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Research project

Desire to Avoid Pregnancy (DAP) scale

The Desire to Avoid Pregnancy (DAP) scale is a psychometrically validated measure of a woman’s preferences about a future pregnancy and childbearing. Existing approaches to measuring pregnancy intentions suffer important limitations, including retrospective assessment, overly simple categories, and a presumption that all women plan pregnancies. The DAP scale is unique in that it prospectively measures a range of preferences and feelings women have about a potential pregnancy and childbearing, and the degrees to which women have a preference to avoid pregnancy. Taking into account the complexity of pregnancy and childbearing in society, the DAP scale captures three domains relevant to women’s conscious and unconscious pregnancy desires, including their cognitive desires and preferences, affective feelings and attitudes, and anticipated practical consequences. Developed by Dr. Corinne Rocca, PhD and colleagues, the DAP scale addresses the urgent need for improved measures of pregnancy intention in the fields of reproductive health and rights, family planning and demography.

Definition: A person’s* desire to avoid pregnancy is their underlying preference, conscious or unconscious, to prevent themselves from becoming pregnant, or their underlying predisposition against pregnancy.

A full description of the development and psychometric evaluation of the DAP scale is described in detail in Medical Care. Briefly, Dr. Rocca and her colleagues developed a library of 60 draft items from existing qualitative research, assessed comprehension of those items through cognitive interviews with 25 English- and Spanish-speaking family planning patients, and administered the items to 594 non-pregnant women seeking reproductive and primary health care from seven facilities in Arizona, New Jersey, New Mexico, South Carolina, and Texas in 2016 and 2017.

The researchers used item response theory, a leading statistical paradigm for the development and assessment of psychometric instruments, to reduce the item set and assess the scale’s reliability, internal structure validity, and external validity. Fourteen items were included in the final scale based on fit to a partial credit item response model, consistency of response options with overall scale scores, and non-differential functioning by participant sociodemographic characteristics. The 14 items fit a unidimensional model, with a separation reliability of 0.90 (Cronbach’s α: 0.95). The scale met established criteria for internal validity, including appropriately covering the ranges of women’s preferences and correspondence between each item’s response categories and overall scale scores. There was no important differential item functioning by key sociodemographic characteristics, garnering evidence for external validity.

Desire to Avoid Pregnancy (DAP) Measure: Instrument, Item Descriptions, and Scoring

The DAP instrument is free to use, and researchers do not need a license or permission to use the scale. Please simply cite the published paper. The instrument can be downloaded using the links below. Please note that in order for the measure to be considered valid, all items should be worded and presented as they appear in the DAP measure. We recommend the DAP be used as published. Any substantial changes to the number of questions administered or wording of questions, introductory text, or answer categories should be evaluated before use. (For researchers new to the use of psychometric measures, the US FDA's guidance on patient reported outcome measures may be useful). For help or advice on use of the DAP scale, please email Corinne Rocca.

*We are referring to cisgender women and transgender men or non-binary people who have the physical ability to become pregnant.

Non-ANSIRH collaborators include Mark Wilson, Graduate School of Education, UC, Berkeley, and Brenly Rowland, Joint Medical Program, UC Berkeley and UCSF.

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ANSIRH is a program within the UCSF Bixby Center for Global Reproductive Health and is a part of UCSF's Department of Obstetrics, Gynecology & Reproductive Sciences.

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