Validation of a measure to assess decision-making autonomy in family planning services in three low- and middle-income countries: The Family Planning Autonomous Decision-Making scale (FP-ADM)
Date
2023
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
PLOS ONE
Abstract
Background
Integrating measures of respectful care is an important priority in family planning programs,
aligned with maternal health efforts. Ensuring women can make autonomous reproductive
health decisions is an important indicator of respectful care. While scales have been devel oped and validated in family planning for dimensions of person-centered care, none focus
specifically on decision-making autonomy. The Mothers Autonomy in Decision-Making
(MADM) scale measures autonomy in decision-making during maternity care. We adapted
the MADM scale to measure autonomy surrounding a woman’s decision to use a contraceptive method within the context of contraceptive counselling. This study presents a psychometric validation of the Family Planning Autonomous Decision-Making (FP-ADM) scale
using data from Argentina, Ghana, and India.
Methods and findings
We used cross-sectional data from women in four subnational areas in Argentina (n = 890),
Ghana (n = 1,114), and India (n = 1,130). In each area, 20 primary sampling units (PSUs)
were randomly selected based on probability proportional to size. Households were ran domly selected in Ghana and India. In Argentina, all facilities providing reproductive and maternal health services within selected PSUs were included and women were randomly
selected upon exiting the facility. Interviews were conducted with a sample of 360 women
per district. In total, 890 women completed the FP-ADM in Argentina, 1,114 in Ghana and
1,130 in India. To measure autonomous decision-making within FP service delivery, we
adapted the items of the MADM scale to focus on family planning. To assess the scale’s
psychometric properties, we first examined the eigenvalues and conducted a parallel analy sis to determine the number of factors. We then conducted exploratory factor analysis to
determine which items to retain. The resulting factors were then identified based on the corresponding items. Internal consistency reliability was assessed with Cronbach’s alpha. We
assessed both convergent and divergent construct validity by examining associations with
expected outcomes related to the underlying construct. The Eigenvalues and parallel analy sis suggested a two-factor solution. The two underlying dimensions of the construct were
identified as “Bidirectional Exchange of Information” (Factor 1) and “Empowered Choice”
(Factor 2). Cronbach’s alpha was calculated for the full scale and each subscale. Results
suggested good internal consistency of the scale. There was a strong, significant positive
association between whether a woman expressed satisfaction with quality of care received
from the healthcare provider and her FP-ADM score in all three countries and a significant
negative association between a woman’s FP-ADM score and her stated desire to switch
contraceptive methods in the future.
Conclusions
Our results suggest the FP-ADM is a valid instrument to assess decision-making autonomy
in contraceptive counseling and service delivery in diverse low- and middle-income countries. The scale evidenced strong construct, convergent, and divergent validity and high
internal consistency reliability. Use of the FP-ADM scale could contribute to improved measurement of person-centered family planning services
Description
Research Article
Keywords
family planning programs, maternal health, Mothers Autonomy, Family Planning Autonomous Decision-Making scale (FP-ADM), Ghana
Citation
Citation: Gausman J, Saggurti N, Adanu R, Bandoh DAB, Berrueta M, Chakraborty S, et al. (2023) Validation of a measure to assess decision-making autonomy in family planning services in three low and middle-income countries: The Family Planning Autonomous Decision-Making scale (FP-ADM). PLoS ONE 18(11): e0293586. https://doi.org/ 10.1371/journal.pone.0293586