Development and validation of a novel, person-centered measure of post-conception pregnancy acceptability

PROJECT SUMMARY
Traditional epidemiologic measures of pregnancy intention are fraught with psychometric and conceptual
limitations. Measures focused on whether pregnancy was intended or optimally timed omit emotional aspects
of pregnancy, do not account for fluctuating or uncertain intentions, and may neglect the reproductive
experiences of significant segments of the US population for whom pregnancy planning may not be salient or
feasible, including socially and economically marginalized populations. Furthermore, there is emerging
evidence that the associations between pre-conception intentions and reproductive health outcomes may be
relatively weak. Extensive qualitative work suggests that women’s responses to existing pregnancies within the
complex contexts of their lives may drive pregnancy-related decisions and reproductive outcomes more than
pre-conception intentions. New measures are needed to more fully assess the cognitive, affective and
circumstantial factors that influence orientations toward, or “acceptability” of, existing pregnancies and affect
downstream outcomes associated with these pregnancies. In this proposal, we aim to develop a
multidimensional, quantitative measure of post-conception pregnancy acceptability (the Post-CAP). Our
specific aims are to: 1) create a comprehensive conceptual framework of post-conception pregnancy
acceptability via in-depth interviews with diverse women of reproductive age; 2) generate quantitative items
based on Aim 1 qualitative findings and existing measures, with subsequent refinement and evaluation using
Delphi methods with lay and academic experts and cognitive interviews; 3) test the Post-CAP in a large,
longitudinal cohort of women seeking abortion or prenatal care, to assess psychometric properties including
factor structure, reliability and validity. Completion of these aims will produce a novel, psychometrically sound
measure which will facilitate a critical expansion of our understanding of associations between pre-conception
intentions, post-conception orientations, and reproductive health outcomes.

Grant Number: 5R01HD103286-05
NIH Institute/Center: NIH
Principal Investigator: SONYA BORRERO