Psychometric Evaluation of the Child and Youth Resilience Measure-Revised (CYRM-R) among young mothers affected by HIV in South Africa

Psychometric Evaluation of the Child and Youth Resilience Measure-Revised (CYRM-R) among young mothers affected by HIV in South Africa | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Psychometric Evaluation of the Child and Youth Resilience Measure-Revised (CYRM-R) among young mothers affected by HIV in South Africa Wylene Saal, Vuyolwetu Tibini, Zintle Wanda Mlomo, Morgan Watson, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8862796/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background: Resilience is a core psychological construct linked to well-being and adaptative functioning, yet few resilience measures have been psychometrically validated for use among young people in low and middle-income settings. Adolescent girls and young women (AGYW) in sub-Saharan Africa face intersecting social and health challenges, s, including early and unintended pregnancies and heightened HIV risk, underscoring the need for culturally appropriate and psychometrically sound tools. This study evaluated the psychometric properties of the Child and Youth Resilience Measure-Revised (CYRM-R) within a cohort of young mothers in the Eastern Cape, South Africa. Methods: Data were drawn from 892 young mothers participating in the HEY BABY cohort study (December 2021 and April 2023). Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were used to examine the dimensional structure of the CYRM-R, and internal consistency was assessed to determine reliability. Results: Analyses supported a two-factor structure representing personal resilience and caregiver resilience. This structure remained stable following item reduction from 17 to 15 items, suggesting strong structural integrity. The overall scale demonstrated acceptable reliability (α = .76; Ω = .75). The personal resilience subscale showed moderate reliability (α = .65; Ω = .61), while the caregiver resilience subscale demonstrated stronger internal consistency (α = .72; Ω = .75). Conclusion: The CYRM-R demonstrates acceptable reliability and structural validity among adolescent and young mothers in South Africa. Findings support its use as a contextually appropriate measure of resilience and contribute to the broader evidence base on resilience assessment in low and middle-income settings This scale may be useful for both research and applied psychological settings focused on youth well-being. Resilience CYRM-R adolescent mothers HIV psychometric validation sub-Saharan Africa 1. Background Resilience is increasingly recognized as a critical factor in understanding how adolescents and young people adapt to adversity, particularly in contexts shaped by structural inequality, social exclusion, and chronic stress (Fergus & Zimmerman, 2005). Although resilience is frequently thought of as the capacity to "bounce back" from adversity, more recent definitions present resilience as a dynamic process that involves the interplay between an individual's strengths and the broader systems of support and opportunity around them. (Ungar & Liebenberg, 2011 ; Fergus & Zimmerman, 2005). The social-ecological theory of resilience, as adopted by Theron ( 2020 ) and grounded in the work of Masten (2001), Rutter (2012) and Ungar ( 2011 ), conceptualizes resilience as a complex, multilevel process enabling positive outcomes despite adversity through interactions across ecological systems. These systems include families, peers, communities, and institutions, each of which plays a role in shaping how young people manage adversity and pursue well-being. Among adolescents in low- and middle-income countries (LMICs), resilience is linked to improved mental health, engagement with education, and continuity in healthcare, including antiretroviral therapy (ART) adherence (Betancourt et al., 2013; Kaunda-Khangamwa et al., 2020 ; Theron et al., 2020). However, measuring resilience remains a challenge due to limited availability of validated, context-appropriate tools that are sensitive to linguistic and cultural variations (Masten, 2018; Clark & Watson, 2019). Existing resilience measures are often developed in high-income settings, with limited attention to adaptation in more vulnerable or marginalized groups (Jefferies et al., 2019 ; Brodsky et al., 2021; Liebenberg & Moore, 2018; Panter-Brick, 2015 ). To understand how young mothers deal with these difficulties and to inform the development of strength-based interventions that can support long-term outcomes for young mothers and their children, it is crucial to measure resilience in this population. Additionally, it fills a significant gap in the research by addressing the fact that resilience measures are frequently not tailored for people who are dealing with intertwined structural, emotional, and health problems (Panter-Brick, 2015 ). This study therefore aims to evaluate the psychometric properties of the CYRM-R among young mothers affected by and living with HIV, in South Africa. Specifically, we assess its reliability, construct validity, and contextual relevance within this high-adversity group. Through this work, we are contributing to the refinement of resilience measurement tools and their application in real-world policy and programming for adolescent health. 2. Resilience in Context The understanding of resilience is culturally and contextually situated. In South Africa, resilience among adolescent mothers has been linked to maintaining school attendance and resisting societal pressures amidst stigma and poverty (Groves et al., 2021 ). Ungar et al. (2011; 2020) emphasize that resilience should not only capture individual coping but also access to relational, cultural, and institutional resources. Globally, resilience manifests differently based on contextual stressors. In Tanzania, it is framed as “reproductive resilience” (Obare et al., 2017 ), while in high-income countries like the U.S., resilience reflects a young mother’s capacity to juggle education, housing instability, and parenting (Kennedy et al., 2006 ). These perspectives underline the need for tools like the CYRM-R to be validated and adapted within specific socio-ecological settings. 2.1 Emerging Evidence in South Africa By adapting the Child and Youth Resilience Measure-Revised (CYRM-R) for South Africa, our team has helped close the gap between the understanding of resilience and its cultural application among adolescent girls (Saal et al., 2023 ). The CYRM-R is a 17-item instrument designed to assess resilience among youth aged 10–23, focusing on both personal and caregiver-related resources. In previous work, psychometric testing among a cohort (n = 892) validated the measures' two-factor structure and appropriate reliability (α = 0.75), while cognitive interviews with young mothers helped improve item wording and lessen social desirability bias in earlier work. This work emphasized the importance of culturally grounding resilience measures in the lived realities of South African young mothers. However, resilience remains underexplored in key subpopulations, such as young mothers affected by HIV (Laurenzi et al., 2021; Van Breda, 2018). This group faces layered vulnerabilities, including poor mental health, stigma, socioeconomic marginalization, and limited access to adolescent-friendly services. While much of the literature on resilience has focused on general adolescent populations, there is little empirical work on how young mothers build and sustain resilience while managing early parenthood and HIV-related challenges (Steventon Roberts et al., 2022; Toska et al., 2020 ; Laurenzi et al., 2021; Van Breda, 2018). 2.2 Resilience Measurement Tools A persistent challenge in resilience research is the lack of tools that are both psychometrically sound and culturally appropriate (Masten, 2018). Among widely used measures, the Connor-Davidson Resilience Scale (CD-RISC) was developed for adults but has occasionally been applied to adolescents. It shows high reliability (α = 0.88–0.89) across diverse populations (Dominguez-Cancino et al., 2022 ; López-Fernández et al., 2024) but may not fully capture the developmental and contextual nuances of adolescents in LMICs. The Child and Youth Resilience Measure (CYRM-28) was developed by Ungar and Liebenberg (2009) as a tool tailored to youth aged 10–23. It was later refined into the CYRM-R, a shorter 17-item version that has been tested in more than 10 countries, including South Africa (van Rensburg et al., 2019). The scale contains two subscales: the personal subscale assesses internal and interpersonal strengths, while the caregiver subscale examines access to emotional safety, caregiving, and basic needs (Höltge et al., 2021 ). The CYRM-R can be administered using either a 3-point or 5-point Likert scale, with the 3-point scale offering greater accessibility for participants with limited literacy. Reliability across samples has generally been strong (α ~ 0.82) (Resilience Research Centre, 2011), but further population-specific validation is needed, especially among young mothers facing intersectional vulnerabilities such as HIV and early motherhood. Recent studies have started to fill this gap. For example, Kaunda-Khangamwa et al. ( 2020 ) validated the CYRM-28 among adolescents living with HIV in Malawi, supporting its cross-cultural applicability. Our team’s study builds on this by further exploring the CYRM-R’s utility among South African young mothers, both living with and without HIV. 3. Methods 3.1 Study Design This study used cross-sectional data from the Helping Empower Youth Brought up in Adversity with their Babies and Young Children (HEY BABY) study—a longitudinal cohort of adolescent and young mothers (aged 10–24 years) living in urban, peri-urban, and rural parts of a mixed urban-rural health district in the Eastern Cape Province, South Africa (Toska et al., 2020 ). The baseline study was conducted between March 2018 and July 2019, during which 1,712 adolescent girls and young women were interviewed. Of these, 1,027 participants had given birth before the age of 20—a cut-off that aligns with the World Health Organization and UNICEF definitions of adolescent pregnancy, which classifies adolescents as individuals aged 10–19 years (WHO, 2014; UNICEF, 2021). 3.2 Participant Recruitment The HEY BABY study initially recruited 1,045 young mothers during its first wave (2017–2019). In the follow-up wave (2021–2022), conducted during the COVID-19 pandemic, 892 adolescent mothers (85%) were successfully re-interviewed telephonically. Of the remaining participants, 2.2% declined participation, 11.3% were untraceable, and 0.9% had died (Toska et al., 2022 ). At follow-up, participants living with HIV were older on average (M = 23.2 years, SD = 2.2) than those not living with HIV (M = 21.5 years, SD = 1.8). Those re-interviewed were more likely to reside in urban areas and less likely to live in informal housing. No significant differences were found between HIV status groups in terms of housing conditions, relationship status, or overall resilience scores (Toska et al., 2022 ). A multi-strategy sampling approach was used to recruit adolescent mothers, living with and without HIV, alongside a comparison group of adolescents who had never given birth but shared similar demographic profiles. Recruitment methods were co-developed with an advisory group of adolescent mothers to ensure inclusion of hard-to-reach participants. Six parallel recruitment strategies were employed: (1) Health facilities (n = 73), where patient files were reviewed to identify adolescents who had initiated HIV treatment (97% enrolment); (2) Maternity obstetric units (n = 9), where adolescent mothers were identified through nurses and community healthcare workers (95% enrolment); (3) District secondary schools (n = 43), where adolescent girls who had recently given birth or dropped out due to pregnancy were approached (98% enrolment); (4) Neighbour referrals, including girls demographically matched to participants, to reduce stigma; (5) Referrals from social workers and NGOs, targeting highly vulnerable adolescent mothers (n = 95; 100% enrolment); (6) Community-based referrals, where adolescent mothers recruited peers with limited access to formal healthcare (n = 51; 100% enrolment). To ensure the appropriateness of data collection tools, all study questionnaires were piloted with 25 adolescents living with HIV (ALHIV) and 9 young mothers some of whom are living with HIV. Voluntary informed consent was obtained from all participants. Participants under the age of 18 provided written informed and voluntary assent, in addition to written informed consent from their parent or caregiver. Ethical approval was granted by the University of Cape Town and the University of Oxford (R48876/RE001; R48876/RE002; HREC REF: 226/2017), as well as the Eastern Cape Departments of Health and Basic Education. All questionnaires and consent forms were translated into isiXhosa, one of the most widely spoken languages in the province. 4. Measures 4.1 Sociodemographic factors Sociodemographic factors: These included adolescent age [categorized as younger (ages 10–14) and older (ages 15–19)], current relationship, and housing type (formal or informal). 4.2 The Child and Youth Resilience Measure-Revised (CYRM-R) The CYRM-R scale is a 17-item measure of resilience among adolescents and young people. The scale has two subscales, namely the personal subscale (n = 10) which includes intrapersonal and interpersonal-related items connected to internal skills and environmental resources such as peers or schools (Höltge et al., 2021 ). The caregiver resilience subscale (n = 7) focuses on traits such as safety, support, and nutrition that are linked to significant relationships with a family member or primary caregiver. The CYRM-R has demonstrated strong internal consistency, with Cronbach’s alpha values ranging between 0.80 and 0.90 across various cultural and linguistic adaptations (Höltge et al., 2021 ). Equally, Höltge et al. ( 2021 ) confirmed the two-factor structure and measurement invariance across gender and country contexts in a large cross-national study including youth from Germany, South Africa, and Canada. The scale is noted for its flexibility and cultural sensitivity, making it suitable for use in low-resource and high-adversity settings. 5. Data Analyses The psychometric analysis was all conducted in STATA 15. First, descriptive statistics of all associated variables were computed to determine the frequencies, means, and standard deviations. Secondly, scale reliability was assessed using Cronbach’s alpha and McDonald’s omega coefficients to evaluate the internal consistency of the outcome variable. Cronbach’s alpha, a widely used reliability estimate, assumes tau equivalence that all items contribute equally to the underlying construct. An assumption that is often violated in practice (Widhiarso & Ravand 2022). In contrast, McDonald’s omega offers a more accurate assessment of dependability by accommodating varying item loadings, rendering it more appropriate for scales where items are not uniformly associated with the latent trait (Brusco & Sella, 2022). Utilizing both measurements facilitates a more thorough and dependable assessment of internal consistency. Both the Cronbach's alpha and McDonald's omega > 0.70 indicate internal consistency (Field, 2000; Bonniga and Saraswathi, 2020). Thirdly, the Kaiser–Meyer–Olkin (KMO) measure and Bartlett's test of sphericity were used to test the suitability of the data to conduct factor analysis (Govender et al., 2017). A KMO closer to 1.0 confirms the feasibility of factor analysis (Acock, 2013; Pritzker and Minter, 2014). To improve the robustness and generalizability of the factor structure, we randomly divided the complete sample into two equal halves (50%), in accordance with the methodology suggested by Brown (2015). This split-sample technique facilitates independent exploratory and confirmatory analyses, reducing the probability that results are influenced by sample-specific peculiarities and enhancing the model's stability across subsamples. Fifth, we conducted an exploratory factor analysis (EFA) with orthogonal rotations to assess the factor structure of the resilience measurement scale and ensure that all items in the scale measured resilience as an underlying construct (Langham et al., 2018), using the calibration subsample (n = 441). The EFA also aimed to determine the number of factors in the adapted CYRM-R measure. Eigenvalues above 1 (Kaiser criterion) and a scree plot was generated to confirm the results of the EFA by visually inspecting the point where the eigenvalues start to level off, indicating the number of factors to retain (Cattell, 1966 ). The scale items had less than 10% missing data, which means that the risk of bias in the Exploratory Factor Analysis (EFA) has been minimized (Graham, 2009 ). With minimal missing data, factor structure validity is maintained (Graham, 2009 ), allowing for a reliable and interpretable resilience measurement in young mothers. Next, using the validation subsample (n = 423), confirmatory factor analysis (CFA) was conducted to validate the factor structure obtained through the EFA and to test whether the data fit the hypothesized measurement model. Items with factor loadings values of 0.32 and below were removed from the scale (Comfrey & Lee, 1992). Finally, goodness-of-fit tests, including indices such as the Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Root Mean Square Error of Approximation (RMSEA), and Standardized Root Mean Square Residual (SRMR), were used to assess how well the model fit the data. Following the guidelines by Hu and Bentler (1999), model fit was considered acceptable with CFI and TLI values ≥ 0.95, RMSEA ≤ 0.06, and SRMR ≤ 0.08. 6. Results 6.1 Sociodemographic Factors A total of n = 892 adolescent mothers in the HEY BABY study was re-interviewed (2.20% refusal, 11.29% could not be traced, 0.86% mortality) at follow-up (2021–2022). Baseline sociodemographic factors are reported elsewhere (Toska et al., 2022 ). Table 1 shows the characteristics of the participants involved in the study at follow-up, disaggregated by HIV status. Participants ranged in age from 16 to 29 years, with adolescent mothers living with HIV being older on average (M = 23.3, SD = 2.2) than those not living with HIV (M = 21.5, SD = 1.8), a statistically significant difference ( p ≤ .001). Resilience scores ranged from 25 to 85, with similar mean scores across groups: 70.0 (SD = 9.8) for HIV-negative participants and 71.5 (SD = 9.5) for those living with HIV ( p = .555). No statistically significant group differences were found in informal housing status or current relationship status 6.2 Exploratory Factor Analyses (EFA) of the CYRM Scale. Bartlett’s test of sphericity was significant, χ² (df ) = 2,356.31, p < .001, indicating sufficient correlations among the variables to justify the use of factor analysis. The Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy was .79, exceeding the recommended threshold of .50, thereby confirming that the sample was appropriate for conducting an exploratory factor analysis (EFA). Exploratory factor analysis (EFA) was conducted on the calibration subsample to examine the underlying structure of the data. An initial analysis was run to obtain eigenvalues for each of the components. Orthogonal varimax rotation was applied to maintain uncorrelated (independent) factors, which is advantageous for interpretability (Kieffer, 1998 ). The results indicated that two factors exceeded the eigenvalue threshold of 1.00 and were therefore retained (see Supplementary File 01. This decision was supported by the scree plot (Ledesma et al., 2015 ) (see Supplementary File 02). The two extracted factors jointly explained approximately 100% of the total variance, suggesting that the scale effectively captures key aspects of resilience. Factor 1 contributed more to the overall variance (60.94%) than Factor 2 (41.45%), indicating that it is the dominant factor. Items were loaded onto a two-factor EFA model. Table 2 presents the factor loadings, which ranged from .01 to .73 for Factor 1, and from .04 to .65 for Factor 2. 6.3 Confirmatory Analysis (CFA) of CYRM-Scale Confirmatory factor analysis (CFA) was conducted on the validation subsample ( n = 423). Two items were removed as they did not meet the factor loading cut-off of .30 (Ding et al., 2024): “Getting an education is important to me” and “I know how to behave/act in different situations.” This reduced the CYRM-R from a 17-item scale to a 15-item scale. Table 3 presents the CFA results. The analysis confirmed the hypothesized two-factor structure of resilience, comprising two latent variables: personal resilience and caregiver resilience. All observed variables (CYRM-R items) significantly loaded onto their respective latent factors ( p < .001), supporting the validity of the measurement model. The estimated correlation between the personal and caregiver subscales was = .46 ( p < .001), indicating a moderate positive relationship between personal resilience and caregiver support among young mothers. 6.4 Goodness of Fit Results Model fit statistics demonstrated mixed support for the two-factor structure. The root mean square error of approximation (RMSEA) was .075, and the standardized root mean square residual (SRMR) was .06, both being within acceptable limits. The comparative fit index (CFI = .79) and Tucker-Lewis index (TLI = .75) were below the suggested threshold of .95. The chi-square statistic was significant, χ²(df) = 1,124.26, p < .001. The results indicate that although the model demonstrates satisfactory absolute fit (as evidenced by RMSEA and SRMR), the incremental fit indices (CFI and TLI) suggest that the two-factor structure inadequately represents the underlying data structure. This suggests that the CYRM-R may need more modification to effectively align with the context of young mothers in this sample. 6.5 Reliability Reliability analysis of the original 17-item scale yielded a Cronbach’s alpha of α = .76 and McDonald’s omega of Ω = .75, indicating acceptable internal consistency. Following the revision of the CYRM-R to 15 items, the overall reliability showed minimal change, with α = .75 and Ω = .74. The personal resilience subscale initially produced a Cronbach’s alpha of α = .65 and McDonald’s omega of Ω = .64. After the number of items was reduced from 10 to 8, reliability decreased slightly to α = .64 and Ω = .62. The caregiver resilience subscale remained consistent across versions, with α = .72 and Ω = .75. Table 1 Sociodemographic characteristics of included participants by HIV status ( n = 892). Follow-up sociodemographic factors Adolescent mothers not living with HIV ( n = 634) Adolescent mother living with HIV ( n = 258) Total ( n = 892) p-value m (SD) m (SD) m (SD)**** Age in years [range 16–29] 21.5 (1.8) 23.3 (2.2) 22.0 (2.1) ≤ 0.001*** Missing value n = 22 Informal housing 187 (29.5%) 59 (25.2%) 246 (28.3%) 0.219 Missing value n = 23 Current relationship 362 (57.0%) 149 (64.0%) 511 (58.9%) 0.066 Missing value n = 24 Resilience [25–85] 70.0 (9.8) 71.5 (9.5) 70.4 (9.8) 0.555 Missing value n = 28 Note . *p < 0.05 **p < 0.01 ***p < 0.001 **** Mean & Standard Deviation Table 2 Exploratory Factor Analysis ( n = 441) Variable Factor 1 Factor 2 I get along with people around me 0.1912 0.3739 Getting an education is important to me 0.2132 0.0467 I know how to behave/act in different situations 0.0242 0.1364 My parent(s)/caregiver(s) really look out for me 0.6713 0.0444 My parent(s)/caregiver(s) know a lot about me 0.4561 0.1233 If I am hungry, there is enough to eat 0.4097 0.2048 People like to spend time with me 0.1609 0.4335 I talk to my family/caregiver(s) about how I feel 0.4105 0.1395 I feel supported by my friends 0.0420 0.6360 I feel that I belong/belonged at my school 0.2656 0.3637 My family/caregiver(s) care about me when times are hard 0.7341 0.0401 My friends care about me when times are hard 0.0123 0.6464 I am treated fairly in my community 0.2289 0.3774 I have chances to show others that I am growing up and I can do things by myself 0.1910 0.3345 I feel safe when I am with my family/caregiver(s) 0.6691 0.00819 I have chances to learn things that will be useful when I’m older 0.2407 0.1159 I like the way my family/caregivers celebrate things 0.4045 0.0747 Note . Factor 1= ; Factor 2==. Table 3 Confirmatory Factor Analysis (n = 423) CYRM-R Subscale Personal Resilience Caregiver Resilience Item: β SE β SE I get along with people around me 0.387 0.059 People like to spend time with me 0.405 0.054 I feel supported by my friends 0.501 0.061 I feel that I belong/belonged at my school 0.519 0.051 My friends care about me when times are hard 0.509 0.062 I am treated fairly in my community 0.437 0.054 I have chances to show others that I am growing up and I can do things by myself 0.335 0.057 I have chances to learn things that will be useful when I am older 0.318 0.057 My parent(s)/caregiver(s) really look out for me 0.702 0.034 My parent(s)/caregiver(s) know a lot about me 0.567 0.041 If I am hungry, there is enough to eat 0.406 0.048 I talk to my family/caregiver(s) about how I feel 0.470 0.045 My family/caregiver(s) care about me when times are hard 0.694 0.034 I feel safe when I am with my family/caregiver(s) 0.573 0.040 I like the way my family/caregivers celebrate things 0.397 0.048 Note . β = coefficient; SE = standard error. p < .05 for all coefficients. Model fit: RMSEA = .075; CFI/TLI = .790/.752 χ 2 (df) = 1124.262; SRMR = .06 7. Discussion In this paper, we aim to evaluate the psychometric properties of the CYRM-R scale to determine how effectively it measures resilience among adolescents and young mothers in the Eastern Cape, South Africa. Exploratory factor analysis revealed a two-factor structure comprising personal and caregiver resilience. This two-factor solution is consistent with findings from previous studies conducted in similar contexts (Cluver et al., 2016, 2021; Kim et al., 2020; Jeffreyset al., 2019; Pantelic et al., 2015; Rochat et al., 2017), supporting the conceptual separation of internal strengths and relational support in resilience measurement. The first factor, personal resilience, captures individual and interpersonal capacities such as social support, adaptability, and a sense of belonging (Ungar, 2011 ; Ungar & Liebenberg, 2011 , 2013). These factors are vital for young mothers who must manage the emotional and psychological challenges of living with HIV while raising children (Cluver et al., 2021; Laurenzi et al., 2020). The second factor, caregiver resilience, emphasizes external support such as safety, food security, and family traditions, which play a crucial role in creating a stable and nurturing environment for these mothers and their children (Ungar & Liebenberg, 2011 , 2013). These supports are particularly important for young mothers affected by HIV, as they help buffer against adversity and promote well-being (Betancourt, Meyers-Ohki, Charrow, & Hansen, 2013; Laurenzi et al., 2023 ). The confirmatory analysis validated the two-factor structure identified in the exploratory factor analysis, with significant loadings for both latent constructs. Personal resilience showed strong associations with items reflecting social connections, such as ‘belonging’ and ‘friends caring’. These findings highlight the importance of interpersonal relationships in fostering resilience among young mothers (Jefferies et al., 2019 ). Caregiver resilience had robust loadings for variables such as ‘hard times’ and ‘look out’, emphasizing the role of caregiving structures in providing safety and stability (Jefferies et al., 2019 ; Liebenberg et al., 2012 ). The moderate fit indices in CFA suggest that while the CYRM-R scale effectively captures resilience, further refinements could enhance its precision. The Root Mean Squared Error of Approximation and Standardized Root Mean Square Residual indicate acceptable error levels, suggesting that the model aligns moderately well with the data (Bedi & Bhale, 2023 ). However, the Comparative Fit Index and Tucker-Lewis Index fall below the ideal threshold of 0.90, indicating limited comparative fit (Bedi & Bhale, 2023 ). Resilience in young mothers living with HIV is strongly influenced by external support systems, with high factor loadings for caregiver relationships emphasizing the crucial role of family, peer networks, and a sense of belonging (Laurenzi et al., 2023 ; Roberts et al., 2022; Saal et al., 2023 ). Given the moderate correlation between personal and caregiver resilience, interventions should not only focus on individual resilience-building but also strengthen family and caregiver support systems (Anandan et al., 2023). The reliability analyses demonstrate variation in the internal consistency of the two subscales. The 8-item personal resilience subscale showed acceptable reliability, although low (α = .64, Ω = .62), while the 7-item caregiver resilience subscale performed more strongly, with reliability coefficients of α = .72 and Ω = .75. Compared to Ding et al. (2024), who reported lower reliability for the personal resilience subscale in a reduced 14-item CYRM-R version (α = .63, Ω = .63), the current study yielded slightly higher reliability estimates (α = .65, Ω = .64) for the personal subscale in our 15-item version. Similarly, the caregiver subscale in our study showed stronger internal consistency than the reliability coefficients reported by Ding et al. (2024) (α = .62, Ω = .62). While the overall reliability in the current study (α = .75) was lower than that reported by Anandan et al. (2023) (α = .92) for their adapted 15-item scale, our findings remain within acceptable thresholds for psychological scales, particularly in diverse and vulnerable populations. Anandan et al. (2023) also reported higher subscale alphas (α = .90 for personal and α = .84 for caregiver), suggesting that further refinement of the personal resilience items may enhance internal consistency. Nonetheless, the caregiver subscale in our study demonstrates solid reliability, indicating it is a well-performing component of the CYRM-R in this population. These findings align with prior literature suggesting that caregiver-related resilience tends to be more stable, while personal resilience may require contextual adaptation (Larsen & Warne, 2010). Personal resilience, represented by social support and self-efficacy, helps mothers navigate the dual burden of caregiving and managing their health (Fayombo, 2010 ; Saal et al., 2023 ; Sanders et al., 2017). Caregiver resilience, reflected in external supports like food security and a sense of safety, provides the stability necessary for them to thrive. Together, these dimensions offer a holistic understanding of the resilience processes in this vulnerable population health (Fayombo, 2010 ; Saal et al., 2023 ; Sanders et al., 2017). 7.1 Limitations and recommendations for future research While the CYRM provides valuable insights, it has limitations in fully capturing the unique experiences of young mothers living with HIV. The 8-item personal resilience subscale demonstrated suboptimal reliability, suggesting that some items may not be suited for this group. In this study, the young mothers’ resilience within relationships was not measured. However, a set of items to examine the relationship between young women living with HIV and their romantic or sexual partners, or the father of the child (if he was not her current romantic or sexual partner), was developed using the CYRM-R questions as a guide. Additionally, because the measure was validated among young mothers who speak isiXhosa in the Eastern Cape, South Africa, its generalizability may be restricted. Future research should focus on refining the CYRM-R to better reflect the resilience pathways of young mothers living with HIV. This includes revising items with low reliability and adding culturally relevant items that address unique challenges, such as stigma, treatment adherence, and mental health (Jefferies, McGarrigle, & Ungar, 2018; Resilience Research Centre, 2022). Validation studies across diverse populations and settings are essential to ensure the scale’s generalizability and effectiveness (Ungar & Liebenberg, 2011 ). Further, qualitative research could complement quantitative analyses by exploring resilience processes in-depth, providing richer insights into how young mothers navigate and build resilience in the face of adversity. Furthermore, mixed-method approaches need to be used to investigate the experiences of resilience among mothers affected by and living with HIV (Ungar & Liebenberg, 2011 ). Our findings resonate with Groves et al. ( 2021 ), who emphasized the role of caregiver and school-based supports in shaping resilience for adolescent mothers in KwaZulu-Natal. Resilience among young mothers living with HIV appears especially dependent on family safety, food security, and community belonging (Laurenzi et al., 2023 ; Saal et al., 2023 ). The efficacy of resilience-focused programming and the transition from risk-centered to resilience-building paradigms of program design and delivery can be greatly influenced using accurate and reliable resilience measures, such as the CYRM-R, to measure resilience among young mothers affected by HIV (Toska et al., 2020 ). 8. Conclusions The CYRM-R demonstrates acceptable psychometric performance among young mothers affected by HIV in South Africa. However, further refinements, especially to the personal subscale are warranted to improve its sensitivity to the unique challenges faced by this group. Strengthening resilience-based interventions that incorporate both internal and external dimensions can significantly improve adolescent maternal well-being, mental health, and HIV care retention. Abbreviations AGYW Adolescent girls and young women ALHIV Adolescents living with HIV ART Antiretroviral therapy CFA Confirmatory factor analysis CFI Comparative Fit Index COVID-19 Coronavirus disease 2019 CYRM Child and Youth Resilience Measure CYRM-28 28-item Child and Youth Resilience Measure CYRM-R Child and Youth Resilience Measure–Revised EFA Exploratory factor analysis HEY BABY Helping Empower Youth Brought up in Adversity with their Babies and Young Children study HIV Human immunodeficiency virus KMO Kaiser–Meyer–Olkin measure of sampling adequacy LMICs Low- and middle-income countries M Mean NGO Non-governmental organization RMSEA Root Mean Square Error of Approximation SD Standard deviation SEM Structural equation modelling SRMR Standardized Root Mean Square Residual TLI Tucker–Lewis Index WHO World Health Organization Declarations Ethics approval and consent to participate Ethical approval was granted by the University of Cape Town and the University of Oxford (R48876/RE001; R48876/RE002; HREC REF: 226/2017), as well as the Eastern Cape Departments of Health and Basic Education. Voluntary informed written consent was obtained from all participants. Participants under the age of 18 provided written informed and voluntary assent, in addition to written informed consent from their parent or caregiver. Consent for publication Not applicable Availability of data and materials All research data will be made available on request subject to participant consent and having completed all necessary documentation. All data requests should be sent to [email protected] or to the Principal Investigators (https://www.heybaby.org.za/contact). Data will be made available on an open platform in 2027, following study data sharing protocols. Competing interests The authors have no competing interests to declare. Funding The HEY BABY Study is funded by the European Research Council under the European Union’s Horizon 2020 research and innovation programme (no 771468); the UK Medical Research Council and the UK Department for International Development under the MRC/DFID Concordat agreement, and by the Department of Health and Social Care through its National Institutes of Health Research (MR/R022372/1); the UKRI GCRF Accelerating Achievement for Africa's Adolescents (Accelerate) Hub (ES/S008101/1); a CIPHER grant from International AIDS Society (2018/625-TOS); Research England (0005218); UCL's HelpAge funding; Oak Foundation (OFIL-20-057) and UNICEF Eastern and Southern Africa Regional Office (UNICEF-ESARO). Additional funding received from: The Horowitz Foundation for Social Policy; Nuffield Foundation (CPF/41513). Further funding is provided by the National Research Foundation: Human and Social Dynamics for Development 2022 (136531) and the Fogarty International Center, National Institute on Mental Health, National Institutes of Health under Award Number K43TW011434 Authors’ contributions Conceptualisation: W.S.; Methodology: W.S., V.T.; Formal analysis: W.S., V.T.; Writing – original draft: V.T., W.S.; Writing – review and editing: all authors. All authors have read and approved the final manuscript. Acknowledgements This research would not have been possible without the contributions of the young mothers who shared their thoughts and lives, and the research team who persisted in collecting the data during the COVID-19 pandemic. We are humbled by your openness. The authors thank Dr Marija Pantelic and Ms Mildred Thabeng for sharing their approach on cognitive interviewing and Profs Lucie Cluver, Don Operario, Cathy Mathews and Abigail Harrison for their mentorship. 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The relationship between personality traits and psychological resilience among Caribbean adolescents. International Journal of Psychological Studies, 2 (2), 105–115. https://doi.org/10.5539/ijps.v2n2p105 George, G., Beckett, S., Reddy, T., Govender, K., Cawood, C., Khanyile, D., & Kharsany, A. B. M. (2022). Role of schooling and comprehensive sexuality education in reducing HIV and pregnancy among adolescents in South Africa. Journal of Acquired Immune Deficiency Syndromes, 90 (3), 270–275. https://doi.org/10.1097/QAI.0000000000002951 Graham, J. W. (2009). Missing data analysis: Making it work in the real world. Annual Review of Psychology, 60,549-576. https://doi.org/10.1146/annurev.psych.58.110405.085530 Groves, A. K., Madhavan, S., Cluver, L., Operario, D., & Maman, S. (2021). Resilience and the transition to motherhood among adolescents in South Africa. Global Public Health, 16 (8–9), 1235–1248. https://doi.org/10.1080/17441692.2021.1970208 Harrison, A., Colvin, C. J., Kuo, C., Swartz, A., & Lurie, M. (2015). Sustained high HIV incidence in young women in Southern Africa: Social, behavioral, and structural factors and emerging intervention approaches. Current HIV/AIDS Reports, 12 (2), 207–215. https://doi.org/10.1007/s11904-015-0261-0 Höltge, J., Theron, L., Cowden, R. G., Govender, K., Maximo, S. I., Carranza, J. S., Kapoor, B., Tomar, A., van Rensburg, A., Lu, S., Hu, H., Cavioni, V., Agliati, A., Grazzani, I., Smedema, Y., Kaur, G., Hurlington, K. G., Sanders, J., Munford, R., ... Ungar, M. (2021). A cross-country network analysis of adolescent resilience. Journal of Adolescent Health, 68 (5), 852–859. https://doi.org/10.1016/j.jadohealth.2020.07.010 Hubacher, D., Mavranezouli, I., & McGinn, E. (2008). Unintended pregnancy in sub-Saharan Africa: Magnitude of the problem and potential role of contraceptive implants to alleviate it. Contraception, 78 (1), 73–78. https://doi.org/10.1016/j.contraception.2008.03.002 Jefferies, P., McGarrigle, L., & Ungar, M. (2019). The CYRM-R: A Rasch-validated revision of the Child and Youth Resilience Measure. Journal of Evidence-Based Social Work, 16 (1), 70–92. https://doi.org/10.1080/23761407.2018.1548403 Kaunda-Khangamwa, B. N., Kapwata, P., Malisita, K., Munthali, A., Chipeta, E., Phiri, S., & Manderson, L. (2020). Adolescents living with HIV, complex needs, and resilience in Blantyre, Malawi. AIDS Research and Therapy, 17 , 35. https://doi.org/10.1186/s12981-020-00292-1 Kennedy, A. C., Bybee, D., Sullivan, C. M., & Greeson, M. R. (2006). The impact of family and community violence on children's depression trajectories: A community-based longitudinal study. Journal of Community Psychology, 34 (5), 559–576. https://doi.org/10.1002/jcop.20115 Kieffer, K. M. (1998). Orthogonal versus oblique factor rotation: A review of the literature regarding the pros and cons. ERIC . https://eric.ed.gov/?id=ED427031 Laurenzi, C., Ronan, A., Phillips, L., Nalugo, S., Mupakile, E., Operario, D., & Toska, E. (2023). Enhancing a peer supporter intervention for young mothers living with HIV in Malawi, Tanzania, Uganda, and Zambia: Adaptation and co-development of a psychosocial component. Global Public Health, 18 (1), 2081711. https://doi.org/10.1080/17441692.2022.2081711 Ledesma, R. D., Valero-Mora, P., & Macbeth, G. (2015). The scree test and the number of factors: A dynamic graphics approach. The Spanish Journal of Psychology, 18 , E11. https://doi.org/10.1017/sjp.2015.13 Liebenberg, L., Ungar, M., & van de Vijver, F. J. R. (2012). Validation of the Child and Youth Resilience Measure-28 (CYRM-28) among Canadian youth. Research on Social Work Practice, 22 (2), 219–226. https://doi.org/10.1177/1049731511428619 Masten, A. S. (2014). Global perspectives on resilience in children and youth. Child Development, 85 (1), 6–20. https://doi.org/10.1111/cdev.12205 Obare, F., Birungi, H., & Undie, C. C. (2017). Reproductive resilience among adolescents in Kenya and Tanzania: A case study of unintended pregnancy. African Journal of Reproductive Health, 21 (3), 49–60. https://doi.org/10.29063/ajrh2017/v21i3.6 Panter-Brick, C. (2015). Culture and resilience: Next steps for theory and practice. Youth & Society, 47 (4), 528–547. https://doi.org/10.1177/0044118X15593547 Saal, W., Thomas, A., Laurenzi, C., Mangqalaza, H., Kelly, J., Tolmay, J., Tibini, V., & Toska, E. (2023). Resilience among young mothers affected by HIV in South Africa: Adaptations and psychometric properties of the Child and Youth Resilience Measure-Revised (CYRM-R) in a large cohort. SSM - Mental Health, 4 , 100285. https://doi.org/10.1016/j.ssmmh.2023.100285 Theron, L. (2020). Towards a culturally and contextually sensitive understanding of resilience: Privileging the voices of Black, South African young people. Transcultural Psychiatry, 57 (4), 588–598. https://doi.org/10.1177/1363461520938916 Toska, E., Saal, W., Charles, J. C., Wittesaele, C., Langwenya, N., Jochim, J., Roberts, K. J. S., Anquandah, J., Banougnin, B. H., Laurenzi, C., Sherr, L., & Cluver, L. (2022). Achieving the health and well-being Sustainable Development Goals among adolescent mothers and their children in South Africa: Cross-sectional analyses of a community-based mixed HIV-status cohort. PLOS ONE, 17 (1), e0278163. https://doi.org/10.1371/journal.pone.0278163 Toska, E., Cluver, L., Laurenzi, C. A., Wittesaele, C., Sherr, L., Zhou, S., & Langwenya, N. (2020). Reproductive aspirations, contraception use, and dual protection among adolescent girls and young women: The effect of motherhood and HIV status. Journal of the International AIDS Society, 23 (1), e25558. https://doi.org/10.1002/jia2.25558 Ungar, M., & Liebenberg, L. (2011). Assessing resilience across cultures using mixed methods: Construction of the Child and Youth Resilience Measure. Journal of Mixed Methods Research, 5 (2), 126–149. https://doi.org/10.1177/1558689811400607 Additional Declarations No competing interests reported. Supplementary Files SupplementaryFilesCYRMpsychometric.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 19 Apr, 2026 Reviewers agreed at journal 14 Apr, 2026 Reviewers agreed at journal 15 Mar, 2026 Reviewers agreed at journal 08 Mar, 2026 Reviewers invited by journal 03 Mar, 2026 Editor assigned by journal 03 Mar, 2026 Editor invited by journal 23 Feb, 2026 Submission checks completed at journal 23 Feb, 2026 First submitted to journal 23 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Background","content":"\u003cp\u003eResilience is increasingly recognized as a critical factor in understanding how adolescents and young people adapt to adversity, particularly in contexts shaped by structural inequality, social exclusion, and chronic stress (Fergus \u0026amp; Zimmerman, 2005). Although resilience is frequently thought of as the capacity to \"bounce back\" from adversity, more recent definitions present resilience as a dynamic process that involves the interplay between an individual's strengths and the broader systems of support and opportunity around them. (Ungar \u0026amp; Liebenberg, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Fergus \u0026amp; Zimmerman, 2005). The social-ecological theory of resilience, as adopted by Theron (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) and grounded in the work of Masten (2001), Rutter (2012) and Ungar (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2011\u003c/span\u003e), conceptualizes resilience as a complex, multilevel process enabling positive outcomes despite adversity through interactions across ecological systems. These systems include families, peers, communities, and institutions, each of which plays a role in shaping how young people manage adversity and pursue well-being.\u003c/p\u003e \u003cp\u003eAmong adolescents in low- and middle-income countries (LMICs), resilience is linked to improved mental health, engagement with education, and continuity in healthcare, including antiretroviral therapy (ART) adherence (Betancourt et al., 2013; Kaunda-Khangamwa et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Theron et al., 2020). However, measuring resilience remains a challenge due to limited availability of validated, context-appropriate tools that are sensitive to linguistic and cultural variations (Masten, 2018; Clark \u0026amp; Watson, 2019). Existing resilience measures are often developed in high-income settings, with limited attention to adaptation in more vulnerable or marginalized groups (Jefferies et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Brodsky et al., 2021; Liebenberg \u0026amp; Moore, 2018; Panter-Brick, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo understand how young mothers deal with these difficulties and to inform the development of strength-based interventions that can support long-term outcomes for young mothers and their children, it is crucial to measure resilience in this population. Additionally, it fills a significant gap in the research by addressing the fact that resilience measures are frequently not tailored for people who are dealing with intertwined structural, emotional, and health problems (Panter-Brick, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study therefore aims to evaluate the psychometric properties of the CYRM-R among young mothers affected by and living with HIV, in South Africa. Specifically, we assess its reliability, construct validity, and contextual relevance within this high-adversity group. Through this work, we are contributing to the refinement of resilience measurement tools and their application in real-world policy and programming for adolescent health.\u003c/p\u003e"},{"header":"2. Resilience in Context","content":"\u003cp\u003eThe understanding of resilience is culturally and contextually situated. In South Africa, resilience among adolescent mothers has been linked to maintaining school attendance and resisting societal pressures amidst stigma and poverty (Groves et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Ungar et al. (2011; 2020) emphasize that resilience should not only capture individual coping but also access to relational, cultural, and institutional resources.\u003c/p\u003e \u003cp\u003eGlobally, resilience manifests differently based on contextual stressors. In Tanzania, it is framed as \u0026ldquo;reproductive resilience\u0026rdquo; (Obare et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), while in high-income countries like the U.S., resilience reflects a young mother\u0026rsquo;s capacity to juggle education, housing instability, and parenting (Kennedy et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). These perspectives underline the need for tools like the CYRM-R to be validated and adapted within specific socio-ecological settings.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Emerging Evidence in South Africa\u003c/h2\u003e \u003cp\u003eBy adapting the Child and Youth Resilience Measure-Revised (CYRM-R) for South Africa, our team has helped close the gap between the understanding of resilience and its cultural application among adolescent girls (Saal et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The CYRM-R is a 17-item instrument designed to assess resilience among youth aged 10\u0026ndash;23, focusing on both personal and caregiver-related resources. In previous work, psychometric testing among a cohort (n\u0026thinsp;=\u0026thinsp;892) validated the measures' two-factor structure and appropriate reliability (α\u0026thinsp;=\u0026thinsp;0.75), while cognitive interviews with young mothers helped improve item wording and lessen social desirability bias in earlier work. This work emphasized the importance of culturally grounding resilience measures in the lived realities of South African young mothers. However, resilience remains underexplored in key subpopulations, such as young mothers affected by HIV (Laurenzi et al., 2021; Van Breda, 2018). This group faces layered vulnerabilities, including poor mental health, stigma, socioeconomic marginalization, and limited access to adolescent-friendly services. While much of the literature on resilience has focused on general adolescent populations, there is little empirical work on how young mothers build and sustain resilience while managing early parenthood and HIV-related challenges (Steventon Roberts et al., 2022; Toska et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Laurenzi et al., 2021; Van Breda, 2018).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Resilience Measurement Tools\u003c/h2\u003e \u003cp\u003eA persistent challenge in resilience research is the lack of tools that are both psychometrically sound and culturally appropriate (Masten, 2018). Among widely used measures, the Connor-Davidson Resilience Scale (CD-RISC) was developed for adults but has occasionally been applied to adolescents. It shows high reliability (α\u0026thinsp;=\u0026thinsp;0.88\u0026ndash;0.89) across diverse populations (Dominguez-Cancino et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; L\u0026oacute;pez-Fern\u0026aacute;ndez et al., 2024) but may not fully capture the developmental and contextual nuances of adolescents in LMICs.\u003c/p\u003e \u003cp\u003eThe Child and Youth Resilience Measure (CYRM-28) was developed by Ungar and Liebenberg (2009) as a tool tailored to youth aged 10\u0026ndash;23. It was later refined into the CYRM-R, a shorter 17-item version that has been tested in more than 10 countries, including South Africa (van Rensburg et al., 2019). The scale contains two subscales: the personal subscale assesses internal and interpersonal strengths, while the caregiver subscale examines access to emotional safety, caregiving, and basic needs (H\u0026ouml;ltge et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe CYRM-R can be administered using either a 3-point or 5-point Likert scale, with the 3-point scale offering greater accessibility for participants with limited literacy. Reliability across samples has generally been strong (α\u0026thinsp;~\u0026thinsp;0.82) (Resilience Research Centre, 2011), but further population-specific validation is needed, especially among young mothers facing intersectional vulnerabilities such as HIV and early motherhood.\u003c/p\u003e \u003cp\u003eRecent studies have started to fill this gap. For example, Kaunda-Khangamwa et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) validated the CYRM-28 among adolescents living with HIV in Malawi, supporting its cross-cultural applicability. Our team\u0026rsquo;s study builds on this by further exploring the CYRM-R\u0026rsquo;s utility among South African young mothers, both living with and without HIV.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Methods","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Study Design\u003c/h2\u003e \u003cp\u003eThis study used cross-sectional data from the Helping Empower Youth Brought up in Adversity with their Babies and Young Children (HEY BABY) study\u0026mdash;a longitudinal cohort of adolescent and young mothers (aged 10\u0026ndash;24 years) living in urban, peri-urban, and rural parts of a mixed urban-rural health district in the Eastern Cape Province, South Africa (Toska et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The baseline study was conducted between March 2018 and July 2019, during which 1,712 adolescent girls and young women were interviewed. Of these, 1,027 participants had given birth before the age of 20\u0026mdash;a cut-off that aligns with the World Health Organization and UNICEF definitions of adolescent pregnancy, which classifies adolescents as individuals aged 10\u0026ndash;19 years (WHO, 2014; UNICEF, 2021).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Participant Recruitment\u003c/h2\u003e \u003cp\u003eThe HEY BABY study initially recruited 1,045 young mothers during its first wave (2017\u0026ndash;2019). In the follow-up wave (2021\u0026ndash;2022), conducted during the COVID-19 pandemic, 892 adolescent mothers (85%) were successfully re-interviewed telephonically. Of the remaining participants, 2.2% declined participation, 11.3% were untraceable, and 0.9% had died (Toska et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). At follow-up, participants living with HIV were older on average (M\u0026thinsp;=\u0026thinsp;23.2 years, SD\u0026thinsp;=\u0026thinsp;2.2) than those not living with HIV (M\u0026thinsp;=\u0026thinsp;21.5 years, SD\u0026thinsp;=\u0026thinsp;1.8). Those re-interviewed were more likely to reside in urban areas and less likely to live in informal housing. No significant differences were found between HIV status groups in terms of housing conditions, relationship status, or overall resilience scores (Toska et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA multi-strategy sampling approach was used to recruit adolescent mothers, living with and without HIV, alongside a comparison group of adolescents who had never given birth but shared similar demographic profiles. Recruitment methods were co-developed with an advisory group of adolescent mothers to ensure inclusion of hard-to-reach participants. Six parallel recruitment strategies were employed: (1) Health facilities (n\u0026thinsp;=\u0026thinsp;73), where patient files were reviewed to identify adolescents who had initiated HIV treatment (97% enrolment); (2) Maternity obstetric units (n\u0026thinsp;=\u0026thinsp;9), where adolescent mothers were identified through nurses and community healthcare workers (95% enrolment); (3) District secondary schools (n\u0026thinsp;=\u0026thinsp;43), where adolescent girls who had recently given birth or dropped out due to pregnancy were approached (98% enrolment); (4) Neighbour referrals, including girls demographically matched to participants, to reduce stigma; (5) Referrals from social workers and NGOs, targeting highly vulnerable adolescent mothers (n\u0026thinsp;=\u0026thinsp;95; 100% enrolment); (6) Community-based referrals, where adolescent mothers recruited peers with limited access to formal healthcare (n\u0026thinsp;=\u0026thinsp;51; 100% enrolment).\u003c/p\u003e \u003cp\u003eTo ensure the appropriateness of data collection tools, all study questionnaires were piloted with 25 adolescents living with HIV (ALHIV) and 9 young mothers some of whom are living with HIV. Voluntary informed consent was obtained from all participants. Participants under the age of 18 provided written informed and voluntary assent, in addition to written informed consent from their parent or caregiver. Ethical approval was granted by the University of Cape Town and the University of Oxford (R48876/RE001; R48876/RE002; HREC REF: 226/2017), as well as the Eastern Cape Departments of Health and Basic Education. All questionnaires and consent forms were translated into isiXhosa, one of the most widely spoken languages in the province.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Measures","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Sociodemographic factors\u003c/h2\u003e \u003cp\u003eSociodemographic factors: These included adolescent age [categorized as younger (ages 10\u0026ndash;14) and older (ages 15\u0026ndash;19)], current relationship, and housing type (formal or informal).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e4.2 The Child and Youth Resilience Measure-Revised (CYRM-R)\u003c/h2\u003e \u003cp\u003eThe CYRM-R scale is a 17-item measure of resilience among adolescents and young people. The scale has two subscales, namely the \u003cem\u003epersonal subscale\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;10) which includes intrapersonal and interpersonal-related items connected to internal skills and environmental resources such as peers or schools (H\u0026ouml;ltge et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). The \u003cem\u003ecaregiver resilience\u003c/em\u003e subscale (n\u0026thinsp;=\u0026thinsp;7) focuses on traits such as safety, support, and nutrition that are linked to significant relationships with a family member or primary caregiver.\u003c/p\u003e \u003cp\u003eThe CYRM-R has demonstrated strong internal consistency, with Cronbach\u0026rsquo;s alpha values ranging between 0.80 and 0.90 across various cultural and linguistic adaptations (H\u0026ouml;ltge et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Equally, H\u0026ouml;ltge et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) confirmed the two-factor structure and measurement invariance across gender and country contexts in a large cross-national study including youth from Germany, South Africa, and Canada. The scale is noted for its flexibility and cultural sensitivity, making it suitable for use in low-resource and high-adversity settings.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Data Analyses","content":"\u003cp\u003eThe psychometric analysis was all conducted in STATA 15. First, descriptive statistics of all associated variables were computed to determine the frequencies, means, and standard deviations. Secondly, scale reliability was assessed using Cronbach\u0026rsquo;s alpha and McDonald\u0026rsquo;s omega coefficients to evaluate the internal consistency of the outcome variable. Cronbach\u0026rsquo;s alpha, a widely used reliability estimate, assumes tau equivalence that all items contribute equally to the underlying construct. An assumption that is often violated in practice (Widhiarso \u0026amp; Ravand 2022). In contrast, McDonald\u0026rsquo;s omega offers a more accurate assessment of dependability by accommodating varying item loadings, rendering it more appropriate for scales where items are not uniformly associated with the latent trait (Brusco \u0026amp; Sella, 2022). Utilizing both measurements facilitates a more thorough and dependable assessment of internal consistency. Both the Cronbach's alpha and McDonald's omega\u0026thinsp;\u0026gt;\u0026thinsp;0.70 indicate internal consistency (Field, 2000; Bonniga and Saraswathi, 2020).\u003c/p\u003e \u003cp\u003eThirdly, the Kaiser\u0026ndash;Meyer\u0026ndash;Olkin (KMO) measure and Bartlett's test of sphericity were used to test the suitability of the data to conduct factor analysis (Govender et al., 2017). A KMO closer to 1.0 confirms the feasibility of factor analysis (Acock, 2013; Pritzker and Minter, 2014). To improve the robustness and generalizability of the factor structure, we randomly divided the complete sample into two equal halves (50%), in accordance with the methodology suggested by Brown (2015). This split-sample technique facilitates independent exploratory and confirmatory analyses, reducing the probability that results are influenced by sample-specific peculiarities and enhancing the model's stability across subsamples. Fifth, we conducted an exploratory factor analysis (EFA) with orthogonal rotations to assess the factor structure of the resilience measurement scale and ensure that all items in the scale measured resilience as an underlying construct (Langham et al., 2018), using the calibration subsample (n\u0026thinsp;=\u0026thinsp;441). The EFA also aimed to determine the number of factors in the adapted CYRM-R measure. Eigenvalues above 1 (Kaiser criterion) and a scree plot was generated to confirm the results of the EFA by visually inspecting the point where the eigenvalues start to level off, indicating the number of factors to retain (Cattell, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e1966\u003c/span\u003e). The scale items had less than 10% missing data, which means that the risk of bias in the Exploratory Factor Analysis (EFA) has been minimized (Graham, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). With minimal missing data, factor structure validity is maintained (Graham, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2009\u003c/span\u003e), allowing for a reliable and interpretable resilience measurement in young mothers.\u003c/p\u003e \u003cp\u003eNext, using the validation subsample (n\u0026thinsp;=\u0026thinsp;423), confirmatory factor analysis (CFA) was conducted to validate the factor structure obtained through the EFA and to test whether the data fit the hypothesized measurement model. Items with factor loadings values of 0.32 and below were removed from the scale (Comfrey \u0026amp; Lee, 1992).\u003c/p\u003e \u003cp\u003eFinally, goodness-of-fit tests, including indices such as the Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Root Mean Square Error of Approximation (RMSEA), and Standardized Root Mean Square Residual (SRMR), were used to assess how well the model fit the data. Following the guidelines by Hu and Bentler (1999), model fit was considered acceptable with CFI and TLI values\u0026thinsp;\u0026ge;\u0026thinsp;0.95, RMSEA\u0026thinsp;\u0026le;\u0026thinsp;0.06, and SRMR\u0026thinsp;\u0026le;\u0026thinsp;0.08.\u003c/p\u003e"},{"header":"6. Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e6.1 Sociodemographic Factors\u003c/h2\u003e \u003cp\u003eA total of n\u0026thinsp;=\u0026thinsp;892 adolescent mothers in the HEY BABY study was re-interviewed (2.20% refusal, 11.29% could not be traced, 0.86% mortality) at follow-up (2021\u0026ndash;2022). Baseline sociodemographic factors are reported elsewhere (Toska et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the characteristics of the participants involved in the study at follow-up, disaggregated by HIV status. Participants ranged in age from 16 to 29 years, with adolescent mothers living with HIV being older on average (M\u0026thinsp;=\u0026thinsp;23.3, SD\u0026thinsp;=\u0026thinsp;2.2) than those not living with HIV (M\u0026thinsp;=\u0026thinsp;21.5, SD\u0026thinsp;=\u0026thinsp;1.8), a statistically significant difference (\u003cem\u003ep\u003c/em\u003e \u0026le; .001). Resilience scores ranged from 25 to 85, with similar mean scores across groups: 70.0 (SD\u0026thinsp;=\u0026thinsp;9.8) for HIV-negative participants and 71.5 (SD\u0026thinsp;=\u0026thinsp;9.5) for those living with HIV (\u003cem\u003ep\u003c/em\u003e = .555). No statistically significant group differences were found in informal housing status or current relationship status\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e6.2 Exploratory Factor Analyses (EFA) of the CYRM Scale.\u003c/h2\u003e \u003cp\u003eBartlett\u0026rsquo;s test of sphericity was significant, χ\u0026sup2; (df )\u0026thinsp;=\u0026thinsp;2,356.31, p \u0026lt; .001, indicating sufficient correlations among the variables to justify the use of factor analysis. The Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy was .79, exceeding the recommended threshold of .50, thereby confirming that the sample was appropriate for conducting an exploratory factor analysis (EFA). Exploratory factor analysis (EFA) was conducted on the calibration subsample to examine the underlying structure of the data. An initial analysis was run to obtain eigenvalues for each of the components. Orthogonal varimax rotation was applied to maintain uncorrelated (independent) factors, which is advantageous for interpretability (Kieffer, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e1998\u003c/span\u003e). The results indicated that two factors exceeded the eigenvalue threshold of 1.00 and were therefore retained (see Supplementary File 01. This decision was supported by the scree plot (Ledesma et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) (see Supplementary File 02). The two extracted factors jointly explained approximately 100% of the total variance, suggesting that the scale effectively captures key aspects of resilience. Factor 1 contributed more to the overall variance (60.94%) than Factor 2 (41.45%), indicating that it is the dominant factor. Items were loaded onto a two-factor EFA model. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the factor loadings, which ranged from .01 to .73 for Factor 1, and from .04 to .65 for Factor 2.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e6.3 Confirmatory Analysis (CFA) of CYRM-Scale\u003c/h2\u003e \u003cp\u003eConfirmatory factor analysis (CFA) was conducted on the validation subsample (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;423). Two items were removed as they did not meet the factor loading cut-off of .30 (Ding et al., 2024): \u0026ldquo;Getting an education is important to me\u0026rdquo; and \u0026ldquo;I know how to behave/act in different situations.\u0026rdquo; This reduced the CYRM-R from a 17-item scale to a 15-item scale.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the CFA results. The analysis confirmed the hypothesized two-factor structure of resilience, comprising two latent variables: personal resilience and caregiver resilience. All observed variables (CYRM-R items) significantly loaded onto their respective latent factors (\u003cem\u003ep\u003c/em\u003e \u0026lt; .001), supporting the validity of the measurement model.\u003c/p\u003e \u003cp\u003eThe estimated correlation between the personal and caregiver subscales was = .46 (\u003cem\u003ep\u003c/em\u003e \u0026lt; .001), indicating a moderate positive relationship between personal resilience and caregiver support among young mothers.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e6.4 Goodness of Fit Results\u003c/h2\u003e \u003cp\u003eModel fit statistics demonstrated mixed support for the two-factor structure. The root mean square error of approximation (RMSEA) was .075, and the standardized root mean square residual (SRMR) was .06, both being within acceptable limits. The comparative fit index (CFI = .79) and Tucker-Lewis index (TLI = .75) were below the suggested threshold of .95. The chi-square statistic was significant, χ\u0026sup2;(df)\u0026thinsp;=\u0026thinsp;1,124.26, p \u0026lt; .001.\u003c/p\u003e \u003cp\u003eThe results indicate that although the model demonstrates satisfactory absolute fit (as evidenced by RMSEA and SRMR), the incremental fit indices (CFI and TLI) suggest that the two-factor structure inadequately represents the underlying data structure. This suggests that the CYRM-R may need more modification to effectively align with the context of young mothers in this sample.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e6.5 Reliability\u003c/h2\u003e \u003cp\u003eReliability analysis of the original 17-item scale yielded a Cronbach\u0026rsquo;s alpha of α\u0026thinsp;=\u0026thinsp;.76 and McDonald\u0026rsquo;s omega of Ω\u0026thinsp;=\u0026thinsp;.75, indicating acceptable internal consistency. Following the revision of the CYRM-R to 15 items, the overall reliability showed minimal change, with α\u0026thinsp;=\u0026thinsp;.75 and Ω\u0026thinsp;=\u0026thinsp;.74. The personal resilience subscale initially produced a Cronbach\u0026rsquo;s alpha of α\u0026thinsp;=\u0026thinsp;.65 and McDonald\u0026rsquo;s omega of Ω\u0026thinsp;=\u0026thinsp;.64. After the number of items was reduced from 10 to 8, reliability decreased slightly to α\u0026thinsp;=\u0026thinsp;.64 and Ω\u0026thinsp;=\u0026thinsp;.62. The caregiver resilience subscale remained consistent across versions, with α\u0026thinsp;=\u0026thinsp;.72 and Ω\u0026thinsp;=\u0026thinsp;.75.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics of included participants by HIV status (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;892).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow-up sociodemographic factors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdolescent mothers not living with HIV (\u003cem\u003en\u003c/em\u003e\u0026nbsp;=\u0026nbsp;634)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdolescent mother living with HIV (\u003cem\u003en\u003c/em\u003e\u0026nbsp;=\u0026nbsp;258)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eTotal (\u003cem\u003en\u003c/em\u003e\u0026nbsp;=\u0026nbsp;892)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003em (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003em (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003em (SD)****\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge in years [range 16\u0026ndash;29]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e21.5 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c4\" namest=\"c3\" rowspan=\"2\"\u003e \u003cp\u003e23.3 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e22.0 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;0.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMissing value n\u0026thinsp;=\u0026thinsp;22\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInformal housing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e187 (29.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c4\" namest=\"c3\" rowspan=\"2\"\u003e \u003cp\u003e59 (25.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e246 (28.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMissing value n\u0026thinsp;=\u0026thinsp;23\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent relationship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e362 (57.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c4\" namest=\"c3\" rowspan=\"2\"\u003e \u003cp\u003e149 (64.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e511 (58.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMissing value n\u0026thinsp;=\u0026thinsp;24\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResilience [25\u0026ndash;85]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e70.0 (9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c4\" namest=\"c3\" rowspan=\"2\"\u003e \u003cp\u003e71.5 (9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e70.4 (9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.555\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMissing value n\u0026thinsp;=\u0026thinsp;28\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cem\u003eNote\u003c/em\u003e. *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 **p\u0026thinsp;\u0026lt;\u0026thinsp;0.01 ***p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 **** Mean \u0026amp; Standard Deviation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eExploratory Factor Analysis (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;441)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFactor 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFactor 2\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI get along with people around me\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.1912\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.3739\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGetting an education is important to me\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.2132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0467\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI know how to behave/act in different situations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.0242\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.1364\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMy parent(s)/caregiver(s) really look out for me\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.6713\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0444\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMy parent(s)/caregiver(s) know a lot about me\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.4561\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.1233\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIf I am hungry, there is enough to eat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.4097\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.2048\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeople like to spend time with me\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.1609\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.4335\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI talk to my family/caregiver(s) about how I feel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.4105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.1395\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI feel supported by my friends\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.0420\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.6360\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI feel that I belong/belonged at my school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.2656\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.3637\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMy family/caregiver(s) care about me when times are hard\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.7341\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0401\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMy friends care about me when times are hard\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.0123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.6464\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI am treated fairly in my community\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.2289\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.3774\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI have chances to show others that I am growing up and I can do things by myself\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.1910\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.3345\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI feel safe when I am with my family/caregiver(s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.6691\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00819\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI have chances to learn things that will be useful when I\u0026rsquo;m older\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.2407\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.1159\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI like the way my family/caregivers celebrate things\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.4045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0747\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cem\u003eNote\u003c/em\u003e. Factor 1= ; Factor 2==.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eConfirmatory Factor Analysis (n\u0026thinsp;=\u0026thinsp;423)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCYRM-R Subscale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePersonal Resilience\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eCaregiver Resilience\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem:\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI get along with people around me\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.387\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeople like to spend time with me\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.405\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI feel supported by my friends\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.501\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI feel that I belong/belonged at my school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.519\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMy friends care about me when times are hard\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.509\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI am treated fairly in my community\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.437\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI have chances to show others that I am growing up and I can do things by myself\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.335\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI have chances to learn things that will be useful when I am older\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.318\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMy parent(s)/caregiver(s) really look out for me\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.702\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMy parent(s)/caregiver(s) know a lot about me\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.567\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIf I am hungry, there is enough to eat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.406\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI talk to my family/caregiver(s) about how I feel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.470\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMy family/caregiver(s) care about me when times are hard\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.694\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI feel safe when I am with my family/caregiver(s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.573\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI like the way my family/caregivers celebrate things\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.397\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eNote\u003c/em\u003e. β\u0026thinsp;=\u0026thinsp;coefficient; SE\u0026thinsp;=\u0026thinsp;standard error. \u003cem\u003ep\u003c/em\u003e \u0026lt; .05 for all coefficients. Model fit: RMSEA = .075; CFI/TLI = .790/.752 χ \u003csup\u003e2\u003c/sup\u003e (df)\u0026thinsp;=\u0026thinsp;1124.262; SRMR = .06\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"7. Discussion","content":"\u003cp\u003eIn this paper, we aim to evaluate the psychometric properties of the CYRM-R scale to determine how effectively it measures resilience among adolescents and young mothers in the Eastern Cape, South Africa. Exploratory factor analysis revealed a two-factor structure comprising personal and caregiver resilience. This two-factor solution is consistent with findings from previous studies conducted in similar contexts (Cluver et al., 2016, 2021; Kim et al., 2020; Jeffreyset al., 2019; Pantelic et al., 2015; Rochat et al., 2017), supporting the conceptual separation of internal strengths and relational support in resilience measurement. The first factor, personal resilience, captures individual and interpersonal capacities such as social support, adaptability, and a sense of belonging (Ungar, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Ungar \u0026amp; Liebenberg, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2011\u003c/span\u003e, 2013). These factors are vital for young mothers who must manage the emotional and psychological challenges of living with HIV while raising children (Cluver et al., 2021; Laurenzi et al., 2020). The second factor, caregiver resilience, emphasizes external support such as safety, food security, and family traditions, which play a crucial role in creating a stable and nurturing environment for these mothers and their children (Ungar \u0026amp; Liebenberg, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2011\u003c/span\u003e, 2013). These supports are particularly important for young mothers affected by HIV, as they help buffer against adversity and promote well-being (Betancourt, Meyers-Ohki, Charrow, \u0026amp; Hansen, 2013; Laurenzi et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe confirmatory analysis validated the two-factor structure identified in the exploratory factor analysis, with significant loadings for both latent constructs. Personal resilience showed strong associations with items reflecting social connections, such as \u0026lsquo;belonging\u0026rsquo; and \u0026lsquo;friends caring\u0026rsquo;. These findings highlight the importance of interpersonal relationships in fostering resilience among young mothers (Jefferies et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Caregiver resilience had robust loadings for variables such as \u0026lsquo;hard times\u0026rsquo; and \u0026lsquo;look out\u0026rsquo;, emphasizing the role of caregiving structures in providing safety and stability (Jefferies et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Liebenberg et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe moderate fit indices in CFA suggest that while the CYRM-R scale effectively captures resilience, further refinements could enhance its precision. The Root Mean Squared Error of Approximation and Standardized Root Mean Square Residual indicate acceptable error levels, suggesting that the model aligns moderately well with the data (Bedi \u0026amp; Bhale, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). However, the Comparative Fit Index and Tucker-Lewis Index fall below the ideal threshold of 0.90, indicating limited comparative fit (Bedi \u0026amp; Bhale, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eResilience in young mothers living with HIV is strongly influenced by external support systems, with high factor loadings for caregiver relationships emphasizing the crucial role of family, peer networks, and a sense of belonging (Laurenzi et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Roberts et al., 2022; Saal et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Given the moderate correlation between personal and caregiver resilience, interventions should not only focus on individual resilience-building but also strengthen family and caregiver support systems (Anandan et al., 2023).\u003c/p\u003e \u003cp\u003eThe reliability analyses demonstrate variation in the internal consistency of the two subscales. The 8-item personal resilience subscale showed acceptable reliability, although low (α\u0026thinsp;=\u0026thinsp;.64, Ω\u0026thinsp;=\u0026thinsp;.62), while the 7-item caregiver resilience subscale performed more strongly, with reliability coefficients of α\u0026thinsp;=\u0026thinsp;.72 and Ω\u0026thinsp;=\u0026thinsp;.75. Compared to Ding et al. (2024), who reported lower reliability for the personal resilience subscale in a reduced 14-item CYRM-R version (α\u0026thinsp;=\u0026thinsp;.63, Ω\u0026thinsp;=\u0026thinsp;.63), the current study yielded slightly higher reliability estimates (α\u0026thinsp;=\u0026thinsp;.65, Ω\u0026thinsp;=\u0026thinsp;.64) for the personal subscale in our 15-item version. Similarly, the caregiver subscale in our study showed stronger internal consistency than the reliability coefficients reported by Ding et al. (2024) (α\u0026thinsp;=\u0026thinsp;.62, Ω\u0026thinsp;=\u0026thinsp;.62).\u003c/p\u003e \u003cp\u003eWhile the overall reliability in the current study (α\u0026thinsp;=\u0026thinsp;.75) was lower than that reported by Anandan et al. (2023) (α\u0026thinsp;=\u0026thinsp;.92) for their adapted 15-item scale, our findings remain within acceptable thresholds for psychological scales, particularly in diverse and vulnerable populations. Anandan et al. (2023) also reported higher subscale alphas (α\u0026thinsp;=\u0026thinsp;.90 for personal and α\u0026thinsp;=\u0026thinsp;.84 for caregiver), suggesting that further refinement of the personal resilience items may enhance internal consistency. Nonetheless, the caregiver subscale in our study demonstrates solid reliability, indicating it is a well-performing component of the CYRM-R in this population. These findings align with prior literature suggesting that caregiver-related resilience tends to be more stable, while personal resilience may require contextual adaptation (Larsen \u0026amp; Warne, 2010).\u003c/p\u003e \u003cp\u003ePersonal resilience, represented by social support and self-efficacy, helps mothers navigate the dual burden of caregiving and managing their health (Fayombo, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Saal et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Sanders et al., 2017). Caregiver resilience, reflected in external supports like food security and a sense of safety, provides the stability necessary for them to thrive. Together, these dimensions offer a holistic understanding of the resilience processes in this vulnerable population health (Fayombo, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Saal et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Sanders et al., 2017).\u003c/p\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e7.1 Limitations and recommendations for future research\u003c/h2\u003e \u003cp\u003eWhile the CYRM provides valuable insights, it has limitations in fully capturing the unique experiences of young mothers living with HIV. The 8-item personal resilience subscale demonstrated suboptimal reliability, suggesting that some items may not be suited for this group. In this study, the young mothers\u0026rsquo; resilience within relationships was not measured. However, a set of items to examine the relationship between young women living with HIV and their romantic or sexual partners, or the father of the child (if he was not her current romantic or sexual partner), was developed using the CYRM-R questions as a guide. Additionally, because the measure was validated among young mothers who speak isiXhosa in the Eastern Cape, South Africa, its generalizability may be restricted.\u003c/p\u003e \u003cp\u003eFuture research should focus on refining the CYRM-R to better reflect the resilience pathways of young mothers living with HIV. This includes revising items with low reliability and adding culturally relevant items that address unique challenges, such as stigma, treatment adherence, and mental health (Jefferies, McGarrigle, \u0026amp; Ungar, 2018; Resilience Research Centre, 2022). Validation studies across diverse populations and settings are essential to ensure the scale\u0026rsquo;s generalizability and effectiveness (Ungar \u0026amp; Liebenberg, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Further, qualitative research could complement quantitative analyses by exploring resilience processes in-depth, providing richer insights into how young mothers navigate and build resilience in the face of adversity.\u003c/p\u003e \u003cp\u003eFurthermore, mixed-method approaches need to be used to investigate the experiences of resilience among mothers affected by and living with HIV (Ungar \u0026amp; Liebenberg, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Our findings resonate with Groves et al. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), who emphasized the role of caregiver and school-based supports in shaping resilience for adolescent mothers in KwaZulu-Natal. Resilience among young mothers living with HIV appears especially dependent on family safety, food security, and community belonging (Laurenzi et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Saal et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The efficacy of resilience-focused programming and the transition from risk-centered to resilience-building paradigms of program design and delivery can be greatly influenced using accurate and reliable resilience measures, such as the CYRM-R, to measure resilience among young mothers affected by HIV (Toska et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"8. Conclusions","content":"\u003cp\u003eThe CYRM-R demonstrates acceptable psychometric performance among young mothers affected by HIV in South Africa. However, further refinements, especially to the personal subscale are warranted to improve its sensitivity to the unique challenges faced by this group. Strengthening resilience-based interventions that incorporate both internal and external dimensions can significantly improve adolescent maternal well-being, mental health, and HIV care retention.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"652\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eAGYW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 530px;\"\u003e\n \u003cp\u003eAdolescent girls and young women\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eALHIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 530px;\"\u003e\n \u003cp\u003eAdolescents living with HIV\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eART\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 530px;\"\u003e\n \u003cp\u003eAntiretroviral therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eCFA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 530px;\"\u003e\n \u003cp\u003eConfirmatory factor analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eCFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 530px;\"\u003e\n \u003cp\u003eComparative Fit Index\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eCOVID-19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 530px;\"\u003e\n \u003cp\u003eCoronavirus disease 2019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eCYRM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 530px;\"\u003e\n \u003cp\u003eChild and Youth Resilience Measure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eCYRM-28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 530px;\"\u003e\n \u003cp\u003e28-item Child and Youth Resilience Measure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eCYRM-R\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 530px;\"\u003e\n \u003cp\u003eChild and Youth Resilience Measure\u0026ndash;Revised\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eEFA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 530px;\"\u003e\n \u003cp\u003eExploratory factor analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eHEY BABY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 530px;\"\u003e\n \u003cp\u003eHelping Empower Youth Brought up in Adversity with their Babies and Young Children study\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eHIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 530px;\"\u003e\n \u003cp\u003eHuman immunodeficiency virus\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eKMO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 530px;\"\u003e\n \u003cp\u003eKaiser\u0026ndash;Meyer\u0026ndash;Olkin measure of sampling adequacy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eLMICs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 530px;\"\u003e\n \u003cp\u003eLow- and middle-income countries\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 530px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eNGO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 530px;\"\u003e\n \u003cp\u003eNon-governmental organization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eRMSEA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 530px;\"\u003e\n \u003cp\u003eRoot Mean Square Error of Approximation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 530px;\"\u003e\n \u003cp\u003eStandard deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eSEM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 530px;\"\u003e\n \u003cp\u003eStructural equation modelling\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eSRMR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 530px;\"\u003e\n \u003cp\u003eStandardized Root Mean Square Residual\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eTLI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 530px;\"\u003e\n \u003cp\u003eTucker\u0026ndash;Lewis Index\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eWHO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 530px;\"\u003e\n \u003cp\u003eWorld Health Organization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was granted by the University of Cape Town and the University of Oxford (R48876/RE001; R48876/RE002; HREC REF: 226/2017), as well as the Eastern Cape Departments of Health and Basic Education. Voluntary informed written consent was obtained from all participants. Participants under the age of 18 provided written informed and voluntary assent, in addition to written informed consent from their parent or caregiver.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll research data will be made available on request subject to participant consent and having completed all necessary documentation. All data requests should be sent to [email protected] or to the Principal Investigators (https://www.heybaby.org.za/contact). Data will be made available on an open platform in 2027, following study data sharing protocols.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no competing interests to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe HEY BABY Study is funded by the European Research Council under the European Union’s Horizon 2020 research and innovation programme (no 771468); the UK Medical Research Council and the UK Department for International Development under the MRC/DFID Concordat agreement, and by the Department of Health and Social Care through its National Institutes of Health Research (MR/R022372/1); the UKRI GCRF Accelerating Achievement for Africa's Adolescents (Accelerate) Hub (ES/S008101/1); a CIPHER grant from International AIDS Society (2018/625-TOS); Research England (0005218); UCL's HelpAge funding; Oak Foundation (OFIL-20-057) and UNICEF Eastern and Southern Africa Regional Office (UNICEF-ESARO). Additional funding received from: The Horowitz Foundation for Social Policy; Nuffield Foundation (CPF/41513). Further funding is provided by the National Research Foundation: Human and Social Dynamics for Development 2022 (136531) and the Fogarty International Center, National Institute on Mental Health, National Institutes of Health under Award Number K43TW011434\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualisation: W.S.; Methodology: W.S., V.T.; Formal analysis: W.S., V.T.; Writing – original draft: V.T., W.S.; Writing – review and editing: all authors. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research would not have been possible without the contributions of the young mothers who shared their thoughts and lives, and the research team who persisted in collecting the data during the COVID-19 pandemic. We are humbled by your openness. The authors thank Dr Marija Pantelic and Ms Mildred Thabeng for sharing their approach on cognitive interviewing and Profs Lucie Cluver, Don Operario, Cathy Mathews and Abigail Harrison for their mentorship.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eArtuch-Garde, R., Gonz\u0026aacute;lez-Torres, M. del C., Mart\u0026iacute;nez-Vicente, J. M., Peralta-S\u0026aacute;nchez, F. J., \u0026amp; de la Fuente-Arias, J. (2022). 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I., Carranza, J. S., Kapoor, B., Tomar, A., van Rensburg, A., Lu, S., Hu, H., Cavioni, V., Agliati, A., Grazzani, I., Smedema, Y., Kaur, G., Hurlington, K. G., Sanders, J., Munford, R., ... Ungar, M. (2021). A cross-country network analysis of adolescent resilience. \u003cem\u003eJournal of Adolescent Health, 68\u003c/em\u003e(5), 852\u0026ndash;859. https://doi.org/10.1016/j.jadohealth.2020.07.010\u003c/li\u003e\n\u003cli\u003eHubacher, D., Mavranezouli, I., \u0026amp; McGinn, E. (2008). Unintended pregnancy in sub-Saharan Africa: Magnitude of the problem and potential role of contraceptive implants to alleviate it. \u003cem\u003eContraception, 78\u003c/em\u003e(1), 73\u0026ndash;78. https://doi.org/10.1016/j.contraception.2008.03.002\u003c/li\u003e\n\u003cli\u003eJefferies, P., McGarrigle, L., \u0026amp; Ungar, M. (2019). The CYRM-R: A Rasch-validated revision of the Child and Youth Resilience Measure. \u003cem\u003eJournal of Evidence-Based Social Work, 16\u003c/em\u003e(1), 70\u0026ndash;92. https://doi.org/10.1080/23761407.2018.1548403\u003c/li\u003e\n\u003cli\u003eKaunda-Khangamwa, B. N., Kapwata, P., Malisita, K., Munthali, A., Chipeta, E., Phiri, S., \u0026amp; Manderson, L. (2020). Adolescents living with HIV, complex needs, and resilience in Blantyre, Malawi. \u003cem\u003eAIDS Research and Therapy, 17\u003c/em\u003e, 35. https://doi.org/10.1186/s12981-020-00292-1\u003c/li\u003e\n\u003cli\u003eKennedy, A. C., Bybee, D., Sullivan, C. M., \u0026amp; Greeson, M. R. (2006). The impact of family and community violence on children\u0026apos;s depression trajectories: A community-based longitudinal study. \u003cem\u003eJournal of Community Psychology, 34\u003c/em\u003e(5), 559\u0026ndash;576. https://doi.org/10.1002/jcop.20115\u003c/li\u003e\n\u003cli\u003eKieffer, K. M. (1998). Orthogonal versus oblique factor rotation: A review of the literature regarding the pros and cons. \u003cem\u003eERIC\u003c/em\u003e. https://eric.ed.gov/?id=ED427031\u003c/li\u003e\n\u003cli\u003eLaurenzi, C., Ronan, A., Phillips, L., Nalugo, S., Mupakile, E., Operario, D., \u0026amp; Toska, E. (2023). Enhancing a peer supporter intervention for young mothers living with HIV in Malawi, Tanzania, Uganda, and Zambia: Adaptation and co-development of a psychosocial component. \u003cem\u003eGlobal Public Health, 18\u003c/em\u003e(1), 2081711. https://doi.org/10.1080/17441692.2022.2081711\u003c/li\u003e\n\u003cli\u003eLedesma, R. D., Valero-Mora, P., \u0026amp; Macbeth, G. (2015). The scree test and the number of factors: A dynamic graphics approach. \u003cem\u003eThe Spanish Journal of Psychology, 18\u003c/em\u003e, E11. https://doi.org/10.1017/sjp.2015.13\u003c/li\u003e\n\u003cli\u003eLiebenberg, L., Ungar, M., \u0026amp; van de Vijver, F. J. R. (2012). Validation of the Child and Youth Resilience Measure-28 (CYRM-28) among Canadian youth. \u003cem\u003eResearch on Social Work Practice, 22\u003c/em\u003e(2), 219\u0026ndash;226. https://doi.org/10.1177/1049731511428619\u003c/li\u003e\n\u003cli\u003eMasten, A. S. (2014). Global perspectives on resilience in children and youth. \u003cem\u003eChild Development, 85\u003c/em\u003e(1), 6\u0026ndash;20. https://doi.org/10.1111/cdev.12205\u003c/li\u003e\n\u003cli\u003eObare, F., Birungi, H., \u0026amp; Undie, C. C. (2017). Reproductive resilience among adolescents in Kenya and Tanzania: A case study of unintended pregnancy. \u003cem\u003eAfrican Journal of Reproductive Health, 21\u003c/em\u003e(3), 49\u0026ndash;60. https://doi.org/10.29063/ajrh2017/v21i3.6\u003c/li\u003e\n\u003cli\u003ePanter-Brick, C. (2015). 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C., Wittesaele, C., Langwenya, N., Jochim, J., Roberts, K. J. S., Anquandah, J., Banougnin, B. H., Laurenzi, C., Sherr, L., \u0026amp; Cluver, L. (2022). Achieving the health and well-being Sustainable Development Goals among adolescent mothers and their children in South Africa: Cross-sectional analyses of a community-based mixed HIV-status cohort. \u003cem\u003ePLOS ONE, 17\u003c/em\u003e(1), e0278163. https://doi.org/10.1371/journal.pone.0278163\u003c/li\u003e\n\u003cli\u003eToska, E., Cluver, L., Laurenzi, C. A., Wittesaele, C., Sherr, L., Zhou, S., \u0026amp; Langwenya, N. (2020). Reproductive aspirations, contraception use, and dual protection among adolescent girls and young women: The effect of motherhood and HIV status. \u003cem\u003eJournal of the International AIDS Society, 23\u003c/em\u003e(1), e25558. https://doi.org/10.1002/jia2.25558\u003c/li\u003e\n\u003cli\u003eUngar, M., \u0026amp; Liebenberg, L. (2011). Assessing resilience across cultures using mixed methods: Construction of the Child and Youth Resilience Measure. \u003cem\u003eJournal of Mixed Methods Research, 5\u003c/em\u003e(2), 126\u0026ndash;149. https://doi.org/10.1177/1558689811400607\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Resilience, CYRM-R, adolescent mothers, HIV, psychometric validation, sub-Saharan Africa","lastPublishedDoi":"10.21203/rs.3.rs-8862796/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8862796/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eResilience is a core psychological construct linked to well-being and adaptative functioning, yet few resilience measures have been psychometrically validated for use among young people in low and middle-income settings. Adolescent girls and young women (AGYW) in sub-Saharan Africa face intersecting social and health challenges, s, including early and unintended pregnancies and heightened HIV risk, underscoring the need for culturally appropriate and psychometrically sound tools. This study evaluated the psychometric properties of the Child and Youth Resilience Measure-Revised (CYRM-R) within a cohort of young mothers in the Eastern Cape, South Africa.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eData were drawn from 892 young mothers participating in the HEY BABY cohort study (December 2021 and April 2023). Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were used to examine the dimensional structure of the CYRM-R, and internal consistency was assessed to determine reliability.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eAnalyses supported a two-factor structure representing personal resilience and caregiver resilience. This structure remained stable following item reduction from 17 to 15 items, suggesting strong structural integrity. The overall scale demonstrated acceptable reliability (α\u0026thinsp;=\u0026thinsp;.76; Ω\u0026thinsp;=\u0026thinsp;.75). The personal resilience subscale showed moderate reliability (α\u0026thinsp;=\u0026thinsp;.65; Ω\u0026thinsp;=\u0026thinsp;.61), while the caregiver resilience subscale demonstrated stronger internal consistency (α\u0026thinsp;=\u0026thinsp;.72; Ω\u0026thinsp;=\u0026thinsp;.75).\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eThe CYRM-R demonstrates acceptable reliability and structural validity among adolescent and young mothers in South Africa. Findings support its use as a contextually appropriate measure of resilience and contribute to the broader evidence base on resilience assessment in low and middle-income settings This scale may be useful for both research and applied psychological settings focused on youth well-being.\u003c/p\u003e","manuscriptTitle":"Psychometric Evaluation of the Child and Youth Resilience Measure-Revised (CYRM-R) among young mothers affected by HIV in South Africa","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-06 16:00:19","doi":"10.21203/rs.3.rs-8862796/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-19T19:32:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"252897881263342017059830820731027819442","date":"2026-04-14T08:26:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"99842030843764680931491644038763841611","date":"2026-03-16T00:22:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"326247610772681058365547266525421701097","date":"2026-03-08T12:04:53+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-03T12:12:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-03T12:07:15+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-23T11:40:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-23T07:47:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2026-02-23T07:43:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ef3a5e66-d8a6-41ca-88ad-747380de9580","owner":[],"postedDate":"March 6th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-06T16:00:19+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-06 16:00:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8862796","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8862796","identity":"rs-8862796","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}