Assessing Iranians’ parental competence: Development and psychometric properties of the Children’s Sexual Behavior Questionnaire (CSBQ-IR), Iranian Version

Introduction

Sexual behaviors are developmentally normative among children.^1,2 The type and frequency of these behaviors vary and depend on the child’s age.^2,3

Parents are known as the first line mediators in sexuality development of children.⁴ The majority of parents tend to have supervision on children sexual behaviors concerning its occurrence in children,¹ particularly in non-Western societies,⁵ such as Iranian culture. Parents’ constrained views, family stressors, cultural origins and day care arrangements are the most influencing indicators of sexual behavior.^6,7 Therefore, the parents are suggested to employ nurturing guidance about their children sexual behaviors. Some parents overreact to their child’s sexual behaviors. Children are affected by their parent’s distress toward their behaviors with sexual nature.⁶ Some of physical, psychological and sexual abuses may happen during the parenting of a child who displays sexual behavior. Some parents may be comfortable with their child’s sexual behaviors but they are not knowledgeable or able to manage those behaviors.⁷

Parents should be involved in their children’s sexuality as the first line educators.⁸ In addition to strengthening a bond between parent and child, education on sexuality would help the child to build up necessary skills and his/her highest capacity. While most parents tend to be their children’s primary sexuality educators, they sometimes experience difficulties discussing topics related to sexuality with their children.⁹ According to the studies, when parents are empowered to become their child’s primary sexuality educator, it has great impacts on increasing parent-child communication and helping children in experiencing healthy sexual life.^10-13 It is important parents to be competent enough to detect an abnormal sexual behavior of their children.^14,15

In some contexts parents seem not to be competent enough to nurture, communicate, care, or to implement sexuality education for children and Iranian parents are not exception.⁵ However, in the realm of sex education Iran is evidently different from most other countries or Westernized societies. For instance, some assume that little boys should not have erections so they can be protected from early sexual awakening.⁵

There are a limited number of measures to evaluate children’s sexuality. The majority of tools related to child sexuality are designed around the problematic sexual behaviors such as unwanted childhood sexual experience questionnaire¹⁶ childhood sexual abuse scale¹⁷ and early sexual experiences.¹⁸

Brick and Koch’s questionnaire assesses the knowledge, attitudes/belief, or comfort level of professions, parents, students, or other groups of adults regarding young children’s sexual development and learning. This instrument is being useful for adults with different backgrounds in various settings which would help to further establish the psychometric properties and norms for the scales. This questionnaire contains three parts including assessing knowledge of young children’s sexual development and learning, evaluating caregivers’ attitudes and beliefs about young children’s sexual development and listing ten topics that adults typically require to talk about or deal with when interacting with young children.¹⁹ A sexual history and adjustment questionnaire is another tool related to children’s sexuality which was introduced by Lewis and Janda to assess parental attitudes toward sexuality, participants’ level of comfort in discussing sexuality with parents and perceptions of parental discomfort regarding sexuality. Information on current adjustment and sexual behavior was also obtained.²⁰ The reliability of the sexual history and adjustment questionnaire was validated over a 15-year period. In comparison with these mentioned scales, Children’s Sexual Behavior Questionnaire (CSBQ-IR) assesses the parent’s competence in intervening and management of their children’s sexual behaviors rather than merely examining sexual behaviors of children.

In these studies emphasis was put on the assessment of parents’ sense of competence in various domains and hence a valid and reliable tool to measure this competency is needed. Aiming to contextualize Iranian parents’ competency in managing sexuality education for children, this current study was designed to develop and to test the psychometric properties of eighteen-item questionnaire to measure the parents’ knowledge, attitudes and practice toward caring and managing of their children’s sexual behaviors.

Materials and Methods

The questionnaire was designed using the principles in measurement theory²¹ the following four steps:

Step 1: through an extensive review of the relevant literature, the concept of children’s sexual behavior was explored.

Step 2: the items of this questionnaire were generated along with a curriculum development which was planned to be implemented in a community-based sexuality education program targeting parents in Tehran. The curriculum was designed for a 6-hour’ workshop including:

Basic concepts about sexuality development of children extracted from stage 1

Common sexual behaviors in different age groups

Appropriate parental interventions to manage children’s sexual behaviors and educate them if needed.

The initial version of the questionnaire had 20 items. Each item was rated on a two-point response (Yes = 1; I don’t know = 0; No = 0). Closed questions evoking a response of one (Yes or No) is convenient in its own because elucidates and retrieves specific information and facts.²² Items 8, 9, 11, 15 and 17 were reversed questions. Higher scores indicated acceptable competency of parent in nurturing and managing children’s sexual behaviors.

Step 3: After preparing the items in the questionnaires, principal component analysis (PCA) was used for evaluating of validity; face validity, Content validity and construct validity.

Step 4: At this step, we evaluated the reliability of the questions.

The final version of questionnaire was translated and back translated by two of the authors (EMK and FS). The English version reviewed by a native English speaker for the editorial issues.

Results

Discussion

The analysis of the CSBQ-IR dimensions revealed satisfactory psychometric properties which is a good result. All components of this tool conceptualize the competency parents need to attain. The questions put emphasis on responsibilities the literature has already pointed out²⁹ including parental supervision, guidance, and addressing children educational needs such as body knowledge, rules and boundaries, respecting and protecting body privacy, sexual safety, and the means of sexuality education. The main idea for the CSBQ-IR stemmed from empirical consideration in respect to the Iranian parents’ beliefs, attitude, knowledge and practice about sexual behaviors of children.^5,7 In the context like Iran, children sexuality facets still lack enough evidence and theoretical derivation, or culturally sensitive exploration.³⁰ Brick and Koch’s questionnaire¹⁹ on young children’s sexual learning domains seems similar to CSBQ-IR; it may not be culturally appropriate for Iranian parents. CSBQ-IR with 18 items is easy and a brief tool to apply before educational workshops for the parents. Lewis and Janda’s sexual history and adjustment questionnaire, another tool in children’s sexuality focused on the childhood sexuality experiences such as nudity and sleeping in the parental bed²⁰ while CSBQ-IR assesses the parent’s competence in intervening and management of their children’s sexual behaviors rather than examining sexual behaviors of children. In other words in contrast with the mentioned tools, target in CSBQ-IR is parents having child in 0-12 age group not children themselves.

Internal consistency assessed by Cronbach’s alpha was acceptable and indicated good reliability and stability for the CSBQ-IR. However, we do not claim that this tool is powerful enough to draw a thorough picture of the parents’ competency. Factors which may influence the validity and reliability of CSBQ-IR include nature of questions and the form of responses affected by the participants’ cognitive level. As Ziyaeemehr mentioned, CSBQ-IR questions and three points response might not challenge parents to interpret, analyze, or manipulate their own responses.³¹ According to Bloom’s taxonomy of questioning CSBQ-IR tends to measure only three levels of the parents’ cognitive processing (knowledge, comprehension, and application).³² A PCA with varimax rotation confirmed its factorial validity and homogeneity (Table 2). All factors showed eigenvalues above 0.3 which indicated that it did explicate enough variance to be considered. The results of the study showed that the development of a valid tool such as CSBQ-IR is necessary to assess parent’s competence in caring and managing their children’s sexual behaviors.

Conclusion

This is the first study to validate CSBQ-IR on a sample of Iranian parents. It can be a valid pre-assessment tool to screen the parents’ competency in management of their children’s sexual behaviors in order to meet the objectives of curriculum we developed to train and prepared the parents in sexuality education of their children. The recommendation for practical implications and policy making can be improvement and systematizing parental training in children sexuality education; expanding training approaches to encourage active parenting and promote parent-child communication skills as the essentials in sexually-related nurturing and caring of children.

Ethical approval

The Ethics Committee of the Industry & University Collaboration Office at Tehran University of Medical Sciences approved the study (Ethics No. 28191-159-01-94).

Competing interests

The authors declare that they have no competing interests.

Funding

This research was funded by the Mental Health Department of Iranian Ministry of Health and approved by the Health Technology Development Office, Tehran University of Medical Sciences (Code: 28191-159-01-94).

Authors’ contributions

As the primary investigator, the first author (EMK) developed the proposal and had full supervision on the whole research project as well as drafting the manuscript. The second author (FA) had full supervision on data management process and conducted the advance analysis. The third (FSH) contributed in writing the manuscript and submission follow ups. The fourth and (SO) and fifth authors (NA) had sufficient contribution in data collection and data entering phase. The last (MH) conducted further data analysis to fulfill the reviewing process.

Acknowledgments

Our special thanks to the parents who participated in this research. We sincerely appreciate Dr. Keith Masnick’s priceless input in this manuscript. We also appreciate Dr. Razieh Maasoumi, our pos-doctorate at the time of data collection for her assistance through data entry.

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