I read with great interest "Young Women's Perceptions of the Benefits of Childbearing: Associations with Contraceptive Use and Pregnancy" [2013, 45(1):23–31], in which Corinne H. Rocca et al. claim that few valid and reliable instruments exist to assess teenagers’ perceptions of childbearing. I would like to call the authors’ and Perspectives readers’ attention to the Thoughts on Teen Parenting Survey, a rigorously constructed and validated tool that measures these constructs.
The survey is based on the theory of reasoned action, which posits that sexual decision making and behaviors may be impacted, in part, by an individual's perceptions of potential consequences. The survey collects demographic data and asks teenagers to report their level of agreement with 44 Likert‐scaled items about the impact of a teenage birth. Teenagers are asked to consider how a teenage birth would change their relationships (with friends, parents and family, boyfriend and girlfriend), educational and work prospects, financial circumstances, life in general and personal characteristics. The cumulative and subscale scores may be used to assess perceptions and their demographic correlates.
Survey questions were developed on the basis of a review of the literature and findings from semistructured interviews and focus groups with teenagers.1-3 Items underwent review and revision by experts, and content validity was ensured through cognitive interviews about questions with local experts and content validity indexing with national teenage pregnancy prevention researchers. The scale was pretested with a group of teenagers, and during subsequent focus groups, teenagers made suggestions to increase understandability of the tool. Piloting the tool with 171 teenagers allowed for a variety of measures to ensure reliability and validity. Exploratory factor analysis and extraction of items, discriminate validity of contrasting items and hypothesis testing assessed scale validity. Operations to assess split‐half and test‐retest reliability were also conducted. The Cronbach's alphas of the tool in the pretest and pilot groups were 0.87–0.90, indicating a moderate to high level of internal consistency.4
The survey was initially administered to 695 teenagers, and data revealed significant differences in perceptions based on gender, socioeconomic status, history of a teenage birth in the family, residence (urban, rural or suburban) and family structure; the Cronbach's alpha for this sample was 0.92.5 The scale has been used to assess changes in perceptions after interventions, including Baby Think It Over,6 Power Through Choices7 and Wise Guys.8 Because research indicates that positive attitudes toward a teenage birth may be predictive of subsequent births,9,10 this survey may be valuable in identifying young women at risk for future teenage births. The tool may also provide structure for instruction to teenagers about the impacts of a teenage birth.
I hope this information is informative as colleagues move forward to measure perceptions and continue work dedicated to prevention efforts based on youth perceptions.
Judith W. Herrman
University of Delaware School of Nursing
Newark, DE
The Authors Reply
We thank Dr. Herrman for bringing the Thoughts on Teen Parenting Survey (TTPS) to our attention, as well as for her valuable comments about the importance of rigorous psychometric testing of measures of childbearing attitudes. We note relevant differences in context and purpose between the TTPS and the Benefits of Childbearing (BOC) measure we developed. The 44‐item TTPS was developed among participants of a youth summit and high school students generally; it is of great use for evaluating the impact of interventions conducted among teenagers as a whole. The nine‐item BOC, in contrast, was developed with and tested among a cohort of young women who were starting a new method of hormonal birth control—young women who both stated that they wanted to avoid pregnancy and were taking the initiative to do so. As such, the scale may be particularly useful in clinical and clinical research settings, as well as in circumstances in which use of a relatively short instrument is necessary. Our study not only established the psychometric properties of the BOC scale, but also is the only study to our knowledge that has documented a prospective association between perceived benefits to childbearing and actual pregnancies among young women wanting to avoid pregnancy.
Corinne H. Rocca
University of California, San Francisco
Cynthia C. Harper
University of California, San Francisco
Tina R. Raine-Bennett
Kaiser Permanente Northern California
Oakland, CA