Person-centered abortion care scale: Validation for medication abortion in the United States

OBJECTIVE Medication abortions now make up the majority of abortions in the US, with new service delivery models such as telehealth; however, it is unclear how this may impact patient experiences. The objective of the study is to adapt and validate a person-centered abortion care (PCAC) scale for medication abortions that was developed in a global South context (Kenya) for use in the United States. STUDY DESIGN This study includes medication abortion patients from a hospital-based clinic who had one of two modes of service delivery: 1) telemedicine with no physical exam or ultrasound; or 2) in-person with clinic-based exams and ultrasounds. We conducted a sequential approach to scale development including: 1) defining constructs and item generation; 2) expert reviews; 3) cognitive interviews (n=12); 4) survey development and online survey data collection (N=182, including 45 telemedicine patients and 137 in-person patients); and 5) psychometric analyses. RESULTS Exploratory factor analyses identified 29-items for the US-PCAC scale with three subscales: 1) Respect & Dignity (10 items), 2) Responsive & Supportive Care (9 items for the full scale, 1 additional mode-specific item each for in-person and telemedicine), and 3) Communication & Autonomy (10 items for the full scale, 1 additional item for telemedicine). The US-PCAC had high content, construct, and criterion validity. It also had high reliability, with a standardized alpha for the full 29-item US-PCAC scale of 0.95. The US-PCAC score was associated with overall satisfaction. CONCLUSION This study found high validity and reliability of a newly-developed person-centered abortion care scale for use in the US. As medication abortion provision expands, this scale can be used in quality improvement efforts. IMPLICATIONS This study found high validity and reliability of a newly-developed person-centered care scale for use in the United States for in-person and telemedicine medication abortion.