Adaptation and validation of the quality of contraceptive counseling (QCC) scale for use in Ethiopia and India

Abstract

We adapted the Quality of Contraceptive Counseling (QCC) scale, originally constructed in Mexico, for Ethiopia and India to expand its utility for measurement of client experiences with counseling. Scale items were modified based on prior research on women’s preferences for counseling in each country, and refined through cognitive interviews (n = 20 per country). We tested the items through client exit surveys in Addis Ababa, Ethiopia (n = 599), and Vadodara, India (n = 313). Psychometric analyses revealed the adapted scales were valid and reliable for use, and the final scales retained content validity according to the original published QCC construct definition. Specifically, confirmatory factor analysis revealed high factor loadings for almost all items on the original dimensions: Information Exchange, Interpersonal Relationship, Disrespect and Abuse. Internal consistency reliability was high in both settings (Alpha = 0.92 for QCC-Ethiopia and 0.74 for QCC-India). Final item pools contained 26 items in the QCC-Ethiopia Scale and 23 in the QCC-India Scale. Correlation analyses established convergent validity. QCC Scales and subscales fill a gap in measurement tools for ensuring high quality of care and fulfillment of human rights in contraceptive services, and consistent findings across continents suggest versatility in use across different contexts.

Validation and Predictive Utility of a Person‐Centered Quality of Contraceptive Counseling (QCC‐10) Scale in Sub‐Saharan Africa: A Multicountry Study of Family Planning Clients and a New Indicator for Measuring High‐Quality, Rights‐Based Care

“…The scale was validated in Mexico and later refined in Ethiopia and India (Holt, Uttekar, et al. 2021; Holt et al., n.d.). In its initial development, the QCC scale was found to be positively and significantly associated with women reporting their informational needs were met within the first three months of their family planning visit, measured via a single item that asked women if they needed more information about contraceptive methods (yes/no) (Holt et al.…”