Journal of General Internal Medicine

, Volume 33, Issue 10, pp 1661–1668 | Cite as

Development and Content Validation of a Patient-Reported Sexual Risk Measure for Use in Primary Care

  • Rob J. FredericksenEmail author
  • Kenneth H. Mayer
  • Laura E. Gibbons
  • Todd C. Edwards
  • Frances M. Yang
  • Melonie Walcott
  • Sharon Brown
  • Lydia Dant
  • Stephanie Loo
  • Cristina Gutierrez
  • Edgar Paez
  • Emma Fitzsimmons
  • Albert W. Wu
  • Michael J. Mugavero
  • William C. Mathews
  • William B. Lober
  • Mari M. Kitahata
  • Donald L. Patrick
  • Paul K. Crane
  • Heidi M. Crane
Original Research



Patient-provider sexual risk behavior discussions occur infrequently but may be facilitated by high-quality sexual risk screening tools.


To develop the Sexual Risk Behavior Inventory (SRBI), a brief computer-administered patient-reported measure.


Qualitative item development/quantitative instrument validation.


We developed SRBI items based on patient interviews (n = 128) at four geographically diverse US primary care clinics. Patients were diverse in gender identity, sex, sexual orientation, age, race/ethnicity, and HIV status. We compared sexual risk behavior identified by the SRBI and the Risk Assessment Battery (RAB) among patients (n = 422).


We constructed an item pool based on validated measures of sexual risk, developed an in-depth interview guide based on pool content, and used interviews to elicit new sexual risk concepts. We coded concepts, matched them to item pool content, and developed new content where needed. A provider team evaluated item clinical relevance. We conducted cognitive interviews to assess item comprehensibility. We administered the SRBI and the RAB to patients.

Key Results

Common, clinically relevant concepts in the SRBI included number of sex partners; partner HIV status; partner use of antiretroviral medication (ART)/pre-exposure prophylaxis (PrEP); and recent sex without barrier protection, direction of anal sex, and concern regarding HIV/STI exposure. While 90% reported inconsistent condom use on the RAB, same-day SRBI administration revealed that for over one third, all their partners were on ART/PrEP.


The SRBI is a brief, skip-patterned, clinically relevant measure that ascertains sexual risk behavior across sex, sexual orientation, gender identity, partner HIV serostatus, and partner treatment status, furnishing providers with context to determine gradations of risk for HIV/STI.


sexual risk behavior measurement patient-reported outcomes 



We thank our patients for their time, candor, and insights. This research was funded by a cooperative agreement awarded to the University of Washington (Principal Investigators: D Patrick, H Crane, P Crane) from the National Institute of Allergy and Infectious Diseases (NIAID) and National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) (Grant No. U01 AR057954). Support was also provided by the National Institute of Allergy and Infectious Diseases (NIAID) University of Washington Center for AIDS Research (Grant No. P30 AI027757) and CNICS (R24AI067039) and National Institute of Alcohol Abuse and Alcoholism (NIAAA) (ARCH Grants U01 AA020802, U01 AA020793, and U24AA020801).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.


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Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Rob J. Fredericksen
    • 1
    Email author
  • Kenneth H. Mayer
    • 2
  • Laura E. Gibbons
    • 1
  • Todd C. Edwards
    • 1
  • Frances M. Yang
    • 3
  • Melonie Walcott
    • 4
  • Sharon Brown
    • 1
  • Lydia Dant
    • 2
  • Stephanie Loo
    • 2
  • Cristina Gutierrez
    • 2
  • Edgar Paez
    • 5
  • Emma Fitzsimmons
    • 1
  • Albert W. Wu
    • 6
  • Michael J. Mugavero
    • 4
  • William C. Mathews
    • 5
  • William B. Lober
    • 1
  • Mari M. Kitahata
    • 1
  • Donald L. Patrick
    • 1
  • Paul K. Crane
    • 1
  • Heidi M. Crane
    • 1
  1. 1.Center for AIDS Research University of WashingtonSeattleUSA
  2. 2.Fenway Community HealthBostonUSA
  3. 3.Augusta UniversityAugustaUSA
  4. 4.University of AlabamaBirminghamUSA
  5. 5.University of CaliforniaSan DiegoUSA
  6. 6.Johns Hopkins UniversityBaltimoreUSA

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