Development of the Person-Centered Contraceptive Counseling scale (PCCC), a short form of the Interpersonal Quality of Family Planning care scale.

OBJECTIVE: Person-centeredness is a critical component of quality in family planning. We previously validated an 11-item Interpersonal Quality of Family Planning (IQFP) scale. We sought to create a parsimonious version of the scale in preparation for testing its appropriateness as a patient-reported outcome performance measure. STUDY DESIGN: To explore clarity and importance of each of the 11 items, we conducted English and Spanish cognitive interviews with patients who received contraceptive counseling (n = 33) at 3 publicly funded California clinics. We triangulated these results with psychometric analysis of previously collected IQFP data (n = 1097) to assess validity and reliability of selected item combinations. RESULTS: The 11-item IQFP scale was reduced to a 4-item scale (the Person-Centered Contraceptive Counseling scale, or PCCC) that includes items evaluating provider performance regarding respect for patients, information provision, and eliciting and honoring patient preferences for birth control. Interview participants deemed the items included in the 4-item PCCC important and clear in both English and Spanish versions of the instrument. The 4-item PCCC retained the 11-item IQFP's psychometric properties, including internal consistency (Cronbach's alpha = 0.92 vs 0.97 for the PCCC and IQFP, respectively) and a consistent single factor analysis solution (factor loadings = 0.86-0.92 and 0.81-0.91). The 4-item PCCC additionally retained the construct and predictive validity of the IQFP. CONCLUSIONS: The 4-item PCCC is a valid and reliable as a measure of person-centered contraceptive counseling that reflects patients' perspectives on contraceptive counseling. IMPLICATIONS: Person-centered measures such as the 4-item PCCC can help inform efforts to improve health care quality. Future work will investigate the validity and reliability of the 4-item PCCC as a performance measure to determine the appropriateness of its use in the quality improvement context.

Breaking the silence in the primary care office: patients' attitudes toward discussing abortion during contraceptive counseling.

OBJECTIVES: Abortions are common health experiences in the United States, yet they are siloed from mainstream health care. To provide guidance on how clinicians could break down these silos, normalize conversations about abortion, and potentially improve patient experience and contraceptive decision-making, we sought to understand patient attitudes regarding discussing abortion during contraceptive counseling. STUDY DESIGN: In 2018, we completed in-depth semi-structured interviews with reproductive-aged women recruited from primary care clinics of two politically disparate regions within California. We elicited acceptability, preferences, and implications of clinicians mentioning abortion during contraceptive counseling. Using directed content analysis, we coded transcripts for inductive and deductive themes. RESULTS: We achieved thematic saturation after 49 interviews. Interviewees were diverse in reproductive history, race/ethnicity, religiosity, and abortion attitudes. Participants with diverse attitudes about abortion reported that having abortion mentioned during contraceptive counseling was generally viewed as acceptable, and even helpful, when delivered in a non-directive manner focused on information provision. For some patients, mentioning abortion may reduce abortion stigma and help contraceptive decision-making. Careful attention to a non-judgmental communication style is critical to safeguard against potential contraceptive coercion. CONCLUSIONS: Discussing abortion during contraceptive counseling was acceptable among this diverse population, and our findings suggest ways to best structure such counseling. Coupled with research on clinician perspectives, our findings can inform development of patient-centered contraceptive counseling approaches that integrate abortion in an attempt to facilitate patient care and reduce stigma. IMPLICATIONS: Mentioning abortion during contraceptive counseling can be acceptable, and even helpful, to patients when delivered in a non-directive manner focused on information provision, even among patients who believed abortion should be illegal in all or most cases. For some patients, mentioning abortion may reduce abortion stigma and help contraceptive decision-making.