Developing and Validating a Measure of Patient-centered Peripartum Contraceptive Care

PROJECT SUMMARY ABSTRACT Background: Contraceptive care is an essential component of maternity care. While patient-centeredness is a key aspect of the quality of contraceptive care, significant evidence suggests that many peripartum women do not receive patient-centered contraceptive care. These poor experiences affect contraceptive use, birth spacing and risk of adverse birth outcomes. Addressing current shortcomings in peripartum contraceptive care requires robust metrics grounded in patient-centeredness, but no such measures currently exist. Commonly used measures of peripartum contraceptive care focus only on the clinical outcome of contraceptive provision. Assessing quality through this measure alone—as opposed to alongside a measure of patient experience—can have unintended consequences of incentivizing the promotion of contraception use or specific method types over individual women’s preferences. Thus, there is critical need for new measures that can capture the patient-centeredness of contraceptive care among peripartum women, overall and among key subgroups at disproportionate risk of non-patient-centered care. Approach: The objective of this proposal is to develop a novel, psychometrically validated measure of the patient experience of peripartum contraceptive care, the Patient-centeredness of Peripartum Birth control Counseling (PPBC) measure. To achieve this objective, we will first adapt an existing patient-reported outcome measure to the unique peripartum context, using modified Delphi methods with patient and expert stakeholders and cognitive interviews with patients (Aim 1). We will then administer the prototype measure developed in Aim 1 to a large sample of peripartum women, to assess and confirm factor structure, evaluate reliability and external validity, and develop a refined measure of the patient experience of peripartum contraceptive care (Aim 2). Impact: Findings from this proposal hold promise to ultimately transform the ability of health systems and researchers to understand and promote patient-centered peripartum contraceptive care delivery and thereby improve health outcomes for the 4 million mothers and infants receiving perinatal care in the U.S. annually.