Abstract
Objective
Evaluating decisional certainty is an important component of medical care, including
preabortion care. However, minimal research has examined how to measure certainty
with reliability and validity among women seeking abortion. We examine whether the
Decisional Conflict Scale (DCS), a measure widely used in other health specialties
and considered the gold standard for measuring this construct, and the Taft–Baker
Scale (TBS), a measure developed by abortion counselors, are valid and reliable for
use with women seeking abortion and predict the decision to continue the pregnancy.
Methods
Eligible women at four family planning facilities in Utah completed baseline demographic
surveys and scales before their abortion information visit and follow-up interviews
3 weeks later. For each scale, we calculated mean scores and explored factors associated
with high uncertainty. We evaluated internal reliability using Cronbach's alpha and
assessed predictive validity by examining whether higher scale scores, indicative
of decisional uncertainty or conflict, were associated with still being pregnant at
follow-up.
Results
Five hundred women completed baseline surveys; two-thirds (63%) completed follow-up,
at which time 11% were still pregnant. Mean scores on the DCS (15.5/100) and TBS (12.4/100)
indicated low uncertainty, with acceptable reliability (α=.93 and .72, respectively). Higher scores on each scale were significantly and positively
associated with still being pregnant at follow-up in both unadjusted and adjusted
analyses.
Conclusion
The DCS and TBS demonstrate acceptable reliability and validity among women seeking
abortion care. Comparing scores on the DCS in this population to other studies of
decision making suggests that the level of uncertainty in abortion decision making
is comparable to or lower than other health decisions.
Implications
The high levels of decisional certainty found in this study challenge the narrative
that abortion decision making is exceptional compared to other healthcare decisions
and requires additional protection such as laws mandating waiting periods, counseling
and ultrasound viewing.
Keywords
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Article info
Publication history
Published online: October 10, 2016
Accepted:
September 4,
2016
Received in revised form:
August 31,
2016
Received:
May 2,
2016
Identification
Copyright
© 2016 Published by Elsevier Inc.
