Development and Validation of the Client-Reported Quality of Contraceptive Counseling Scale to Measure Quality and Fulfillment of Rights in Family Planning Programs

Abstract

We developed the Quality of Contraceptive Counseling (QCC) Scale to improve measurement of client experiences with providers in the era of rights-based service delivery. We generated scale items drawing on the previously published QCC Framework and qualitative research on women's preferences for counseling in Mexico, and refined them through cognitive interviews (n = 29) in two Mexican states. The item pool was reduced from 35 to 22 items after pilot testing using exit interviews in San Luis Potosí (n = 257). Exploratory Factor Analysis revealed three underlying dimensions (Information Exchange, Interpersonal Relationship, Disrespect and Abuse); this dimensionality was reproduced in Mexico City (n = 242) using Confirmatory Factor Analysis. Item Response Theory analyses confirmed acceptable item properties in both states, and correlation analyses established convergent, predictive, and divergent validity. The QCC Scale and subscales fill a gap in measurement tools for ensuring high quality of care and fulfillment of human rights in contraceptive services, and should be evaluated and adapted in other contexts.

Figure 1

Quality in contraceptive counseling Reprinted from Contraception 96(3), Kelsey Holt, Christine Dehlendorf, Ana Langer, “Defining quality in contraceptive counseling to improve measurement of individuals' experiences and enable service delivery improvement,” page 5, copyright 2017, with permission from Elsevier.

Figure 2

Test Information Functions from Item Response Theory models before and after item reduction

Figure 3

Distribution of Quality of Contraceptive Counseling Scale composite and subscale scores, Mexico City and San Luis Potosí (N=499)