Exploring validity evidence of the Sexual Relationship Power Scale to advance sexual and reproductive health among young women and men growing up in Durban and Soweto, South Africa

Abstract

Gender inequity and the subsequent health impacts disproportionately affect communities in the Global South. However, most gender equity measures, such as Pulerwitz’ (2000) Sexual Relationship Power (SRP) Scale (SRPS), are developed and validated in the Global North and then applied in Global South settings without investigation of context applicability or validity. Using a collaborative youth-engaged approach, the objectives of this dissertation were to 1) systematically review the literature to identify the ways SRP has been measured and used within sub-Saharan African sexual and reproductive health (SRH) youth studies; 2) explore and compare validity evidence of the SRPS, and 3) explore how gender and power intersect to shape contemporary relationship dynamics of young women and men in South Africa. The literature was synthesized using a systematic review. Psychometric properties of the SRPS were explored using quantitative data from a youth-engaged SRH cohort study AYAZAZI (2014-2017) of 425 participants aged 16-24 from Durban and Soweto, South Africa. From 2019-2021 AYAZAZI participants were re-contacted to participate in qualitative cognitive interviews exploring perceptions of the SRPS and the role of power and control within youth relationships. The review revealed that SRP inequities are commonly associated with experiences (among women) and perpetration (among men) of intimate partner violence, however, limited validity evidence has been presented. Using quantitative data, validity evidence relating to the scale’s internal structure was relatively low. Cognitive interview data highlighted several issues with the scale’s contemporary and contextual relevance and provided youth recommendations for revising the SRPS to validly measure constructs of power inequities in South African youth’s relationships. These data also revealed different strategies and expectations undertaken by young women and men as they navigate intimacy within patriarchal societies and identified key power holders including institutions, parents, and male partners that future youth SRH programs and research must engage with to support discussions and efforts to advance gender equity and SRH at multiple levels of influence. This dissertation makes several contributions to the field of gender equity measurement and youth health and emphasizes the need for measures that reflect the living realities of young people in the Global South.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat