Psychometric evaluation of the desire to avoid pregnancy scale in India.

Abstract

Objective: This study aimed to evaluate the psychometric performance of the Desire to Avoid Pregnancy (DAP) scale in India.

Study design: We utilized survey data from married women enrolled in a family planning intervention in Maharashtra, India, who provided responses to the 14-item DAP scale at 18-month intervention study follow-up. We assessed scale internal consistency using Cronbach α and used exploratory factor analysis to evaluate scale unidimensionality and item response theory (IRT) to assess item performance. We used regression models to assess whether DAP predicts current reported contraceptive use, as well as future contraceptive use and pregnancy, to evaluate construct validity.

Results: A total of 1088 participants responded to 18-month intervention study follow-up survey; 99% of eligible participants (887/888) provided the full-scale response. One item, "makes me smile," performed in the reverse direction as anticipated (negative item-test correlation) and was excluded for use in this analysis. The mean 13-item DAP score (DAP-13) was 2.14 of 4 (SD 0.95, range 0-4); internal consistency was high (Cronbach α = 0.92). Most items fit the partial credit model on IRT. Exploratory factor analyses supported either a one- or two-factor model; the unidimensional model was considered acceptable for use as the single factor explained 71% of all variance, and all items had stable absolute factor loadings ≥0.38. DAP-13 score only differed by parity; nulliparous women had the lowest scores (0.56), followed by women with one (1.94), two (2.60), or three or more births (2.56; p < 0.001). A one-point increase in DAP-13 was associated with greater odds of current contraception use reported at time of DAP assessment (adjusted odds ratio [aOR] 1.79, 95% CI 1.43-2.26), subsequent contraception use reported 18 months after DAP assessment (aOR 1.88, 95% CI 1.44-2.44), and half the odds of subsequent pregnancy in the 18-month period after DAP assessment (aOR 0.57, 95% CI 0.46-0.71).

Conclusions: The DAP scale demonstrated good reliability and unidimensionality in this population. Higher DAP scores were associated with higher odds of contraception use and lower odds of pregnancy, supporting construct validity. Future research on the DAP scale in Maharashtra should explore alternative translations of the "makes me smile" item that better capture local expressions of joy about potential childbearing.

Implications: A modified version of the DAP scale is acceptable for use in an Indian population and can be utilized in future research and program evaluation that focus on contraception and pregnancy prevention in this context. One item was excluded and requires additional formative research to better capture the intended emotional valence in this cultural context.

Clinical trial registration number: NCT03514914.