Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Hospital, Baltimore, MD, United States.
Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Hospital, Baltimore, MD, United States.
Contraception. 2024 Mar;131:110329. doi: 10.1016/j.contraception.2023.110329. Epub 2023 Nov 17.
We aimed to adapt and validate person-centered measures to evaluate various contributors to self-determination in perinatal contraceptive decision-making.
We developed and administered four scales adapted from existing measures in the context of Self-Determination Theory: the Treatment Self-Regulation Questionnaire (TSRQ), Perceived Competence Scale, modified Health Care Climate Questionnaire, and Important Other Climate Questionnaire. The TSRQ consists of three subscales: autonomous motivation, controlled motivation, and amotivation. We recruited a nonprobability convenience sample of 300 hospitalized postpartum patients in Baltimore, MD, between 2015 and 2016 and administered surveys in English and Spanish. We validated the scales with Cronbach's alpha coefficients, confirmatory factor analysis, and invariance analysis. We examined construct validity by testing correlations between the scales and other person-centered measures, such as satisfaction with counseling.
Cronbach's alpha was >0.8 except for the amotivation subscale. Confirmatory factor analysis was adequate for all scales. Autonomous motivation correlated positively and significantly with perceived competence, health care provider autonomy support, important other autonomy support, and other measures of patient satisfaction.
We found the four scales to be internally consistent and valid except for the amotivation subscale. We recommend using the autonomous motivation subscale in place of the full TSRQ. The autonomous motivation subscale, Perceived Competence Scale, modified Health Care Climate Questionnaire, and Important Other Climate Questionnaire showed adequate internal consistency, construct validity, and adherence to the expected conceptual structure of the scales.
Autonomous decision-making is central to ethics and quality of care, especially for contraceptive methods that require a provider for initiation or discontinuation and at more vulnerable times, such as postpartum and postabortion. These scales may help tailor person-centered and autonomy-supportive interventions and programs to improve contraceptive counseling and care delivery.
我们旨在改编和验证以患者为中心的措施，以评估围产期避孕决策中自我决定的各种促成因素。
我们根据自我决定理论开发并实施了四项改编自现有措施的量表：治疗自我调节问卷（TSRQ）、感知能力量表、改良医疗保健气候问卷和重要他人气候问卷。TSRQ 由三个分量表组成：自主动机、受控动机和动机缺乏。我们在 2015 年至 2016 年间招募了马里兰州巴尔的摩市的 300 名住院产后患者，采用英语和西班牙语进行问卷调查。我们使用 Cronbach's alpha 系数、验证性因子分析和不变性分析对量表进行验证。我们通过测试量表与其他以患者为中心的措施（如咨询满意度）之间的相关性来检验构念效度。
除动机缺乏分量表外，Cronbach's alpha 均>0.8。所有量表的验证性因子分析均合理。自主动机与感知能力、医疗保健提供者自主支持、重要他人自主支持以及其他患者满意度测量指标呈正相关且具有统计学意义。
我们发现除动机缺乏分量表外，其余四个量表均具有内部一致性和有效性。我们建议使用自主动机分量表代替完整的 TSRQ。自主动机分量表、感知能力量表、改良医疗保健气候问卷和重要他人气候问卷具有足够的内部一致性、构念效度和对量表预期概念结构的遵循性。
自主决策是伦理和护理质量的核心，尤其是对于需要提供者启动或停止使用以及在更脆弱时期（如产后和流产后）使用的避孕方法。这些量表可能有助于定制以患者为中心和支持自主的干预措施和项目，以改善避孕咨询和护理服务。
