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Development of a Survey to Assess Adolescent Perceptions of Teen Parenting

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Journal of Nursing Measurement, Volume 20, Number 1, 2012

Development of a Survey to Assess

Adolescent Perceptions of Teen Parenting
Judith W. Herrman, PhD, RN, ANEF
Ratna Nandakumar, PhD
University of Delaware

Initiatives designed to prevent teen pregnancy are often based on adult perceptions of
the negative aspects of a teen birth. Qualitative research has revealed that teens may
perceive positive rewards associated with teen parenting. These perceptions have not
yet been examined through survey research. The theory of reasoned action proposes that
individuals assess the costs and rewards prior to engaging in a behavior and provides a
framework for the development of a survey instrument designed to measure adolescent
thoughts about the costs and rewards of the teen parenting experience. This manuscript
describes the development and testing of a quantitative survey instrument designed to
measure adolescents’ perceptions. Pretesting, piloting, exploratory factor analysis, and
a variety of reliability and validity measures were used to determine the value of the
measure. The Thoughts on Teen Parenting Survey (TTPS) demonstrates an alpha level
of .90. The TTPS yields a cumulative score of teen perceptions about the impact of a
teen birth during the adolescent years that may be used to assess youth beliefs, correlated
with demographic data, used to identify teens at risk for pregnancy/parenting, or provide
a pretest/posttest to assess the effectiveness of interventions designed to foster realistic
attitudes toward teen parenting.

Keywords: survey development; teen parenting; adolescent perceptions; teen pregnancy;

prevention

P
regnancy and parenting during the teen years are associated with significant
personal, social, health, and economic consequences. Many programs, policy
initiatives, and research studies have been devoted to teen pregnancy preven-
tion, yielding a steady decrease in teen pregnancy and birth rates since 1991 (National
Campaign to Prevent Teen Pregnancy, 2005). Despite these declines in rates, the United
States maintains a teen pregnancy rate higher than any other developed nation in the
world. Vacillating rates in teen births reinforce the need to maintain a focus on teen
pregnancy and parenting (Martin et al., 2010). Whereas more than 400,000 teen women
give birth in the United States each year, it is estimated that twice this number of preg-
nancies occur in the teen population (Hamilton, Martin, & Ventura, 2009). There are
significant racial, ethnic, geographic, and economic disparities related to teen pregnan-
cies and births.
Traditional discourse viewed teen pregnancy from adult perspectives, reflecting that a
teen birth had largely negative impacts on the lives of the young parents, their families, and
communities (Rosengard, Pollock, Weitzen, Meers, & Phipps, 2006). In contrast, recent
qualitative studies indicate that teens often cite positive aspects, balancing the negative

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4 Herrman and Nandakumar

costs derived from the pregnancy and parenting experience (Burton, 2007; Herrman, 2006;
Spear, 2004). Teens’ points of views concerning teen parenting should be considered when
developing programs and policies. This requires efficient, reliable, and valid ways to assess
adolescent perceptions (Rosengard et al., 2006; SmithBattle, 2009). This manuscript
describes the development of a survey instrument designed to examine teens’ perceptions
of the costs and rewards of adolescent births and to explore these insights as the foundation
of adolescent sexual decision making.

BACKGROUND AND CONCEPTUAL FRAMEWORK

Research studies have largely disclosed the negative consequences, or costs, associated
with teen pregnancy in several areas. Negative effects related to the development and
maintenance of friendships, the ability to have a social life, and the time available for
friends were cited by several authors (Clemmens, 2003; Herrman, 2006; Wayland &
Rawlins, 1997). Having a child as a teen was noted to create problems for teen inti-
mate relationships, including stress between partners, jealousy, and power struggles
over money and childrearing (Clemmens, 2003; Oxley & Weekes, 1997; Rentschler,
2003). Research examining family conflicts cited those related to the announcement
of the pregnancy, the additional stresses imposed by young children in already tense
families, and lack of family support (Rentschler, 2003; Spear, 2001, 2004; Wayland &
Rawlins, 1997).
Landmark studies substantiated the negative impacts of teen pregnancy on young
women completing their education, including dealing with the demands of parenting
and schooling, maintaining a focus on education, and attending secondary education
(Furstenberg, 1976; Furstenberg, Brooks-Gunn, & Morgan, 1987). More current studies
corroborate these findings (Paskiewicz, 2001; Rosengard et al., 2006). Teen pregnancy has
been shown to negatively influence young parents’ abilities to reach self-sustainability,
access a job, regularly attend work, secure a job with higher wages, deal with child care,
and avoid poverty (Furstenberg, 1976; Rosengard et al., 2006). Largely, these studies
reflect negative impacts associated with teen parenting.
In contrast, selected studies have discovered that teen pregnancies and births may be
perceived by adolescents to have a positive effect on their lives. Geronimus (2003) pro-
posed that, for youth, teen pregnancy serves as an adaptive strategy to cope with social
disadvantage. Having a baby during the teen years may reflect community norms, occur
during the healthiest time of an impoverished teen’s life yielding a more positive birth out-
come, and allow for the greatest level of social support in an indigent family (Geronimus,
2003). Qualitative studies have demonstrated that after a teen birth, some families become
closer (Williams & Vines, 1999); teens may feel more mature and responsible (Herrman,
2006; Spear, 2001, 2004); and births provide a stable force in a young person’s life
(Burton, 2007; Geronimus, 2003; SmithBattle, 1995; SmithBattle & Leonard, 1998).
Several studies reflected that the young mothers perceived that the experience afforded
them a higher level of respect, sense of maturity, control over previous aberrant behavior,
and an enhanced self-concept (Lesser, Anderson, & Koniak-Griffin, 1998; SmithBattle,
1995; SmithBattle & Leonard, 1998; Spear, 2001, 2004). These findings suggest that teens
may associate both positive and negative consequences with the parenting experience. No
quantitative instruments designed to assess adolescent perceptions of the parenting experi-
ence were found in the literature.

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Adolescent Perceptions of Teen Parenting 5

Conceptual Framework
Previous interviews and focus groups assessing adolescent perceptions of the costs and
rewards associated with teen births provided the foundation for the development of an
instrument measuring youth perceptions (Herrman, 2006, 2007, 2008). These studies were
based on an adaptation of the theory of reasoned action to construct the questions and
organize and analyze data (Adler, Kegeles, Irwin, & Wibbelsman, 1990). This theory origi-
nally integrated the cost–reward framework into the model of reasoned action to develop
a decision-making framework for adolescent contraceptive use. It is the attitudes toward
a behavior; or the beliefs about the costs and rewards of the behavior; and the associated
social expectations that lead to the intention to engage in a behavior, in this case, sexual
activity and subsequent parenting, and results in performance of the behavior. Within this
model, youth perceptions of consequences are at the origin of a deliberate decision-making
process in youth (Adler et al., 1990).
It is conjectured that teens who believe that a baby will positively change their life, or
will not cause any appreciable negative impact, may not attempt to prevent conception
as diligently as someone for whom the pregnancy is perceived to have a negative impact
(Herrman, 2007; Rosengard, Phipps, Adler, & Ellen, 2004). If teens perceive the rewards
of teen parenting higher than the costs, teen pregnancy prevention initiatives may not
attend to the realities of adolescent life or cause any change in behaviors (Gordon, 1996;
Herrman, 2007; Loewenstein & Furstenberg, 1991). Informing teens of the realities and
consequences of teen parenting based on these perceptions may be an effective means to
prevent teen pregnancy (Hulton, 2001). Determining if teens preconceive the costs and
rewards associated with teen pregnancy prior to sexual activity may inform how adults
address teen pregnancy and prevention. Developing a survey instrument measuring adoles-
cent perceptions serves as an initial step to influence teen sexual decision making.

DEVELOPMENT OF SURVEY ITEMS

The Thoughts on Teen Parenting Survey (TTPS) was designed to measure adolescents’
perceptions of teen births. For the purposes of this study, adolescents were defined as 14
through 19 years of age. The construct elements for this study were teen perceptions of
the costs and rewards associated with teen parenting. Costs were defined as the negative
aspects of the parenting experience, and rewards represented the positives related to births
and having a child. Findings from previous research and the review of literature served
as the basis for item development for the survey. Individual semi-structured interviews
conducted with young mothers about the costs and rewards of parenting provided the
personal reflections used in tool development (n 5 20; Herrman, 2006, 2007). Adolescent
focus groups yielded rich data about teens’ perceptions of teen births (17 focus groups,
participant [n 5 120]; Herrman, 2008). Quotes and paraphrases from these research stud-
ies provided the foundation for items. For example, young mothers discussed losing their
friends after having a child, informing the item “If I had a baby as a teen I would lose
friends.” DeVon et al. (2007) supported the use of qualitative data findings as means to
generate quantitative survey items.
To ensure construct validity of the instrument, the costs and rewards items were shaped by
the model used by Camarena, Minor, Melmer, and Ferrie (1998) to describe the aspirations
of young mothers. Their research delineated that teens’ hopes and goals for the future could

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6 Herrman and Nandakumar

be categorized in the areas of family, education, and work. These groups were expanded
based on the recommendation of several national teen pregnancy prevention authorities and
previous qualitative research to the three general areas of Relationships (friends, boyfriends/
girlfriends, and family), Vocation (education, work, and money), and Life Impacts or those
associated with personal characteristics and life in general (Herrman, 2006). These catego-
ries then shaped both the organization and subscales of the interview guide.
Local experts and a review of the literature informed the selection of the most criti-
cal demographic data to be accessed from surveys. Analysis of key demographic areas
resulted in questions related to age, gender, ethnicity, socioeconomic status, level of reli-
giosity, with whom the teen lived, and whether they considered their home to be in rural,
urban, or suburban communities. Socioeconomic status was measured via two questions:
“Are you eligible for free or reduced lunch at school?” and “Does your family receive
financial assistance in the form of food stamps, public housing, Medicaid, or WIC (Women,
Infants, & Children)?” Affirmative answers to either question designated the individual as
low income. Religiosity was measured as the function of two questions asking “Do you
consider yourself a religious or spiritual person?” and “Do you attend any religious or
spiritual groups at least once per month?” Positive responses to either question character-
ized the individual as religious or spiritual. “Not sure” options were offered to participants
who were unsure of their answers. The demographic data from the TTPS was designed to
be linked to youth perceptions to determine if perceptions differ based on selected personal
characteristics.

ASSESSING CONTENT VALIDITY

The key concepts identified to represent construct validity were used to develop a short
questionnaire to assess for content validity of the instrument. These questions are found
in Table 1. Surveys were distributed to a panel of local teen pregnancy prevention experts.
These content experts were youth advocates concerned with teen pregnancy prevention
(n 5 12). Participants were asked to review the survey and participate in a focus group
analyzing each survey item and the total instrument to determine content and construct
validity. These experts made suggestions and informed the draft survey instrument of more
than 100 five-point Likert scale items. This group suggested a 4th–5th grade reading level
for the survey. Based on content expert feedback items were added, deleted, and revised,
affirming preliminary content validity. According to the Flesch–Kincaid index, the reading
level of the survey is 4th–6th grade.
Cognitive or “think-aloud interviews” give experts the opportunity to read each question
aloud, comment on questions, and intuitively respond to questions (Czaja & Blair, 2005).
Three cognitive interviews with individuals having expertise in adolescent sexual behavior
and teen pregnancy prevention were conducted to ensure face validity, representativeness
of the construct, and completeness of the content. These interviews resulted in subtle
wording changes, standardization of question structure, the deletion of repetitious or less
vital items, and the addition of items to comprehensively capture the construct of teen
perceptions. Reworded items included changing the phrase “significant other” to “boyfriend/
girlfriend” as it was thought to be more appropriate for teens. Extensive discussions
resulted in transforming the boyfriend/girlfriend section such that questions asked youth
to consider how “Having a baby as a teen” affects these relationships in the third person
rather than “If I had a baby as a teen” in the first person. This allowed teens to discuss the

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Adolescent Perceptions of Teen Parenting 7

TABLE 1. Pre-Survey Questionnaire

As a content expert, please take a minute to complete the following survey:
1. What ages would you like to survey related to teen pregnancy, births, and parenting?
2. What specific questions would you like to ask about teen pregnancy, births, and
parenting?
3. We are asking about the costs and benefits in the following areas about teen births,
what would you like to add to this list?
a. Vocation (education, work, and money)
b. Relationships (peers, intimate others, and family)
c. Life Impacts (personal characteristics and life in general)
4. What specific questions would you like to ask about teen pregnancy prevention?
5. How would you suggest distributing the survey?
6. What reading level do you feel would be appropriate?
7. Do you think there is a need to reward or provide an incentive to each participant?
If so, what or how much?
8. Am I missing something? What?

potential impact a teen birth on a partner whether or not the teen was currently in or ever
had been in a boyfriend/girlfriend relationship. The balance of the instrument was left in
the first person to encourage those completing the survey to personalize the questions.
The tool was sent electronically to four national experts in teen pregnancy prevention.
These electronic reviews provided a broader, national perspective in contrast to the local
experts accessed thus far. An adaptation of the content validity ratio method was used
to carry out this task (DeVon et al., 2007). These experts were asked to participate in an
adapted form of this method and to complete content validity indexing in which each
item was given a score: 0, omit the item; 1, keep but revise the item; or 2, keep the item.
Content experts were asked to include their suggestions for revisions to those items receiv-
ing a score of “1” and to provide any comments about the survey to strengthen its validity,
including adding items to expand the breadth of the tool. This group suggested additional
items related to personal values in the subscales of personal characteristics and family.
They also suggested the addition of an item related to the impact of a teen birth on a young
woman’s body to the personal characteristics subscale. Items were omitted and revised
following this process.
The focus groups, psychometric expert analysis, content expert review, content validity
indexing, and cognitive interviews reduced the number of items and led to the two part
TTPS. Part A included demographics and Part B represented the 54 items measuring
perceptions. Part B included questions about the impact of a teen birth on a participants’
personal life and was subjected to statistical reliability and validity measurements.

DESIGN, ADMINISTRATION, AND SCORING

The TTPS was designed to be administered as a paper and pencil self-report survey.
Each of the eight subscales, with three to nine items, represented one of the categories of

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8 Herrman and Nandakumar

Relationships (including subscales for friends, boyfriend/girlfriend, and family), Vocations

(with education, work, and money subscales), and Life Impacts (with designated subscales
of personal characteristics and life in general). These items are structured such that par-
ticipants’ agreement with an item varies from strongly agree to strongly disagree with a
statement about the impact a teen birth would have on various components of their lives.
Significant controversy exists over the use of four or five response category choices for
items in survey research, wherein the five response choices allow for a neutral option
(Busen, 1991; Czaja & Blair, 2005). Psychometric consultants agreed that this topic could
benefit from a neutral option.
The survey yields a cumulative score of perceptions, allowing for comparison with
demographic variables and for pretest/posttest analyses related to an intervention. A higher
score suggests a more positive view of teen births (higher rewards, lower costs). A lower
score means a more negative view of teen births (lower rewards, higher costs).
The questions include both positively and negatively worded items to ensure accurate
reading of the items and to prevent “rapid-fire” answering of the survey. Neutral items
were omitted from the tool because they did not contribute to the composite score. Reward
items were naturally scored in which 5 indicates the greatest reward and 1 the least reward.
A reverse scoring mechanism was developed for items such that, for cost items, a 5 indi-
cates the least cost and 1 the greatest cost. The survey includes an equal number of cost
and reward items in no set order to reduce potential bias. Some of the survey items were
changed from negative wording to positive wording to ensure that participants thought
carefully about each question rather than providing the “socially acceptable” response.

METHODS FOR ASSESSING RELIABILITY AND VALIDITY

The TTPS was then put through a rigorous assessment of item analysis, reliability, and validity
reflecting classical measurement theory. We first determined the reliability and validity of
the TTPS using data from the pretesting process. The refined version of the instrument
was then subjected to additional tests for reliability and validity using the data from a pilot
implementation. The details of these processes are described in the following text.

Pretesting of the Survey

According to Czaja and Blair (2005), an effective method to determine reliability and
validity of an instrument is to conduct pretesting with participants similar to the target
population. To ensure readability, understandability, timing, and accuracy of the survey,
pretesting was conducted with a group of adolescents (n 5 37). The pretesting of the
survey was approved by the institutional review board (IRB) at the affiliating university
and a local youth development agency. This agency provides tutoring, college scholar-
ships, life skills, after school programming, and personal counseling to low income, high-
risk teens. The group included 13 boys and 24 girls aged 14–19 years with a mean age
of 15.8 years. Ethnically, the group was 54% African American, 19% White, 14% Latina/
Latino, and 13% identified themselves as “Other.” None of these teens were adolescent
parents, but one high school senior was 6 months pregnant at the time of data collection.
The TTPS was administered to four groups of 8–10 participants as part of an evening
presentation. Students receiving parental permission and providing assent were given pre-
liminary instructions. Students completed the survey and were asked to save any questions

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Adolescent Perceptions of Teen Parenting 9

TABLE 2. Discussion of the Survey—Pretest

Following student completion of the survey, students will be asked the following questions:
1. Were there any questions you would like to change in the survey?
2. Were there any words you feel some teens may not understand in the survey?
3. Can you reword any of the questions to make them more understandable?
4. Were there any questions you think might offend some teens?
5. Were there any questions that seemed repetitive?
6. Comment on the length of the survey.
7. Comment on the format of the survey.
8. Is there anything else you would like to add?

or comments until after survey administration. The surveys were completed in 14–40
minutes, with a mean time of 27 minutes. Following the survey, students were offered
pizza and beverages; and a focus group was conducted to allow for their comments on
the instrument, to discuss any issues generated from its completion, and to explore their
thoughts about teen pregnancy and parenting. The questions discussed with the survey
students are found in Table 2.
The teens provided important insights into question wording, contemporary terms,
readability, and relevance of the questions to teens. For example, participants mentioned
that some teens may perceive that having a child as a teen provides an individual with more
attention from others, so this item was added to the life in general subscale. The instruc-
tions for the survey were also made more clear and succinct based on youth input.

Pretesting Results
The TTPS data from the pretesting were analyzed to determine the instrument’s ability
to meet its measurement objectives. The calculated internal consistency (Cronbach’s
alpha) equaled .75, indicating that the tool may be improved through additional revision.
According to Huth (1998a), new instruments should strive for an alpha level of .80 and
those used in clinical research for a level of .90. Internal consistency measures were
calculated for each of the predetermined subscales as listed in Table 3. These lower alpha
levels, although inherent of fewer items, suggested further revisions. Item–total instrument
correlations, in which internal consistency levels were measured following the revision or
omission of selected items, and inter-item correlations were conducted and informed the
instrument improvement process.
Exploratory factor analysis was conducted on the pretest data of the 54-item TTPS.
Because the sample was smaller (n 5 37), this analysis provided only a preliminary assess-
ment of instrument construct validity. Factor analysis yielded six factors including external
impact, self-esteem, family and finance, friends and relationships, personal time, and
work. These factors were extracted using principal axis factoring and the rotation method
was Obliman with Kaiser Normalization. By observing items correlated within each sub-
scale and the full scale, several subscale revisions were indicated to increase instrument
validity. These actions were taken based on the values and are noted in Table 4, yielding
an improved 47-item scale with a Cronbach’s alpha of .89.

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10 Herrman and Nandakumar

TABLE 3. Coefficients of Pretest Group Established Subscales

Subscale N of Items Alpha
Friends 5 .14
Boyfriend/ girlfriend 7 .01
Family 6 .64
Education 7 .67
Money 6 .80
Work 6 .69
Personal characteristics 9 .67
Life in general 8 .69
Total 54 .75

Piloting of the Survey

The data from the pilot program allowed for further testing of the TTPS. Czaja & Blair
(2005) proposed that piloting tools in a manner similar to their intended use is an impor-
tant part of instrument refinement. A value of the TTPS is its ability to yield a composite
score of the participants’ perceptions of the costs and rewards of the teen parenting experi-
ence with high scores indicating a higher reward associated with teen births. This score
allows for the measurement of interventions when used in a pretest and posttest manner.
Interventions may be measured by their ability to decrease this score to indicate more
realistic views of the impact of a teen birth on the lives of participants.
A pilot program, the Young Mothers Get Real Project, was developed on the peer leader-
ship model and was informed by recommendations from teens in the initial focus groups

TABLE 4. Coefficients of Pretest Group Factor Analysis

N of Items N of Items
Loading on After Alpha After
Subscale Factorsa Alpha Changes in Items Revisions Revisions
External impact 14 .85 Omit 2 questions 12 .89
Self-esteem 8 .76 Omit 3 questions 5 .81
Family and 9 .81 No revisions 9 .81
finance
Friends and 7 .70 Omit 2 questions 5 .78
relationships
Personal time 11 .74 Revise 1 question 11 .74
Work 12 .81 Revise 1 question 12 .81
Total 54 .89 47 .89
aItems may load on more than one factor.

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Adolescent Perceptions of Teen Parenting 11

(Herrman, 2008). Young mothers trained in public speaking and how to share their stories
provided presentations to three high school health classes (n 5 84). This sample included
39 males and 45 females. The ages ranged from 14 to 18 years, with a mean age of
15.6 years. Ethnically, the group was 41% African American, 36% White, and 23% identi-
fied themselves as “Other.”
The Young Mothers Get Real presentations were also conducted at a youth development
summit with teens from around the state (n 5 87). Those students participating in the
youth development summit included 22 males and 65 females. The ages ranged from 14 to
19 years, with a mean age of 16.0 years. Ethnically, the group was 66% African American,
23% White, 4% Latina/Latino, and 7% identified themselves as “Other.”
Pilot program pretests were conducted immediately prior to the presentation inter-
vention. The pilot program posttests for the health classes were administered 1 month
following the presentation intervention. Posttests for the youth summit were conducted
immediately following the Young Mothers Get Real presentations.

Piloting Results
The data from the Young Mothers Get Real Project, both from the health classes and youth
summit, were examined for reliability and validity. The pretests from the health classes
and the youth summit were analyzed (n 5 171). The internal consistency of the TTPS was
found to be .87. Exploratory factor analysis was conducted using a scree plot and Eigen
values greater than one were used to determine factor loadings. The first exploratory factor
analysis using the pretest sample yielded six factors. However, upon further revising the
instrument and analyzing the exploratory factor analysis of the pilot program data, four
factors were identified. These four factors included time and commitments, personal char-
acteristics, family and finances, and relationships. These four factors explained 49% of
the total variance of the scale. Factor analysis allowed for revision of the instrument based
on factor loading. Individual subscale values are noted in Table 5. Items were correlated
within each subscale and items with low inter-item correlations or with low correlations
with the subscale score were deleted or revised to increase the reliability of each subscale.
Item–total instrument correlations were also conducted. Two items were revised and three
items were omitted based on these processes. These efforts yielded a 44-item TTPS with
a Cronbach’s alpha level of .90.
The TTPS was analyzed for split-half reliability yielding an alpha level of .77. The
lower coefficient in this analysis may be attributed to the distinct nature of each of the
subscales. An assessment of test-retest reliability with a new group of teens (n 5 14)
demonstrated a coefficient of .55. As recommended by Huth (1998b), posttests should
be implemented 2–4 weeks after intervention. This posttest was administered 4 weeks
postintervention.
Using hypothesis testing as a means to confirm validity is a well-documented strategy
(Waltz, Strickland, & Lenz, 2005). A hypothesis generated in this study, based on the research
of Wayland and Rawlins (1997), was that African American teens would have a more posi-
tive perception of the experience of teen parenting compared to other ethnic groups. The
composite scores on the TTPS of African American participants (mean 5 112.26) were com-
pared to scores of White sample members (102.09). T test analyses for independent variables
(one-tailed) on pilot program posttest data demonstrated a significantly more positive score
among African American youth than White teens (T 5 1.96, df 5 52, p , .05). No other
relationships were found when cumulative scale scores were correlated with demographic

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12 Herrman and Nandakumar

TABLE 5. Coefficients of Pilot Group Factor Analysis

N of Items N of Items
Loading on After Alpha After
Factor Subscale Factorsa Alpha Changes in Items Revisions Revisions
Time and 21 .89 No revisions 21 .89
commitment
Personal 8 .74 Revise 2 items 7 .81
characteristics Omit 1 item
Family and 10 .80 Omit 1 item 9 .84
finances
Relationships 14 .86 Omit 1 item 13 .87
Total 47 .87 44 .90
aItems may load on more than one factor.

variables. Further study with larger samples must be conducted to confirm this finding and
determine other relationships (see Herrman & Waterhouse, 2011).
A final method of validity testing was implemented by conducting correlations with
opposite items within the TTPS. Discriminant validity is supported when opposite items
yield significant correlations, in this case, positive correlations because of the reverse
scoring of contrasting items (Waltz et al., 2005). Pairs of items representing opposite
constructs were selected and correlated. Out of seven pairs of items, four were noted to
demonstrate statistically significant correlations (p , .05). Those items noted to have
significant correlations are noted in Table 6. These items support the ability of this tool to
measure teen perceptions. The current version of the TTPS is found in Table 7.

TABLE 6. Discriminant Validity of Contrasting Items

Item Correlation P value
I would need money. .28 .01
Money would not be a problem.
I would be more likely to graduate high school if I had a .21 .05
baby as a teen
I would drop out of school if I had a baby as a teen.
I would have higher goals for a future career if had a baby .33 .002
as a teen.
I would not achieve as much in my future work if I had a
baby as a teen.
I would have a better life if I had a baby as a teen. .47 .000
I would be upset if I found out that I (or my girlfriend) was
pregnant.

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Adolescent Perceptions of Teen Parenting 13

TABLE 7. Thoughts on Teen Parenting Survey (TTPS)

Code Number: __________

Thoughts on Teen Parenting Survey (TTPS)

PART A

Your Age: 14: 15: 16: 17: 18: 19:

Your Gender: Male: Female:

How do you describe your ethnic origin?

Latino/Latina: African American (Black): Caucasian (White):
Native American: Asian: Mixed: Other:

Are you eligible for reduced or free lunch at your school? Yes No
Not sure

Does your family receive financial assistance? Yes No Not sure

If yes, please check all that apply:

Food stamps
Public housing
Medicaid
WIC

Do you consider yourself a religious or a spiritual person? Yes No

Not sure

Do you attend any spiritual or religious groups at least once per month?
Yes No

Do you have a sister or brother who had a teen pregnancy? Yes No

Not sure

Do you have a parent who was a teen parent? Yes No Not sure

How would you describe where you live? Urban (city) Suburban
Rural (country)
What is your zip code?

With whom do you live? 1 parent Adult/relative

Adult/non-relative Parent/Partner
2 parents None of the Above

(Continued)

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14 Herrman and Nandakumar

TABLE 7. (Continued)

PART B
This section as ks about the impact of teen parenting on areas of your life. Please
indicate if you agree or disagree with the following statements.

A. Your friendships:

Strongly Strongly
If I had a baby as a teen . . . disagree Disagree Neutral Agree agree
1 I would have more friends.
2 I would have less time to spend
with friends.
3 I would lose friends.

B. Relationships with a boyfriend or girlfriend:

Strongly Strongly
Having a baby as a teen . . . disagree Disagree Neutral Agree agree
4 Brings boyfriends and girlfriends
closer.
5 Makes the boyfriend stay in a
relationship with the mother of
the baby.
6 Makes couples break up.
7 Makes boys feel more like men.
8 Is easy because teen parents
share child care responsibilities
more than older parents.
9 Is usually an unwelcome
surprise.

C. Relationships with your family and parents/guardians:

Strongly Strongly
If I had a baby as a teen . . . disagree Disagree Neutral Agree agree
10 It would conflict with my
family’s values.
11 My parents/guardians would be
angry.
12 My family would be closer.
13 My family would help with
babysitting.
(Continued)

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Adolescent Perceptions of Teen Parenting 15

TABLE 7. (Continued)

D. Your money status:

Strongly Strongly
If I had a baby as a teen . . . disagree Disagree Neutral Agree agree
14 I would need more money.
15 Money would not be a problem.
16 My family and I would be short
of money.
17 I would have to learn how to
budget more.
18 I would have to get a job/another
job.

E. Education:

Strongly Strongly
If I had a baby as a teen . . . disagree Disagree Neutral Agree agree
19 I would be more likely to
graduate from high school.
20 I would easily juggle (balance)
school and being a parent.
21 I would drop out of school.
22 I would do better in school.

F. Career and work:

Strongly Strongly
If I had a baby as a teen . . . disagree Disagree Neutral Agree agree
23 I would set higher goals for my
future career.
24 I would not achieve as much in
my future work.
25 I would still be able to reach my
dreams and goals.
26 I would have a hard time
juggling work and being a
parent.
(Continued)

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16 Herrman and Nandakumar

TABLE 7. (Continued)

G. Personal characteristics:

Strongly Strongly
If I had a baby as a teen . . . disagree Disagree Neutral Agree agree
27 I would be more responsible.
28 I would get in more trouble.
29 I would feel better about my life.
30 It would conflict with my
personal values.
31 I would feel bad about myself.
32 I would make better decisions.
33 I would feel more grown up.
34 It would have a bad effect on my
(or a girl’s) body.
35 I would take better care of
myself.

H. Life in general:

Strongly Strongly
If I had a baby as a teen . . . disagree Disagree Neutral Agree agree
36 I would have a better life.
37 I would not be able to participate
in sports and school activities.
38 I would lose sleep.
39 I would be upset when I find
out that I (or my girlfriend) is
pregnant.
40 It would make my life easier.
41 I would get more attention.
42 It would have a positive effect
on my life.
43 My life would be more stressful.
44 I would get labeled in a bad way.

Data for the pilot program pretests and posttests of the health classes were analyzed
using t tests for all participants completing both tests in their entirety (n 5 54). Analyses
of the demographic characteristics of those who completed the posttest did not differ
from those who did not (n 5 30). No significant difference in the pretest and posttest
totals were found following the intervention (T 5 .861, df 5 53, p 5 .393). The pretest
mean score was 111.2 (SD 5 20.4), and the posttest mean was 107.9 (SD 5 21.1). Both

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Adolescent Perceptions of Teen Parenting 17

of these mean scores are below the midpoint of 122, reflecting more negative attitudes.
The lack of statistical significance following this presentation was not surprising in light
of the brevity of the teaching session. Comparison of the means was not conducted on the
youth summit data bacause of the brief encounter with those participants. The pilot project
provided valuable information about the use and interpretation of the tool as a pretest/
posttest measure.

DISCUSSION

The development of a survey instrument is a work in progress. Current assessments of

reliability and validity demonstrate that the TTPS may be useful in determining the per-
ceptions of teens about the impact of a teen birth. Lower alpha levels in the assessments
of split-half and test-retest reliability warrant a repeat of these procedures. Limitations
included the purposive sampling method, participant self-selection, and restriction of the
sample to those health teachers and school districts that responded to the call for participa-
tion and consented to participate in the pretesting and piloting processes. Further research
with participants accessed via a randomized sampling method, a larger sample size, and
stratified sampling may increase the reliability of the measure and the usefulness of the
research findings.
Results of this survey may be shared with teens to begin a discussion of the realities
of teen parenting; the benefits of delaying parenting until emotionally, socially, physi-
cally, and financially ready; and the value of goals and aspirations for the future. Another
important use for the TTPS is the comparison of key demographic data with perceptions.
It is proposed that adolescent needs may differ based on resources, social supports, culture,
communities, and attitudes (Herrman, 2008). The TTPS may determine differences and
commonalities among teen groups. Cohort-specific perceptions may be used to develop
teen pregnancy prevention strategies.
Another use for this tool is to determine the effectiveness of interventions designed to
change teens’ perceptions about the impact of teen births. The TTPS is currently being
used by a teen pregnancy prevention-child support enforcement strategy, with teen mothers
to assess the impact of an additional teen birth on their lives, to determine the effective-
ness of a video peer-based intervention on rural adolescents’ perceptions of teen parenting,
and to measure perception changes following the realities of teen parenting course that
includes an experience with infant simulators (Herrman, Waterhouse, & Chiquoine, 2011).
Researchers proposed that positive attitudes may be associated with subsequent pregnancy
(Jaccard, Dodge, & Dittus, 2003). This instrument may be useful in identifying individuals
at risk by measuring perceptions of teen births.
A larger sample may lend itself to further exploratory factor analysis and revision.
The current factor analysis was implemented on the pilot sample (n 5 171). Authorities
recommend five participants per item (DeVon et al., 2007; Jones, 2006). With the 44-item
scale, factor analysis with at least 220 subjects may be more meaningful. Costello and
Osborne (2005) caution that even larger samples provide more accurate factor loading and
extraction. Confirmatory factor analysis will continue to contribute to the assessment of
reliability and validity of the scale.
Future testing of validity may include administering the TTPS to groups considered high
and low risk. These results may be contrasted based on predictive criteria to discover if the
high risk groups have a more positive perception, further validating the TTPS. Hypothesis

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18 Herrman and Nandakumar

testing may examine the concurrent or predictive validity with other survey instruments
designed to measure a similar or related construct (Waltz et al., 2005). One such survey,
the Parent Teen Sexual Communication Scale (PTSCS-III; Hutchinson, 2007) may be
valuable in this endeavor. Another tool, the Teen Attitude Pregnancy Scale (TAPS), has
been used to evaluate the effectiveness of Baby Think It Over programs (Somers, Johnson,
& Sawilowsky, 2002). Future research may cross-validate the TTPS with TAPS to support
both instruments. In an effort to provide another assessment for validity, a question could
be added to the final section asking participants to agree or disagree with the statement
“Having a baby as a teen is a bad thing.” Responses to this question may be correlated with
the composite scale score to assess convergent validity. As noted by Busen (1991), adding
this additional item, known as a validity index item, will ensure that participants are not
answering items based on noncomprehension of an item, disinterest in the topic, avoidance
of commitment to an answer, or randomly responding to items.
The TTPS may also be used to determine the potential correlation of perceptions and
attitudes with intentions and behavior. As noted in the Adler et al. (1990) model, a key
component to consider is how intentions lead to engaging in a behavior—in this case,
unprotected sexual activity or intentionally attempting to become pregnant. It is important
to determine teen perceptions because they may differ from those of adults and to align
interventions with adolescent development and decision making to create effective strate-
gies to promote responsible sexual behavior.

CONCLUSION

Teen pregnancy, teen parenting, and prevention continue to be important issues for nursing
research and practice. The ability to gain information about adolescents and perceptions
will continue to build a body of nursing knowledge related to teens, working with high-risk
youth, peer teaching, and assessing teen insights. The TTPS may assist in the discovery of
teen perceptions to inform policies and to develop programs designed to influence adoles-
cent sexual decision making and to prevent teen pregnancy. It may be used to assess ado-
lescent perceptions, determine beliefs that characterize specific groups of teens, identify
teens at risk for early childbearing, and measure the effectiveness of interventions designed
to decrease teen pregnancy and reinforce the realities of adolescent parenting.

REFERENCES

Adler, N. E., Kegeles, S. M., Irwin, C. E., Jr., & Wibbelsman, C. (1990). Adolescent contraceptive
behavior: An assessment of decision processes. Journal of Pediatrics, 116(3), 463–471.
Burton, L. (2007). Childhood adultification in the economically disadvantaged families: A concep-
tual model. Family Relations, 56, 329–345.
Busen, N. H. (1991). Development of an adolescent risk-taking instrument. Journal of Child and
Adolescent Psychiatric and Mental Health Nursing, 4(4), 143–149.
Camarena, P. M., Minor, K., Melmer, T., & Ferrie, C. (1998). The nature and support of adolescent
mothers’ life aspirations. Family Relations, 47, 129–137.
Clemmens, D. (2003). Adolescent motherhood: A meta-synthesis of qualitative studies. MCN The
American Journal of Maternal Child Nursing, 28(2), 93–99.
Costello, A. B., & Osborne, J. W. (2005). Best practices in exploratory factor analysis: Four rec-
ommendations for getting the most from your analysis. Practical Assessment, Research &
Evaluation, 10(7), 1–9.

Copyright © Springer Publishing Company, LLC

Adolescent Perceptions of Teen Parenting 19

Czaja, R., & Blair, J. (2005). Designing surveys: A guide to decisions and procedures. Thousand
Oaks, CA; Sage.
DeVon, H. A., Block, M. E., Moyle-Wright, P., Ernst, D. M., Hayden, S. J., Lazarra, D. J., et al. (2007).
A psychometric toolbox for testing validity and reliability. Journal of Nursing Scholarship,
39(2), 155–164.
Furstenberg, F. (1976). Unplanned parenthood: The social consequences of teenage childbearing.
New York: Free Press.
Furstenberg, F., Jr., Brooks-Gunn, J., & Morgan, S. P. (1987). Adolescent mothers in later life. New
York: Cambridge University Press.
Geronimus, A. T. (2003). Damned if you do: Culture, identity, privilege, and teenage childbearing in
the United States. Social Science & Medicine, 57(5), 881–893.
Gordon, C. P. (1996). Adolescent decision making: A broadly based theory and its application to the
prevention of teen pregnancy. Adolescence, 31(123), 561–584.
Hamilton, B. E., Martin, J. A., & Ventura, S. J. (2009). Births: Preliminary data for 2007.
Washington, DC: National Center for Health Statistics/National Vital Statistics System.
Herrman, J. W. (2006). The voices of teen mothers: The experience of repeat pregnancy. MCN The
American Journal of Maternal Child Nursing, 31(4), 243–249.
Herrman, J. W. (2007). Repeat pregnancy in adolescence: Intentions and decision making. MCN The
American Journal of Maternal Child Nursing, 32(2), 89–94.
Herrman, J. W. (2008). Adolescent perceptions of teen births. Journal of Obstetrical, Gynecological,
and Neonatal Nursing. 37(1), 42–50.
Herrman, J. W., & Waterhouse, J. K. (2011). What do adolescents think about teen parenting?
Western Journal of Nursing Research, 33(4), 557–592.
Herrman, J. W., Waterhouse, J. K., & Chiquoine, J. (2011). Evaluation of an infant simulator
intervention for teen pregnancy prevention. Journal of Obstetric, Gynecologic, and Neonatal
Nursing, 40(3), 322–328.
Hulton, L. J. (2001). Adolescent sexual decision-making: An integrative review. The Online Journal
of Knowledge Synthesis for Nursing, 8(4).
Hutchinson, M. K. (2007). The Parent-Teen Sexual Risk Communication Scale (PTSRC-III):
Instrument development and psychometrics. Nursing Research, 56(1), 1–8.
Huth, M. M. (1998a). A rendezvous with reliability. Journal of Child and Family Nursing, 1(1), 49–53.
Huth, M. M. (1998b). Taking the voodoo out of validity. Journal of Child and Family Nursing, 1(2),
118–123.
Jaccard, J., Dodge, T., & Dittus, P. (2003). Do adolescents want to avoid pregnancy? Attitudes
toward pregnancy as predictors of pregnancy. Journal of Adolescent Health, 33(2), 79–83.
Jones, R. (2006). Reliability and validity of the sexual pressure scale. Research in Nursing and
Health, 29(4), 281–293.
Lesser, J., Anderson, N. L., & Koniak-Griffin, D. (1998). “Sometimes you don’t feel ready to be
an adult or a mom”: The experience of adolescent pregnancy. Journal of Child & Adolescent
Psychiatric Nursing, 11(1), 7–16.
Loewenstein, G., & Furstenberg, F. (1991). Is teenage sexual behavior rational? Journal of Applied
Social Psychology, 21, 957–986.
Martin, J. A., Hamilton, B. E., Sutton, P. D., Ventura, S. J, Mathews, T. J, & Osterman, M. J. (2010).
Births: Final data for 2008. National Vital Statistics Report, 59(1), 1, 3–71.
National Campaign to Prevent Teen Pregnancy. (2005). The power of prevention. Retrieved
December 22, 2007, from http://www.thenationalcampaign.org.
Oxley, G. M., & Weekes, D. P. (1997). Experiences of pregnant African American adolescents:
Meanings, perceptions, and coping. Journal of Family Nursing, 3(2), 167–188.
Paskiewicz, L. S. (2001). Pregnant adolescents and their mothers: A shared experience of teen moth-
ering. MCN The American Journal of Maternal Child Nursing, 26(1), 33–38.
Rentschler, D. D. (2003). Pregnant adolescents’ perspectives of pregnancy. MCN The American
Journal of Maternal Child Nursing, 28(6), 377–383.
Rosengard, C., Phipps, M. G., Adler, N. E., & Ellen, J. M. (2004). Adolescent pregnancy intentions and
pregnancy outcomes: A longitudinal examination. Journal of Adolescent Health, 35(6), 453–461.
Rosengard, C., Pollock, L., Weitzen, S., Meers, A., & Phipps, M. G. (2006). Concepts of the advan-
tages and disadvantages of teenage childbearing among pregnant adolescents: A qualitative
analysis. Pediatrics, 118(2), 503–510.

Copyright © Springer Publishing Company, LLC

 20 Herrman and Nandakumar

SmithBattle, L. (1995). Teenage mothers’ narratives of self: An examination of risking the future.
Advanced in Nursing Science, 17(4), 22–36.
SmithBattle, L. (2009). Reframing the risks and losses of teen mothering. MCN The American
Journal of Maternal Child Nursing, 34(2), 122–128.
SmithBattle, L., & Leonard, V. W. (1998). Adolescent mothers four years later: Narratives of self and
visions of the future. Advances in Nursing Science, 20(3), 36–49.
Somers, C. L., Johnson, S. A., & Sawilowsky, S. S. (2002). A measure for evaluating the effective-
ness of teen pregnancy programs. Psychology in the Schools, 39, 337–342.
Spear, H. J. (2001). Teenage pregnancy: “Having a baby won’t affect me that much.” Pediatric
Nursing, 27(6), 574–580.
Spear, H. J. (2004). A follow-up case study on teenage pregnancy: “Havin’ a baby isn’t a nightmare,
but it’s really hard.” Pediatric Nursing, 30(2), 120–125.
Waltz, C. F., Strickland, O. L. & Lenz, E. R. (2005). Measurement in nursing and health research.
New York: Springer Publishing.
Wayland, J. & Rawlins, R. (1997). African American teen mothers’ perceptions of parenting. Journal
of Pediatric Nursing, 12(1), 13–20.
Williams, C., & Vines, S. W. (1999). Broken past, fragile future: Personal stories of high-risk ado-
lescent mothers. Journal of the Society of Pediatric Nurses, 4(1), 15–23.

Acknowledgments. Support for this project was provided by the Alliance for Adolescent Pregnancy
Prevention (Delaware Division of Public Health/Christiana Care Health Services) and the Center for
Research Development, College of Health Sciences, University of Delaware.
This project was undertaken as part of the Maternal Child Fellow Leadership Academy sponsored
jointly by Sigma Theta Tau International and Johnson and Johnson Pediatrics.

Correspondence regarding this article should be directed to Judith W. Herrman, PhD, RN, ANEF,
School of Nursing, University of Delaware, 375 McDowell Hall, Newark, DE 19716. E-mail:
jherrman@udel.edu

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