Measuring contraceptive agency in the community

Area of Science:

• Reproductive Health
• Psychometrics
• Sociology

Background:

• The Contraceptive Agency Scale (CAS) was initially developed as a clinic-based measure.
• Evaluating the CAS in a community population is crucial for understanding real-world contraceptive decision-making.
• Assessing how contraceptive agency varies by demographic and reproductive characteristics provides essential insights.

Purpose of the Study:

• To evaluate the psychometric properties of the Contraceptive Agency Scale (CAS) in a community-based sample.
• To assess contraceptive agency and its variation across diverse demographic and reproductive characteristics.

Main Methods:

• A cross-sectional survey of 1917 participants aged 15-45 years in Oregon.
• Participants completed the 7-item CAS assessing decision-making, freedom from coercion, and nonjudgmental care.
• Psychometric performance was analyzed using a partial credit model; differences in agency were assessed via multivariable linear regression.

Main Results:

• The CAS demonstrated adequate to good internal consistency reliability (Cronbach alpha: 0.78) and reasonable fit to a partial credit model.
• Significant variations in contraceptive agency were observed across racial/ethnic groups, with Black participants reporting lower scores than White participants.
• Factors associated with higher agency included not desiring pregnancy, while lower education and nonbinary/transgender identity were associated with lower agency.

Conclusions:

• The Contraceptive Agency Scale (CAS) is a valid measure for evaluating patient-centered contraceptive decision-making in community samples.
• The findings highlight the importance of considering demographic and reproductive characteristics when assessing contraceptive agency.
• This study underscores the value of analyzing contraceptive agency within community populations to improve contraceptive counseling.