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Rocca CH, Muñoz I, Rao L, Levin S, Tzvieli O, Harper CC. Measuring a Critical Component of Contraceptive Decision Making: The Contraceptive Concerns and Beliefs Scale. Matern Child Health J 2024; 28:847-857. [PMID: 38194129 PMCID: PMC11001673 DOI: 10.1007/s10995-023-03856-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 01/10/2024]
Abstract
INTRODUCTION Concerns about safety and side effects from contraceptives are widespread and related to reluctance to use them. Measuring these concerns is an essential component of understanding contraceptive decision-making and guiding contraceptive and interpregnancy clinical care. METHODS We used qualitative research and item response theory to develop and test a psychometric instrument to measure contraceptive concerns and beliefs. We developed 55 candidate scale items and tested them among 572 adolescents and adults across nine California healthcare facilities in 2019-2020. We derived a 6-item scale and assessed differences by age and social determinants of health with multivariable regression. RESULTS In qualitative data, participants voiced both concerns and positive beliefs about contraception. Quantitative survey respondents were aged 21 years on average, and 24% were parous. Over half (54%) worried contraception has dangerous side effects, and 39% worried it is unnatural. The mean Contraceptive Concerns score, increasing with higher concerns, was 1.85 (SD: 1.00, range 0-4, α = 0.81). Items fit a partial credit item response model and met prespecified criteria for internal structure validity. Contraceptive use declined with increasing Concerns score (adjusted prevalence ratio [aPR] = 0.81 [0.72-0.92]). Scores were elevated among Black (mean: 2.06; aβ = 0.34 [0.09, 0.59]) and Multiracial or other race (2.11; aβ = 0.34 [0.02, 0.66]) respondents vs. White (1.66), but not Latinx respondents (1.81; aβ = 0.11 [- 0.11, 0.33]). Scores were also elevated among participants with lower maternal education (high school/Associate's 1.89 versus college 1.60; aβ = 0.28 [0.04, 0.53]). DISCUSSION The psychometrically robust Concerns instrument can be used in research to measure autonomous contraceptive decision-making and to design person-centered care.
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Affiliation(s)
- Corinne H Rocca
- Advancing Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, Oakland, CA, USA.
| | - Isabel Muñoz
- Advancing Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, Oakland, CA, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Lavanya Rao
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Sara Levin
- Division of Public Health, Contra Costa Health, Martinez, CA, USA
| | - Ori Tzvieli
- Division of Public Health, Contra Costa Health, Martinez, CA, USA
| | - Cynthia C Harper
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Sznajder K, Thaler K, Perin J, Burke AE, Williams GC, Sufrin C. Development and evaluation of measures to assess self-determination in peripartum contraceptive decision-making. Contraception 2024; 131:110329. [PMID: 37979643 DOI: 10.1016/j.contraception.2023.110329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVES We aimed to adapt and validate person-centered measures to evaluate various contributors to self-determination in perinatal contraceptive decision-making. STUDY DESIGN We developed and administered four scales adapted from existing measures in the context of Self-Determination Theory: the Treatment Self-Regulation Questionnaire (TSRQ), Perceived Competence Scale, modified Health Care Climate Questionnaire, and Important Other Climate Questionnaire. The TSRQ consists of three subscales: autonomous motivation, controlled motivation, and amotivation. We recruited a nonprobability convenience sample of 300 hospitalized postpartum patients in Baltimore, MD, between 2015 and 2016 and administered surveys in English and Spanish. We validated the scales with Cronbach's alpha coefficients, confirmatory factor analysis, and invariance analysis. We examined construct validity by testing correlations between the scales and other person-centered measures, such as satisfaction with counseling. RESULTS Cronbach's alpha was >0.8 except for the amotivation subscale. Confirmatory factor analysis was adequate for all scales. Autonomous motivation correlated positively and significantly with perceived competence, health care provider autonomy support, important other autonomy support, and other measures of patient satisfaction. CONCLUSIONS We found the four scales to be internally consistent and valid except for the amotivation subscale. We recommend using the autonomous motivation subscale in place of the full TSRQ. The autonomous motivation subscale, Perceived Competence Scale, modified Health Care Climate Questionnaire, and Important Other Climate Questionnaire showed adequate internal consistency, construct validity, and adherence to the expected conceptual structure of the scales. IMPLICATIONS Autonomous decision-making is central to ethics and quality of care, especially for contraceptive methods that require a provider for initiation or discontinuation and at more vulnerable times, such as postpartum and postabortion. These scales may help tailor person-centered and autonomy-supportive interventions and programs to improve contraceptive counseling and care delivery.
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Affiliation(s)
- Katharine Sznajder
- Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Hospital, Baltimore, MD, United States.
| | - Katrina Thaler
- Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Hospital, Baltimore, MD, United States
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Anne E Burke
- Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Hospital, Baltimore, MD, United States; Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Geoffrey C Williams
- Department of Medicine, Psychology, and Psychiatry, Center for Community Health and Prevention, University of Rochester Medical Center, Rochester, NY, United States
| | - Carolyn Sufrin
- Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Hospital, Baltimore, MD, United States
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Holt K, Challa S, Alitubeera P, Atuyambe L, Dehlendorf C, Galavotti C, Idiodi I, Jegede A, Omoluabi E, Waiswa P, Upadhyay U. Conceptualizing Contraceptive Agency: A Critical Step to Enable Human Rights-Based Family Planning Programs and Measurement. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300299. [PMID: 38346841 PMCID: PMC10906552 DOI: 10.9745/ghsp-d-23-00299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/23/2024] [Indexed: 03/01/2024]
Abstract
We propose a detailed framework for contraceptive agency to serve as a rights-based guide for centering individuals’ ability to make and act on their own contraceptive choices, regardless of what those choices are, in program design and evaluation.
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Affiliation(s)
- Kelsey Holt
- University of California, San Francisco, San Francisco, CA, USA.
| | - Sneha Challa
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Lynn Atuyambe
- Makerere University School of Public Health, Kampala, Uganda
| | | | | | | | | | | | - Peter Waiswa
- Makerere University School of Public Health, Kampala, Uganda
| | - Ushma Upadhyay
- University of California, San Francisco, San Francisco, CA, USA
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Watson A, Yarger J, Sedlander E, Urbina J, Hopkins K, Rodriguez MI, Fuentes L, Harper CC. Concern that contraception affects future fertility: How common is this concern among young people and does it stop them from using contraception? Contracept X 2023; 5:100103. [PMID: 38162189 PMCID: PMC10755709 DOI: 10.1016/j.conx.2023.100103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/16/2023] [Accepted: 11/26/2023] [Indexed: 01/03/2024] Open
Abstract
Objectives This study examines the concern that contraception affects future fertility among community college students and its association with contraceptive use. Study design We used baseline data from a randomized controlled trial with 2060 community college students assigned female at birth. We used mixed-effects multivariate logistic regression adjusted for clustered data to assess sociodemographic factors associated with concerns about contraception affecting future fertility and to test the association between this concern and contraceptive use. Results Most participants (69%) worried about contraception affecting their future fertility. Multivariable results indicated that first-generation college students (adjusted odds ratio [aOR], 1.24; 95% confidence interval [CI], 1.01-1.55) and non-English speakers at home (aOR, 1.30; 95% CI, 1.04-1.64) were more concerned. Racial and ethnic differences were significant, with Black non-Hispanic (aOR, 2.83; 95% CI, 1.70-4.70), Asian/Pacific Islander non-Hispanic (aOR, 2.12; 95% CI, 1.43-3.14), and Hispanic (aOR, 1.54; 95% CI, 1.17-2.02) participants more likely to be concerned than White non-Hispanic counterparts. Participants who received contraceptive services in the past year had lower odds of this concern (aOR, 0.72; 95% CI 0.59-0.88). Furthermore, participants with this concern had lower odds of using contraception (aOR, 0.67; 95% CI, 0.49-0.91), especially hormonal contraception (aOR, 0.77; 95% CI, 0.61-0.97). Conclusions Most students feared contraception's impact on fertility, and this fear was associated with not using contraception. Disparities in this concern may be tied to discrimination, reproductive coercion, and limited reproductive health care access. Addressing concerns about contraception affecting future fertility is crucial to person-centered contraceptive counseling. Implications This study examines the concern that contraception affects future fertility among sexually active female community college students and its impact on contraceptive use. Most participants expressed concerns about contraception affecting future fertility. Addressing future fertility concerns in patient-centered contraceptive counseling is crucial for reaching young people.
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Affiliation(s)
- Annalisa Watson
- School of Public Health, University of California, Berkeley, CA, United States
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, United States
| | - Jennifer Yarger
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States
| | - Erica Sedlander
- Department of Social and Behavioral Sciences, Institute for Health and Aging, University of California, San Francisco, CA, United States
| | - Josephine Urbina
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, United States
| | - Kristine Hopkins
- Population Research Center, University of Texas at Austin, Austin, TX, United States
| | - Maria I. Rodriguez
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, United States
| | - Liza Fuentes
- Boston Medical Center, Boston, MA, United States
| | - Cynthia C. Harper
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, United States
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, United States
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Rao L, Rocca CH, Muñoz I, Chambers BD, Devaskar S, Asiodu IV, Stern L, Blum M, Comfort AB, Harper CC. "She should support me, she's my doctor:" Patient perceptions of agency in contraceptive decision-making in the clinical encounter in Northern California. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2023; 55:94-103. [PMID: 37216964 PMCID: PMC10537387 DOI: 10.1363/psrh.12226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Agency in contraceptive decision-making is an essential aspect of reproductive autonomy. We conducted qualitative research to investigate what agency means to patients seeking contraceptive care to inform the development of a validated measure of this construct. METHODOLOGY We held four focus group discussions and seven interviews with sexually-active individuals assigned female at birth, ages 16-29 years, recruited from reproductive health clinics in Northern California. We explored experiences in contraceptive decision-making during the clinic visit. We coded data in ATLAS.ti and by hand, compared codes across three coders, and used thematic analysis to identify salient themes. RESULTS The sample mean age was 21 years, with 17% of participants identifying as Asian, 23% as Black, 27% as Latinx, 17% as Multiracial/other, and 27% as white. Overall, participants reported active and engaged decision-making in their recent contraceptive visit but noted experiences that had undermined their agency in the past. They described how non-judgmental care allowed them to communicate openly, affirming their ability to make their own decisions. However, several mentioned how unexpected contraceptive side effects after the visit had reduced their sense of agency over their decision in retrospect. Several participants, including those who identified as Black, Latinx, and/or Asian, described prior experiences where pressure to use a contraceptive method had undermined their agency and where they had switched providers to regain agency over their contraceptive decisions. DISCUSSION Most participants were aware of their agency during contraceptive visits and how it varied in different experiences with providers and the healthcare system. Patient perspectives can help to inform measurement development and ultimately the delivery of care that supports contraceptive agency.
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Affiliation(s)
- Lavanya Rao
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, California, USA
| | - Corinne H. Rocca
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, California, USA
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, School of Medicine, San Francisco, California, USA
| | - Isabel Muñoz
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, California, USA
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, School of Medicine, San Francisco, California, USA
| | - Brittany D. Chambers
- Department of Human Ecology, University of California, Davis, School of Agricultural and Environmental Sciences, Davis, California, USA
| | - Sangita Devaskar
- Planned Parenthood Northern California, Santa Rosa, California, USA
| | - Ifeyinwa V. Asiodu
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Lisa Stern
- Coalition to Expand Contraceptive Access (CECA), San Francisco, California, USA
| | - Maya Blum
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, California, USA
| | - Alison B. Comfort
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, California, USA
| | - Cynthia C. Harper
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, California, USA
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