Development and Psychometric Evaluation of the Provider Confidence in Adolescent Sexual Health (P-CASH) Scale

To develop and psychometrically evaluate the Provider Confidence in Adolescent Sexual Health (P-CASH) Scale and to explore primary care providers' confidence delivering sexual and reproductive health (SRH) care to adolescents.

We developed scale items from a co-design study with adolescent mothers and healthcare professionals. A cross-sectional survey assessed U.S.-based primary care providers' confidence delivering SRH care using a 4-point Likert scale. Psychometric evaluation included exploratory factor analysis (EFA), internal consistency, and internal structure. We compared confidence between pediatric and non-pediatric providers using subscale means in multivariable linear regression.

The sample included 141 providers, primarily White, cisgender women. EFA supported a three-factor model with good fit (RMSR = 0.06): Clinical SRH (STIs, contraception, pregnancy options counseling); Healthy Relationships; and Development and Sexual Activity. Internal consistency was excellent (α = 0.90-0.95), and within-factor inter-item correlations consistently exceeded between-factor correlations, supporting the proposed factor structure. Providers reported the highest confidence in Clinical SRH and the lowest in Development and Sexual Activity. Pediatric providers reported significantly lower confidence than non-pediatric providers across all three subscales.

The P-CASH demonstrates preliminary reliability and validity. Providers, especially pediatric specialists, report uneven confidence delivering SRH care. Research and targeted training are needed to improve provider confidence and SRH care delivery to adolescents.