Support for Texting-Based Condom Negotiation Among Forcibly Displaced Adolescents in the Slums of Kampala, Uganda: Cross-sectional Validation of the Condom Use Negotiated Experiences Through Technology Scale

Promoting sexual health among forcibly displaced adolescents is a global public health priority. Digital sexual communication strategies (eg, sexting) may increase adolescents' confidence in discussing sexual health issues and negotiating condom use. However, limited evidence exists describing...

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Veröffentlicht in:	JMIR public health and surveillance Jg. 8; H. 4; S. e27792
Hauptverfasser:	Okumu, Moses, Logie, Carmen H, Ansong, David, Mwima, Simon, Hakiza, Robert, Newman, Peter A
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	Canada JMIR Publications 06.04.2022
Schlagworte:	Adaptation Adolescent Adolescents Adult Attitudes Children & youth Communication Condoms Cross-Sectional Studies Displaced persons Female Gender Ghettos Girls Health surveillance Humans Informed consent Marginalized groups Negotiating Negotiations Original Paper Poverty Areas Public health Reproducibility of Results Reproductive health Research methodology Sexual health Sexually Transmitted Diseases Slums Social networks Socialization STD Technology Teenagers Text Messaging Uganda Young Adult Uganda United States > US Kampala Uganda condom negotiation digital sexual communication sexting HIV prevention gender refugee and displaced adolescents
ISSN:	2369-2960, 2369-2960
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Abstract	Promoting sexual health among forcibly displaced adolescents is a global public health priority. Digital sexual communication strategies (eg, sexting) may increase adolescents' confidence in discussing sexual health issues and negotiating condom use. However, limited evidence exists describing validated measures for text-based condom negotiation in the literature. This study helps fill this gap by adapting and examining the psychometric properties of a condom use experience through technology (condom use negotiated experiences through technology [CuNET]) scale. Using peer network sampling, 242 forcibly displaced adolescents (aged 16-19 years) living in Kampala's slums were recruited for participation between January and March 2018. A subscale (embarrassment to negotiate condom use) of the Multidimensional Condom Attitudes Scale was adapted to incorporate sexting, yielding CuNET. Participants were randomly assigned to calibration and validation subsamples to conduct exploratory and confirmatory factor analyses to establish and validate the scale. CuNET measured participants' support levels for texting-based condom negotiation via sexting based on gender, and multivariable logistic regression was used to explore its associations with sexual health outcomes (recent consistent condom use, access to sexual and reproductive health services, and lifetime sexually transmitted infection testing). The one-factor CuNET with the validation sample was valid (χ =5.3; P=.26; root mean square error of approximation=0.05, 90% CI 0.00-0.16; comparative fit index=0.99; Tucker-Lewis index=0.99; standardized root mean square residual=0.006), and reliability (Cronbach α=.98). Adolescent girls showed significantly lower levels of support for using sexting to negotiate condom use (mean 13.60, SE 0.70 vs mean 21.48, SE 1.23; P=.001). In multivariable analyses, a 1-point increase in the CuNET score was associated with increased odds of recent consistent condom use (adjusted odds ratio [aOR] 1.73, 95% CI 1.24-2.41) but not with access to sexual and reproductive health services (aOR 1.51, 95% CI 0.99-2.30) or lifetime sexually transmitted infection testing (aOR 0.90, 95% CI 0.64-1.26). The unidimensional CuNET scale is valid and reliable for forcibly displaced adolescents living in slums in Kampala, gender-sensitive, and relevant for predicting consistent condom use among urban displaced and refugee adolescents. Further development of this scale will enable a better understanding of how adolescents use digital tools for condom negotiation.
AbstractList	Background: Promoting sexual health among forcibly displaced adolescents is a global public health priority. Digital sexual communication strategies (eg, sexting) may increase adolescents’ confidence in discussing sexual health issues and negotiating condom use. However, limited evidence exists describing validated measures for text-based condom negotiation in the literature. Objective: This study helps fill this gap by adapting and examining the psychometric properties of a condom use experience through technology (condom use negotiated experiences through technology [CuNET]) scale. Methods: Using peer network sampling, 242 forcibly displaced adolescents (aged 16-19 years) living in Kampala’s slums were recruited for participation between January and March 2018. A subscale (embarrassment to negotiate condom use) of the Multidimensional Condom Attitudes Scale was adapted to incorporate sexting, yielding CuNET. Participants were randomly assigned to calibration and validation subsamples to conduct exploratory and confirmatory factor analyses to establish and validate the scale. CuNET measured participants’ support levels for texting-based condom negotiation via sexting based on gender, and multivariable logistic regression was used to explore its associations with sexual health outcomes (recent consistent condom use, access to sexual and reproductive health services, and lifetime sexually transmitted infection testing). Results: The one-factor CuNET with the validation sample was valid (χ24=5.3; P=.26; root mean square error of approximation=0.05, 90% CI 0.00-0.16; comparative fit index=0.99; Tucker-Lewis index=0.99; standardized root mean square residual=0.006), and reliability (Cronbach α=.98). Adolescent girls showed significantly lower levels of support for using sexting to negotiate condom use (mean 13.60, SE 0.70 vs mean 21.48, SE 1.23; P=.001). In multivariable analyses, a 1-point increase in the CuNET score was associated with increased odds of recent consistent condom use (adjusted odds ratio [aOR] 1.73, 95% CI 1.24-2.41) but not with access to sexual and reproductive health services (aOR 1.51, 95% CI 0.99-2.30) or lifetime sexually transmitted infection testing (aOR 0.90, 95% CI 0.64-1.26). Conclusions: The unidimensional CuNET scale is valid and reliable for forcibly displaced adolescents living in slums in Kampala, gender-sensitive, and relevant for predicting consistent condom use among urban displaced and refugee adolescents. Further development of this scale will enable a better understanding of how adolescents use digital tools for condom negotiation. Promoting sexual health among forcibly displaced adolescents is a global public health priority. Digital sexual communication strategies (eg, sexting) may increase adolescents' confidence in discussing sexual health issues and negotiating condom use. However, limited evidence exists describing validated measures for text-based condom negotiation in the literature. This study helps fill this gap by adapting and examining the psychometric properties of a condom use experience through technology (condom use negotiated experiences through technology [CuNET]) scale. Using peer network sampling, 242 forcibly displaced adolescents (aged 16-19 years) living in Kampala's slums were recruited for participation between January and March 2018. A subscale (embarrassment to negotiate condom use) of the Multidimensional Condom Attitudes Scale was adapted to incorporate sexting, yielding CuNET. Participants were randomly assigned to calibration and validation subsamples to conduct exploratory and confirmatory factor analyses to establish and validate the scale. CuNET measured participants' support levels for texting-based condom negotiation via sexting based on gender, and multivariable logistic regression was used to explore its associations with sexual health outcomes (recent consistent condom use, access to sexual and reproductive health services, and lifetime sexually transmitted infection testing). The one-factor CuNET with the validation sample was valid (χ =5.3; P=.26; root mean square error of approximation=0.05, 90% CI 0.00-0.16; comparative fit index=0.99; Tucker-Lewis index=0.99; standardized root mean square residual=0.006), and reliability (Cronbach α=.98). Adolescent girls showed significantly lower levels of support for using sexting to negotiate condom use (mean 13.60, SE 0.70 vs mean 21.48, SE 1.23; P=.001). In multivariable analyses, a 1-point increase in the CuNET score was associated with increased odds of recent consistent condom use (adjusted odds ratio [aOR] 1.73, 95% CI 1.24-2.41) but not with access to sexual and reproductive health services (aOR 1.51, 95% CI 0.99-2.30) or lifetime sexually transmitted infection testing (aOR 0.90, 95% CI 0.64-1.26). The unidimensional CuNET scale is valid and reliable for forcibly displaced adolescents living in slums in Kampala, gender-sensitive, and relevant for predicting consistent condom use among urban displaced and refugee adolescents. Further development of this scale will enable a better understanding of how adolescents use digital tools for condom negotiation. BackgroundPromoting sexual health among forcibly displaced adolescents is a global public health priority. Digital sexual communication strategies (eg, sexting) may increase adolescents’ confidence in discussing sexual health issues and negotiating condom use. However, limited evidence exists describing validated measures for text-based condom negotiation in the literature. ObjectiveThis study helps fill this gap by adapting and examining the psychometric properties of a condom use experience through technology (condom use negotiated experiences through technology [CuNET]) scale. MethodsUsing peer network sampling, 242 forcibly displaced adolescents (aged 16-19 years) living in Kampala’s slums were recruited for participation between January and March 2018. A subscale (embarrassment to negotiate condom use) of the Multidimensional Condom Attitudes Scale was adapted to incorporate sexting, yielding CuNET. Participants were randomly assigned to calibration and validation subsamples to conduct exploratory and confirmatory factor analyses to establish and validate the scale. CuNET measured participants’ support levels for texting-based condom negotiation via sexting based on gender, and multivariable logistic regression was used to explore its associations with sexual health outcomes (recent consistent condom use, access to sexual and reproductive health services, and lifetime sexually transmitted infection testing). ResultsThe one-factor CuNET with the validation sample was valid (χ24=5.3; P=.26; root mean square error of approximation=0.05, 90% CI 0.00-0.16; comparative fit index=0.99; Tucker-Lewis index=0.99; standardized root mean square residual=0.006), and reliability (Cronbach α=.98). Adolescent girls showed significantly lower levels of support for using sexting to negotiate condom use (mean 13.60, SE 0.70 vs mean 21.48, SE 1.23; P=.001). In multivariable analyses, a 1-point increase in the CuNET score was associated with increased odds of recent consistent condom use (adjusted odds ratio [aOR] 1.73, 95% CI 1.24-2.41) but not with access to sexual and reproductive health services (aOR 1.51, 95% CI 0.99-2.30) or lifetime sexually transmitted infection testing (aOR 0.90, 95% CI 0.64-1.26). ConclusionsThe unidimensional CuNET scale is valid and reliable for forcibly displaced adolescents living in slums in Kampala, gender-sensitive, and relevant for predicting consistent condom use among urban displaced and refugee adolescents. Further development of this scale will enable a better understanding of how adolescents use digital tools for condom negotiation. Promoting sexual health among forcibly displaced adolescents is a global public health priority. Digital sexual communication strategies (eg, sexting) may increase adolescents' confidence in discussing sexual health issues and negotiating condom use. However, limited evidence exists describing validated measures for text-based condom negotiation in the literature.BACKGROUNDPromoting sexual health among forcibly displaced adolescents is a global public health priority. Digital sexual communication strategies (eg, sexting) may increase adolescents' confidence in discussing sexual health issues and negotiating condom use. However, limited evidence exists describing validated measures for text-based condom negotiation in the literature.This study helps fill this gap by adapting and examining the psychometric properties of a condom use experience through technology (condom use negotiated experiences through technology [CuNET]) scale.OBJECTIVEThis study helps fill this gap by adapting and examining the psychometric properties of a condom use experience through technology (condom use negotiated experiences through technology [CuNET]) scale.Using peer network sampling, 242 forcibly displaced adolescents (aged 16-19 years) living in Kampala's slums were recruited for participation between January and March 2018. A subscale (embarrassment to negotiate condom use) of the Multidimensional Condom Attitudes Scale was adapted to incorporate sexting, yielding CuNET. Participants were randomly assigned to calibration and validation subsamples to conduct exploratory and confirmatory factor analyses to establish and validate the scale. CuNET measured participants' support levels for texting-based condom negotiation via sexting based on gender, and multivariable logistic regression was used to explore its associations with sexual health outcomes (recent consistent condom use, access to sexual and reproductive health services, and lifetime sexually transmitted infection testing).METHODSUsing peer network sampling, 242 forcibly displaced adolescents (aged 16-19 years) living in Kampala's slums were recruited for participation between January and March 2018. A subscale (embarrassment to negotiate condom use) of the Multidimensional Condom Attitudes Scale was adapted to incorporate sexting, yielding CuNET. Participants were randomly assigned to calibration and validation subsamples to conduct exploratory and confirmatory factor analyses to establish and validate the scale. CuNET measured participants' support levels for texting-based condom negotiation via sexting based on gender, and multivariable logistic regression was used to explore its associations with sexual health outcomes (recent consistent condom use, access to sexual and reproductive health services, and lifetime sexually transmitted infection testing).The one-factor CuNET with the validation sample was valid (χ24=5.3; P=.26; root mean square error of approximation=0.05, 90% CI 0.00-0.16; comparative fit index=0.99; Tucker-Lewis index=0.99; standardized root mean square residual=0.006), and reliability (Cronbach α=.98). Adolescent girls showed significantly lower levels of support for using sexting to negotiate condom use (mean 13.60, SE 0.70 vs mean 21.48, SE 1.23; P=.001). In multivariable analyses, a 1-point increase in the CuNET score was associated with increased odds of recent consistent condom use (adjusted odds ratio [aOR] 1.73, 95% CI 1.24-2.41) but not with access to sexual and reproductive health services (aOR 1.51, 95% CI 0.99-2.30) or lifetime sexually transmitted infection testing (aOR 0.90, 95% CI 0.64-1.26).RESULTSThe one-factor CuNET with the validation sample was valid (χ24=5.3; P=.26; root mean square error of approximation=0.05, 90% CI 0.00-0.16; comparative fit index=0.99; Tucker-Lewis index=0.99; standardized root mean square residual=0.006), and reliability (Cronbach α=.98). Adolescent girls showed significantly lower levels of support for using sexting to negotiate condom use (mean 13.60, SE 0.70 vs mean 21.48, SE 1.23; P=.001). In multivariable analyses, a 1-point increase in the CuNET score was associated with increased odds of recent consistent condom use (adjusted odds ratio [aOR] 1.73, 95% CI 1.24-2.41) but not with access to sexual and reproductive health services (aOR 1.51, 95% CI 0.99-2.30) or lifetime sexually transmitted infection testing (aOR 0.90, 95% CI 0.64-1.26).The unidimensional CuNET scale is valid and reliable for forcibly displaced adolescents living in slums in Kampala, gender-sensitive, and relevant for predicting consistent condom use among urban displaced and refugee adolescents. Further development of this scale will enable a better understanding of how adolescents use digital tools for condom negotiation.CONCLUSIONSThe unidimensional CuNET scale is valid and reliable for forcibly displaced adolescents living in slums in Kampala, gender-sensitive, and relevant for predicting consistent condom use among urban displaced and refugee adolescents. Further development of this scale will enable a better understanding of how adolescents use digital tools for condom negotiation.
Author	Hakiza, Robert Logie, Carmen H Newman, Peter A Mwima, Simon Ansong, David Okumu, Moses
AuthorAffiliation	2 School of Social Sciences, Uganda Christian University Mukono Uganda 6 AIDS Control Program, Ministry of Health Kampala Uganda 1 School of Social Work, University of Illinois, Urbana-Champaign Urbana, IL United States 5 School of Social Work, University of North Carolina at Chapel Hill Chapel Hill, NC United States 8 Young African Refugees for Integral Development Kampala Uganda 3 Factor Inwentash Faculty of Social Work, University of Toronto Toronto, ON Canada 4 United Nations University Institute for Water, Environment, and Health Hamilton, ON Canada 7 Bukedi Prevention Institute Kampala Uganda
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Copyright	Moses Okumu, Carmen H Logie, David Ansong, Simon Mwima, Robert Hakiza, Peter A Newman. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 06.04.2022. 2022. This work is licensed under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. Moses Okumu, Carmen H Logie, David Ansong, Simon Mwima, Robert Hakiza, Peter A Newman. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 06.04.2022. 2022
Copyright_xml	– notice: Moses Okumu, Carmen H Logie, David Ansong, Simon Mwima, Robert Hakiza, Peter A Newman. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 06.04.2022. – notice: 2022. This work is licensed under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. – notice: Moses Okumu, Carmen H Logie, David Ansong, Simon Mwima, Robert Hakiza, Peter A Newman. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 06.04.2022. 2022
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Keywords	condom negotiation digital sexual communication sexting HIV prevention gender refugee and displaced adolescents
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License	Moses Okumu, Carmen H Logie, David Ansong, Simon Mwima, Robert Hakiza, Peter A Newman. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 06.04.2022. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Public Health and Surveillance, is properly cited. The complete bibliographic information, a link to the original publication on https://publichealth.jmir.org, as well as this copyright and license information must be included.
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References_xml	– ident: ref34 doi: 10.1177/1077801218821444 – ident: ref29 doi: 10.1097/01.aids.0000172879.20628.e1 – ident: ref26 doi: 10.46743/2160-3715/2017.2951 – ident: ref13 doi: 10.1016/j.jadohealth.2012.03.014 – ident: ref14 doi: 10.1016/j.jadohealth.2013.12.009 – ident: ref12 doi: 10.2196/11242 – ident: ref15 doi: 10.1007/s12119-018-9508-4 – ident: ref19 doi: 10.1111/j.1559-1816.2005.tb02137.x – year: 2020 ident: ref16 publication-title: The Role of Digital Sexual Communication in the Sexual Health of Forcibly Displaced Adolescents Living in Informal Urban Settlements of Kampala, Uganda – ident: ref27 doi: 10.1016/j.chb.2018.02.003 – ident: ref38 doi: 10.1177/1464700113499853 – year: 2015 ident: ref36 publication-title: Principles and Practice of Structural Equation Modeling, 4th edition – ident: ref25 doi: 10.1177/1461444818761869 – ident: ref10 doi: 10.1001/jamapediatrics.2019.1658 – ident: ref18 doi: 10.1080/00224499.2011.626907 – ident: ref22 doi: 10.1111/jcc4.12187 – ident: ref37 doi: 10.1007/BF02310555 – ident: ref23 doi: 10.1007/bf02701260 – ident: ref20 doi: 10.1111/1464-0597.00092 – ident: ref30 doi: 10.3389/fpubh.2018.00149 – ident: ref21 doi: 10.1016/j.chb.2015.10.003 – ident: ref4 – ident: ref2 – ident: ref28 doi: 10.1016/j.jadohealth.2017.05.009 – ident: ref6 – ident: ref11 doi: 10.1071/SH18127 – year: 2011 ident: ref32 publication-title: Structural Equation Modeling doi: 10.1093/acprof:oso/9780195367621.001.0001 – ident: ref3 doi: 10.1155/2016/5360180 – ident: ref17 doi: 10.1037/0278-6133.13.3.224 – year: 2017 ident: ref31 publication-title: Mplus User's Guide. 8th edition – ident: ref35 doi: 10.1080/10705519909540118 – ident: ref24 doi: 10.1177/0891243205278639 – ident: ref8 – year: 2015 ident: ref9 publication-title: The Wiley Handbook of Psychology, Technology, and Society – ident: ref5 doi: 10.1007/s10461-019-02444-5 – ident: ref33 doi: 10.1177/002224378101800104 – ident: ref7 doi: 10.1080/17450128.2018.1489168 – ident: ref1 doi: 10.1186/s13031-019-0240-y
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Snippet	Promoting sexual health among forcibly displaced adolescents is a global public health priority. Digital sexual communication strategies (eg, sexting) may... Background: Promoting sexual health among forcibly displaced adolescents is a global public health priority. Digital sexual communication strategies (eg,... BackgroundPromoting sexual health among forcibly displaced adolescents is a global public health priority. Digital sexual communication strategies (eg,...
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SubjectTerms	Adaptation Adolescent Adolescents Adult Attitudes Children & youth Communication Condoms Cross-Sectional Studies Displaced persons Female Gender Ghettos Girls Health surveillance Humans Informed consent Marginalized groups Negotiating Negotiations Original Paper Poverty Areas Public health Reproducibility of Results Reproductive health Research methodology Sexual health Sexually Transmitted Diseases Slums Social networks Socialization STD Technology Teenagers Text Messaging Uganda Young Adult
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Title	Support for Texting-Based Condom Negotiation Among Forcibly Displaced Adolescents in the Slums of Kampala, Uganda: Cross-sectional Validation of the Condom Use Negotiated Experiences Through Technology Scale
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