Contraception: X最新文献

{"title":"Change and stability in contraceptive use patterns among US women over a 12-month period: analysis using the 2013–2015 National Survey of Family Growth life history calendar","authors":"Sean M. Finn,&nbsp;Ayana Douglas-Hall,&nbsp;Rachel K. Jones","doi":"10.1016/j.conx.2020.100028","DOIUrl":"10.1016/j.conx.2020.100028","url":null,"abstract":"<div><h3>Objective</h3><p>To improve understanding of contraceptive use over 1 year among women in the United States.</p></div><div><h3>Study design</h3><p>We used the 2013–2015 National Survey of Family Growth to examine monthly contraceptive use patterns over a 12-month period. We focused on use of contraception during months in which non-sterilized women were sexually active and not pregnant; our outcomes were contraceptive use in every month, some months, and no months. We used simple and multivariate logistic regression to examine socio-demographic and method use characteristics associated with contraceptive use patterns.</p></div><div><h3>Results</h3><p>Some 72% of non-pregnant, non-surgically sterile women used contraception in every sexually active month. After controlling for other demographic and individual characteristics, adolescents had higher odds (aOR<!--> <!-->=<!--> <!-->2.45) of using contraception in each sexually active month compared to women aged 25–29. Other groups more likely to use contraception monthly included those with some college (aOR<!--> <!-->=<!--> <!-->1.58) compared to less than high school and non-cohabiting unmarried women (aOR<!--> <!-->=<!--> <!-->1.49) compared to married women. Those with gaps in insurance coverage during the past year (aOR<!--> <!-->=<!--> <!-->0.70), women who were not sexually active all 12 months (aOR<!--> <!-->=<!--> <!-->0.42), and those with more than two male sexual partners (aOR<!--> <!-->=<!--> <!-->0.49), were less likely to use contraception every sexually active month. Nearly half (46%) of contraceptive users in our sample used more than one type of contraceptive method over the 12-month period.</p></div><div><h3>Conclusions</h3><p>The majority of women use contraception every month they are sexually active, although there is variation between socio-demographic groups. However, over a one-year period, many women used dynamic contraceptive strategies.</p></div><div><h3>Implications</h3><p>Health care providers should recognize that contraceptive use patterns are dynamic and change over a relatively short time period for many women.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100028"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38133736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Which contraceptive side effects matter most? Evidence from current and past users of injectables and implants in Western Kenya","authors":"George Odwe ,&nbsp;Francis Obare ,&nbsp;Kazuyo Machiyama ,&nbsp;John Cleland","doi":"10.1016/j.conx.2020.100030","DOIUrl":"10.1016/j.conx.2020.100030","url":null,"abstract":"<div><h3>Objectives</h3><p>The objectives were to assess experiences of menstrual bleeding and nonbleeding side effects among current and past users of injectables and implants and the associations between side effects and method evaluations by women — satisfaction, perceived suitability, the likelihood of future use and intended duration of use.</p></div><div><h3>Study design</h3><p>We used data on past and current users of injectables and implants from a survey of 1866 married or cohabiting women who participated in the third round of a 2-year prospective longitudinal study conducted in Homa Bay County, Western Kenya. Descriptive and bivariate analysis with <em>χ²</em> tests was used to assess statistically significant associations between experience of bleeding/nonbleeding side effects and method-specific attitudes.</p></div><div><h3>Results</h3><p>Self-reported method-related bleeding problems were high among current and past users of injectables (range 69%–79%) and implants (range 55%–60%) and much more common than nonbleeding side effects. For both methods, experience of either bleeding or nonbleeding side effects reduces positive evaluations, but the conjunction of both types had particularly pronounced consequences. Heavy bleeding was more strongly related to method evaluation (satisfaction and the likelihood of future use; p &lt; .001) among past users than other forms of menstrual bleeding disorders. Even among current users, about one third regarded bleeding side effects as very serious. Care-seeking from a healthcare provider for management of contraceptive-related side effects was low among current users (less than 40%) and modest among past users (range 53%–63%).</p></div><div><h3>Conclusions</h3><p>The results underscore the need to strengthen programs on counseling and information on contraceptive side effects including menstrual bleeding disturbances to improve method satisfaction and reduce discontinuation.</p></div><div><h3>Implication</h3><p>The experience of contraceptive-related menstrual bleeding and nonbleeding side effects reduces positive evaluation of the method and deters past users from future use of the method.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100030"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38133738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel vaginal pH regulator: results from the phase 3 AMPOWER contraception clinical trial","authors":"Michael A. Thomas ,&nbsp;B. Todd Chappell ,&nbsp;Bassem Maximos ,&nbsp;Kelly R. Culwell ,&nbsp;Clint Dart ,&nbsp;Brandon Howard","doi":"10.1016/j.conx.2020.100031","DOIUrl":"10.1016/j.conx.2020.100031","url":null,"abstract":"<div><h3>Objective</h3><p>The objective was to evaluate the contraceptive effectiveness, safety, and acceptability of a novel vaginal pH regulator over seven cycles of use.</p></div><div><h3>Study design</h3><p>A single-arm, open-label, phase 3 study was conducted across 112 sites in the United States in sexually active 18–35-year-old women at risk of pregnancy. Women administered the study treatment ≤<!--> <!-->1 h before each episode of intercourse. Women recorded use of study drug, coital information, and any symptoms experienced in electronic diaries. The primary outcome was the seven-cycle cumulative pregnancy rate as calculated using the Kaplan–Meier methodology; secondary outcomes included safety. Overall satisfaction was assessed via written questionnaires.</p></div><div><h3>Results</h3><p>A total of 1384 women were enrolled in the study from July 2017 to November 2018. Mean age was 27.7 ± 4.4 years; most women were white (69.0%). The seven-cycle cumulative pregnancy percentage was 13.7% [95% confidence interval (CI): 10.0%–17.5%], meeting the prespecified primary endpoint of having the upper bound 95% CI ≤<!--> <!-->21%. Most common adverse events (AEs) occurring in ≥<!--> <!-->2% of women were vulvovaginal burning sensation, vulvovaginal pruritus, urinary tract infection, vulvovaginal pain, mycotic infection, bacterial vaginosis, and nasopharyngitis. Of 1330 women who used the study drug at least once, fewer than 2% of women discontinued due to any AEs, and &lt;<!--> <!-->1% of women discontinued due to genitourinary symptoms. Overall, &gt;<!--> <!-->80% of women reported being “very satisfied” or “satisfied” with study treatment.</p></div><div><h3>Conclusions</h3><p>In this phase 3 study, the novel vaginal pH regulator demonstrated 86.3% contraceptive effectiveness, was safe and well tolerated, and was highly acceptable.</p></div><div><h3>Implications</h3><p>This novel vaginal pH regulator is a safe, nonhormonal, woman-controlled method of contraception that expands women's options.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100031"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100031","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38178467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A qualitative exploration of women's experiences discovering pregnancies in the emergency department","authors":"Sarah C.M. Roberts,&nbsp;Erin Wingo,&nbsp;Katrina Kimport","doi":"10.1016/j.conx.2020.100024","DOIUrl":"10.1016/j.conx.2020.100024","url":null,"abstract":"<div><h3>Objectives</h3><p>The few studies examining pregnancy testing in emergency departments (EDs) address pregnancy-related physical risks. Here, we examine experiences of people who discover pregnancies in EDs.</p></div><div><h3>Methods</h3><p>Between 2015 and 2017, as part of a larger study, we conducted interviews with 29 women in Southern Louisiana (<em>n</em> = 13) and Baltimore, MD (<em>n</em> = 16), who reported discussing their pregnancy during an ED visit. We analyzed these interviews for content and themes.</p></div><div><h3>Results</h3><p>Respondents reported diagnosis of pregnancy as a routine and straightforward component of care received in EDs. They reported receiving diagnostic studies and therapeutic interventions to rule out and treat complications of pregnancy and care for what brought them to the ED to begin with, such as treatments for nausea and vomiting; education about physical symptoms and nutrition-related needs during pregnancy; and referrals to prenatal care. However, we find evidence of unmet needs related to patient-centered communication, such as providing emotional care to women discovering pregnancies in EDs and lack of support for transitions to abortion care.</p></div><div><h3>Conclusions</h3><p>While diagnosis of pregnancy in the ED may be routine for ED clinicians, it is not necessarily routine or straightforward for people receiving the diagnosis. ED clinicians should not assume that all people who discover their pregnancies in the ED want to continue their pregnancy. People who discover pregnancies in EDs may benefit from patient-centered communication and support for the range of transitions to care people might need in addition to the routinely provided diagnostic and therapeutic interventions.</p></div><div><h3>Implications</h3><p>ED clinicians may need additional training and support to ensure that they can meet the range of needs of people who discover their pregnancies in the ED.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100024"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38060106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bucket-handle uterine rupture during second-trimester medication abortion, a rare form of rupture of the lower uterine segment and vaginal fornix: a case report","authors":"Ferid A. Abubeker MD ,&nbsp;Abraham Fessehaye MD ,&nbsp;Mekdes Daba Feyssa MD,MPH ,&nbsp;Sarah Prager MD,MAS","doi":"10.1016/j.conx.2020.100025","DOIUrl":"10.1016/j.conx.2020.100025","url":null,"abstract":"<div><p>A bucket-handle uterine rupture, a rare form of uterine rupture involving the posterior lower uterine segment and posterior vaginal fornix, occurred in a primigravid woman at 23 weeks of gestation during successful medication abortion.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100025"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38060107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adoption of no-test and telehealth medication abortion care among independent abortion providers in response to COVID-19","authors":"Ushma D. Upadhyay,&nbsp;Rosalyn Schroeder,&nbsp;Sarah C.M. Roberts","doi":"10.1016/j.conx.2020.100049","DOIUrl":"10.1016/j.conx.2020.100049","url":null,"abstract":"<div><h3>Objective</h3><p>Access to abortion care in the United States (US) is restricted by numerous logistical and financial barriers, which have been further intensified by the COVID-19 pandemic. We sought to understand the ways in which COVID-19 prompted changes in clinical practices in abortion care among independent abortion clinics.</p></div><div><h3>Study design</h3><p>We surveyed independent US abortion clinics and documented changes in practice regarding the provision of abortion since March 1, 2020.</p></div><div><h3>Results</h3><p>Among about 153 independent clinics invited, 100 clinics contributed relevant data and were included in the analytic sample. A total of 87% reported changes in protocols in response to the COVID-19 pandemic. Reported changes included moving to telehealth (phone or video) for follow-up (71%), starting or increasing telehealth for patient consultations and screening (41%), reducing Rh testing (43%) and other tests (42%), and omitting the preabortion ultrasound (15%). A total of 20% reported allowing quick pickup of medication abortion pills, and 4% began mailing medications directly to patients after a telehealth consultation. Clinical practice changes were reported throughout all regions of the US, but facilities in the Northeast (73%) were more likely to report starting or increasing telehealth than facilities in the South (23%, p &lt; .001).</p></div><div><h3>Conclusion</h3><p>The COVID-19 pandemic accelerated use of telehealth among independent abortion clinics, but many clinics, particularly those in the South, have been unable to make these changes. Other practices such as reducing preabortion ultrasounds were less common in all regions despite clinical guidelines and evidence supporting such changes in practice and positive benefits for public health and patient-centered care.</p></div><div><h3>Implications</h3><p>The COVID-19 pandemic has created a window of opportunity to remove barriers to abortion, including expanding telehealth and reducing preabortion tests. Clinics can strive for a culture shift towards simplifying the provision of medication abortion and routinely avoiding preabortion tests and in-person visits. Such changes in practice could have positive benefits for public health and patient-centered care.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100049"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100049","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38699538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined hormonal contraceptive use in Europe before and after the European Commission mandated changes in product information","authors":"Deeksha Khialani ,&nbsp;Mary Elizabeth Jones ,&nbsp;Szimonetta Komjáthiné Szépligeti ,&nbsp;Anne Gulbech Ording ,&nbsp;Vera Ehrenstein ,&nbsp;Irene Petersen ,&nbsp;Astrid van Hylckama Vlieg","doi":"10.1016/j.conx.2020.100018","DOIUrl":"10.1016/j.conx.2020.100018","url":null,"abstract":"<div><h3>Objectives</h3><p>We investigated combined hormonal contraceptives (CHC) prescribing patterns (focusing on combined oral contraceptives; COC) in three countries (Netherlands, Denmark, United Kingdom) in a time period preceding and in a time period following the European Commission's decision to update product information, and we estimated changes in incidence of venous thromboembolism (VTE) between the two periods.</p></div><div><h3>Study design</h3><p>We conducted a drug utilization analysis and a cohort study using routinely collected data. We calculated number, proportion and incidence rate of new users, switchers, and stoppers of COC in both time periods. VTE incidence was calculated in new users of COC and in all women aged 18–49 years.</p></div><div><h3>Results</h3><p>In all countries, the largest proportion (&gt;<!--> <!-->75%) of new users used COC containing levonorgestrel, norethisterone, or norgestimate, (i.e., indicated by European Medicines Agency (EMA) as the safest preparations) in both time periods. Switching did not demonstrate a clear pattern towards these types of COC and distribution of stoppers was similar in both time periods. While the proportion of new users initiating COC containing levonorgestrel, norethisterone, or norgestimate increased slightly, this did not translate to a decrease in the overall VTE incidence.</p></div><div><h3>Conclusion</h3><p>All three countries had the greatest proportion of women initiating a COC containing levonorgestrel, norethisterone, or norgestimate, and this proportion increased in the period after the European Commission decision albeit the increase was small due to the high percentage of use before the decision. This did not translate into a measureable change in the incidence of VTE.</p></div><div><h3>Implications</h3><p>Both before and after the European Commission's decision, the largest proportion of new users started with combined oral contraceptives containing levonorgestrel, norethisterone, or norgestimate. Earlier studies had already indicated an increased risk of VTE associated with COC containing other progestogens compared with these preparations, so it is possible that physicians were already preferentially prescribing COC containing levonorgestrel, norethisterone, or norgestimate to new users.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100018"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38059127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex education and contraceptive use of adolescent and young adult females in the United States: an analysis of the National Survey of Family Growth 2011–2017","authors":"Aneesha Cheedalla ,&nbsp;Caroline Moreau ,&nbsp;Anne E. Burke","doi":"10.1016/j.conx.2020.100048","DOIUrl":"10.1016/j.conx.2020.100048","url":null,"abstract":"<div><h3>Objectives</h3><p>The effects of the comprehensiveness of sex education on sexual health measures have not been well-studied. We compared trends in comprehensive sex education and its relation to contraceptive use at first intercourse and current contraceptive use for women ages 15–24 in the United States between 2011 and 2017.</p></div><div><h3>Study design</h3><p>Analyses included females ages 15–24 from the 2011–2017 National Survey of Family Growth. We defined comprehensive sex education as including 6 topics queried in the NSFG (how to say no to sex, birth control methods, where to get birth control, how to use condoms, sexually transmitted infections, HIV/AIDS), and non-comprehensive sex education as including less than 6 topics. Multivariable regression models investigated associations with contraceptive indicators.</p></div><div><h3>Results</h3><p>Among 5445 respondents, percentages of women receiving comprehensive sex education in 2011–2013, 2013–2015, and 2015–2017 were 35%, 40%, and 34%. Across all periods, respondents reporting comprehensive sex education before first sex were less likely to report first sexual intercourse before age 15 (aOR 0.55; 95% CI: 0.40–0.74) and non-volitional first intercourse (aOR 0.42, 95% CI: 0.26–0.72) compared to those with non-comprehensive sex education. At first intercourse, those with comprehensive sex education were more likely to have used any (aOR = 1.63; 95% CI: 1.18–2.25) and very effective (aOR = 1.35; 95% CI: 1.04–1.75) contraception. Comprehensive sex education was unrelated to current contraceptive use (aOR = 0.87; 95% CI: 0.63–1.21).</p></div><div><h3>Conclusions</h3><p>Comprehensive sex education was associated with increased odds of contraceptive use at first intercourse, but not current contraceptive use.</p></div><div><h3>Implications</h3><p>Programs that promote comprehensive sex education may have a positive impact on preventive behaviors at sexual debut.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100048"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100048","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38727107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abortion service delivery in clinics by state policy climate in 2017","authors":"Elizabeth Witwer,&nbsp;Rachel K. Jones,&nbsp;Liza Fuentes,&nbsp;S. Kate Castle","doi":"10.1016/j.conx.2020.100043","DOIUrl":"10.1016/j.conx.2020.100043","url":null,"abstract":"<div><h3>Objective</h3><p>The objective was to examine service delivery in clinics that provided abortions in 2017, including differences by abortion policy climate.</p></div><div><h3>Study design</h3><p>Using data from the Guttmacher Institute's 2017 Abortion Provider Census, we examine amount charged for abortion care, pregnancy gestation at which abortions were offered, number of days per week that clinics provided abortions and types of nonabortion services offered. Our analysis focuses on the 808 clinic facilities that provided 95% of abortions that year. Measures were calculated nationally and according to whether the clinic was in a state we categorized as hostile, middle ground or supportive of abortion rights.</p></div><div><h3>Results</h3><p>In 2017, 64% of clinics offered abortion at 11 weeks pregnancy gestation, and 22% did so at 20 weeks gestation. Supportive states had a higher density of clinics that provide abortion for every measured gestation than hostile states. Clinics charged an average of $549 for a surgical abortion at 10 weeks and $551 for medication abortion. Some 46% of clinics in supportive states offered abortion care 5 or more days per week compared to 29% in hostile states. Most clinics offered standalone contraception and family planning (87%) and gynecological care (85%), but the proportion of clinics that provided these services was higher in supportive states (93% and 90%) than in hostile states (75% and 73%).</p></div><div><h3>Conclusions</h3><p>A substantial proportion of abortion facilities provide a range of other health care services. Aspects of service delivery, such as number of days abortions are provided, may vary according to abortion policy climate.</p></div><div><h3>Implications statement</h3><p>Onerous policies in states hostile to abortion rights may inhibit some facilities from providing abortion more days per week, and if so, could further burden patients obtaining abortion care in these states.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100043"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38517453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring contraceptive self-efficacy in sub-Saharan Africa: development and validation of the CSESSA scale in Kenya and Nigeria","authors":"Lillian Whiting-Collins ,&nbsp;Lindsay Grenier ,&nbsp;Peter J. Winch ,&nbsp;Amy Tsui ,&nbsp;Pamela K. Donohue","doi":"10.1016/j.conx.2020.100041","DOIUrl":"10.1016/j.conx.2020.100041","url":null,"abstract":"<div><h3>Objectives</h3><p>Contraceptive self-efficacy, a women's belief about her own ability to complete the actions necessary for successful family planning, is a well-documented determinant of contraceptive use. However, there is currently no validated measure appropriate for low-resource settings. We developed and tested a new scale to measure Contraceptive Self-Efficacy among women in sub-Saharan Africa (CSESSA) using samples in Kenya and Nigeria.</p></div><div><h3>Study design</h3><p>The CSESSA scale was administered to women in Kenya (<em>n</em> = 314) and Nigeria (<em>n</em> = 414). Reliability and validity were analyzed separately by setting. Validity analysis included assessment of the area under the curve (AUC) to demonstrate predictive capability of CSESSA score for contraceptive use. Logistic regression was employed to test the relationship between CSESSA score and contraceptive use.</p></div><div><h3>Results</h3><p>Item reduction resulted in 11 items in Kenya (<em>α</em> = 0.90) and 10 items in Nigeria (<em>α</em> = 0.93). Three domains of contraceptive self-efficacy emerged in both settings: (1) husband/partner communication, (2) provider communication and (3) choosing and managing a method. Items related to the first two subscales, but not the third, were identical across settings. The AUC indicated predictive capability as mild in Kenya (AUC = 0.58) and strong in Nigeria (AUC = 0.73). In both settings, CSESSA score was associated with use of a modern contraceptive method at 12 months postpartum.</p></div><div><h3>Conclusions</h3><p>The CSESSA scale is a reliable and valid measure in two countries. Variation of the third subscale by site indicates that certain scale items may be more relevant in areas of low versus high contraceptive prevalence. Further research should be done to validate this subscale in other contexts.</p></div><div><h3>Implications</h3><p>This study contributes a reliable, valid measure of contraceptive self-efficacy in two African countries. The CSESSA scale and subscales can be administered in research (for example for evaluation of interventions to increase contraceptive uptake) or in a clinical setting to inform and improve contraceptive counseling.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100041"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38659636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}