Measuring contraceptive self-efficacy in sub-Saharan Africa: development and validation of the CSESSA scale in Kenya and Nigeria

Objectives

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.

Study design

The CSESSA scale was administered to women in Kenya (n = 314) and Nigeria (n = 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.

Results

Item reduction resulted in 11 items in Kenya (α = 0.90) and 10 items in Nigeria (α = 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.

Conclusions

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.

Implications

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.