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 pregnant and postpartum (hereafter “peripartum”) individuals do not receive patient-centered contraceptive care and that

marginalized groups are disproportionately at risk of poor experiences. 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 and health equity, 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 patients’ preferences. Thus, there is critical need for new measures that can capture the patient-centeredness of contraceptive care among peripartum populations, 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 individuals, 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, equitable peripartum contraceptive care delivery and

thereby improve health outcomes for the 4 million mothers and infants receiving perinatal care in the U.S. annually.