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

May Sudhinaraset; Jessica D Gipson; Michelle Kao Nakphong; Brenda Soun; Patience Afulani; Ushma 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 May 14:110485. doi: 10.1016/j.contraception.2024.110485. Online ahead of print.

Authors

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

Affiliations

¹ Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles. Electronic address: msudhinaraset@ucla.edu.
² Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles.
³ Division of Prevention Science, Department of Medicine, University of California, San Francisco.
⁴ University of California, Los Angeles.
⁵ Epidemiology and Biostatistics Department, University of California, San Francisco.
⁶ Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco.
⁷ David Geffen School of Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles.

PMID: 38754758
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 & Dignity (10 items), 2) Responsive & Supportive Care (9 items for the full scale, 1 additional mode-specific item each for in-person and telemedicine), and 3) Communication & Autonomy (10 items for the full scale, 1 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.