Cross-cultural measurement equivalence
of the Revised Conflict Tactics Scales (CTS2)
Portuguese version used to identify violence
within couples
Equivalência transcultural de mensuração da
versão em português das
Revised Conflict Tactics
Scales (CTS2)
na aferição de violência entre casais
1 Departam en to de Ep id em iologia, In stitu to d e Med icin a Social, Un iversid ad e d o Estad o d o Rio d e Jan eiro. Ru a São Fran cisco Xavier 524, Rio d e Jan eiro, RJ 20559-900, Brasil. clm oraes@im s.u erj.br m ich ael@im s.u erj.br Clau d ia Leite Moraes 1 M ich ael E. Reich en h eim 1
Abstract Follow in g a previou s evalu ation of con cept, item an d sem an tic equ ivalen ces, th is paper assesses th e m easu rem en t equ ivalen ce betw een a Portu gu ese version of Revised Con flict Tactics Scales (CTS2) an d th e origin al in stru m en t con ceived in En glish . Th e CTS2 h as been w idely u sed to tap violen ce betw een cou p les. An in tra-observer reliability evalu ation in volved 165 rep lication s carried ou t w ith in a 24-48 h ou r period. Kappa poin t-estim ates w ere above 0.75 for all scales except sexu al coercion . Th e an alysis of in tern al con sisten cy con cern ed 768 su bjects w ith com p lete sets of item s. Ku der-Rich ardson -20 estim ates ran ged from 0.65 to 0.86. Resu lts w ere sim ilar to th ose fou n d in th e origin al in stru m en t in En glish for th e n egotiation , psych ological aggression an d ph ysical vi-olen ce scales, yet n ot so for th e sexu al coercion an d in ju ry scales. Factor an alysis iden tified factors w ith a recogn izable corresp on d en ce to th e u n d erlyin g d im en sion s, alth ou gh a few in con sisten cies w ere d etected . For th e assessm en t of con stru ct valid ity (n = 528) association s betw een th e in stru -m en t’s scales w ere evalu ated , as w ell as th e relation sh ip s betw een violen ce an d p u tative u n d erly-in g dim en sion s. Overall, th e ferly-in derly-in gs su ggest th at th e version can be u sed erly-in th e Brazilian con text, alth ou gh fu rth er in vestigation sh ou ld be carried ou t to u n veil som e im p ortan t rem ain in g issu es. Key words Valid ity; Qu estion n aire; Sp ou se Abu se; Dom estic Violen ce
Resumo Dan d o con tin u id ad e ao p rocesso d e ad ap tação tran scu ltu ral d o in stru m en to Revised Co n flict Ta ctics Sca le s(CTS2), u sad o p ara a id en tificação d a violên cia en tre casais, o objetivo d este artigo é ap reciar a equ ivalên cia d e m en su ração en tre o origin al con cebid o em in glês e u m a versão em p ortu gu ês. A avaliação d a con fiabilid ad e in tra-observad or en volveu 165 rep licações realiz ad as d e 24 a 48 h oras ap ós a p rim eira abord agem . À exceção d a escala d e coerção sex u al, tod os as estim ações d e p on to d o coeficien te k ap p a foram acim a d e 0,75. As estim ativas d o Ku d er-Rich ard son -20 p ara a an álise d e con sistên cia in tern a variaram d e 0,65 a 0,86 (n = 768), sen d o as relativas às escalas d e n egociação, agressão p sicológica e violên cia física bem sem elh an tes às d a versão origin al d as CTS2, d iferen te d as d e coerção sex u al e in jú ria. A an álise fatorial (n = 768) id en tificou fatores com u m a recon h ecível corresp on d ên cia com as d im en sões su bjacen tes, ain d a qu e algu m as in con sistên cias ten h am sid o d etectad as. Para estu d ar a valid ad e d e con stru cto (n = 528) foram avaliad as as associações en tre as d iversas escalas d o in stru m en to e as relações en tre violên cia e su p ostas d im en sões su bjacen tes. Ain d a qu e algu n s p on tos m ereçam m aior ap rofu n d am en to e m ais in vestigação, os ach ad os su gerem qu e a versão p rop osta p od e ser u sad a n o con -texto brasileiro.
Introduction
In d ifferen t p arts of th e world , fam ily violen ce h as h ad an im p ortan t im p act on th e h ealth an d m ortality of ch ild ren , ad olescen ts, an d wom en (Gelles, 1997; Heise et al., 1994; Kash an i et al., 1992; Stra u s & Gelles, 1995). In Bra zil, a clea r p ictu re h as n ot yet b een estab lish ed , sin ce in -form ation on th e m agn itu d e of fam ily violen ce at th e p op u lation level is still scarce. Still, even th o u gh a va ila b le d a ta a re sca n t, th ey p o in t to vio len ce a t th e fa m ily level a s a n esca la tin g p rob lem (Heise, 1994; Soares, 1997).
The biopsychosocial con sequen ces of fam ily violen ce h ave led to in creasin g in terest with in th e scien tific com m u n ity in regard to p reven -tion , follow-u p of victim s, an d th e develop m en t of p ertin en t research p rogram s. Id en tification o f vio len ce in fa m ilies is a m a jo r ch a llen ge. Th u s, b oth th e d evelop m en t of n ew an d m ore accu rate in stru m en ts an d th e im p rovem en t of existin g on es for u se at th e clin ical or research level h ave received world wid e atten tion , in ad -dition to becom in g th e focu s of several research grou p s (Aldaron do & Strau s, 1994; Arch er, 1999; Blin n -Pike & Min gu s, 2000; Miln er, 1994; Strau s et al., 1998; Strau s & Ham by, 1997; Weiss et al., 2000).
Accep tin g th a t in th e field o f fa m ily vio -len ce it is of great in terest to com p are p rofiles b etween cu ltu res in d ifferen t settin gs, it is essen tial th at in stru m en ts con ceived an d exten -sively resea rch ed in on e cou n try a lso b e th or-ou gh ly ad ap ted for u se in a n ew con text. Local o r regio n a l n u a n ces n eed to b e co n tem p la ted in ord er to ach ieve cross-cu ltu ral equ ivalen ce. Th is sea rch fo r cro ss-cu ltu ra l eq u iva len ce h a s m o tiva ted th e Ep id em io lo gica l Resea rch Pro gra m o n Fa m ily Vio len ce a t th e Sta te Un i-versity o f Rio d e Ja n eiro to fo cu s o n stu d ies aim ed at p rovid in g Portu gu ese version s of sev-eral key in stru m en ts wid ely u sed in th e field of fa m ily violen ce (Ha sselm a n n & Reich en h eim , 2001; Mo ra es et a l., 2002; Reich en h eim et a l., 2000). Given th e en cou ragin g evalu ation s of th e Con flict Tactics Scales (CTS) an d th eir su ccess-fu l u se in at least 20 cou n tries (Arch er, 1999; As-sis, 1995; Hasselm an n et al., 1998; Strau s, 1979; Stra u s et a l., 1996, 1998), th e Revised Co n flict Tactics Scales (CTS2) were selected to be adap t-ed to th e Portu gu ese lan gu age for u se in Brazil. Strau s et al. (1996) con ceived th e in stru m en t in En glish in 1996 as an offsh oot of th e first CTS, n ow sp ecifica lly d irected to id en tify vio len ce with in m arried or d atin g cou p les an d th ose in sim ila r rela tio n sh ip s. Th e CTS2 in stru m en t con sists of 78 item s d ivid ed in five scales – n e-go tia tio n , p sych o lo gica l a ggressio n , p h ysica l
vio len ce, sexu a l co ercio n , a n d in ju ry – cla ssi-fied a ccord in g to typ e a n d in ten sity. Item s re-late to th e resp on d en t an d p artn er.
Ad a p ta tio n o f th e CTS2 is b a sed o n gu id e-lin es p ro p o sed b y Herd m a n et a l. (1998). Ac-co rd in gly, th e p ro cess b egin s with a fo rm a l scru tin y o f th e releva n ce a n d eq u iva len ce o f co n cep ts a n d d o m a in s covered b y th e in stru m en t as d evelop ed an d u sed in th e sou rce p op -u lation an d th at of th e target c-u lt-u re wh ere th e n ew versio n is to b e a p p lied (co n cep t eq u iva len ce). Th e m o d el a lso p rescrib es a n eva lu a -tion of th e p ertin en ce of each item com p risin g th e origin al in stru m en t in term s of its cap acity to rep resen t th e u n d erlyin g co n cep ts a n d d o -m a in s in th e n ew co n text (ite-m eq u iva len ce). On ly th en sh o u ld th e eva lu a tio n o f lin gu istic eq u iva len ce b e p erfo rm ed (sem a n tic eq u iva -len ce). Th e su itab ility of op eration al asp ects in th e n ew settin g – fo rm o f a d m in istra tio n , in -stru ction s, n u m b er of rep ly op tion s, etc. – m u st also b e ob served (op eration al eq u ivalen ce). In th e sequ en ce, th e equ ivalen ce of p sych om etric p ro p erties b etween th e o rigin a l a n d th e n ew version a re form a lly eva lu a ted (m ea su rem en t eq u iva len ce). Acco rd in g to th e a u th o rs, o n ly after all th ese requ isites h ave b een m et is it ap -p ro-p riate to state th at th e n ew version’s cross-cu ltu ra l a d a p ta tio n h a s b een a ch ieved (fu n c-tion al equ ivalen ce).
In a p reviou s p ap er, th e first 3 p h ases of th e p rocess – con cep t, item , an d sem an tic eq u iva-len ce – were p resen ted a n d a p rovision a l Po r-tu gu ese versio n p ro p o sed fo r u se a n d fu rth er testin g (Moraes et al., 2002). Th e p resen t p ap er ca rries th e a d a p ta tio n p ro cess a step fu rth er, fo rm a lly a ssessin g th e m ea su rem en t eq u iva -len ce b etween th e o rigin a l CTS2 a n d th e n ew version . Th is article’s m ain ob jective is to eval-u a te th e Po rteval-u geval-u ese versio n’s p sych o m etric p ro p erties – relia b ility, in tern a l co n sisten cy, an d con stru ct valid ity – an d to com p are th e re-su lts with wh a t h a s p revio u sly b een rep o rted on th e origin al in stru m en t in En glish .
Methods
Portuguese test version of the CTS2
covered by the origin al in strum en t in the Brazil-ian con text. Th e en su in g ap p raisal of sem an tic eq u ivalen ce con sisted of two tran slation s an d resp ective b a ck-tra n sla tio n s; a n in d ep en d en t assessm en t of th e equ ivalen ce b etween th e lat-ter an d th e origin al in stru m en t with regard s to referen tial (literal) an d gen eral m ean in g; a d is-cu ssio n p h a se with sp ecia lists to re-exa m in e an d select item s for th e p rop osed version ; an d a p re-test on 774 wom en ad m itted to th e h os-p ital for ch ild b irth . It was os-p ossib le to ascertain con cep tu al, item , an d sem an tic equ ivalen ce. In a d d itio n , a ccep ta b ility o f th e Po rtu gu ese ver-sio n wa s en co u ra gin g. On ly th ree wo m en re-fu sed to fin ish th e in terview. Th e p rop osed ver-sion is p resen ted in Moraes et al. (2002) wh ere th e read er can also fin d th e item n u m b ers u sed th rou gh ou t th e rest of th is p ap er. For th e origi-n al iorigi-n stru m eorigi-n t iorigi-n Eorigi-n glish , refer to Strau s et al. (1996). No te, h owever, th a t in th is p a p er th e n u m b erin g seq u en ce is d ifferen t sin ce th e re-sp o n d en ts a n d p a rtn ers receive co n secu tive n u m b ers.
Fieldwork and data analysis
Th e p resen t stu d y is su b sid ia r y to a h o sp ita lb a sed ca seco n tro l stu d y exp lo rin g th e rela -tio n sh ip b etween vio len ce with in fa m ilies o f p regn an t wom en an d p rem ature childbirth. Th e field work took p lace from March to Sep tem b er 2000 in th ree la rge p u b lic m a tern ity wa rd s in Rio d e Ja n eiro. Sp ecia lly tra in ed in ter viewers co llected d a ta d u rin g th e first 72 h o u rs p o st-p artu m .
Th e an alysis of in tra-ob server reliab ility re-la tes to 165 su b jects fo r wh o m rep lica tio n s were carried ou t by th e sam e in terviewer, 24-48 h ou rs after th e first m eetin g. Reliab ility is evalu a ted sep a ra tely fo r ea ch sca le o f th e in strevalu -m en t, eith er u sin g sco res o r a s d ich o to -m o u s variab les. A p ositive even t is d efin ed as h avin g at least on e p ositive item in th e scale, irresp ec-tive of wh eth er th e p erp etrator is th e wom an or h er p a rtn er. Two su m m a r y va ria b les a re a lso co n sid ered – Vio len ce I ( V1) a n d Vio len ce II (V2). Th e first covers on ly item s from th e p h ys-ical violen ce an d in ju ry scales. Th e secon d vari-ab le en com p asses all item s excep t th ose from th e n egotiation scale.
For d ich otom ized variab les, reliab ility is es-tim ated by th e sim p le kap p a statistic (Reliab ility I) for in terrater agreem en t. Con fid en ce in -tervals are calcu lated accord in g to Fleiss et al. (1981) (eq u a tio n s 13.15 – 13.20) u sin g a n ad h ocStata 7.0 rou tin e (Reich en h eim , 2001). For scores, kap p as with qu ad ratic weigh ts are u sed (Reliab ility II) (Coh en , 1968). Con fid en ce in
ter-va ls a re ca lcu la ted via b o o tstra p with 1,000 rep lica tio n s (Efro n & Tib sh ira n i, 1993; Sta ta Corp, 2001). Th e op tion to u se a weigh ted kap -p a is ju stified , sin ce all scores are far from n or-m a l. Th e in terp reta tio n o f ka p p a fo llows th e gu id elin es by Sh rou t (1998), a d evelop m en t of th e classification origin ally p rop osed by Lan d is & Koch (1977). Accord in gly, agreem en t is clas-sified as follows: virtu ally n on e (κ< 0.1); sligh t (κ= 0.11-0.40); fa ir (κ= 0.41-0.60); m o d e ra t e (κ= 0.61-0.80); an d su b stan tial (κ= 0.81-1.0).
Fo r a n a lysis o f in tern a l co n sisten cy, d a ta fro m a ll 768 su b jects with co m p lete sets o f item s is u sed . Each scale is evalu ated sep arate-ly fo r th e resp o n d en t o r p a rtn er a n d in a ggre-gate form . All item s are dealt with dichotom ou s-ly. For th e p u rp ose of th is an alysis, in ju ry item s from th e resp on d en t an d p artn er are swap p ed over sin ce q u estio n s rela te to co n seq u en ces rath er th an action s. Th is exch an ge en ab les th e assessm en t of in tern al con sisten cy as seen from th e p ersp ective o f th e p erp etra to r, a n a lyzin g th e d eed s as well as an y h arm fu l effect b rou gh t ab ou t on th e oth er. Calcu lation s of p oin t-esti-m ates u se th e Ku d er-Rich ard son -fort-esti-m u la 20 –
KR-20 (Strein er & Norm a n , 1995). Recogn izin g
th at KR-20 is always th e lower lim it of reliab ility
(con sisten cy) (Bleda & Tobias, 2000), a on e-sid ed co n fid en ce in ter va l is a lso ca lcu la ted (Feld t, 1965). Th is m ea n s th a t th ere is a 95% ch a n ce th at th e reliab ility estim ate will b e h igh er th an th is com p u ted valu e.
Fa cto r a n a lysis a lso rela tes to a ll 768 su b -jects with com p lete sets of item s. Th e p rin cip al factors m eth od is u sed with varim axrotation. Here too, item s referrin g to th e resp on d en t are a n a lyzed sep a ra tely fro m p a rtn er. Th e resu lts co n sid er o n ly fa cto rs with eigen valu eso f a n d a ro u n d 1, a s su ggested in Klein b a u m et a l. (1988). All item s a re a n a lyzed in b in a r y fo rm (Ru m m el, 1988).
An alysis of con stru ct valid ity is con fin ed to in fo rm a tio n fro m th e m a in stu d y’s co n tro l grou p (n = 528). Restrictin g th e su b jects to con -trols p reven ts overestim atin g association s b etween violen ce an d th e oth er in vestigated con -stru cts, sin ce th ese are all p u tatively related to p rem atu rity. Given th e h osp itals’ b road cover-a ge, o n e ccover-a n cover-a ssu m e th cover-a t th e scover-a m p le is fcover-a irly rep resen tative of ch ild b earin g-age wom en u s-in g p u b lic h ea lth services s-in th e city o f Rio d e Jan eiro.
tested. Sin ce th ese h ave been form erly exp lored by Strau s et al. (1996), p roxim ity to th e resu lts ob tain ed in th e origin al in stru m en t is sou gh t. Variab les were selected th at b est rep resen t th e relation sh ip s at th e th eoretical level. Th e stated h yp oth esis an d resp ective variab les are sh own in Tab le 4 in th e resu lts section .
Th e secon d strategy in volves exp lorin g th e relation s b etween th e su m m ary variab les ou t-lin ed ab ove (V1 an d V2) an d oth er d im en sion s p revio u sly rep o rted in th e litera tu re, n a m ely, th e wo m a n’s ed u ca tio n a l sta tu s a n d a ge; p re-n atal care; su sp iciore-n of alcoh ol are-n d illicit d ru g ab u se in th e h ou seh old ; level of social su p p ort d u rin g p regn a n cy; a n d th e fa m ily’s so cio eco -n o m ic sta tu s (CDC, 1994; Fa ga -n & Brow-n e, 1994; Gelles, 1997; Hillard , 1985; Stewart & Ce-cu tti, 1993; Stra u s & Gelles, 1995; Web ster & Palm er, 2000).
Va riab les corresp on d in g to th e u n d erlyin g con stru cts are d escrib ed in Tab le 5 fou n d in th e resu lts section . Alth ou gh m ost are self-evid en t, a few p oin ts n eed clarification : (a) Th e con cep t o f ed u ca tio n a l sta tu s h a s b een red u ced to a fou level variab le in accord an ce with th e cu r-ren t Bra zilia n ed u ca tio n a l system . Th u s, first level stan d s for 8 years of form al sch oolin g an d secon d level for an ad d ition al 3 years. Th e first category (in com p lete first level) in clu d es a few illitera tes, b u t co n sists m o stly o f wo m en with u p to 3 or 4 years of sch oolin g. Th e last categor y (co m p lete seco n d level o categor m o categore) a lso in -clu d es th ose few wh o wen t on to grad u ate from u n iversity. (b ) Th e cu toff p oin t u sed for p ren atal care follows th e m in im u m accep tab le n u m -b er o f co n su lta tio n s reco m m en d ed -b y th e Bra zilia n Min istry o f Hea lth (Bra sil, 2000). (c) Su sp icion of alcoh ol ab u se is d efin ed as eith er th e resp on d en t or h er p artn er an swerin g p osi-tively to two or m ore item s from th e CAGE (Cu t-d own ; An n oyet-d ; Gu ilty & Eye-o p en et-d ) q u es-tion n aire (Mayfield et al., 1974). (d ) Use of illic-it d ru gs is d eterm in ed by m ean s of th e NSDUQ (Non Stu d en t Dru g Use Qu estion n aire) in stru -m en t su p p orted by th e World Heath Organ iza-tio n (Sm a rt et a l., 1981). A p o sitive ca se is d e-fin ed a s eith er th e resp o n d en t o r th e p a rtn er h avin g con su m ed at least on e listed illicit d ru g. Th e referen ce p eriod for d ru g con su m p tion is co n fin ed to p regn a n cy. (e) Th e level o f so cia l su p p ort is evalu ated by th e in stru m en t d evel-o p ed b y Sh erb evel-o u rn e & Stewa rt (1991) a n d a d a p ted for u se in Bra zil by Ch or et a l. (2001). Sin ce there is n o con sen sus as to how on e sh ou ld q u alify social su p p ort, th e overall score is first con verted in to q u in tiles. For ease of p resen ta-tio n , th e th ree m id d le stra ta a re th en p o o led to geth er, given th a t th e vio len ce p a ttern b
e-tween th em is virtu a lly in d istin gu ish a b le. (f ) An in d icator d escrib in g en viron m en tal con d i-tio n s fo r th e fa m ily h o u seh o ld is u sed a s a p roxy for th e socioecon om ic situ ation . Th e in -dicator is form ed by fou r ch aracteristics, n am e-ly, th e h ou seh old crowd in g level, exp ressed as th e ratio b etween th e n u m b er of d wellers an d room s; th e p red om in an t floor m aterial; typ e of sewa ge d isp o sa l system ; a n d th e stru ctu re o f d om estic garb age d isp osal facilities.
Fo llowin g th e a b sen ce o f n o rm a lity m en -tio n ed p revio u sly, Ken d a ll’s τbis u sed to a n a
-lyze th e association s b etween ord in al variab les (Ken d all, 1970). Th e sp ecific ch oice of τb is ju
s-tified b eca u se th e m eth o d a p p ro p ria tely co r-rects for ties (Agresti, 1984). Pearson’s χ2test is used for categorical variables (Arm itage & Berry, 1994). In the case of three-level variables, a score test for lin ear tren d of th e log od d s is also em -ployed in order to evaluate the presen ce of a vio-len ce grad ien t by strata (Clayton & Hills, 1995). Data en try an d its qu ality con trol were con -d u cte-d , resp ectively, in Ep i In fo 6.04 (Dea n et a l., 1990) a n d Sta ta 7.0 (Sta ta Co rp, 2001). Th e la tter wa s a lso u sed fo r d a ta p ro cessin g a n d an alysis.
Results
Reliability
In tra-observer agreem en ts are shown in Table 1. Both weigh ted an d u n weigh ted kap p a p oin t-es-tim ates are aroun d or above 0.75 for all scales ex-cep t sexu al coercion . Regardin g su b-scales, on e n otes that in gen eral the estim ates are also high. The cogn itive n egotiation scale p resen ts a m uch lower valu e wh en an alyzed d ich otom ou sly.
Ob servin g th e con tin gen cy tab les u n d erly-in g th e estim ates (Tab le 1, colu m n 3), on e m ay n otice th at m ost d isagreem en ts relate to an as-sertion of th e violen t act or in ju ry su stain ed as rep o rted in th e first in ter view a n d a d en ia l in th e seco n d sittin g. Th is o ccu rs m a in ly in th e m in or su b -scales.
Internal consistency
In tern a l co n sisten cies rega rd in g th e n ego tia -tion , p sych ological aggression , an d p h ysical vi-olen ce scales are h igh an d very sim ilar to th ose fo u n d in Stra u s et a l. (1996) ( Ta b le 2). Never-th eless, co n sisten cy estim a tes fo r Never-th e sexu a l coercion an d in ju ry scales are som ewh at lower th an in th e origin al in stru m en t.
Table 1
Intra-observer reliability of the Portuguese version of the Revised Conflict Tactics Scales (CTS2).
Scale Sub-scale 2nd Reliability I* Reliability II**
1st + + + - [Kappa (95% CI)] [Kappaw(95% CI)]
- +
-Negotiation emotional 164 0 1.0 (-) 0.73 (0.61-0.84)
0 1
cognitive 157 2 0.53 (0.17-0.89) 0.82 (0.72-0.88)
3 3
both 164 0 1.0 (-) 0.83 (0.60-0.82)
0 1
Psychological minor 117 8 0.85 (0.77-0.94) 0.88 (0.82-0.92)
Aggression 1 39
severe 74 5 0.86 (0.79-0.94) 0.90 (0.84-0.94)
6 80
both 122 6 0.85 (0.75-0.94) 0.90 (0.85-0.94)
3 34
Physical minor 53 15 0.74 (0.64-0.84) 0.87 (0.79-0.95)
Violence 5 92
severe 25 5 0.83 (0.72-0.94) 0.91 (0.82-0.96)
3 132
both 57 13 0.78 (0.69-0.88) 0.91 (0.84-0.96)
4 91
Sexual minor 11 10 0.66 (0.46-0.85) 0.70 (0.38-0.86)
Coercion 0 144
severe 2 2 0.80 (0.41-1.0) 0.80 (0-1.0)
0 3
both 12 10 0.68 (0.50-0.86) 0.72 (0.46-0.88)
0 143
Injury minor 17 8 0.74 (0.59-0.89) 0.73 (0.52-0.90)
2 138
severe 9 1 0.85 (0.68-1.0) 0.76 (0.50-0.94)
2 153
both 20 8 0.74 (0.60-0.89) 0.83 (0.65-0.93)
3 134
Violence I minor 71 0 1.0 (-) 1.0 (-)
0 94
severe 33 0 1.0 (-) 1.0 (-)
0 132
both 73 0 1.0 (-) 1.0 (-)
0 92
Violence II minor 124 5 0.90 (0.82-0.98) 0.90 (0.85-0.93)
1 35
severe 79 6 0.84 (0.76-0.92) 0.91 (0.87-0.96)
7 73
both 128 3 0.89 (0.80-0.98) 0.92 (0.88-0.95)
3 31
* Dichotomized variables; positives comprising a positive answer in at least one item of the respective sub-scale. Estimates using simple unweighted kappa.
o b ser ves a sligh t d ecrea se. Aga in , th e sexu a l co ercio n a n d in ju r y sca les a re excep tio n s. Wh en th e p a rtn er is th e p erp etra to r, in tern a l con sisten cy is ab ou t twice as h igh as wh en it is th e wom an . It m u st b e p oin ted ou t th at in b oth situ a tio n s, th ere is n o cro ssin g over b etween wo m en’s p o in t-estim a tes a n d p a rtn ers’ lower 95% con fid en ce lim its.
When each item is system atically withd rawn fro m its resp ective sca le, o n ly item 8 sta n d s o u t. Om ittin g th is sexu a l co ercio n item ra ises th e scale’s p oin t-estim ate from 0.350 to 0.438, th e on ly in crease ab ove 10% th at is d etected .
Factor analysis
Resu lts o f th e fa cto r a n a lysis a re p resen ted in Ta b le 3. Five fa cto rs a re u n covered wh en th e resp o n d en t (wo m a n ) is th e p erp etra to r a n d fo u r fa cto rs wh en th e p a rtn er (m a n ) is co n -cern ed . Th e total varian ce exp lain ed is, resp ec-tively, 97% an d 82.9%.
Th e first factor relates, by an d large, to p h ys-ical violen ce, alth ou gh several item s p ertain in g to th e p sych o lo gica l a ggressio n sca le a lso re-ceived m od erate to h igh load in gs in sp ite of th e fa ct th a t th is d im en sion is a lso p ortra yed by a sep a ra te fa cto r. On e item is p a rticu la rly p er-cep tib le. Lo a d in gs fo r item 35 (th reaten in g to h it or th row som eth in g at th e oth er) are m ore in lin e with th ose relatin g to p h ysical violen ce, yet q u ite d ilu ted in rega rd s to th e o rigin a l sca le
(see fa cto r 5 fo r resp o n d en ts a n d fa cto r 4 fo r p artn ers).
Con cen tratin g on th e item s origin ally allo-cated to th e p h ysical violen ce scale, on ly item 31 (bu rn in g th e oth er on p u rp ose) sta n d s o u t with a n a lm o st n u ll lo a d in g. No te th a t, wh ile th is item d oes n ot con trib u te to an y oth er fac-tor wh en wom en are p erp etrafac-tors, a q u ite d if-feren t p ictu re em erges for th e oth er grou p. For p a rtn ers, item 31 seem s to b e ver y m u ch in keep in g with th e secon d factor, wh ich d ep icts sexu al coercion , in sp ite of origin ally b elon gin g to th e p h ysica l vio len ce sca le. To a lesser d e-gree, so d oes item 11 (u se of k n ife or gu n).
As m en tion ed , th e secon d factor ap p ears to rep resen t sexu al coercion . Ap art from item s 10 (in sisted on oral or an al sex by force) an d 24 (in -sisted on sex by force), wh ich fo r resp o n d en ts are n on -in form ative du e to a com p lete absen ce o f p o sitive a n swers, lo a d in gs ten d to sp rea d ou t am on g th e oth er item s of th e scale. Th e ex-cep tion s are item s 8 (in sistin g on sex w ith ou t a con dom) an d 26 (in sistin g on sex w ith ou t u se of force).
Th e th ird fa ctor clea rly ca p tu res item s en -com p assin g th e n egotiation scale for b oth rela-tion s. Th e forth , h owever, ap p ears to b e rep re-sen tin g d ifferen t d im en sio n s. In ju r y-rela ted item s a re fa vo red wh en resp o n d en ts a re co n -sidered, wh ereas p sych ological aggression takes th e fo rth fa cto r a m o n g p a rtn ers. Alth o u gh a t first sigh t th is seem s to b e d escrib in g a gen d er-Table 2
Internal consistency of the Portuguese version of the Revised Conflict Tactics Scales (CTS2) and the original instrument in English.
Scale (no. of items) Woman perpetrator; Man perpetrator; Both Straus et al.*
male victim female victim (original)
Negotiation 0.668** 0.719 0.807 0.86
(6/12) (0.637)*** (0.692) (0.790)
Psychological aggression 0.712 0.700 0.823 0.79
(8/16) (0.686) (0.672) (0.807)
Physical violence 0.779 0.860 0.864 0.86
(12/24) (0.759) (0.847) (0.852)
Sexual coercion 0.368 0.627 0.650 0.87
(7/14) (0.310) (0.592) (0.619)
Injury 0.387 0.681 0.659 0.95
(6/12) (0.329) (0.651) (0.628)
Table 3
Factor analysis of the Portuguese version of the Revised Conflict Tactics Scales (CTS2).
Scale Item no. Woman perpetrating Man perpetrating
f1 f2 f3 f4 f5 f1 f2 f3 f4
Neg 1 0.026 0.016 0.481 -0.023 0.085 -0.124 -0.125 0.443 -0.181 2 0.049 0.009 0.445 -0.032 0.012 -0.004 -0.046 0.494 -0.059 7 -0.127 0.012 0.312 0.014 0.236 -0.207 -0.029 0.441 -0.314 20 -0.035 0.013 0.629 -0.029 -0.066 -0.071 -0.060 0.620 0.023 30 0.027 0.018 0.608 -0.015 -0.185 0.001 -0.051 0.601 0.080 39 -0.039 0.024 0.499 0.010 0.059 -0.073 0.026 0.571 -0.105
Psy-M 3 0.320 0.016 0.003 -0.098 -0.540 0.291 0.065 -0.132 0.543 18 0.288 0.018 0.136 -0.115 -0.560 0.208 0.044 0.009 0.563 25 0.246 0.034 0.077 -0.144 -0.389 0.071 0.068 -0.032 0.503 34 0.308 0.093 -0.003 -0.042 -0.362 0.323 0.038 -0.096 0.435 35 0.632 0.081 0.009 -0.103 -0.152 0.556 0.218 0.031 0.231
Psy-S 13 0.149 0.041 0.050 -0.020 -0.455 0.097 0.088 -0.062 0.425 15 0.371 -0.021 0.080 -0.034 -0.221 0.335 0.154 -0.072 0.203 33 0.129 -0.003 -0.041 -0.006 -0.206 0.035 0.056 -0.053 0.250
Phy-M 4 0.600 -0.034 -0.032 0.017 -0.103 0.480 0.062 -0.087 0.104 5 0.356 -0.012 0.015 0.091 -0.052 0.592 0.163 -0.089 0.133 9 0.589 -0.036 -0.008 -0.055 -0.343 0.579 0.101 -0.015 0.351 23 0.588 -0.017 0.030 -0.111 -0.174 0.520 0.096 0.016 0.371 27 0.607 -0.024 0.048 -0.136 -0.124 0.741 0.116 -0.039 0.111
Phy-S 11 0.325 0.005 -0.010 -0.218 0.040 0.348 0.480 -0.176 -0.018 14 0.643 -0.016 -0.008 -0.102 -0.009 0.770 0.025 -0.039 -0.016 17 0.316 -0.002 -0.036 -0.080 -0.007 0.442 0.281 -0.127 -0.104 19 0.502 0.160 -0.058 -0.077 -0.053 0.719 0.251 0.013 0.122 22 0.420 0.006 -0.090 -0.067 0.099 0.752 0.090 -0.083 -0.042 31 0.074 -0.009 -0.037 0.003 -0.027 0.129 0.693 -0.048 -0.063 37 0.522 0.131 -0.041 -0.062 -0.039 0.635 0.161 -0.027 0.145
Sex-M 8 0.029 -0.007 -0.003 0.044 0.039 0.198 -0.001 -0.116 -0.023 26 -0.001 0.270 0.109 -0.010 -0.223 0.192 0.160 0.014 0.246 32 -0.024 0.612 0.052 0.008 -0.016 0.055 0.537 0.053 0.099
Sex-S 10 * * * * * 0.098 0.883 -0.056 -0.011
24 * * * * 0.280 0.615 -0.029 -0.021
29 0.014 0.990 0.001 0.003 -0.006 0.082 0.812 0.030 0.122 38 0.014 0.990 0.001 0.003 -0.006 0.153 0.565 0.011 0.161
Inj-M 6 0.270 -0.015 -0.081 -0.492 -0.072 0.346 0.037 0.125 0.257 36 0.315 -0.010 0.000 -0.608 -0.095 0.335 -0.080 0.083 0.249
Inj-S 12 -0.027 -0.003 0.040 -0.549 -0.006 * * * *
16 0.066 -0.003 0.035 -0.608 -0.083 0.026 -0.032 0.015 0.218 21 0.050 -0.009 0.061 -0.550 -0.059 -0.004 -0.014 0.052 0.048 28 -0.001 -0.004 -0.001 -0.435 0.061 0.034 -0.036 -0.112 -0.003
% of variance explained 41.7 20.6 14.3 12.7 7.7 46.2 16.4 11.4 8.9 by the factor
* Item not considered in the estimation due to lack of any positive answer.
d ep en d en t p a ttern , it is wo rth p o in tin g o u t th at a d ata-related artifact is at th e core of th is d ifferen ce. Sin ce th ere are virtu ally n o in ju ries rep o rted fo r p a rtn ers a n d , a s a resu lt, a co m -p lete fa ilu re to re-p resen t th is fa cto r fo r th e gro u p, a re-lo ca tio n o f p sych o lo gica l a ggres-sion item s to th e forth factor au tom atically oc-cu rs, leavin g th e fifth factor virtu ally em p ty an d void of an y im p ortan t con trib u tion (h en ce n ot shown in Table 5). This p oin t is further stren gth -en ed by th e fact th at, excep t for op p osite sign s, th e resp on d en t’s fifth factor rep resen tin g p sy-ch ological aggression is qu ite sim ilar to th e re-located p artn er’s factor 4. Besid es, wh en artifi-cially withdrawin g the resp on den t’s in jury item s fro m th e d a ta , a n a lm o st in terch an geab le re-spon den t-partn er pattern em erges. Now, a clos-er lo o k a t resp o n d en t’s fa cto r 5 a n d p a rtn clos-er’s factor 4 sh ows th at, as with item 35 p reviou sly ad d ressed , b oth item s 15 (destroyin g som eth in g belon gin g to th e oth er) a n d 33 (accu sin g th e oth er of bein g a lou sy lover) gen erate relatively sm a ll lo a d in gs. Wh erea s th e fo rm er item m a y b e regard ed as also con trib u tin g to factor 1, th e latter d oes n ot, n or to an y oth er factor.
Construct validity
Resu lts fro m th e first eva lu a tio n stra tegy a re sh own in Ta b le 4. Th e test h yp o th eses a re d e-scrib ed in th e first colu m n . Th e m id d le colu m n con tain s th e relation sh ip s actu ally tested . Th e n ext two colu m n s p resen t th e correlation s an d resp ective p -valu es. Alth ou gh p oin t-estim ates are som etim es low (< ± 0.10), all ten d in th e th e-o retica lly exp ected d irectie-o n a n d a re sta tisti-cally sign ifican t at th e 10% level.
Association s between the two sum m ary vari-ab les (V1 an d V2) an d selected con stru ct-relat-ed va ria b les a re sh own in Ta b le 5. Th e overa ll p ictu re is ver y co n sisten t. Preva len ce o f vio -len ce is system atically h igh er in extrem e strata of all variab les in sp ected an d sign ifican t corre-lation s are in agreem en t with th eoretically ex-p ected ten d en cies.
Discussion
Focu sin g th e an alysis on ord in al scales an d d is-regard in g th e in ten sity of th e even ts, reliab ility estim a tes a re, by a n d la rge, q u ite su b sta n tia l. Wh en in ten sity is taken in to accou n t, in traob -server agreem en ts ten d to b e sligh tly lower, os-cilla tin g b etween su b sta n tia l a n d m o d era te. Even if estim a tes a re a ga in sligh tly lower, d i-ch o to m izin g th e sca les still p resen ts a ccep t-a b le levels o f relit-a b ility. Th e eccen tric vt-a lu e
fo u n d in th e co gn itive n ego tia tio n su b -sca le ca n b e overlo o ked , sin ce it is m o re a co n se-q u en ce o f th e id io syn cra sies in th e estim a to r (kap p a) th an a con crete fin d in g. In fact, on ly 5 o u t o f 165 ca ses a re m iscla ssified . All a gree-m en ts a re excellen t wh en va ria b les V1 a n d V2 are con sid ered . It sh ou ld n ot go u n n oticed th at su m m ary variab les like th ese are th e m ost like-ly on es to b e u sed in fu tu re su b stan tive in vesti-gation s.
No tice th a t fo r m in o r even ts, wh en d is-a greem en ts o ccu r, th ere is is-a regu lis-a r p is-a ttern wh ereby th e resp on d en t ten d s to system atical-ly d en y th e in cid en t on rep lication . Th ree sce-n arios are p lau sib le. Isce-n th e first, assertisce-n g vio-len ce to b egin with wo u ld o n ly ta ke p la ce to p lease th e in terviewer, wh ereas th e actu al facts wo u ld o n ly su rfa ce in th e seco n d in ter view. Ra th er m o re su b sta n tive th a n p ro ced u ra l, in th e secon d scen ario, an h on est in itial p ositive statem en t wou ld b e su b seq u en tly rejected fol-lowin g so m e overn igh t th o u gh ts a b o u t th e m atter an d a gen u in e d istru st of th e felt n ega-tive rep ercu ssion s th at d isclosin g an y ep isod e of violen ce wou ld en tail. In th e th ird scen ario, d esp ite wh at was rep orted in th e first m eetin g, th e resp o n d en t wo u ld th en co n sisten tly d en y th e even t in o rd er to sp eed u p th e rep lica tio n in terview (lead in g to wh at is kn own as n ay-say-in gb ias).
Alth o u gh n o n e o f th e th ree scen a rio s d i-rectly tells u s a n yth in g a b o u t th e Po rtu gu ese version’s p erform an ce, th is fin d in g lead s on e to reflect o n th e CTS2’s gen era l p ro p erties a n d p o ssib ly th o se o f o th er rela ted in stru m en ts. Mo re stu d ies a re n eed ed to cla rify th e m a tter an d to d eal with th e p rob lem , sh ou ld it b e con -firm ed . On e p o ten tia lly h elp fu l a p p ro a ch to d ea l with th e th ird scen a rio d escrib ed a b ove wou ld b e to focu s m ore effort on red u cin g th e len gth o f th e in stru m en t. Th is issu e is d is-cu ssed later in th is article.
In tern a l co n sisten cy estim a tes fo r th e n e-gotiation , p sych ological aggression , an d p h ysi-cal violen ce sysi-cales are qu ite sim ilar to th ose re-p orted in th e origin al CTS2 re-p are-p er (Strau s et al., 1996), a s o p p o sed to th e sexu a l co ercio n a n d in ju ry scales. Som e exp lan ation s for th ose fin d -in gs are -in ord er. Th e first con cern s th e scarce-n ess o f iscarce-n fo rm a tio scarce-n iscarce-n th e d a ta . Fo cu siscarce-n g o scarce-n th e sca le d escrib in g th e in ju ries su sta in ed b y th e p artn er (KR-20 = 0.387), for exam p le, ap art
from th e overall low p revalen ce of each even t – o n ly a b o u t 10% o f th e sa m p le h a vin g a t lea st o n e p o sitive item –, p o sitives a re m o stly co n -cen tra ted in th e two item s rela ted to m in o r even ts. In con trast, th is p attern is rath er d iffer-en t for th e resp on d iffer-en t’s in ju ry scale wh ere th e d istrib u tio n o f p o sitive item s is m o re sp rea d ou t. Alth ou gh som e clu sterin g in m in or item s rem ain s, th ere are m ore p ositives in m ajor in -ju r y item s, a s exp ected . Preva len ce o f severe in ju ries su stain ed by wom en is six tim es th at of m en (6.2% vs. 1.2%).
Th e sm a ll va ria b ility o f in ju r y sco res fo r p a rtn ers m a y a lso b e resp o n sib le fo r th e low
KR-20 valu es. It sh ou ld b e p oin ted ou t th at th e
virtu al ab sen ce of severe in ju ries am on g p art-n ers is art-n ot su rp risiart-n g, siart-n ce th e coart-n seq u eart-n ces of a violen t act in m en are con sid erab ly less se-vere th an in wom en , as d ep icted in Tab le 4 (5th
test h yp o th esis) a n d severa l p revio u s stu d ies (Barn ett et al., 1997; Gelles, 1997; Hillard , 1985; Jasin ski & William s, 1998; Strau s & Gelles, 1995; Web ster & Palm er, 2000).
Th e sam e m ay b e h ap p en in g with th e sexu -al coercion sc-ale, an d even m ore strikin gly. For in stan ce, th e n u m b er of p ositive an swers refer-rin g to p artn ers is ab ou t twice as large if severity is ign ored . Con sid erin g on ly th e severe su b -scale, th is ratio in creases to ten . Sm all variab il-ity o f sco res ca n a lso b e fo u n d h ere, sin ce th e m ajority of p ositives are con cen trated in item s 8 an d 26, b oth p ertain in g to m in or even ts. An -oth er p ossib ility th at m ay p artially exp lain th e low in tern al con sisten cy of th e sexu al coercion scale in p articu lar is th e ap p aren t in ap p rop ri-a t e n e ss o f it e m 8. It s wit h d rri-a wri-a l sh o o t s t h e
KR-20 estim a te fro m 0.395 to 0.487, a lm o st a
25% in crease. Th is d oes n ot occu r with th e in -ju r y sca le o r, fo r th a t m a tter, a n y o th er sca le. In tern al con sisten cy estim ates rem ain rou gh ly u n ch an ged wh en on e system atically with d raws each item . Th e th ird exp lan ation is th at th e d is-crep an cies fou n d b etween th e estim ates of th e two sca les a n d th e o rigin a l a re sim p ly d u e to rea l d ifferen ces b etween th e a d a p ted versio n an d th e CTS2 p ap er m en tion ed in Tab le 2. Ac-cord in g to Strau s et al. (1996), sem an tic m od i-fica tio n s were in tro d u ced in severa l item s o f Table 4
Construct validity of the Portuguese version of the Revised Conflict Tactics Scales (CTS2) according to selected associations between scales and/or sub-scales.
Hypothesis Tested association τb* p-value
1) In couples where psychological aggression takes Severe psychological aggression vs. minor physical violence 0.405 0.000 place, physical violence is more common Severe psychological aggression vs. severe physical violence 0.326 0.000
2) In couples that resort to negotiation tactics to deal Negotiation vs. severe physical violence -0.095 0.009 with their conflicts, there is a tendency for less severe Negotiation vs. severe injury -0.085 0.026 physical violence or injuries to occur
3) In couples where physical violence occurs, there is Physical violence of any type vs. sexual coercion 0.237 0.000 a tendency for sexual coercion to take place as well, of any type; man perpetrating
especially when the man is the perpetrator Physical violence of any type vs. sexual coercion 0.076 0.061 of any type; woman perpetrating
4) In couples where severe psychological aggression Severe psychological aggression vs. sexual coercion 0.163 0.000 occurs, sexual coercion is more frequent, especially of any type; man perpetrating
when the man is the perpetrator Severe psychological aggression vs. sexual coercion 0.099 0.015 of any type; woman perpetrating
5) Severe physical violence leads to severe injuries Severe physical violence vs. severe injury grave; 0.355 0.000 when the man is perpetrating but not when the man perpetrating
woman is the agent Severe physical violence vs. severe injury; 0.064 0.131
woman perpetrating
th e two scales after th e rep orted p sych om etric resu lts h a d b een esta b lish ed . Th u s, th e esti-m ates u sed for coesti-m p arison d o n ot strictly refer to th e in stru m en t’s fin a l ed itio n to wh ich th e cu rren t ad ap tation ap p lies.
Overa ll, th e fa cto r a n a lysis id en tified fa c-tors with a recogn izab le corresp on d en ce to th e u n d erlyin g d im en sion s origin ally p rop osed by Stra u s et a l. (1996). No n eth eless, it sh o u ld b e p o in ted o u t th a t, a lth o u gh q u ite a b le to ca p tu re th e larger d im en sion s p u rp orted by th e in -stru m en t, n o d istin ction cou ld b e m ad e in regard s to su b scales. Sin ce, to th e b est of th e au -th ors’ kn owled ge, n o em p irica l evid en ce a risin g from a factor an alysis of th e origrisin al risin stru -m en t in En glish is a va ila b le, it is d ifficu lt to kn ow wh eth er su ch a d iscrim in ation sh ou ld b e exp ected b u t fa iled to m a teria lize in th e p rsen t stu d y o r, ra th er, if th e d ifferen tia tio n b e-tween m in o r a n d severe even ts is to b e m a d e solely on th e b asis of th eory, wh atever th e cu l-tu re. Th is im p ortan t p oin t clearly n eed s fu rth er ligh t. In a n y ca se, a co m p reh en sib le p a ttern can still b e id en tified wh ich is en cou ragin g so far as th e establish m en t of cross-cu ltu ral equ iv-alen ce is con cern ed .
Co m m en ts o n th e p ecu lia rities o f so m e item s a n d sca les a re a lso d u e. Co n fin in g th e d iscu ssio n to th e resu lts fo r th e resp o n d en t’s a ttitu d es, a d istin ctive a gglo m era tio n o f h igh lo a d in gs is o b served fo r th e p h ysica l vio len ce item s in th e first factor an d , in ad d ition , th ere ap p ears to b e som e in flu en ce by p sych ological a ggressio n item s. Th is is n o t a n u n exp ected fin d in g if on e b ears th e related literatu re wh ich p oin ts to h igh correlation s b etween th e two d i-m en sio n s ( Ja sin ski &ai-mp; Willia i-m s, 1998; So a res, 1997; Stra u s et a l., 1996). Th e sa m e co n cu rren ce h a s b een d etected in o n e o f th e co n -firm ed h yp oth esis exp lored to assess con stru ct va lid ity. On th e o th er h a n d , th e existen ce o f a sep arate factor rep resen tin g p sych ological ag-gression sh ou ld n ot go u n n oticed . Th is m ean s th at b oth d im en sion s are effectively d iscrim i-n ated , oi-n ce agaii-n u i-n d erlii-n ii-n g th e su itab ility of th e ad ap tation p rocess.
Th e d ivergen ces d etected for som e item s in relation to th eir resp ective scales d eserve clari-fication . Th e sim ilarity of th e load in gs for item 35 an d th ose corresp on d in g to th e p h ysical vi-o len ce set cvi-o u ld well b e exp la in ed by th e fa ct th at th is is th e on ly item from th e p sych ologi-ca l a ggressio n set b rin gin g u p a vio len t a ct th at, taken a step fu rth er, m ay escalate an d en d u p in co rp o ra l figh tin g. Th rea ten in g to h it o r th row som eth in g at th e p artn er (or vice versa) is q u ite d ifferen t fro m th e o th er item s in th e scale wh ich refer strictly to offen sive b eh avior Table 5
Construct validity of the Portuguese version of the Revised Conflict Tactics Scales (CTS2) according to associations between violence variables and selected construct variables.
Construct variablea N Violence I a Violence II b
% τbc % τbc
Educational status (woman)
Incomplete first level 309 21.4 56.0
Complete first level 86 17.4 53.5
Incomplete second level 59 10.2 49.1
Complete second level or more 75 10.7 37.3
p-value d 0.056 0.033
p-value e 0.007 0.005
Correlation c -0.089 -0.094
p-value 0.012 0.012
Adolescent (mother)
Yes 165 24.2 57.6
No 364 15.1 49.7
p-value d 0.009 0.011
Correlation c -0.073 -0.050
p-value 0.036 0.121
Attendance, pre-natal care
Less than six visits 254 22.0 59.8
Six or more visits 257 14.4 45.1
p-value d 0.029 0.001
Correlation c -0.083 -0.141
p-value 0.024 0.000
Suspicion of alcoholism (CAGE)
Yes 123 29.3 71.5
No 406 14.5 46.3
p-value d 0.000 0.000
Correlation c 0.153 0.186
p-value 0.000 0.000
Illicit drug consumption (NSDUQ)
Yes 87 43.7 67.8
No 442 12.9 49.1
p-value d 0.000 0.001
Correlation c 0.294 0.121
p-value 0.000 0.005
Social Support (MOS)
Q1 112 28.6 61.6
Q2 – Q4 311 17.0 54.6
Q5 106 9.4 34.9
p-value d 0.001 0.000
p-value e 0.000 0.000
Correlation c -0.114 -0.136
p-value 0.001 0.000
Conditions of the household
Bad 95 33.7 64.2
Regular 202 16.3 52.0
Good 226 13.3 47.3
p-value d 0.000 0.023
p-value e 0.000 0.008
Correlation c -0.128 -0.076
p-value 0.000 0.030
aSummary variable covering items from the physical violence and injury scales. bSummary variable covering items from the psychological aggression, physical violence, sexual coercion, and injury scales.
su ch as sh ou tin g, yellin g, swearin g, or “tu rn in g on e’s b ack an d walkin g away”. It is worth p oin t-in g ou t th at th e load t-in g of item 35 is n ot m u ch d ifferen t from an oth er th at goes b eyon d in tim -id a tio n a n d a sks if so m eth in g wa s a ctu a lly th rown . Fifty-th ree p ercen t of th e resp on d en ts wh o m a d e th rea ts en d ed u p th rowin g so m e-th in g, wh ich clearly sh ows e-th e syn ch ron icity of th e two p ra ctices. If th is p ecu lia rity is lim ited to th e Portu gu ese version an d th e local cu ltu re o r wh eth er it a lso rela tes to th e o rigin a l CTS2 rem ain s to b e estab lish ed . At an y rate, item 35 d oes n ot ap p ear to b e cau sin g m u ch of a p rob -lem , a s co n veyed b y th e in tern a l co n sisten cy an alysis. Its with d rawal on ly red u ces th e KR-20
estim a te b y 3.8% wh en th e p erp etra to r is th e resp on d en t, an d by 1.6% wh en it is th e p artn er. Th ese are n egligib le am ou n ts by all m ean s.
Th e two item s relatin g to p h ysical violen ce yet p ecu lia rly co n trib u tin g to fa cto r 2 a m o n g p artn ers also m erit exp lan ation . So far as item 31 is con cern ed n ot m u ch can b e in ferred sin ce th ere wa s o n ly o n e p o sitive su b ject wh o, p er-hap s in ciden tally, er-hap p en ed to also an swer p os-itively to fou r ou t of six sexu al coercion item s. Neverth eless, it sh ou ld b e p oin ted ou t th at fol-lowin g a ten tative su b stitu tion by an oth er item in wh ich th e scop e of th e origin a l item is n a r-rowed d own to sp ecifics su ch as b u rn in g with a cloth es iron , cigarette, or sim ilar h ot ob ject, th e o d d lo a d in g o f 0.693 is n ow red u ced to 0.033, wh ich m ay su ggest th ere is som e b en efit from re-p h ra sin g th e q u estion . Th e exp la n a tion for item 11 is rath er m ore su b stan tive. Ap art from th ere b ein g m ore in form a tion in th e d a ta , th e m a jo rity o f p o sitive rep lies to th rea ten in g o r u sin g a gu n to force sex, also u sed th e latter in gen era l a s m ea n s to reso lve co n flicts. Testin g h yp oth esis 3 p resen ted in Tab le 4 h as cap tu red th e sam e relation sh ip. Th is sh ows th at item 11, a lth o u gh va lu a b le o n it own righ t to fa cto r 1 (p h ysica l vio len ce), is red u n d a n t so fa r a s th e con trib u tion to factor 2 is con cern ed .
As to th e secon d factor th at ap p aren tly cap -tu res sexu a l co ercio n , item 8 sta n d s o u t. Th e item’s in a d eq u a cy, a lrea d y m en tio n ed in th e d iscu ssion on in tern al con sisten cy, again cor-rob orates fin d in gs from p reviou s p h ases of th e a d a p ta tio n p ro cess, esp ecia lly with rega rd to th e scru tin y of item equ ivalen ce an d som e im -p o rta n t im -p ressio n s th a t ca m e u -p d u rin g th e version’s p re-testin g (Moraes et al., 2002). Sin ce con d om u se is n ot wid esp read am on g cou p les in sta b le rela tio n sh ip s, a n d given th a t th is is th e m o st co m m o n typ e o f rela tio n sh ip fo u n d in th e d ata, it is n ot su rp risin g th at in terviewed wom en ten d to sim p ly d ism iss th e m an’s in sist-in g on sex with ou t a con d om as an act of
coer-cio n . Po ssib ly th e sa m e o ccu rs with rega rd to item 26. In fu tu re version s, rep lacin g th e item s with oth ers m ore in tu n e with th e Brazilian so-cio-cu ltu ral con text sh ou ld b e con sid ered .
Tu rn in g to th e p sych o lo gica l a ggressio n scale, th e sm all load in g for item 33 ap p ears to co n firm th e su sp icio n ra ised in th e p revio u s p h a ses o f th e a d a p ta tio n p ro cess th a t, in th e Brazilian con text, accu sin g th e oth er of b ein g a lou sy lover does n ot really p rovoke a con fron ta-tio n , a s first en visa ged b y th e a u th o rs o f th e o rigin a l CTS2. Even b efo re th is h a rd p sych o -m etric evid en ce, Moraes et al. (2002) id en tified th e n eed to fin e-tu n e or even rep lace th is item a lto geth er in fu tu re versio n s. Ra tifyin g th e p ro p o sitio n s m a d e in th is p revio u s stu d y, in a d d itio n to a fo rm a l eva lu a tio n o f m ea su re-m en t eq u iva len ce of a n y p ossib le n ew su b sti-tu tion item s, q u alitative evalu ation s in volvin g su b jects from th e p op u lation wh ere th e in stru -m en t is to b e u sed sh ou ld also b e p u rsu ed .
Wh ereas item 33 is off m ark wh atever factor is co n cern ed , item 15 – wh ich a lso p la ys a n u n im p o rta n t ro le with rega rd s to d escrib in g sp ecifica lly p sych o lo gica l a ggressio n – seem s to offer som e con trib u tion to factor 1. At a clos-er look th is sh ou ld n ot b e u n exp ected . Destroy-in g b elon gDestroy-in gs go well b eyon d verb al d eed s, al-so in volvin g n egative p h ysical acts. Perh ap s th is sp lit con trib u tion in term s of load in gs is tellin g u s exa ctly th a t. Fu rth er eva lu a tio n s to sh ed som e ligh t on th is m atter m ay b e en cou raged .
Resu lts o b ta in ed in th e eva lu a tio n o f co n -stru ct va lid ity a lso p rovid e go o d evid en ce fo r th e ad equ acy of th e con version of th e CTS2 in -to Po rtu gu ese, sin ce a ll a sso cia tio n s scru tin ized are cotin sistetin t with b oth th eory atin d oth -er em p irical stu dies. Th e related lit-eratu re ch ar-acterizes victim s as b ein g p referen tially ad oles-cen t, p oorly-ed u cated fem ales livin g in p recar-iou s socioecon om ic con d ition s, in volved in re-lation sh ip s wh ere alcoh ol an d illicit d ru g ab u se are com m on , an d wh ere op p ortu n ities for con -tact with h ealth services are lim ited d u e to low levels of p ren atal care (CDC, 1994; Gielen et al., 1994; Heise et al., 1994; Hillard , 1985; O’Cam p o et al., 1995; Stewart & Cecu tti, 1993; Web ster et al., 1994; Web ster & Palm er, 2000). Precisely th e sam e p ictu re was fou n d in th e p resen t stu d y.
-scale an d p h ysical violen ce, wh eth er m in or or severe, corrob orate th e h yp oth esis th at cou p les wh o a re a ccu sto m ed to in itia tin g a ttem p ts a t reso lvin g co n flicts by m ea n s o f o ffen sive p sych o lo gica l a tta cks ten d to su b seq u en tly esca -late to p h ysical violen ce. Th e n egative associa-tio n s o b served b etween th e n ego tia associa-tio n sca le an d th e p h ysical violen ce an d / or severe in ju ry scales su p p ort th e h yp oth esis th at th ere is less seriou s violen ce b etween cou p les th at are u sed to resolvin g th eir m isu n d erstan d in gs an d d is-agreem en ts th rou gh d em on stration s of ap p re-cia tio n a n d to lera n ce. Th e d isp a rity b etween th e co n seq u en ces o f p h ysica l a ggressio n p er-p etrated by m en an d wom en , as d eer-p icted by a p o sitive co rrela tio n b etween severe vio len ce an d in ju ry wh en th e m an is th e agen t an d a to-ta l la ck o f a sso cia tio n wh en th e wo m a n is th e p erp etrator, also su p p orts th e ad eq u acy of th e ad ap tation p rocess.
Th e p resen t fin d in gs m u st a lso b e exa m -in ed -in th e ligh t of som e op eration al d ecision s th a t h a d to b e m a d e in th e stu d y. First, u n like th e origin al CTS2, con ceived as a self-rep ortin g d evice, th e cu rren t version was ad ju sted to th e th ird p erson for face-to-face in terviews to keep it in lin e with lo ca l p ra ctice. Sin ce litera cy is still n ot u n iversal in Brazil, m ost ep id em iologi-ca l stu d ies ten d to b e co n d u cted u sin g in ter-views. Secon d , in lin e with th e requ irem en ts of th e m a in ca se-co n tro l stu d y, th e reca ll refer-en ce p eriod was n arrowed d own to cover on ly th e m o n th s o f p regn a n cy. Th ird , th e a n a lysis in vo lves exclu sively two level item s (h a p p en ed / d id n ot h ap p en ), again a p ractical con -strain t im p osed by th e fact th at in form ation on violen ce was collected alon g with oth er asp ects as p art of an exten sive, tim e-con su m in g m u lti-d im en sion al q u estion n aire. Th erefore, fu rth er stu d ies u sin g th e origin ally p rop osed form , re-call p eriod , an d scorin g system ou gh t to b e car-ried o u t. In a d d itio n , it wo u ld b e sen sib le to test th e Po rtu gu ese versio n in o th er p o p u la -tion s an d con texts, sin ce th is stu d y is restricted to wom en in th eir first p ostp a rtu m h ou rs a n d con fin ed to p u b lic h ealth services.
As h in ted b efore, an oth er in terestin g d evel-op m en t wou ld b e to in vest in a red u ced ed ition of th e in stru m en t for u se in h ealth
service-re-lated evalu ation s or in m u lti-th em atic in vestigation s requ irin g m u ltid im en sion al qu estion -n a ires. However, p ro p o si-n g a sh o rte-n ed versio n d e m a n d s n e w t ria ls, e sp e cia lly wit h re -gard to p sych om etric evalu ation s an d en tailin g eq u ivalen ce com p arison s with b oth th e origi-n al CTS2 aorigi-n d th e com p lete versioorigi-n . It is worth recallin g th at all efforts sp en t in form ally adap t-in g an t-in stru m en t con ceived t-in an oth er cu ltu r-a l co n text r-a re fu lly rewr-a rd ed b y th e extern r-a l com p arab ility th at p rop erly attu n ed an d valid in stru m en ts p rovid e. Th is is even m ore im p or-tan t in th e field of fam ily violen ce, sin ce m an y gap s still n eed to b e filled , p articu larly in cou n -tries like Brazil, wh ere on ly n ow is th e p rob lem com in g ou t in to th e op en .
At p resen t, th e litera tu re on cross-cu ltu ra l a d a p ta tion m eth od s in th e field of fa m ily vio-len ce is still fu zzy. Even wh ere som e gu id elin es exist, th ere is n o con sen su s as to th e ap p rop ri-a te p roced u res req u ired to ri-a d ri-a p t in stru m en ts to n ew con texts, cu ltu res, or lan gu ages. Strate-gies ran gin g from sim p le tran slation by field re-search ers th em selves to m ore detailed p rocess-es, like th e o n e p ro p o sed b y Herd m a n et a l. (1998), are still u n d er d eb ate. Non eth eless, th is m od el was ch osen b ecau se it is com p reh en sive an d u n am bigu ou sly stresses th e n eed to ap p re-ciate several n u an ces of th e adap tation p rocess. It sh o u ld b e b o rn in m in d th a t it is o n ly o n e am on gst several rou tin es availab le in th e liter-atu re, p articu larly in th e field of Health -Relat-ed Qu a lity o f Life (Gu illem in et a l., 1993; Per-n eger et al., 1999).
Acknowledgments
C. L. M. h a s b een gen ero u sly su p p o rted th ro u gh o u t th e p ro ject b y a resea rch gra n t fro m th e Esco la Na -cio n a l d e Sa ú d e Pú b lica – ENSP (Na tio n a l Sch o o l o f Pu b lic Hea lth )/ Fu n d a çã o Oswa ld o Cru z – FIOCRUZ (Oswa ld o Cru z Fo u n d a tio n ). M. E. R. wa s p a rtia lly fu n d ed by th e Con selh o Nacion al d e Desen volvim en to Cien tífico e Tecn ológico – CNPq (Brazilian Nation -al Research Cou n cil), gran t 300234/ 94-5. Th e au th ors a re a lso th a n kfu l to Ma ria Helen a Ha sselm a n n wh o kin d ly sh a red h er tim e a n d o p in io n s a n d th e field
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Su b m itted on 22 Ju n e 2001
