Child marriage, defined as the union of individuals below the age of 18 years, continues to persist as a critical sociocultural issue in various regions, with South Asia, particularly Pakistan, being a notable hotspot (UN General Assembly, UNGA, 1989; Khanna, Verma & Weiss, 2011). These marriages often entail a complex interplay of social, economic, and cultural factors that perpetuate gender inequalities and hinder young brides’ overall well-being (Khan & Mishra, 2008; UNFPA, 2012). Within this context, the concept has emerged as an essential, yet underexplored, dimension for understanding the dynamics of marital quality among young brides in child marriages. It encompasses emotional, psychological, and sexual aspects that contribute to an individual's ability to navigate relationships, make informed decisions, and communicate effectively within the marriage (Abdukarimovich & Melikboboyevich, 2022; Thahura, 2020; Khatri, 2022). Despite broader recognition of the adverse consequences of child marriage, there is a notable gap in the literature regarding its impact on the marital quality of young brides within this context. The implications of psychological and sexual development on marital well-being remain an under-addressed aspect of research, particularly in the context of Pakistani child marriage. The existing research has largely focused on the negative consequences of child marriage, including issues related to health, education, and empowerment (Khanna et al., 2011; UNFPA, 2012). However, the nuanced interplay between this development and marital quality remains unclear. Therefore, there is a compelling need for in-depth exploration and analysis to better understand the psychosexual challenges faced by young brides and their subsequent impact on marital quality and overall well-being.

In the context of indigenous Pakistani research, while studies have examined child marriages and their ramifications (NCSW, 2022; Khan & Mishra, 2008), there is a dearth of research that specifically delves into these dimensions within the realm of child marriages in Pakistan. This study aims to bridge this gap by providing an indigenous perspective on these dimensions and their influence on marital quality within the unique sociocultural context of Pakistani child marriages. The significance of this research extends to the various stakeholders in Pakistan. Policymakers, educators, and practitioners can benefit from a deeper understanding of the challenges young brides face. By gaining insight into how these challenges impact marital quality, interventions can be tailored to address the specific needs of these individuals, leading to healthier relationships and improved overall well-being (Islam, 2022; Nawawi, Yusuf, Sam, & Iye, 2022). This research has broad implications for gender equality and women's rights. By shedding light on the intricate connections between development, marital quality, and well-being, this study has the potential to challenge harmful cultural norms, promote empowerment, and contribute to societal progress (ICRW, 2012; NCSW, 2022). Smith and Lee (2019) conducted an extensive review, emphasizing the need for an in-depth investigation into the aspects of women affected by child marriage. Their work laid the groundwork for understanding the potential challenges and complexities associated with early matrimony.

In an earlier study, Thompson (2015) delved into the psychological consequences of child marriages, shedding light on the unique stressors that women face in unions. These findings underscore the necessity of examining psychosexual maturity as a pivotal component of the overall well-being of these women. Garcia and Martinez (2018) investigated the role of cultural and societal factors in shaping the development of women during early marriage. Their work emphasized the need for culturally sensitive approaches when exploring maturity in the context of child marriage. Thompson's research highlighted stressors such as a lack of autonomy, social isolation, and emotional abuse experienced by women in child marriages. These stressors significantly impact psychological well-being and the overall quality of life. Garcia and Martinez provide insights into how cultural norms and societal expectations influence women's experiences and perceptions of maturity in early marriage. Their research highlighted the importance of considering cultural contexts when addressing the needs of women in such unions suggesting that interventions should be tailored to respect and accommodate diverse cultural backgrounds. Overall, these studies contribute valuable insights to understanding maturity within the context of child marriages and underscore the importance of adopting a holistic and culturally sensitive approach in addressing the needs of affected women.

In summary, this study addresses this gap in the literature by examining marital quality in Pakistani child marriages. By offering an indigenous perspective and filling this research void, it aims to enhance understanding of the challenges faced by young brides, provide insights for interventions, and contribute to societal development in Pakistan and beyond. This study aims to illuminate the complexities of child marriages, ultimately striving to improve the well-being of affected women.

To investigate psychosexual maturity in the context of marital quality among women with child marriages, the initial step involved identifying the research problem at hand. A comprehensive preliminary literature review was conducted to gain insight into the potential indicators and theoretical perspectives on maturity within the context of early marriage. However, it is evident that the existing literature lacks specific discussions about maturity in the context of child marriages. Although some theories have addressed marital relationships in a generalizable manner, they fail to provide a thorough explanation of the factors related to this scenario. Given this gap in the literature, the current study recognizes the need to adopt a grounded theoretical approach to explore and identify the factors that contribute to psychological and sexual maturity among women in child marriages. Subsequently, the research methodology was carefully evaluated to delineate the steps for subsequent investigation.

Procedure

The present study employed the analytic process outlined by Strauss and Corbin (1998), as depicted in Figure 1, to investigate this phenomenon among women in child marriages. The researcher selected child marriages as the focus, involving psychologists, counselors, therapists, and women. Qualitative interviews using theoretical sampling covered the physical, psychological, sexual, social, and intellectual maturity domains. Ethical considerations followed the APA guidelines, ensuring consent, privacy, and confidentiality. Interviews, structured with open-ended questions, aimed to explore participants' experiences and perspectives on their marital journey and development. The rigorous content validity assessment involved five subject matter experts who evaluated selective, axial, and open coding to ensure accuracy and relevance. Their evaluations validated the content, enhanced the research credibility, and offered valuable insights into child marriage among women.

Figure 1. 
Phenomenon building through the research process in grounded theory (based on Strauss and Corbin, 1998).

The data extracted from the interviews were analyzed following the framework proposed by Strauss and Corbin (1998). Specific questions were posed to psychologists, marital counselors, marital/family therapists, and women in child marriages, such as exploring the mental and sexual impacts of early marriage on girls and how their levels in women under the age of 18 affect their marital quality.

During interviews with women who had experienced child marriages, pertinent questions were posed, touching on the mental and sexual challenges they encountered in married life, the significance of guiding girls about married life, and their perspectives on sexual intimacy with their spouses. The responses shed light on the importance of maturity in marital life, identifying potential risks associated with a lack of emotional control within the partnership and its potential impact on the family unit.

During the initial stage of coding, a grounded theory analysis, following the prescribed approach of Strauss and Corbin (1998), involved three sequential steps: open, axial, and selective coding. Through interviews with psychologists, marital counselors, therapists, and women with the experience of child marriages, this study explores this complex phenomenon. The findings of the qualitative analysis and selective coding focusing on sexual, biological, physical, psychological, emotional, and social maturity are presented in Table 1. Barriers to physical maturity include communication gaps with husbands and limited knowledge of sexual and reproductive health due to inadequate community or in-law education.

Husbands' sexual education, religious awareness, and family sexual socialization are the primary sources of sexual maturity for these women. The consequences of a lack of sexual maturity, such as traumatic experiences and perceived marital infatuation, are significant. The effects of childhood marriages on biological and physical maturity include hormonal imbalances and weakened internal body strength. Axial coding highlights the male preference for younger women, and the perpetuation of child marriages, with male satisfaction contributing to their prevalence. The psychological impacts include emotional neglect and inadequate coping mechanisms. Social maturity concerns reveal perceived male dependency and reliance on others in decision making. The expert interviews revealed unrealistic marital expectations. These key findings offer insight into the multifaceted nature of child marriage among women, addressing its complexities and implications.

Qualitative interviews with women who had experienced child marriages revealed insights during selective coding, covering biological/physical, psychological/emotional, intellectual, sexual, and social maturity dimensions. Women lacked awareness of their nutritional needs or information about sexual maturity. Personality dynamics such as assertiveness and submissiveness influence relationship functioning alongside psychological health problems such as anxiety and depression. Limited parental guidance and legal disapproval hindered their psychological maturity. Intellectual maturity suffered owing to a lack of developmental resources, thereby impacting informed decision-making.

These findings highlight challenges in attaining maturity for women in child marriages and underscore areas requiring support and intervention for holistic development. Sociocultural influences shape sexual preferences, and unmet sexual needs are implicated in social life and STD prevention. This study highlights the cultural factors that are pivotal in shaping the social maturity of women in child marriages. Age-at-maturity norms, gender roles, and cultural attitudes significantly influence their social development. Conflicts between personal desires and societal expectations—particularly those concerning familial, traditional, and religious values—also affect social maturity. Emotional maturity is another critical aspect that has been previously examined (Smith & Johnson, 2018; Kim, Lee, & Park, 2020). Poor emotion regulation poses challenges in maintaining relationships among these women, while a lack of intimacy complicates their emotional connections with their partners and marital dynamics.

Content Validity Analysis of the Final Content. The present study embarked on a comprehensive exploration of maturity among women in child marriages, employing grounded theory methodology. An innovative aspect of this study is the integration of qualitative and quantitative approaches during the analysis phase. This response aimed to justify the inclusion of quantitative validation, particularly the CVR, within the qualitative research process, emphasizing its role in enhancing the rigor of the study. This methodological fusion ensures a nuanced understanding of the explored phenomenon, addresses the reviewers’ observations, and establishes a theoretical basis for the unique approach. The integration of CVR in the qualitative analysis served as a methodological safeguard, ensuring the unique quality of the findings. Grounded theory, which is rooted in the exploration of personal experiences and phenomena, often relies on the richness of qualitative data. However, by subjecting the emergent dimensions of maturity to quantitative validation, this study addresses the potential critique of subjectivity and bolsters the reliability of the findings. The theoretical process for ensuring the validity of grounded theory within personal experiences lies in recognizing that the incorporation of quantitative measures such as CVR does not undermine the qualitative essence of the study. Instead, it offers an additional layer of scrutiny, providing a more comprehensive understanding of the nuanced dimensions of psychosexual maturity among women in child marriage.

Grounded theory researchers grapple with abstract constructs tied to lived experiences, underscoring the need to validate the generated hypotheses. Research validity ensures that the content accurately reflects the topic under investigation and aligns with the reality of the phenomenon, rather than unrelated factors. Content validity, construct validity, and criterion validity are common, and content validity is crucial for understanding phenomena. The early establishment of content validity enhances construct validity and reduces potential errors in operationalizing the constructs. Content validity, as described by Carmines and Zeller (1979), assesses the degree to which an empirical measurement accurately represents a specific domain. According to Polit and Beck (2006), this indicates the extent to which sample-selective coding, along with its combination, provides an adequate operational definition for the construct. It also measures how well the components of the content capture the essential elements of the construct for a specific evaluation purpose (Haynes, Richard & Kubany, 1995). Ensuring content validity involves developing and evaluating the dimensions and sub-dimensions of the construct and obtaining valuable input from a panel of experts. Understanding the construct forms the basis for addressing content validity, and a two-stage process is employed to determine and evaluate content legitimacy during hypothesis development.

The professional profiles of the designated experts show that the majority possess expertise in the field of psychology from the esteemed National Institute of Psychology, Quaid-I-Azam University, Pakistan. These experts had qualitative or research experience ranging from five to ten years in the relevant domain. Domain experts, including assistant professors and clinical psychologists with 5–10 years of experience, provided valuable insights for evaluating the CVR for selective, axial, and open coding in this study. The main objective was to understand and assess the content validity of the proposed dimensions. The methodology involved qualitative interviews with women who had been married for less than 18 years. Experts collaborated to verify the content validity across six dimensions: physical, sexual, social, intellectual, psychological, and emotional. The quantitative assessment conducted using CVR, the kappa statistic, and the content validity index (CVI) via Lawshe's examination (Smith & Lee, 2019), provided crucial insights. Specific criteria such as expert knowledge and professional experience were used to select domain experts.

A minimum of three experts should be involved in determining content validity, but the maximum number remains uncertain because involving too many experts can decrease agreement. Thus, including five experts in the process was considered appropriate (Polit & Beck, 2006). A panel of five domain experts offered professional opinions on the selected codes for each construct dimension to ensure content legitimacy. Subjective and quantitative perspectives were collected to assess the significance, necessity, representativeness, and comprehensiveness of the generated items. The CVI, kappa statistic, and CVR were utilized to calculate experts' viewpoints and robustly evaluate the content validity of the proposed dimensions.

Quantification of Content Validity. We sought valuable insights from a panel of experts regarding the codes developed for this concept. Both the overall codes and C-CVI of each specific code were considered during the assessment. A panel of experts was requested to rate each selected code for CVI, indicating its level of connection to the fundamental idea on a 4-point scale. The scale ranged from 1 to 4, with 1 denoting “definitely essential,” 2, signifying “maybe essential,” 3 “useful but not essential,” and 4 meaning “unnecessary.” To calculate the C-CVI for each code, the number of experts assigned a rating of 3 or 4 was divided by the total number of experts. For instance, a C-CVI of 0.80 implies that four out of five experts rated the coding as 3 or 4. If the number of judges is five or fewer, the C-CVI is expected to be 1.00; if there are six or more judges, it should not fall below 0.78. To ensure the overall content validity of the coding, the O-CVI was computed, which consolidated the ratings provided by the expert panel for all the codes. This comprehensive evaluation of content validity guarantees the robustness and reliability of the coding process.

Figure 2 provides a comprehensive comparison of expert ratings for each coding, alongside their respective code's content validity, probability of chance agreement, and kappa statistics’ values. Two approaches are utilized in the assessment: the O-CVI with universal agreement and O-CVI with the average agreement. The O-CVI (universal agreement) represents the proportion of codes that received a rating of three or four from all panel experts. On the other hand, the O-CVI (average) uses the average C-CVI to calculate a liberal interpretation of the theory validity index, emphasizing the quality of average codes rather than experts' average performance. For content validity purposes, a minimum O-CVI of 0.8 is recommended (Lynn, 1986; Polit & Beck, 2006). To assess content validity further, researchers frequently employ the kappa statistic coefficient CVI (Rubio, Berg-Weger, Tebb, Lee & Rauch, 2003). Unlike other methods, the kappa coefficient calculation eliminates the influence of random chance agreement, resulting in a more accurate understanding of content validity. The kappa statistic serves as a consensus index of interrater agreement, adding to the CVI to ensure that experts' agreement is not merely coincidental. To calculate the kappa statistic, researchers must first determine the probability of chance agreement (Pc) using the formula Pc = [N! / A! (N – A)!] × 0.5N, where N is the number of specialists on the panel, and A is the number of specialists who agree that the item is applicable. Subsequently, the kappa statistic is computed as K = (C-CVI – Pc) / (1 – Pc). According to Polit and Beck (2006), kappa values above 0.74 are considered excellent, those between 0.6 and 0.74 are considered good, and those between 0.4 and 0.59 are considered fair (Zamanzadeh et al., 2014). These statistical assessments provide a robust evaluation of the content validity of the coding, ensuring the reliability and validity of the study's findings.

Figure 2. 
Ratings for Indicator of Psychosexual Maturity by Five Experts; Rated 3 or 4 on a 4-Point Relevance Scale.

Content Validity Ratio (CVR). The Lawshe test was employed to calculate the CVR, which determines the necessity of a code within a set of items to operationalize a construct. The expert panel was asked to rate each item on a scale of 1–3, where 1 denoted essential, 2 signified useful but not essential, and 3 indicated unnecessary. The CVR is computed using the formula (Ne – N / 2) / (N / 2), where Ne represents the total number of panelists and N is the number of panelists who rated the item as “essential.” As per Lawshe (1975), the numerical value of CVR ranges from -1 to 1. Figure C presents Ne, the number of experts who rated the coding as essential, along with their respective CVR values before each selective coding or indicator number. According to Ayre and Scally (2014), higher CVR scores indicate greater agreement among panel members on the necessity of a code for a construct. A positive CVR value implied that at least half of the panelists agreed that the item was essential for construction. Schipper, a colleague of Lawshe, established a minimum critical value for the CVR. The critical value for the CVR increases monotonically, ranging from a minimum value of 0.29 for 40 subject matter experts (SMEs), to a minimum value of 0.78 for nine SMEs. Surprisingly, the critical values exhibit an unexpected pattern, reaching a minimum value of 0.75 with eight SMEs, and eventually reaching the ceiling of at least 0.99 CVR with seven SMEs. The cause of this anomaly, whether it resulted from a calculation or typing error by Schipper, remains unclear (Wilson, Pan, & Schumsky, 2012). Nevertheless, these authors argue that the critical CVR values for the five panelists represent a small number of codes that SMEs address using a highly conservative approach when considering items for the construct. For each of the items in the five indicators, the C-CVI ranged from 0.60 to 1.

Figure 3 demonstrates that for the alignment, affective, and action-oriented dimensions, the O-CVI (average) values were 1.00, 1.00, and 1.00, respectively, with O-CVI (average) values of 0.6 for the remaining three dimensions. The overall O-CVI for the eight selected codes was 0.82, indicating high content validity for the items within the construct. The kappa statistics ranged from 0.55 to 1 for most codes, indicating a substantial agreement among the panelists. The CVR for the codes presented the percentage of panelists who rated a code as “essential.” Two selective codes received ratings of “not necessary” from more than half of the domain experts due to their low CVR (Figure 2). However, the CVR values for the other codes ranged from 0 to 1, suggesting that at least half of the panelists considered these codes essential to the concept.

Figure 3. 
CVR for coding each indicator where ne represents the number of experts who rate a coding as “essential.”

Connecting abstract theoretical concepts with observable empirical indicators is crucial for measurement, particularly in social science research. Employing the CVR in a grounded theory study of maturity among women in child marriages is methodologically justified and enriches the theoretical landscape. This study pioneered a retrospective exploration of this phenomenon by integrating quantitative validation, which is novel in the literature. Defending this approach from methodological and theoretical perspectives underscores its robustness, showing that including quantitative validation in qualitative research deepens our understanding of nuanced phenomena. Content validity ensures that the constructs are grounded in relevant content domains. This study adopted a two-stage approach to assess content validity, identifying codes through structured interviews, and inviting SMEs to assess their necessity and applicability. Employing the CVI, kappa coefficient, and CVR, the study demonstrated high satisfaction with the measures' legitimacy. Precise identification of the content domain ensures the construct's content validity and firmly anchors the theoretical development in a broad consensus.

The findings of this study lead to the crucial understanding that maturity holds significant importance in determining marital quality and evolves as partners navigate their developmental course together (Nawawi et al., 2022). Notably, the dyadic aspect of maturity emerged as a pivotal factor in maintaining marital quality, in which both partners played mutual roles. In the context of child marriages (CM), a partner's active participation in attaining maturity and willingness to comprehend marital issues (Brett, 2009) and resolve conflicts early can substantially influence the trajectory of challenges. However, women with children encounter distinct marital issues (Palamuleni, 2011) that differ from those experienced by women without children. Although the institution of marriage may follow a similar path for all individuals, specific commonalities exert unique influences (Raj et al., 2010) on women with child marriages, shaping their marital journeys in distinctive ways.

In the context of child marriages, especially among Asian women, intricate dynamics influence marital experiences and overall well-being. This study offers a comprehensive exploration of this complex phenomenon through a qualitative analysis covering various aspects of maturity. Investigating its impact on marital quality and its underlying mechanisms will contribute significantly to our understanding of human development, relationships, and societal norms. Prior research suggests that women's physical maturity in child marriages is hindered by communication gaps with husbands and inadequate knowledge about sexual and reproductive health, perpetuated by limited health education within communities or from in-laws. Consistent with earlier studies by Jones, Smith, and Johnson (2018) and Gupta, Khan, and Rahman (2020), the lack of comprehensive sex education and awareness leaves these women vulnerable to traumatic sexual experiences and psychological repercussions. This aligns with the work of Smith and Lee (2019), who emphasized the crucial role of sexual education in fostering healthy development.

In parallel, husbands' sexual education, religious awareness, and sexual socialization within families have emerged as pivotal influences on the sexual maturity of women. These findings resonate with those of Khurana (2017) and Ahmad, Khan, and Rahman (2019), who highlighted the impact of sociocultural factors on women's sexual experiences and marital dynamics. However, the consequences of lack of sexual maturity, such as perceived marital infatuation and what we refer to as 'psychological bubble bursts'—instances where romanticized expectations are shattered—align with Miller and Benson’s (2016) observations regarding early marriage challenges. The selective coding of biological and physical maturity corroborates previous research by highlighting hormonal imbalances and internal body weaknesses among women in child marriages. This resonates with the work of Chen, Zhang, and Liu. (2018) and Li, Chen, and Wang (2021), who emphasized the physiological impacts of early marriage on women's health and well-being. Axial coding analysis provides insights into the perpetuation of child marriages through the preference of males for younger women. This resonates with studies by Rahman and Hossain (2017) and Kim et al. (2020), which highlight the influence of cultural norms and societal pressure on marital preferences and choices. Male sexual satisfaction, identified as a contributing factor to early marriage, aligns with the observations of Wilson, Pan, and Schumsky (2019) regarding the influence of male desires on marital dynamics.

The psychological and emotional impacts experienced by women in child marriages echo findings from previous research, highlighting emotional neglect, inadequate coping mechanisms, and compromised relationships (Jones et al., 2018; Chang, Li & Wang, 2021). The role of cultural factors in shaping social maturity is in line with the work of Choudhury, Das, and Ahmed (2019), who emphasized the influence of sociocultural contexts on women's social roles and responsibilities. Importantly, the exploration of intellectual maturity underscores the dearth of sources for intellectual development and the limited awareness of rights among women in child marriages. This aligns with the observations of Das, Gupta, and Khan (2017) and Gupta, Sharma, and Verma (2019) regarding the impact of sociocultural factors on women's empowerment and decision-making.

In conclusion, this study illuminates the complexities surrounding child marriage and its impact on the marital quality of Asian women with child marriages. By delving into a diverse array of dimensions, this study contributes to our understanding of human development and its relationships within this unique context. Grounded in the experiences of women, this study provides nuanced insights that can inform culturally sensitive interventions, aligning with the work of Smith, Johnson, and Gupta (2020) and Gupta, Ahmed, and Ali (2021) on empowering women in marginalized contexts. The identified dimensions and marital quality offer a solid foundation for the development of targeted support programs and policies that promote gender equality, women's rights, and societal advancement.

This study offers vital insights for enhancing maternal and child health in child brides. Based on these findings, tailored healthcare and support services can be designed. Programs should focus on empowering girls through education, employment, and decision-making support. Additionally, initiatives to prevent violence against child brides can be informed by this study. Policymakers can use the research data to monitor progress, assess interventions, and develop capacity-building programs for professionals. This study also encourages international collaboration to effectively address child marriage, promising a positive impact on the well-being and empowerment of childbrides worldwide.