Conceptualisation, development, and evaluation of a measure of unplanned pregnancy

Study objective: To develop a measure of unplanned pregnancy that is valid, reliable, and appropriate in the context of contemporary demographic trends and social mores and can be used in a variety of situations, including the production of population prevalence estimates. Design: A two stage study design: qualitative (inductive) methods to delineate the construct of pregnancy planning, and quantitative/psychometric methods to establish the means of measurement. Setting: Eight health service providers (comprising 14 clinics, including antenatal, abortion, and one general practitioner) across London, Edinburgh, Hertfordshire, Salisbury, and Southampton in the UK. Participants: Samples comprised a mixture of pregnant (continuing pregnancy and opting for abortion) and recently pregnant (post-abortion and postnatal) women. At the qualitative stage, 47 women took part in depth interviews (20 of whom were re-interviewed after the birth of their baby). Items were pre-tested with 26 women, and two psychometric field tests were carried out with, respectively, 390 and 651 women. Main results: A six item measure of unplanned pregnancy was produced. Psychometric testing demonstrated the measure’s high reliability (Cronbach’s α = 0.92; test-retest reliability = 0.97) and high face, content, and construct validity. Women’s positions in relation to pregnancy planning are represented by the range of scores (0–12). Conclusions: A psychometric measure of unplanned pregnancy, the development of which was informed by lay views, is now available. The measure is suitable for use with any pregnancy regardless of outcome (that is, birth, abortion, miscarriage) and is highly acceptable to women.

[1]  L. Cronbach.  Coefficient alpha and the internal structure of tests , 1951 .

[2]  A. Cartwright.  Parents and family planning services , 1970 .

[3]  R. P. Fishburne,et al.  Derivation of New Readability Formulas (Automated Readability Index, Fog Count and Flesch Reading Ease Formula) for Navy Enlisted Personnel , 1975 .

[4]  J. R. Landis,et al.  The measurement of observer agreement for categorical data. , 1977, Biometrics.

[5]  Pratt Wf,et al.  The national survey of family growth. , 1977 .

[6]  K. Dunnell,et al.  Family Formation 1976. , 1980 .

[7]  Family Formation 1976 , 1981 .

[8]  J. Jurich.  The relationship of modernity of sex roles to pregnancy planning. , 1984, Sociological focus.

[9]  Family planning services in England and Wales , 1985 .

[10]  M. Eliasziw,et al.  Sample size requirements for reliability studies. , 1987, Statistics in medicine.

[11]  Paul Kline,et al.  A Handbook of Test Construction : Introduction to Psychometric Design , 1987 .

[12]  J. Cleland,et al.  The World Fertility Survey: an assessment. , 1989 .

[13]  J. Guillebaud.  Unintended pregnancies and contraceptive use. , 1991, BMJ.

[14]  A. Fleissig.  Unintended pregnancies and the use of contraception: changes from 1984 to 1989. , 1991, BMJ.

[15]  Stopping the pill. , 1991, BMJ.

[16]  D. Brogan,et al.  The Pregnancy Risk Assessment Monitoring System: design, questionnaire, data collection and response rates. PRAMS Working Group. , 1991, Paediatric and perinatal epidemiology.

[17]  Robert F. DeVellis,et al.  Scale Development: Theory and Applications. , 1992 .

[18]  J. Morrison,et al.  The mental health of women 6 months after they give birth to an unwanted baby: a longitudinal study. , 1991, Social science & medicine.

[19]  C. Smith.  Family planning services. , 1992, Quality in health care : QHC.

[20]  David L. Streiner,et al.  Sample-Size Formulae for Parameter Estimation , 1994 .

[21]  Miller Wb.  Reproductive decisions: how we make them and how they make us. , 1994, Advances in population : psychosocial perspectives.

[22]  Reproductive decisions: how we make them and how they make us. , 1994, Advances in population : psychosocial perspectives.

[23]  J. Forrest,et al.  Intention status of U.S. births in 1988: differences by mothers' socioeconomic and demographic characteristics. , 1995, Family planning perspectives.

[24]  The National Survey of Family Growth: Principal Source of Statistics on Unintended Pregnancy: Supplement to Chapter 2 , 1995 .

[25]  J. Shelby.  The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families , 1997 .

[26]  M. Moos,et al.  Defining and measuring unintended pregnancy: issues and concerns. , 1997, Women's health issues : official publication of the Jacobs Institute of Women's Health.

[27]  R. Kaufmann,et al.  Comparison of two question sequences for assessing pregnancy intentions. , 1997, American journal of epidemiology.

[28]  J. Stockbauer,et al.  Pregnancy wantedness and adverse pregnancy outcomes: differences by race and Medicaid status. , 1997, Family planning perspectives.

[29]  G. Kearns.  Fertility, class and gender in Britain, 1860–1940 , 1997, Medical History.

[30]  P. Kline.  The New Psychometrics: Science, Psychology and Measurement , 1998 .

[31]  The plans in unplanned pregnancy: secondary gain and the partnership. , 1999, The British journal of medical psychology.

[32]  J. Stanford,et al.  Are all contraceptive failures unintended pregnancies? Evidence from the 1995 National Survey of Family Growth. , 1999, Family planning perspectives.

[33]  K. Luker,et al.  A reminder that human behavior frequently refuses to conform to models created by researchers. , 1999, Family planning perspectives.

[34]  W. Mosher,et al.  Options for measuring unintended pregnancy in cycle 6 of the National Survey of Family Growth. , 1999, Family planning perspectives.

[35]  K. Fisher.  Uncertain aims and tacit negotiation: birth control practices in Britain, 1925-50. , 2000, Population and development review.

[36]  G. Barrett.  Developing a measure of unplanned pregnancy , 2002 .

[37]  K. Wellings,et al.  What is a 'planned' pregnancy? Empirical data from a British study. , 2002, Social science & medicine.

[38]  J. Santelli,et al.  The measurement and meaning of unintended pregnancy. , 2003, Perspectives on sexual and reproductive health.

[39]  M. Moos,et al.  Measuring the intensity of pregnancy planning effort. , 2003, Paediatric and perinatal epidemiology.

[40]  J. Ware.  SF-36 health survey: Manual and interpretation guide , 2003 .

[41]  Kathleenl N. Lohr,et al.  Assessing health status and quality-of-life instruments: Attributes and review criteria , 2002, Quality of Life Research.

[42]  J. Stanford,et al.  Defining Dimensions of Pregnancy Intendedness , 2000, Maternal and Child Health Journal.

[43]  L. Rajmil.  Health measurement scales. A practical guide to their development and use, 3rd ed , 2005 .