Person-centered abortion care scale: Validation for medication abortion in the United States

May Sudhinaraset; Jessica D Gipson; Michelle K Nakphong; Brenda Soun; Patience A Afulani; Ushma D Upadhyay; Rajita Patil

doi:10.1016/j.contraception.2024.110485

Person-centered abortion care scale: Validation for medication abortion in the United States

Contraception. 2024 Sep:137:110485. doi: 10.1016/j.contraception.2024.110485. Epub 2024 May 15.

Authors

May Sudhinaraset¹, Jessica D Gipson², Michelle K Nakphong³, Brenda Soun⁴, Patience A Afulani⁵, Ushma D Upadhyay⁶, Rajita Patil⁷

Affiliations

¹ Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, United States; UCLA Bixby Center to Advance Sexual and Reproductive Health Equity, University of California, Los Angeles, CA, United States. Electronic address: msudhinaraset@ucla.edu.
² Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, United States; UCLA Bixby Center to Advance Sexual and Reproductive Health Equity, University of California, Los Angeles, CA, United States.
³ Division of Prevention Science, Department of Medicine, University of California, San Francisco, CA, United States.
⁴ Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, United States.
⁵ Epidemiology and Biostatistics Department, University of California, San Francisco, CA, United States; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, United States.
⁶ Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, United States.
⁷ UCLA Bixby Center to Advance Sexual and Reproductive Health Equity, University of California, Los Angeles, CA, United States; David Geffen School of Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, United States.

PMID: 38754758
PMCID: PMC11849315
DOI: 10.1016/j.contraception.2024.110485

Abstract

Objective: Medication abortions now make up the majority of abortions in the US, with new service delivery models such as telehealth; however, it is unclear how this may impact patient experiences. The objective of the study is to adapt and validate a person-centered abortion care (PCAC) scale for medication abortions that was developed in a global South context (Kenya) for use in the United States.

Study design: This study includes medication abortion patients from a hospital-based clinic who had one of two modes of service delivery: (1) telemedicine with no physical exam or ultrasound; or (2) in-person with clinic-based exams and ultrasounds. We conducted a sequential approach to scale development including: (1) defining constructs and item generation; (2) expert reviews; (3) cognitive interviews (n = 12); (4) survey development and online survey data collection (N = 182, including 45 telemedicine patients and 137 in-person patients); and (5) psychometric analyses.

Results: Exploratory factor analyses identified 29-items for the US-PCAC scale with three subscales: (1) Respect and Dignity (10 items), (2) Responsive and Supportive Care (nine items for the full scale, one additional mode-specific item each for in-person and telemedicine), and (3) Communication and Autonomy (10 items for the full scale, one additional item for telemedicine). The US-PCAC had high content, construct, and criterion validity. It also had high reliability, with a standardized alpha for the full 29-item US-PCAC scale of 0.95. The US-PCAC score was associated with overall satisfaction.

Conclusion: This study found high validity and reliability of a newly-developed person-centered abortion care scale for use in the US. As medication abortion provision expands, this scale can be used in quality improvement efforts.

Implications: This study found high validity and reliability of a newly-developed person-centered care scale for use in the United States for in-person and telemedicine medication abortion.

Keywords: Abortion; Medication abortion; Person-centered care; Quality of care.

Publication types

Validation Study

MeSH terms

Abortifacient Agents
Abortion, Induced* / methods
Adolescent
Adult
Factor Analysis, Statistical
Female
Humans
Patient Satisfaction*
Patient-Centered Care*
Pregnancy
Psychometrics*
Reproducibility of Results
Surveys and Questionnaires
Telemedicine*
United States
Young Adult

Substances

Abortifacient Agents

Grants and funding

P2C HD041022/HD/NICHD NIH HHS/United States