Adapting the Sexual Relationship Power Scale for HIV/AIDS Research in Malawi

Background: HIV prevention programs in Malawi are starting to consider relationship power in couple-based interventions, however, no local measure of power exists to inform program designs or evaluate their effectiveness. The objective of this study was to develop and evaluate a new measure of relationship power for Malawi by building upon the Sexual Relationship Power Scale (Pulerwitz et al., 2000). Methods: This study employed a sequential, mixed-methods design. Semi-structured interviews (n=34) were conducted separately, but simultaneously, with romantic partners in order to understand hypothesized dimensions of relationship power: decision-making, control, dependence, dominance, communication, trust, and love. Qualitative data were analyzed to create a preliminary pool of scale items, which were pilot tested on men and women (n=254) from three distinct geographical areas. Data were subjected to an exploratory factor analysis with oblique rotation. Associations were tested between the scale and sexual behaviors using the Cuzick test for trend. Results: Factor analysis supported a 16-item power scale with moderate internal consistency (coefficient alpha~0.60) and four sub-scales: autonomy, communication, love and trust, and relationship dominance. Condom use was positively associated with autonomy (p<0.05) and love/trust (p<0.05). Significant correlations were also found between physical abuse and communication (p<0.05) and relationship dominance (p<0.01). Conclusions: The Malawian sexual relationship power scale is the first fully-validated power measure applicable to both married and dating couples and shows promising utility to study sexual behavior around HIV/AIDS. Future studies using larger samples with more diverse power experiences are needed to confirm the reliability and validity of the scale.