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Desire to Avoid Pregnancy (DAP) Scale

The Desire to Avoid Pregnancy (DAP) scale is a psychometrically validated measure of a person’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 individuals plan pregnancies. The DAP scale is unique in that it prospectively measures a range of preferences and feelings people have about a potential pregnancy and childbearing, and the degrees to which they 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 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.
[*We are referring to cisgender women and transgender men or non-binary people who have the physical ability to become pregnant.]

Scale Development

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.

 

                     

Download English version here.
Download Spanish version here.

Research Collaborators Using the DAP Scale

United States Collaborators:

Jennifer Bello Kottenstette, MD, MS, St. Louis University, Department of Family and Community Medicine, US

Dr. Bello Kottenstette and colleagues are using the DAP as part of a reproductive health intake assessment for women entering a jail-based substance use disorder treatment program in St. Louis, MO. Abstract at NAPCRG 2019.

Antonia Biggs, PhD, University of California, San Francisco, School of Medicine, ANSIRH, US

Dr. Biggs and colleagues are using the DAP in a California study of the reasons adolescents present for emergency contraception use lower efficacy contraception.

Maria Gallo, PhD and Alison Norris, MD, PhD, Ohio State University College of Public Health

Drs. Gallo, Norris and colleagues are using the DAP to evaluate the effects of reproductive health policies in the US Midwest.

Jessica Gipson, PhD, University of California, Los Angeles, School of Public Health, Department of Community Health Sciences, US

Dr. Gipson used the DAP to example the reproductive health experiences and perceptions of women seeking treatment for opioid use disorder at methadone clinics in Los Angeles. Paper in Contraception 2021 (forthcoming).

Cynthia Harper, PhD, University of California, San Francisco, School of Medicine, Bixby Center for Global Reproductive Health, US

Dr. Harper and colleagues are using the DAP in a cluster randomized trial of a contraceptive intervention in California and Texas community colleges.

Megan Kavanaugh, PhD, Guttmacher Institute, US

Dr. Kavanaugh and colleagues are using the DAP to evaluate the effects of reproductive health policies across several diverse US states.

Amal Khoury, PhD, MPH, East Tennessee State University, College of Public Health, Department of Health Management & Policy, US

Dr. Khoury and colleagues at ETSU are using the DAP to evaluate a contraceptive intervention in the US South. Abstract at APHA 2020.

Michael Randall, PhD, and Michel Boudreaux, PhD, University of Maryland, School of Public Health

Dr. Boudreaux and colleagues are using the DAP to evaluate a contraceptive intervention in the US Northeast.

Goleen Samari, PhD, Columbia University Mailman School of Public Health

Dr. Samari and colleagues at UCSF evaluated the relationship between DAP scores and contraceptive use. They found a very strong association, but no differences in the types of methods used by pregnancy preferences. They also found use of contraception was common among women who were very open to the possibility of pregnancy. Abstract at SFP 2018Paper in Contraception 2020.

Julia Steinberg, PhD, University of Maryland, Department of Family Science, US

Dr. Steinberg and colleagues are using the DAP in a study examining the association between depression and contraceptive behaviors among young women seeking reproductive health services in the DC metro area.

Debra Stulberg, MD, MAPP, University of Chicago, School of Medicine, Department of Family Medicine, US

Dr. Stulberg and colleagues used the DAP in a cross-sectional study of 200 women presenting for care at 6 primary care facilities. They compared responses to One Key Question® and the DAP scale and examined associations of both with patient contraceptive and folic acid use. Abstract at AcademyHealth 2019Abstract at SFP 2019. Paper in Contraception 2020.

International Collaborators:

Caitlin Bernard, MD, MS, and John Humphrey, MD, Indiana University School of Medicine; Julie Thorne, MD, FRCS(C), MPH, University of Toronto, Obstetrics and Gynaecology; and Rena Patel, MD, MPH, MPhil, University of Washington School of Medicine

Drs. Bernard, Thorne, Humphrey and Patel are using the DAP in a study examining patterns of antiretroviral therapy and contraception prescriptions in Kenya in light of the international warning that dolutegravir might be associated with birth defects. Abstract at IAS 2020.

Ana Borges, Universidade de Sao Paulo Campus da Capital, Brazil

Dr. Borges and colleagues are testing the performance of the DAP in Portuguese in Brazil.

Jessica Gipson, PhD, University of California, Los Angeles, School of Public Health, Department of Community Health Sciences, US

Dr. Gipson and colleagues are investigating the DAP in a study among couples in the Philippines.

Jenny Hall, PhD, University College of London, Institute for Women’s Health.

Dr. Hall and colleagues are conducting a longitudinal study to test the performance of the DAP in the United Kingdom and to assess its association with key reproductive health outcomes.

Chelsea Morroni, MPH, MPhil, PhD, MBChB, Botswana-University of Pennsylvania Partnership

Drs. Morroni and Rocca are conducting a study to examine the psychometric performance of the DAP scale among women living with and without HIV in Botswana.

Sarah Rominski, PhD, MPH, University of Michigan

Dr. Rominski and colleagues are utilizing the DAP in a one-year cohort study of women obtaining contraception at family planning clinics in Accra and Kumasi, Ghana.

Additional Resources