Measuring Informed Choice for Contraception in Burkina Faso: Comparing self-rated and researcher-ascribed measures

While self-rated measures that rely on participant's perceptions of themselves are common in public health, they remain underused in contraceptive research. Family planning scholars often rely on researcher-ascribed measures of success that capture whether people have the criteria researchers deem necessary for a given outcome. As family planning researchers shift toward rights-based outcomes, understanding women's perceptions of their contraceptive knowledge is imperative.

We sought to determine whether researcher-ascribed measures of contraceptive knowledge or information provided during contraceptive counseling and self-rated measures of informed choice for contraception align. Informed choice captures whether people have sufficient, unbiased information about their contraceptive options.

Using data from a population-based sample of 3,929 reproductive-aged women in Burkina Faso, we compared researcher-ascribed measures, including the informed choice subdomain of the contraceptive autonomy indicator (CAIC) and the Method Information Index (MII), with novel self-rated measures of informed choice developed based on formative research, including in-depth interviews and focus group discussions, that capture people's perceptions of their contraceptive knowledge (self-rated overall informed choice and self-rated method-specific informed choice) using Cohen's Kappa Statistic.

We find that researcher-ascribed measures of contraceptive knowledge and counseling content diverge substantially from self-rated measures of informed choice. CAIC and self-rated overall informed choice had no agreement (Kappa: -0.03); the MII and self-rated method-specific informed choice had no to slight agreement (Kappa=0.05). These findings reveal that the information researchers consider important for informed choice may not align with women's perceptions of their informed choice.

Both researcher-ascribed and self-rated measures provide uniquely important information needed to inform family planning programs and should be measured on population-based surveys.