Procedures for an instrument development study: the Botswana experience.
BACKGROUND
Health protective sexual communication (HPSC) between sexual partners can contribute to human immunodeficiency virus (HIV) prevention, but women face difficulties with HPSC because of cultural and gender issues.


PURPOSE
To present the procedures for an instrument development study conducted in Botswana between 2006 and 2008 on different aspects of HPSC. The study was guided by the theory of planned behaviour constructs.


METHODS
A literature review and a qualitative pilot study among young women aged 18-35 years in Gaborone city clinics generated items for the measures. Eleven measures were developed and evaluated for content validity. The measures were translated and evaluated by three typical participants for cultural relevance and acceptance. A quantitative pilot among ten women and a larger quantitative study among 280 other young women followed in 13 Gaborone city clinics for internal consistency reliability, and construct validity based on principal components analysis. All women who met selection criteria consented and responded to all questions. Research protocols were strictly adhered to.


RESULTS
Eight measures were reliable, with Cronbach's alphas between 0.69 and 0.95. Underlying factors were extracted for these. Two measures were unreliable, one with spuriously low reliability due to its brevity. Some significant relationships were identified between measures. DISCUSSION OF FINDINGS: The results highlighted the importance of HPSC, the significant influence of the male sexual partners and other relatives, and the need to integrate HPSC at all levels of HIV/acquired immunodeficiency syndrome prevention and research, focusing on the effectiveness of HPSC.