Getting Intentional about Intention to Use: A Scoping Review of Person-Centered Measures of Demand

In recent years, there has been much reflection on the measures used to assess and monitor contraceptive programming outcomes. The meaning and measurement of intention‐to‐use (ITU) contraception, however, has had less attention and research despite its widespread inclusion in many major surveys. This paper takes a deeper look at the meaning and measurement of ITU around contraception. We conducted a scoping review guided by the following questions: What is the existing evidence regarding the measurement of ITU contraception? What definitions and measures are used? What do we know about the validity of these measures? We searched databases and found 112 papers to include in our review and combined this with a review of the survey instruments and behavioral theory. Our review found growing evidence around the construct of ITU in family planning programming and research. However there are inconsistencies in how ITU is defined and measured, and this tends not to be informed by advances in behavioral theory and research. Further work is needed to develop and test measures that capture the complexity of intention, examine how intention differently relates to longer‐range goals compared to more immediate implementation, and demonstrate a positive relationship between ITU and contraceptive use.

Use of hormonal contraceptives among immigrant women and their daughters in Norway: Data from the Norwegian Prescription Database

INTRODUCTION

Immigrants and their offspring constitute 16.3% of the population in Norway. Knowledge about their contraceptive use is important in order to inform adequate family planning services. Prior research has shown less use of contraception among first-generation immigrants than among non-immigrant women. Our aim is to compare the use of hormonal contraceptives between immigrants and their adult daughters.

MATERIAL AND METHODS

Information from the Norwegian Prescription Database on all hormonal contraceptives dispensed at all pharmacies in Norway in 2008 was merged with demographic, socioeconomic and immigration data from the National Population Register and information from the Regular General Practitioner Database and the Medical Birth Registry Norway. A total of 10 451 women aged 16-30 from five countries with relatively large numbers of immigrants and adult daughters living in Norway in 2008 were included in the study. Descriptive statistics and logistic regression analyses were conducted. The main outcome measure was use of any hormonal contraceptive.

RESULTS

More daughters of immigrants from Vietnam compared with immigrant women from these countries (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.8-2.8) and Poland (OR 2.3, 95% CI: 1.6-3.3) used hormonal contraceptives. However, no adjusted differences between generations were detected for immigrants from Pakistan (OR 1.2, 95% CI 1.0-1.4), Morocco (OR 1.0, 95% CI 0.7-1.4) or Chile (OR 1.3, 95% CI 0.8-1.9).

CONCLUSIONS

Further research should explore the reasons for heterogeneity in use of contraception among daughters of immigrants from different origins and explore whether daughters of immigrant mothers from some areas have unmet needs of contraception.

Psychometric Properties of a Measure Assessing Attitudes and Norms as Determinants of Intention to Use Oral Contraceptives

PURPOSE

Asian immigrant and Asian American women are less likely to use oral contraceptives (OCs) and tend to rely on low-efficacy methods of contraception. This contraceptive pattern remains poorly understood, in part, because no theory-driven measurement exists to assess psychosocial determinants essential in explaining behaviors related to OC use in this population. The current study aimed to evaluate the psychometric properties of a measure of attitudes and subjective norms toward OC use among Korean American women as a first step to determine whether the measure can be used in this population and, potentially, in other Asian ethnic groups.

METHODS

The sample consisted of 329 Korean immigrant women living in New York City. The theory of reasoned action guided the development of the measure assessing attitudes and norms. Psychometric evaluation included item analysis, internal consistency estimates of reliability, and construct validity (i.e., factorial, discriminant, and predictive).

RESULTS

All item-total correlations were above the recommendation of .30. The Cronbach's alpha for the attitudes and subjective norms measure was .88 and .86, respectively. Exploratory factor analyses revealed four interpretable factors, and confirmatory factor analyses confirmed that the factor structures derived from the exploratory factor analyses fit the data well. Discriminant and predictive validity of the measure were also established.

CONCLUSIONS

The study provides support for the validity and reliability of the measure and its use for determining the degree to which Korean immigrant women intend to use OCs.

Sexual Health and Risk Behaviour among East Asian Adolescents in British Columbia

Despite the large number of adolescents of East Asian origin in Canada, there is limited research on sexual health among this population. A first step to develop strategies for sexual health promotion for adolescents is to document the prevalence of sexual behaviours. This study thus estimated the prevalence of sexual health and risk behaviours among East Asian adolescents in grades 7 to 12, using the province-wide, school-based 2008 British Columbia Adolescent Health Survey (unweighted N = 4,311). Less than 10% of East Asian adolescents have ever had sexual intercourse. However, most of these sexually active adolescents have engaged in risky sexual behaviours, including multiple sexual partners and non-condom use at last intercourse. In particular, nearly half of sexually active girls reported not using a condom at last intercourse. Compared to immigrant students whose primary language at home was not English, immigrant and Canadian-born students speaking English at home were more likely to experience sexual intercourse. Among students who have never had sexual intercourse, two most common reasons for sexual abstinence were not feeling ready and waiting to meet the right person. Findings suggest the need for sexual health interventions tailored to gender and sociocultural contexts in which adolescents live.

Relationships among acculturative stress, sleep, and nondipping blood pressure in Korean American women

Generally blood pressure (BP) should drop or dip by 10-20% during sleep. The phenomenon of nondipping BP during sleep has gained interest because of its association with various damaging effects to end-organs. This exploratory study examined nighttime nondipping BP, acculturative stress and quality of sleep in 30 Korean American women. Acculturative stress and sleep quality were measured using the Revised Social, Attitudinal, Familial, and Environmental Acculturative Stress Scale (R-SAFE) and the Pittsburg Sleep Quality Index (PSQI), respectively. Participants' BP was monitored over a 24-hour period. Participants were categorized as dippers and nondippers based on the drop in nocturnal systolic BP. Of the 30 women, 8 (26.7%) were nondippers. A shorter sleep duration and more disturbed sleep were associated with nondipping and, interestingly, less acculturative stress was also associated with nondipping BP. Our finding supports that sleep evaluation is needed in caring for individuals with nondipping BP.