CHAPTER THREE
3.6 Data collection methods and tools
3.6.1 Psychological measures
3.6.1.3. Vineland’s Social Maturity Scale
The Vineland‘s Social Maturity Scale (Doll, 1965) measures social competence, self-help skills and adaptive behaviour from birth up to the age of 30 years. It can be used in planning therapy and/or individualised instruction for people with intellectual impairment or emotional disorders, and also as an adjunct to establish intellectual impairment or mental retardation.
It consists of a 117-item (categorised by age) interview with a parent, sibling or other primary caregiver. Personal and social roles are evaluated in the following areas: daily living skills (general self-help, eating and dressing); communication (listening, speaking and writing); motor skills (fine and gross, including locomotion); socialisation (interpersonal relationships, play and leisure, and coping skills); occupational skills; and self-direction.
163 3.6.2 Quantitative methods
A structured questionnaire was used for quantitative data collection.
3.6.2.1 Development of structured questionnaire
The questionnaire was adapted from a previous study from the University of KwaZulu-Natal on HIV/AIDS and adolescents (Taylor et al., 2007). The questionnaire (Appendix F) consisted of the following sections:
- Demographics - Sexuality - History of STIs
- HIV/AIDS awareness and testing
- Sexual abstinence as a preventative behaviour – perceived risk of HIV infection, attitudes, outcome expectations, social influences, self-efficacy, intention in relation to sexual abstinence
- HIV/AIDS transmission - Cues to action
- Substance use
As the study by Taylor et al. (2007) assesses HIV testing among learners, it was imperative to develop different scales to assess sexual abstinence in this study. Therefore, to assess perceived HIV risk, attitudes, outcome expectations, social influences, self-efficacy and intention in relation to sexual abstinence, different scales were developed based on the literature on sexual abstinence of adolescents.
To reduce response biases associated with a sensitive issue like sex, the questions were arranged so that sexuality topics were not immediately introduced. In addition, questions about HIV transmission were at the end of the questionnaire. This was to elicit honest responses from the participants, especially regarding their sexual behaviours. It was likely that they would under- report their sexual activities if questions on HIV transmission preceded sexuality questions. The
164 sequence also allowed good rapport to be established between the participants and the interviewers before more sensitive questions were broached.
Furthermore, to facilitate that learners with intellectual impairment understood the questions, they were framed using simple, non-ambiguous language. Wherever possible, double-barrelled questions were avoided. People with intellectual disabilities are particularly prone to response biases (Sigelman, Schoenrock et al., 1981; Sigelman, Winer, & Schoenrock, 1982). Because questions may elicit either overt or passive responses, the careful design of questionnaires and interviews is vital to optimising responsiveness, reliability and validity (Sigelman et al., 1980).
Another study reveals that PWID are more likely than the control group to comply with unreasonable instructions and to be overly affirmative in their responses to questions (Rosen, Floor, & Baxter, 1974). Greater acquiescence is associated with more complex questions, when a question is not understood and possibly when the correct answer is unknown or not readily accessible (Sigelman, Budd, Spanhel, & Schoenrock, 1981).
In light of the aforementioned, the questionnaire was thus made up of a mixture of yes/no questions; yes/no questions followed by open-ended questions (e.g. ‗have you ever had a STI, or not?‘ followed by ‗how did you know that you had an STI?‘); multiple-choice questions; and 5- points Likert‘s scale questions. To reduce acquiescence, yes/no questions were avoided wherever possible, except in cases where there was no alternative way of asking the question. In such cases, the questions were framed so that they ended in ‗or not‘ (e.g. ‗have you ever heard of HIV/AIDS, or not?‘). This served two purposes: it granted the respondents the implicit permission to answer ‗no‘ where there might be strong pressure to acquiesce, and also injected a conversational tone into the questions (McCabe, Cummins, & Deeks, 1999).
McCabe et al. (1999) suggest that pictures or graphic aids can also be used adjunct to questions to create better understanding. Therefore, pictures were used to facilitate better understanding of some of the questions, particularly with questions about knowledge of HIV transmission. They took the form of ‗tell me about this picture‘. McCabe et al. (1999) argue that this approach is preferable to asking ‗‗what are these people doing?‘ which would focus attention on an act, rather than general knowledge and feelings about a situation‘. After respondents stated what a
165 picture was about, they then answered a knowledge-based question (e.g. the picture of a woman breastfeeding her baby was followed by the question: ‗if the woman is HIV positive, can HIV be transmitted from a breastfeeding mother to her baby?‘).
For this purpose, visual resources from All about me – a life skills, sexuality and HIV/AIDS education programme for learners with intellectual disability: a facilitator‟s manual
(Johns, 2007) were adapted for use in this study. The manual was published by the Western Cape Forum for Intellectual Disability, and is being used in the Western Cape Province of South Africa to provide sexuality and HIV/AIDS education to learners with intellectual disability.
In addition, the 5-point Likert‘s scale statements adopted a stepped approach for IIL so as to avoid ambiguity. For example, respondents were asked to indicate whether they agreed or disagreed with a statement, and then were asked to indicate how strong their agreement or disagreement was.
Measurement scales were developed to assess learners‘ risk perception, attitudes, outcome evaluation, social influences, self-efficacy and intention in relation to sexual abstinence. It was based on previous literature on the subject.
Risk perception was measured with three positively-worded items. Risk perception increased along the gradient from 1 (strongly disagree) to 5 (strongly agree): I think I can get HIV/AIDS; I need to change my behaviour to avoid HIV/AIDS; and people my age can get HIV/AIDS.
Attitude was measured with four positively-worded items, two of which are misconceptions. The ratings were reversed for the misconceptions in that 1 denoted ‗strongly agree‘ and 5 denoted
‗strongly disagree‘, whereas, with the other positively-worded items, 1 denoted ‗strongly disagree‘ and 5 denoted ‗strongly agree‘: sexual abstinence prevents STIs and HIV/AIDS; sexual abstinence prevents unwanted pregnancy; sexual abstinence is dangerous and unhealthy; and sexual activity is a sign of maturity.
Five items, one of which was negatively-worded, measured outcome evaluation. Outcome evaluation increased along the gradient from 1 (strongly disagree) to 5 (strongly agree), except for the negatively-worded item, which increased from 1 (strongly agree) to 5 (strongly disagree):
166 sex now could mess up my future; sex now could not affect my future goals; sex could expose me to STIs; sex could expose me to HIV/AIDS; and sex could expose me to pregnancy.
Learners‘ social influence was measured using five negatively-worded items that were the right/normal things expected, and one positively-worded item that was not deemed the right thing. Confidence in receiving support from significant others increased from 1 (strongly disagree) to 5 (strongly agree) for the five negatively-worded items and from 1 (strongly agree) to 5 (strongly disagree) for the last item: my boy/girlfriend would support us not to have sex now;
my father would support me not to have sex now; my mother would support me to have sex now;
my friends would support me not to have sex now; my friends are not having sex; and my brothers/sisters would support me to have sex now.
Three positively-worded items measured learners‘ self-efficacy. Two of them signified high self- efficacy and scores increased from 1 (strongly disagree) to 5 (strongly agree), and the third item showed low self-efficacy, with scores going up from 1 (strongly agree) to 5 (strongly disagree): I can firmly say „no‟ to sex; I can have a boy/girlfriend for a long time without having sex; it is difficult to tell a lover that I don‟t want to have sex.
Lastly, two negatively-worded items were used to measure learners‘ intention. Both of them showed the intention to postpone sexual activity until later in life and scores increased from 1 (strongly disagree) to 5 (strongly agree): I will not have sex until I am married; and I will not have sex until I am older.