served as a final validation step with the target population.

Adults with spina bifida face substantial gaps in sexual and reproductive health knowledge that motivated the need for a validated assessment tool.

  • Identified gaps include low use of contraception, poor utilization of preventative sexual health care, and unintended pregnancies.
  • Additional concerns include 'missed opportunities to pursue their SRH goals, and increased risk of abuse and coercion.'
  • No previously validated questionnaires existed to reliably test and track SRH and self-efficacy in adults with spina bifida, providing the rationale for this study.

The validated survey is intended for use in both research and clinical settings for multiple purposes.

  • Stated uses include assessing baseline SRH knowledge, identifying risky behaviors, and screening for sexual abuse.
  • The instrument is designed to be applicable in both research and clinical settings.
  • The survey's development in clinical contexts was supported by involvement of registered nurses from spina bifida clinics as panel members.

What This Means

This research describes the development and validation of a new survey tool designed to assess the sexual and reproductive health (SRH) of adults living with spina bifida (SB), a condition affecting the spine that can impact many aspects of daily functioning. People with spina bifida often lack access to adequate sexual health education and face higher risks of unintended pregnancy, limited use of preventive healthcare, and vulnerability to abuse. Until now, no validated tool existed to systematically measure their sexual health knowledge, behaviors, and self-confidence in this area. The research team created a 100-item survey covering five areas: sexual knowledge and education, sexual practices, sexual safety and risk, history of abuse, and self-efficacy (confidence in managing one's own sexual health). A panel of 22 national experts—including urologists, pediatricians, nurses, and other specialists—reviewed the survey over three rounds using a structured process called the modified Delphi method, refining questions until strong agreement was reached on clarity, relevance, and completeness. Five adults with spina bifida then tested the survey in interviews to confirm it was understandable and acceptable to the people it was designed to serve. This research suggests that this new tool could help healthcare providers and researchers better understand and address the sexual and reproductive health needs of adults with spina bifida. By identifying gaps in knowledge, risky behaviors, or experiences of abuse, the survey could support more targeted education, counseling, and clinical care for this population that has historically been underserved in the area of sexual health.

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Citation

Hopson B, Carmen Tong C, Streur C, Rocque B, Blount J, Ivankova N, et al.. (2025). Development and content validation of a survey assessing domains of sexual and reproductive health in adults with spina bifida.. Journal of pediatric rehabilitation medicine. https://doi.org/10.1177/18758894241304357