Development of patient-reported experience and patient-reported outcome measurement tool for abortion care in...

Measuring patient-reported experiences and outcomes of abortion care would enhance access to person-centred and rights-based abortion care. Assessment requires a reliable measurement approach to improve healthcare outcomes and service quality. Worldwide, there are no patient-reported measures to assess abortion care experiences and outcomes from the perspectives of the women accessing this service. This study developed a Patient-Reported Experience Measure (PREM) and Patient-Reported Outcome Measure (PROM) tool for women receiving abortion care services in Ethiopia.

A sequential, exploratory mixed-methods study was conducted to develop the measures through standard tool development approaches. First, item pools were identified via a systematic review exploring experiences and current measures of outcomes of abortion care in sub-Saharan countries, and a qualitative study exploring the lived experience of abortion care pathways in Ethiopia. Second, item pools for experiences and outcomes of abortion care were assessed by a panel of experts in Ethiopia during two modified Delphi rounds. Items were removed if expert consensus or the item-level content validity index (I-CVI) was not achieved (I-CVI < 0.70). Finally, cognitive interviews were conducted with women to assess the relevance of measurement, interpretation, judgment formation, information recall, and response mapping. Qualitative data were analysed using inductive thematic analysis. Quantitative data were analysed descriptively using frequencies and percentages.

Overall, 72 items were included in the first round of the modified Delphi study, while 30 items remained in the final tools. Twenty-one items for the PREM and nine items for the PROM were retained. During the second Delphi round, I-CVI ranged between 0.55 and 1. During cognitive interviews, women reported that item instructions, wording, response options, and the recall period were clear and comprehensible. Women also described that the developed tool was relevant, brief, and covered important experiences and outcomes of abortion care.

The PREM and PROM tool was developed to assess experiences and outcomes for Ethiopians who access abortion care services. Researchers and healthcare providers can use the new measurements to monitor service quality, and policymakers can use the tool's results to improve women's health. Future research should undertake psychometric validation and assess potential applications worldwide.