Development and validation of a person-centered abortion scale: the experiences of care in private facilities in Kenya
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RESEARCH ARTICLE
Open Access
Development and validation of a personcentered abortion scale: the experiences of care in private facilities in Kenya May Sudhinaraset1, Amanda Landrian1* , Patience A. Afulani2, Beth Phillips2, Nadia Diamond-Smith2 and Sun Cotter2
Abstract Background: There is a need for a standardized way to measure person-centered care for abortion. This study developed and validated a measure of person-centered abortion care. Methods: Items for person-centered abortion care were developed from literature reviews, expert review, and cognitive interviews, and administered with 371 women who received a safe abortion service from private health clinics in Nairobi, Kenya. Exploratory factor analyses were performed and stratified by surgical abortion procedures and medication abortion. Bivariate linear regressions assessed for criterion validity. Results: We developed a 24-item unifying scale for person-centered abortion care including two sub-scales. The two sub-scales identified were: 1) Respectful and Supportive Care (14 items for medication abortion, 15 items for surgical abortion); and 2) Communication and Autonomy (9 items for both medication and surgical abortion). The person-centered abortion care scale had high content, construct, criterion validity, and reliability. Conclusions: This validated scale will facilitate measurement and further research to better understand women’s experiences during abortion care and to improve the quality of women’s overall reproductive health experiences to improve health outcomes. Keywords: Abortion, Quality of care, Person-centered care, Kenya, Patient experience, Patient-provider communication
Background Positive patient experience is a critical component in ensuring quality abortion care for women, linked to health outcomes such as decreases in severe abortion complications and seeking timely care [1]. Globally, there are approximately 56 million abortions yearly [2]. In Kenya, changes to the Constitution were passed in 2010, allowing abortions in instances where the health or the life of * Correspondence: [email protected]; [email protected] 1 Community Health Sciences, University of California, Los Angeles, Jonathan and Karin Fielding School of Public Health, 650 Charles E Young Dr. S, Los Angeles, CA, USA Full list of author information is available at the end of the article
the mother is at risk [3]. However, the Kenya law is still restrictive and requires a qualified health professional to determine if the mother’s health or life is jeopardized. These restrictions continue to limit women’s access to quality care – resulting in abortion providers working in contexts where women experience high levels of fear and uncertainty, mistreatment and discrimination, and consequently women delaying timely care. Given these circumstances, there is evidence of high maternal mortality as a result of unsafe abortions in Kenya [4]. Safe abortion services can help prevent these avoidable deaths, and such services are available even in places like Kenya where laws
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