505 participants took place in the study. The mean age of the participants was 23.82 ± 5.74 (min: 18, max: 47). When the education level of the participants is examined, 1 (0%) participant has primary school, 33 (6.5%) participants have secondary school, 171 (33.9%) participants have high school, 262 (51.9%) participants have associate's degree and 38 (7.5%) participants have graduate education. When the income distribution is examined, it is found that the income of 228 (45.1%) participants is less than their expenditure, the income of 210 (41.6%) participants is equal to their expenditure, and the income of 67 (13.3%) participants is more than their expenditures. 413 (81.8%) of the participants do not have any addiction, 6 (1.2%) are addicted to alcohol and 86 (17%) are cigarette addicts. 171 (33.9%) of the participants have a relationship and 334 (66.1%) have no relationship. The number of participants with an active sexual life is 74 (14.7%). 436 (86.3%) of the participants have knowledge about STD.
Table 1. Participant characteristics.
Demographic Data
|
Descriptive Statistics
|
|
mean ± standard deviation(min:max)
|
Age
|
23.82 ± 5.74 (min: 18. max:47)
|
|
n
|
%
|
Education Level
|
|
|
Primary school
|
1
|
0.20%
|
Middle School
|
33
|
6.50%
|
High school
|
171
|
33.90%
|
Associate-Bachelor's
|
262
|
51.90%
|
Graduate
|
38
|
7.50%
|
Income
|
|
|
Income less than expenditures
|
228
|
45.10%
|
Income equals to expenditures
|
210
|
41.60%
|
Income more than expenditures
|
67
|
13.30%
|
Addiction
|
|
|
Alcohol
|
6
|
1.20%
|
Cigarette
|
86
|
17.00%
|
No
|
413
|
81.80%
|
Relationship Status
|
|
|
I'm in a Relationship
|
171
|
33.90%
|
I have no relationship
|
334
|
66.10%
|
Do you have an active sex life?
|
|
|
Yes
|
74
|
14.70%
|
No
|
431
|
85.30%
|
Do you have any information about STD?
|
|
|
Yes
|
436
|
86.30%
|
No
|
69
|
13.70%
|
What is Information Source
|
|
|
Magazine. Book. Newspaper
|
102
|
20.20%
|
School
|
195
|
38.60%
|
Internet. TV
|
316
|
62.60%
|
Family. friend
|
112
|
22.20%
|
Health Institution
|
147
|
29.10%
|
Which STDs do you know?
|
|
|
AIDS
|
419
|
83.00%
|
Syphilis
|
208
|
41.20%
|
chlamydia
|
248
|
49.10%
|
hepatitis B
|
249
|
49.30%
|
Trichomonas
|
349
|
69.10%
|
hepatitis C
|
175
|
34.70%
|
Herpes (herpes simplex)
|
131
|
25.90%
|
HPV
|
244
|
48.30%
|
Gonorrhea
|
214
|
42.40%
|
What do you know about STD symptoms?
|
|
|
redness
|
219
|
43.40%
|
Itching
|
263
|
52.10%
|
Vaginal discharge
|
241
|
47.70%
|
Pain during sexual intercourse
|
329
|
65.10%
|
Fever
|
176
|
34.90%
|
Skin eruption
|
302
|
59.80%
|
Weakness
|
188
|
37.20%
|
Weight loss
|
160
|
31.70%
|
burning while urinating
|
245
|
48.50%
|
diarrhea, nausea
|
180
|
35.60%
|
Can sexually transmitted diseases be treated?
|
|
|
Yes
|
309
|
61.20%
|
No
|
44
|
8.70%
|
I do not know
|
152
|
30.10%
|
Are common areas effective in STD transmission?
|
|
|
Yes
|
303
|
60.00%
|
No
|
137
|
27.10%
|
I do not know
|
65
|
12.90%
|
Does having an STD affect your psychology negatively?
|
|
|
Yes
|
489
|
96.80%
|
No
|
16
|
3.20%
|
*Descriptive statistics of data are expressed as frequency (percentage) and mean ± standard deviation.
According to Table-2, the KMO value is 90.6%. A KMO test result greater than 60% and a significant Bartlett test result (p < 0.001) indicate that the scale is suitable for factor analysis. Therefore, it can be said that there are correlations between the items.
Table 2. Test Results for Factor Analysis Suitability
Kaiser-Meyer-Olkin Measure of Sampling Adequacy
|
0.906
|
Bartlett’s Test of Sphericity
|
p-value <0.001
|
In the study, the varimax rotation method was used to bring the factors together with the related items. As a result of Varimax rotation, two factors with eigenvalues greater than 1 were found in the scale: 1. Factor eigenvalue = 8.595, and 2. Factor eigenvalue = 4.146. The percentages of variance explained by both factors are 38.161 and 19.753, respectively. The total variance explained is 57.914%. Thus, it has been concluded that the STD scale is two-dimensional. The factor loads of the two-factor STD behavior scale, which was created as a result of the EFA applied, and the percentage of total variance they explained are summarized in Table-3.
Table 3. Explanatory Factor Analysis Information of the STD Behavior Scale
Varimax Rotated Factor Loads
|
Scale Items
|
I
|
M
|
SD
|
Factor 1
|
|
|
|
If I suspect a sexually transmitted disease, I go to a health institution
|
0.776
|
4.202
|
1.166
|
I use a condom (sheath) to protect myself from sexually transmitted infection.
|
0.807
|
3.848
|
1.240
|
I have unprotected intercourse with someone who has a sexually transmitted disease unless the disease is fully treated
|
0.735
|
3.947
|
1.210
|
|
0.737
|
3.800
|
1.311
|
I track whether I have symptoms of sexually transmitted diseases
|
|
0.826
|
3.790
|
1.202
|
I get the necessary vaccinations to protect against sexually transmitted diseases
|
|
0.796
|
3.733
|
1.222
|
I do not go to the doctor if I do not have symptoms of a sexually transmitted disease
|
|
0.755
|
3.800
|
1.313
|
If I have a sexual illness, I do not tell my partner (spouse, lover, dating, etc.).
|
|
0.706
|
3.727
|
1.220
|
Since sexually transmitted diseases can be transmitted without symptoms, I definitely take precautions.
|
|
0.748
|
4.172
|
1.228
|
I ask my partner (spouse, lover, dating, etc.) to use an unused condom (sheath) in every sexual intercourse.
|
|
0.816
|
3.953
|
1.129
|
In sexually transmitted diseases, only the sick partner should be treated.
|
I participate in early diagnosis and screening programs to prevent sexually transmitted diseases.
|
0.727
|
3.867
|
1.153
|
|
0.714
|
4.127
|
1.207
|
I share items with someone who has an STD
|
|
0.667
|
3.826
|
1.293
|
If I am not sexually active, I will not get a sexually transmitted disease.
|
|
0.683
|
3.335
|
1.254
|
Sexually transmitted diseases are transmitted only to individuals of the same sex.
|
Factor 2
|
I regularly track changes in my vaginal discharge.
|
0.719
|
4,093
|
1,095
|
|
0.862
|
4,034
|
1,118
|
If I bleed after sexual intercourse, I immediately go to the doctor.
|
In order not to have a sexually transmitted disease, I wash my vagina with water and vinegar after sexual intercourse.
|
0.721
|
3,556
|
1,251
|
|
0.818
|
4,143
|
1,063
|
Sex during menstruation increases the transmission risk of a sexually transmitted disease.
|
|
0.806
|
3,984
|
1,188
|
I hesitate to be in the same environment with someone who has a sexually transmitted disease.
|
|
0.728
|
4,016
|
1,061
|
If I suspect a sexually transmitted disease, I first try to get information from social media.
|
|
0.760
|
3,992
|
1,195
|
When I have pain during sexual intercourse, I suspect that I have a sexually transmitted disease.
|
Ratio of Variance Explained 57.91%
|
M: mean, SD: Standard Deviation I: Vector Loads
When Table-3 is examined, it can be said that the scale can explain the attitude towards STD well. According to factor analysis, two sub-dimensions of the scale are shown in Table-3. Finally, the internal consistency coefficient of the scale consisting of 21 items was calculated. The overall Cronbach Alpha coefficient of the scale was calculated as 0.911 for the first sub-dimension, 0.941 for the second sub-dimension, and 0.889 for the second sub-dimension. The results regarding the reliability coefficient are given in Table-4.
Table 4. Cronbach Alpha coefficient and inter-item difference results for STD Behavior Scale
Scale
|
Number of Items
|
Cronbach Alpha
|
Hotelling T2 test p-value
|
|
Raw alpha
|
Standardized Alpha
|
Total
|
21
|
0.911
|
0.910
|
p < 0.001
|
Factor 1
|
14
|
0.941
|
0.941
|
p < 0.001
|
Fakctor 2
|
7
|
0.889
|
0.890
|
p < 0.001
|
When Table-4 was examined, it was concluded that the internal consistency of the scale was sufficient and the difference between the scale items was statistically significant according to the Hotelling T2 test (p < 0.001).
In order to evaluate the test-retest reliability of the developed scale, the scale was reapplied to 50 participants after a certain time. The consistency between the first and last test results obtained from the same 50 participants was evaluated with the Intraclass Correlation Coefficient (ICC), and the statistical differences within the group were evaluated with the Wilcoxon test. The results are as given in Table-5.
Table 5. Test-Retest Reliability Results
Test-Retest
|
Median(min-max)
|
p-valuea
|
ICC
|
p-valueb
|
Total Score
|
|
|
|
|
Test
|
91(26–105)
|
0.067
|
0.656
|
p < 0.001
|
Re-test
|
76(26–96)
|
Sub-dimension 1
|
|
|
|
|
Test
|
63(14–70)
|
0.655
|
1
|
p < 0.001
|
Re-test
|
63.50(17–70)
|
Sub-dimension 2
|
|
|
|
|
Test
|
30.50(10–35)
|
0.596
|
0.945
|
p < 0.001
|
Re-test
|
28(7–32)
|
a: p-value is the p-value of the Wilcoxon test. b: It is the p value of the ICC analysis. Data are expressed as median (min-max).
When Table-5 is examined, the ICC coefficient of the test-retest results for the total score of the scale indicates that there is a statistically significant and moderate compatibility. The difference between the means of test-retest results, on the other hand, does not have a statistically significant difference. As a result of the test-retest performed for the first and second sub-dimension scores of the scale, the ICC coefficient was found to be 1 and 0.945, respectively, and it was found to be statistically significant and highly compatible. In addition, the difference between the averages of the test-retest results of both the first and second sub-dimension scores does not have a statistically significant difference. In the light of these results, it is seen that the test-retest reliability of the STD Behavior Scale is also ensured.
Confirmatory Factor Analysis (CFA) was applied to examine the two-factor construct validity of the STD Behavior scale created by EFA. The model to be tested in line with examining the construct validity of the EFA results was created using 21 observed and two latent variables (Factor 1 and Factor 2). Analyses were made using the LISREL 8.7 program. The fit index values for the said measurement model were found as \({\chi }^{2}/SD\) =1.39 (p < 0.001), CFI = 0.97, RMSEA = 0.04, NNFI=0.96, NFI=0.89, SRMR=0.07. As a result of CFA, the fit index values indicate that the model and the data are compatible. The measurement model and the goodness of fit criteria for the model are given in Table-6.
Table 6. Goodness of Fit Indexes
Goodness of Fit Indexes
|
Correspondence Indicator
|
Result
|
Ki-Kare/SD
|
≤ 4–5
|
1.39
|
RMSEA
|
0 ≤ RMSEA ≤ 0.08
|
0.04
|
CFI
|
0.90 ≤ CFI ≤ 1
|
0.97
|
NNFI
|
0.90 ≤ NNFI ≤ 1
|
0.96
|
NFI
|
0.90 ≤ NFI ≤ 1
|
0.89
|
SRMR
|
0 ≤ SRMR ≤ 0.08
|
0.07
|