Understanding the fertility desires and intentions among HIV-positive men living in Ontario: survey instrument development and validation

Abstract

Fathers living with human immunodeficiency virus (HIV) infection play a pivotal role in shaping the lives of their families and children. However, women living with HIV have received disproportionally more attention in studies of parenting and the importance of having children, with men frequently left out of the picture. In addition, there is a gap in the literature, however, as no instrument specific to the measurement of the fertility desires and intentions among men living with HIV has been validated for use for all men including, heterosexuals (straights), gays, bisexuals and others. The problem addressed by this study is the need for a well substantiated tool with multiple items which demonstrates reliable and valid assessments of fertility desires and intentions for all men living with HIV. Therefore, this study was designed to develop and validate a survey instrument. The instrument will be used by clinicians or service providers to gather information about fertility desires and intentions for men living with HIV and developing appropriate services. The scale was developed in four phases. During the first phase, the instrument questions were developed by adapting questions from previous surveys. In phases two and three, the questions were collated and reviewed by experts and then by community members in a focus group for further evaluation in a pilot study. Specifically, content validity was maximized by undertaking a thorough literature review and consulting with experts in the fields of HIV and parenting. Face validity was evaluated via focus group of men living with HIV. Construct validity was verified for many of the questionnaire sections using confirmatory factor analysis (CFA). The test-retest reliability was assessed using Spearman’s rho correlation, internal consistency was determined using Cronbach's alpha and concurrent validity was assessed. The number of agreements across items were used to assess concurrent vality. Ordinal logistic regression was used to assess the associations between fertility desire/intention and independent variables. The draft questionnaire consisted of 14 constructs. Content validation suggested removal of seven items. Focus group participants suggested that the overall flow of the survey was smooth. In addition, they recommended 18 new items to be added. Construct analysis confirmed the predetermined model. Cronbach’s alpha was above 0.70 for most of the constructs. Test-retest statistic showed a stability of the responses Spearman’s rho correlation >0.70. The results showed the proportion of individuals who desire /intend to becoming a father correspond to those of previously established measurements for the same constructs confirming evidence for good concurrent validity. In this study, sexual orientation and age were demonstrated to be associated with fertility desire and intention. In conclusion, an instrument was developed for determining the fertility desires and intentions of men living with HIV.