Advancing Innovative Measurement of Pregnancy Preferences with Longitudinal Data

利用纵向数据推进怀孕偏好的创新测量

• 批准号: 10709484
• 负责人: Corinne H. Rocca
• 金额: $ 26.9万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10709484
• 关键词: Accounting; Address; Adopted; Adoption; Adverse effects; Affect; Affective; Behavior; Birth; Birth Intervals; Birth Order; Child; Childbirth; Clinical; Code; Cognitive; Communities; Contraceptive Usage; Couples; Data; Development; Equation; Ethnic Origin; Feeling; Future; Goals; Grouping; Health; Intention; Intervention; Investigation; Knowledge; Lead; Left; Longitudinal Studies; Longitudinal Surveys; Low Birth Weight Infant; Maternal Health; Maternal and Child Health; Measurement; Measures; Mediating; Mediation; Methodology; Methods; Modeling; Nature; Outcome; Pathway interactions; Personal Satisfaction; Physiological; Pregnancy; Pregnancy Interval; Premature Birth; Psychometrics; Public Health; Race; Research; Research Design; Research Personnel; Research Project Summaries; Risk; Risk Factors; Role; Science; Shapes; Social Environment; Standardization; Surveys; Time; US State; Uncertainty; United States; Woman; Women' s Group; adverse maternal outcomes; aged; avoid pregnancy; child bearing; clinical care; contextual factors; effective intervention; evidence base; improved; innovation; insight; instrument; longitudinal analysis; neonatal health; neonatal outcome; novel; person centered; population based; preference; prepregnancy; preservation; prevent; prospective; public health research; reproductive; response; social factors; theories; therapy development; tool; unintended pregnancy

PROJECT SUMMARY Research into effective strategies to reduce unintended pregnancy and short interval births, and to mitigate associated adverse maternal and neonatal health outcomes, has been hampered by poor conceptualization and measurement of pregnancy intentions. Until recently, no validated psychometric measures had been available to prospectively capture the range and complexity of feelings many women have about pregnancy, including ambivalence and uncertainty. Reliance on simplistic measures and retrospective data have left serious scientific gaps in our understanding of the causes, and health consequences, of unintended pregnancy and short interpregnancy intervals (IPIs). Scholars have expressed an urgent need for improved measures and longitudinal study designs, citing their importance to rigorous investigations of the role of pregnancy intentions on the causal pathway to unintended pregnancy, short IPIs, and adverse health outcomes. This proposal addresses these critical scientific and measurement gaps using longitudinal data from population-based surveys, fielded to over 12,000 women, aged 18-44, across nine US states. These surveys include the Desire to Avoid Pregnancy (DAP) scale, a novel instrument developed by our team using cutting-edge, rigorous psychometric methods. The instrument reconceptualizes “intentions” as “preferences” and captures the diversity of considerations and feelings women have about a potential future pregnancy. Using three years of data, we will examine the predictive relationships between DAP scores, contraceptive use, incident pregnancy, and birth outcomes. We will use structural equation models to investigate the extent to which DAP scores mediate relationships between the personal and social contexts of women’s lives and pregnancy and birth outcomes, addressing confounding that has hindered prior investigations. Critically, analyses will for the first time apply prospective pregnancy preference data to investigate whether the elevated risk of negative maternal and birth outcomes from short IPIs results from physiologic mechanisms, or the contexts in which these frequently unintended pregnancies occur. We will then capitalize on the DAP’s strengths to develop novel measurement tools that expand its utility. First, we will use item response theory (IRT) to develop a shorter DAP version that maintains construct validity, facilitating the integration of rigorous, person-centered measures into future research, surveillance, and clinical care. Then, we will use IRT to establish evidence-based thresholds on the scale, defining standardized groupings of pre-pregnancy preferences (e.g., “undesired” or “less preferred”), and addressing the urgent need for alternative measures to “unintended pregnancy” that capture if women attain their reproductive preferences. A better understanding of how pregnancy preferences are formed, and how unintended pregnancy contributes to adverse maternal and neonatal outcomes – as well as the contributions of our novel instruments to future science – can guide the field toward interventions that can more successfully promote reproductive autonomy and improve maternal and child health.

项目摘要 研究有效的策略，以减少意外怀孕和短时出生，并减轻 相关的不良母校和新生儿健康结果受到概念不佳的障碍 和妊娠意图的测量。直到最近，还没有经过验证的心理测量措施 可以预期捕获许多女性对怀孕的感受的范围和复杂性， 包括矛盾和不确定性。依靠简单的测量和回顾性数据 意外怀孕的原因和健康后果的理解严重的科学差距 和简短的解释间隔（IPI）。学者表示迫切需要改进测量和 纵向研究设计，理由是他们对怀孕意图作用的严格研究的重要性 在意外怀孕，短期IPI和不良健康结果的因果途径上。这个建议 使用基于人群的纵向数据来解决这些关键的科学和测量差距 在美国九个州的调查中，有12,000多名18-44岁的妇女。这些调查包括欲望 为了避免怀孕（DAP）量表，这是我们团队使用尖端，严格开发的一种新颖的乐器 心理测量方法。该工具将“意图”重新概念化为“偏好”，并捕获 女性对未来怀孕潜在的考虑和感受的多样性。使用三年 数据，我们将检查DAP评分，避孕药使用，出现怀孕的预测关系， 和出生结果。我们将使用结构等效模型来研究DAP得分的程度 调解妇女生活，怀孕和出生的个人和社会环境之间的关系 结果，解决了阻碍先前调查的混杂问题。至关重要的是，第一个分析将 时间应用预期的怀孕偏好数据以调查负阴性的风险是否升高 来自简短IPI的出生结果是由生理机制或这些背景 经常发生意外怀孕。然后，我们将利用DAP的优势来发展小说 扩展其实用性的测量工具。首先，我们将使用项目响应理论（IRT）来开发较短的 保持构建有效性的DAP版本，支持严格，以人为本的措施的整合 进入未来的研究，监视和临床护理。然后，我们将使用IRT建立基于证据的 规模上的阈值，定义了孕前偏好的标准化组（例如，“不希望”或 “不太喜欢”），并解决了迫切需要采取替代措施来“无意义的怀孕” 捕获女性是否获得了繁殖偏好。更好地了解怀孕偏好 形成了，以及意外怀孕如何促进不良的母校和新生儿结果 作为我们对未来科学的新颖工具的贡献 - 可以指导领域采取干预措施 可以更成功地促进复制性自主权并改善母校和儿童健康。