ADVANCING INNOVATIVE MEASUREMENT OF PREGNANCY PREFERENCES WITH A SHORT-FORM DESIRE TO AVOID PREGNANCY SCALE

Objectives

The Desire to Avoid Pregnancy (DAP) Scale represents an important step forward for pregnancy “intention” measurement. The 14-item psychometric instrument captures pregnancy preferences prospectively across domains (cognitive, affective, consequences) and allows for nuance, uncertainty, and ambivalence. However, a DAP short-form scale is needed to reduce respondent burden and facilitate integration of this rigorous, person-centered measure into future research and surveillance.

Methods

We used state-representative data from >30,000 self-identified women, aged 18-44 years, from nine diverse US states (Surveys of Women, 2017–2023) to develop a four-item version of the DAP scale (DAP-4). After splitting the dataset in half, stratified by state, we used classical test theory and item response theory methods to iteratively identify a reduced item set that maintained construct validity (eg, included items across conceptual domains and were worded negatively and positively), internal structure validity (eg, monotonicity), and external validity (eg, no differential item functioning), while maintaining reasonable internal consistency reliability. Scale properties were retested on the second half of the dataset.

Results

The DAP-4 included two items in the cognitive domain and one each in the affective and practical consequences domains, and items worded in both directions. The internal consistency was high for a short-form (alpha=0.83), covered the full range of respondent pregnancy preferences, and met criteria for internal structure validity. We found no evidence of differential item functioning by age, race and ethnicity, relationship status or parity, and high correlation with the longer DAP scale (0.96).

Conclusions

A short-form DAP that maintains psychometric rigor is now available to measure pregnancy preferences.