Development and Validation of the Agency in Contraceptive Decisions Scale in Uganda and Nigeria

Abstract

To fill a gap in measures of empowered contraceptive decision-making, we developed the Agency in Contraceptive Decisions Scale in Uganda and Nigeria. We developed an item pool drawing on the previously published Contraceptive Agency framework. We refined items through cognitive interviews (N = 80) and expert feedback and piloted a reduced item pool via surveys (N = 3002). Exploratory factor analysis using a random half of the sample suggested a 15-item scale (Cronbach's α = 0.8) including four subscales: (1) Beliefs about Rights and Perceived Decision-making Control (α = 0.8), (2) Decision-making Self-efficacy (α = 0.8), (3) Knowledge Aligned with Preferences (α = 0.8), and (4) Control over Use or Non-use (α = 0.8). Confirmatory factor analysis with the other half of the sample supported this solution. Agency in Contraceptive Decisions Scale scores were significantly associated with scores on the contraceptive existence of choice and contraceptive exercise of choice subscales of the Women's and Girls Empowerment in Sexual and Reproductive Health Index, supporting construct validity. The 15-item Agency in Contraceptive Decisions Scale and individual subscales are valid and reliable for use in Nigeria and Uganda. This measure offers an innovative alternative for gauging the success of contraceptive programs and policies in advancing the right to empowered choices.