Measuring pregnancy preferences among women and men in a resource-limited, high-fertility setting

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PROJECT SUMMARY/ABSTRACT Our goal is to improve measurement of women’s and men’s prospective pregnancy preferences in low-resource, high-fertility settings in sub-Saharan Africa through gender-specific evaluation and adaptation of the Desire to Avoid Pregnancy (DAP) scale (Aim 1) and assess the reliability and validity of adapted DAP scales through testing among women and men in Uganda (Aim 2). Our team of experts in qualitative methods, scale development, and survey research from the United States and Uganda will conduct a sequential mixed-methods study to understand transferability of DAP domains among Ugandan women and men, adapt and develop items that reflect their perspectives, and pilot test and psychometrically evaluate items. Specific aims are to: 1. Aim 1: Develop gender-specific versions of the Desire to Avoid Pregnancy (DAP) scale that have construct validity among women and men, respectively, in the Ugandan context. We will translate the DAP scale items into local languages and use qualitative methods, including cognitive and in-depth interviews, among 30 women aged 15-49 and 30 men aged 18+ years to explore item comprehension and salience of DAP domains. We will use deductive, thematic analysis to examine convergence and divergence of women’s and men’s pregnancy preferences, respectively, with each DAP domain and adapt DAP items to capture pregnancy preferences in the Ugandan context. 2. Aim 2: Evaluate the reliability and validity of the Ugandan DAP scales. We will purposively sample 400 women aged 15-49 years and 400 men aged 18+ years in one rural and one urban district to conduct face validity and pilot testing of the adapted DAP scales. We will analyze the psychometric properties of the DAP scales, including dimensionality, internal consistency reliability, and structure validity, separately for men and women, using methodologies grounded in Item Response Theory. The development and validation of the adapted DAP scales will improve the capacity of health programs in low-resource, high-fertility contexts to (i) identify individuals with strong desires to avoid pregnancy, (ii) tailor person-centered reproductive services to meet their needs, (iii) strengthen understanding of the dynamics of pregnancy preferences within couples, and (iv) enhance the utility that measures of pregnancy preferences offer for predicting and addressing fertility, maternal, and child health outcomes to promote lifelong health and well-being.