Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

A Guttman Scale to Assess Knowledge About Sexually Transmitted Diseases in Adults with Cerebral Palsy


Sexuality issues are a core aspect of human development and still remain a challenging theme for professionals working with people with disabilities. Health literacy, which includes the individual knowledge about Sexually Transmitted Diseases (STDs), is a factor with influence in safe behaviors regarding own sexual living and It assessment is often neglected in services for adults with Cerebral Palsy (CP). The purpose of this study was to develop a simple, easily administered scale to assess the knowledge about STDs for adults with CP, in Portugal. Forty-two participants (28 men, 14 women), aged 18–53 years, with CP were interviewed with a structured questionnaire about sexuality knowledge, where questions about STDs were used as basis for Guttman scale development. From the eighteen items of the questionnaire, 10 were considered as related to STD and a valid Guttman scale containing 8 items was derived (CR = 0.92, MMR = 0.80, CS = 0.61). The median score of the summed items from the developed scale was 6 (IQ1–IQ3 = 5.0–8.0) and the range of correct answers was between 3 and 8. The proportion of correct answers to each question ranged between 97.6 and 47.6 %. The results of this study suggest that it is possible to combine questions that represent diverse aspects of STDs knowledge in an ordered scale and be used in an assessment, including self-administered tools, of adults of CP. This measure is time effective and can be used in with advantages both for health professionals and persons with CP.

This is a preview of subscription content, log in to check access.


  1. 1.

    United Nations: Convention on the rights of persons with disabilities [Internet]. United Nations. http://www.un.org/disabilities/convention/conventionfull.shtml (2006). Cited 2016 Feb 9

  2. 2.

    Jahoda, A., Pownall, J.: Sexual understanding, sources of information and social networks; the reports of young people with intellectual disabilities and their non-disabled peers. J. Intellect. Disabil. Res. 58(5), 430–441 (2014)

  3. 3.

    Wiegerink, D., Roebroeck, M., Bender, J., Stam, H., Cohen-Kettenis, P.: Sexuality of young adults with cerebral palsy: experienced limitations and needs. Sex. Disabil. 29(2), 119–128 (2011)

  4. 4.

    Maart, S., Jelsma, J.: The sexual behaviour of physically disabled adolescents. Disabil. Rehabil. 32(6), 438–443 (2010)

  5. 5.

    Castro-Sanchez, E., Chang, P.W.S., Vila-Candel, R., Escobedo, A.A., Holmes, A.H.: Health literacy and infectious diseases: why does it matter? Int. J. Infect. Dis. 43, 103–110 (2016)

  6. 6.

    Murphy, N., Young, P.C.: Sexuality in children and adolescents with disabilities. Dev. Med. Child Neurol. 47(09), 640–644 (2005)

  7. 7.

    Dukes, E., Mcguire, B.E.: Enhancing capacity to make sexuality related decisions in people with an intellectual disability. J. Intellect. Disabil. Res. 53(8), 727–734 (2009)

  8. 8.

    Colver, A., Fairhurst, C., Pharoah, P.O.D.: Cerebral palsy. Lancet 383(9924), 1240–1249 (2014)

  9. 9.

    Himmelmann, K., Sundh, V.: Survival with cerebral palsy over five decades in western Sweden. Dev. Med. Child Neurol. 57(8), 762–767 (2015)

  10. 10.

    Wiwanitkit, V.: Sexuality and rehabilitation for individuals with cerebral palsy. Sex. Disabil. 26(3), 175–177 (2008)

  11. 11.

    East, L.J., Orchard, T.R.: Somebody Else’s Job: experiences of sex education among health professionals, parents and adolescents with physical disabilities in southwestern ontario. Sex. Disabil. 32(3), 335–350 (2013). doi:10.1007/s11195-013-9289-5

  12. 12.

    Wiegerink, D.J.H.G., Roebroeck, M.E., Donkervoort, M., Cohen-Kettenis, P.T., Stam, H.J.: Social, intimate and sexual relationships of adolescents with cerebral palsy compared with able-bodied age-mates. J. Rehabil. Med. 40(2), 112–118 (2008)

  13. 13.

    Kingsnorth, S., King, G., McPherson, A., Jones-Galley, K.: A retrospective study of past graduates of a residential life skills program for youth with physical disabilities. Child Care Health Dev. 41(3), 374–383 (2015)

  14. 14.

    Alriksson-Schmidt, A., Hagglund, G., Rodby-Bousquet, E., Westbom, L.: Follow-up of individuals with cerebral palsy through the transition years and description of adult life: the Swedish experience. J. Pediatr. Rehabil. Med. 7(1), 53–61 (2014)

  15. 15.

    Wiegerink, D.J.H.G., Roebroeck, M.E., van der Slot, W.M., Stam, H.J., Cohen-Kettenis, P.T.: Importance of peers and dating in the development of romantic relationships and sexual activity of young adults with cerebral palsy. Dev. Med. Child Neurol. 52(6), 576–582 (2010)

  16. 16.

    Thomsen, F.K.: Prostitution, disability and prohibition. J. Med. Ethics 41(6), 451–459 (2015)

  17. 17.

    Earp, B.D., Moen, O.M.: Paying for sex-only for people with disabilities? J. Med. Ethics 42(1), 54–56 (2016)

  18. 18.

    Schei, B., Stigum, H.: A study of men who pay for sex, based on the Norwegian national sex surveys. Scand. J. Public Health 38(2), 135–140 (2010)

  19. 19.

    Samkange-Zeeb, F.N., Spallek, L., Zeeb, H.: Awareness and knowledge of sexually transmitted diseases (STDs) among school-going adolescents in Europe: a systematic review of published literature. BMC Public Health 11, 727 (2011)

  20. 20.

    Neufeld, J.A., Klingbeil, F., Bryen, D.N., Silverman, B., Thomas, A.: Adolescent sexuality and disability. Phys. Med. Rehabil. Clin. N. Am. 13(4), 857–873 (2002)

  21. 21.

    Crow, J.L., Harmeling-van der Wel, B.C.: Hierarchical properties of the motor function sections of the Fugl-Meyer assessment scale for people after stroke: a retrospective study. Phys. Ther. 88(12), 1554–1567 (2008)

  22. 22.

    da Andrada, M.G., Virella, D., Calado, E., Gouveia, R., Alvarelhão, J., Folha, T.: Sistema de Classificação da Função Motora Global - Revisto e Alargado [Internet]. http://motorgrowth.canchild.ca/en/GMFCS/resources/FINALGMFCS-ERwebformat-Portuguese.pdf (2010). Cited 2014 Jun 1

  23. 23.

    Pennington, L., Virella, D., Mjøen, T., da Graça, Andrada M., Murray, J., Colver, A., et al.: Development of The Viking Speech Scale to classify the speech of children with cerebral palsy. Res. Dev. Disabil. 34(10), 3202–3210 (2013)

  24. 24.

    Law, M., Baptiste, S., McColl, M., Opzoomer, A., Polatajko, H., Pollock, N.: The Canadian occupational performance measure: an outcome measure for occupational therapy. Can. J. Occup. Ther. 57(2), 82–87 (1990)

  25. 25.

    Borgatti. Anthropac 4.0. Analytic Technologies, Natic, MA (1996)

  26. 26.

    Adams, S.A., Ashburn, A., Pickering, R.M., Taylor, D.: The scalability of the Rivermead motor assessment in acute stroke patients. Clin. Rehabil. 11(1), 42–51 (1997)

  27. 27.

    Guest, G.: Using Guttman scaling to rank wealth: integrating quantitative and qualitative data. Field Methods 12(4), 346–357 (2000)

  28. 28.

    Pharr, J., Chino, M.: Predicting barriers to primary care for patients with disabilities: a mixed methods study of practice administrators. Disabil. Health J. 6(2), 116–123 (2013)

  29. 29.

    Gothwal, V.K., Wright, T.A., Lamoureux, E.L., Pesudovs, K.: Guttman scale analysis of the distance vision scale. Investig. Ophthalmol. Vis. Sci. 50(9), 4496–4501 (2009)

Download references

Author information

Correspondence to Joaquim Alvarelhão.

Ethics declarations

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Alvarelhão, J., Lopes, D. A Guttman Scale to Assess Knowledge About Sexually Transmitted Diseases in Adults with Cerebral Palsy. Sex Disabil 34, 485–493 (2016). https://doi.org/10.1007/s11195-016-9454-8

Download citation


  • Cerebral palsy adults
  • Guttman scale
  • Sexually transmitted diseases
  • Assessment
  • Portugal