Evaluation of the Psychometric Properties of a Version of the London Measure of Unplanned Pregnancy for Women’s Partners

Main Article Content

Geraldine Barrett
Jennifer A Hall
Beth Howden
Dilisha Patel
Jill Shawe
Judith Stephenson

Abstract

Background
The role of women’s partners in pregnancy planning has gained importance with the development of preconception care. The measurement of pregnancy planning/intention has also changed in the last two decades with the development of psychometric measures such as the London Measure of Unplanned Pregnancy (LMUP). This analysis aimed to evaluate the psychometric properties of a version of the LMUP for women’s partners in the UK.


Methods
The LMUP items, adapted for completion by partners, were piloted and included in a survey of (mainly male) partners in three antenatal clinics in London, UK, as part of a study of pre-pregnancy health and care. The psychometric properties of the partner LMUP were assessed according to the principles of Classical Test Theory.


Results
There were 575 partners of pregnant women in the sample, 573 (99.7%) being men. There were high comple-tion rates for all the LMUP items. The distribution of LMUP scores ranged from 1–12, with a negative skew (biased towards planned/intended pregnancies). In terms of reliability (internal consistency), Cronbach’s alpha was 0.69, item-rest correlations were >0.2 for five items, and all inter-item correlations were positive. In terms of construct validity, principal components analysis showed that measurement was unidimensional, confirmatory factor analysis showed good model fit, and the convergent validity hypothesis of non-perfect, moderate-to-good agreement between couples’ LMUP scores was met.


Conclusions
The partner LMUP performed well in terms of reliability and validity according to internationally-accepted criteria for the performance of psychometric measures and can be used in future research on men and couples. However, we recommend further research relating to the concept of pregnancy planning/inten-tion among partners of all gender identities to understand whether additional content would enhance the measurement of the construct. In particular, we recommend further conceptual exploration with men who have experienced unplanned pregnancies.


 

Article Details

Section
Articles
Author Biographies

Geraldine Barrett, University College London

Research Department of Reproductive Health, UCL Elizabeth Garrett Anderson Institute for Women’s Health

Jennifer A Hall, University College London

Research Department of Reproductive Health, UCL Elizabeth Garrett Anderson Institute for Women’s Health

Beth Howden, University of Bristol

Bristol Medical School

Dilisha Patel, University College London

Research Department of Reproductive Health, UCL Elizabeth Garrett Anderson Institute for Women’s Health

Jill Shawe, University of Plymouth

Institute of Health and Community

Judith Stephenson, University College London

Research Department of Reproductive Health, UCL Elizabeth Garrett Anderson Institute for Women’s Health

References

1. Barrett G, Smith SC, Wellings K. Conceptualisation, development, and evaluation of a measure of un-planned pregnancy. J Epidemiol Community Health 2004;58(5):426–33.
2. Morin P, Payette H, Moos MK, et al. Measuring the intensity of pregnancy planning effort. Paediatr Perinat Epidemiol 2003;17(1):97–105.
3. Santelli JS, Lindberg LD, Orr MG, et al. Toward a multidimensional measure of pregnancy intentions: evidence from the United States. Stud Fam Plann 2009;40(2):87–100.
4. Freedman R, Whelpton PK, Campbell AA. Family Planning, Sterility and Population Growth. New York: McGraw Hill; 1959.
5. Cartwright A. Parents and Family Planning Services. London: Routledge Kegan Paul; 1970.
6. Ryder NB, Westoff CF. Reproduction in the United States, 1965. New Jersey: Princeton University Press; 1971.
7. Cleland J, Scott C. The World Fertility Survey: an assessment. Oxford: Oxford University Press; 1987.
8. Fleissig A. Unintended pregnancies and the use of contraception: changes from 1984 to 1989. BMJ 1991;302(6769):147.
9. Mosher WD, Jones J, Abma JC. Intended and unintended births in the United States: 1982-2010. Natl Health Stat Report. 2012(55):1–28.
10. (USAID) USAfID. The DHS Program: Demographic and Health Surveys 2019 [Available from: https://www. dhsprogram.com/.
11. Magnusson B, Lapane K. Fathers’ pregnancy intentions. Perspect Sex Reprod Health 2009;41(2):132.
12. Lindberg LD, Kost K. Exploring U.S. men’s birth intentions. Matern Child Health J 2014;18(3):625–33. 13. Carter M, Speizer IS. Pregnancy intentions among Salvadoran fathers: results from the 2003 National Male Reproductive Health Survey. Int Fam Plan Perspect
2005;31(4):179–82.
14. Huang CC. Pregnancy intention from men’s perspectives: does child support enforcement matter? Perspect Sex Reprod Health 2005;37(3):119–24.
15. Waller MR, Bitler MP. The link between couples’ pregnancy intentions and behavior: does it matter who is asked? Perspect Sex Reprod Health 2008;40(4):194–201.
16. Hohmann-Marriott B. The couple context of pregnancy and its effects on prenatal care and birth outcomes. Matern Child Health J 2009;13(6):745–54.
17. Sipsma H, Divney AA, Niccolai LM, et al. Pregnancy desire among a sample of young couples who are expecting a baby. Perspect Sex Reprod Health 2012;44(4):244–51.
18. Lewin A, Mitchell SJ, Hodgkinson S, et al. Pregnancy intentions among expectant adolescent couples. J Pediatr Adolesc Gynecol 2014;27(3):172–6.
19. Kagesten A, Bajos N, Bohet A, Moreau C. Male experiences of unintended pregnancy: characteristics and prevalence. Hum Reprod 2015;30(1):186–96.
20. Bodin M, Kall L, Tyden T, et al. Exploring men’s pregnancy-planning behaviour and fertility knowledge:a survey among fathers in Sweden. Ups J Med Sci 2017;122(2):127–35.
21. Stykes JB. Methodological Considerations in Couples’ Fertility Intentions: Missing Men and the Viability of Women’s Proxy Reports. Matern Child Health J 2018;22(8):1164–71.
22. Freda MC, Moos MK, Curtis M. The history of preconception care: evolving guidelines and standards. Matern Child Health J 2006;10(5 Suppl):S43–S52.
23. Johnson K, Posner SF, Biermann J, et al. Recommendations to improve preconception health and health care--United States. A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR Recomm Rep. 2006;55(RR-6):1–23.
24. Frey KA, Navarro SM, Kotelchuck M, Lu MC. The clinical content of preconception care: preconception care for men. Am J Obstet Gynecol 2008;199(6 Suppl 2):S389–95.
25. Shawe J, Delbaere I, Ekstrand M, et al. Preconception care policy, guidelines, recommendations and services across six European countries: Belgium (Flanders), Denmark, Italy, the Netherlands, Sweden and the United Kingdom. Eur J Contracept Reprod Health Care 2014:1–11.
26. Kotelchuck M, Lu M. Father’s Role in Preconception Health. Matern Child Health J 2017;21(11):2025–39.
27. Wegner MN, Landry E, Wilkinson D, Tzanis J. Men as partners in reproductive health: from issues to action. Int Fam Plan Perspect 1998;24(1):38–42.
28. Dudgeon MR, Inhorn MC. Men’s influences on women’s reproductive health: medical anthropological perspectives. Soc Sci Med 2004;59(7):1379–95.
29. Bond MJ. The missing link in MCH: paternal involvement in pregnancy outcomes. Am J Mens Health 2010;4(4):285–6.
30. Guadagno M, Mackert M, Rochlen A. Improving prenatal health: setting the agenda for increased male involvement. Am J Mens Health 2013;7(6):523–6.
31. Rocca CH, Krishnan S, Barrett G, Wilson M. Measuring pregnancy planning: An assessment of the London Measure of Unplanned Pregnancy among urban, south Indian women. Demogr Res 2010;23:293–34.
32. Morof D, Steinauer J, Haider S, et al. Evaluation of the London Measure of Unplanned Pregnancy in a United States population of women. PLoS One 2012;7(4):e35381.
33. Hall J, Barrett G, Mbwana N, et al. Understanding pregnancy planning in a low-income country setting: validation of the London measure of unplanned pregnancy in Malawi. BMC Pregnancy Childbirth 2013;13:200.
34. Roshanaei S, Shaghaghi A, Jafarabadi MA, Kousha A. Measuring unintended pregnancies in postpartum Iranian women: validation of the London Measure of Unplannned Pregnancy. Eastern Medi Health J 2015;21(8):572–8.
35. Borges AL, Barrett G, Dos Santos OA, et al. Evaluation of the psychometric properties of the London Measure of Unplanned Pregnancy in Brazilian Portuguese. BMC Pregnancy Childbirth 2016;16:244.
36. Habib MA, Raynes-Greenow C, Nausheen S, et al. Prevalence and determinants of unintended pregnancies amongst women attending antenatal clinics in Pakistan. BMC Pregnancy Childbirth. 2017;17(1):156.
37. Almaghaslah E, Rochat R, Farhat G. Validation of a pregnancy planning measure for Arabic-speaking women. PLoS One 2017;12(10):e0185433.
38. Goossens J, Verhaeghe S, Van Hecke A, et al. Psychometric properties of the Dutch version of the London Measure of Unplanned Pregnancy in women with pregnancies ending in birth. PLoS One 2018;13(4):e0194033.
39. Lang AY, Hall JA, Boyle JA, et al. Validation of the Lon-don Measure of Unplanned Pregnancy among pregnant Australian women. PLoS One 2019;14(8):e0220774.
40. Bukenya JN, Nalwadda CK, Neema S, et al. Pregnancy planning among female sex workers: evaluation of the psychometric properties of the London Measure of Unplanned Pregnancy. African J Reproduct Health 2019;23(3):79–95.
41. London Measure of Unplanned Pregnancy: LMUP versions 2020 [Available from: www.lmup.org.uk/ versions.htm.
42. Frayne DJ, Verbiest S, Chelmow D, et al. Health Care System Measures to Advance Preconception Wellness: Consensus Recommendations of the Clinical Workgroup of the National Preconception Health and Health Care Initiative. Obstet Gynecol 2016;127(5):863–72.
43. Stephenson J, Vogel C, Hall J, et al. Preconception health in England: a proposal for annual reporting with core metrics. Lancet 2019;393(10187):2262–71.
44. Cater S, Coleman L. ‘Planned’ teenage pregnancy: perspectives of young parents from disadvantaged backgrounds. Bristol; 2006.
45. Bodin M, Stern J, Kall LF, et al. Coherence of pregnancy planning within couples expecting a child. Midwifery 2015;31(10):973–8.
46. Yeatman S. The relationship between pregnancy plannedness and parental and child health in Malawi. Contraception 2016;94:424.
47. Yeatman S, Smith-Greenaway E. Birth Planning and Women’s and Men’s Health in Malawi. Stud Fam Plann 2018.
48. Shawe J, Patel D, Joy M, et al. Preparation for fatherhood: A survey of men’s preconception health knowledge and behaviour in England. PLoS One 2019;14(3):e0213897.
49. U.S.Department of Health and Human Services FaDA. Guidance for Industry, Patient-Reported Outcome Measures: Use in Medical Product Development to Support Labeling Claims. 2009 2009.
50. Mokkink LB, Terwee CB, Patrick DL, et al. The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol 2010;63(7):737–45.
51. Reeve BB, Wyrwich KW, Wu AW, et al. ISOQOL recommends minimum standards for patient-reported outcome measures used in patient-centered outcomes and comparative effectiveness research. Qual Life Res 2013;22(8):1889–905.
52. Flower A, Shawe J, Stephenson J, Doyle P. Pregnancy planning, smoking behaviour during pregnancy, and neonatal outcome: UK Millennium Cohort Study. BMC Pregnancy Childbirth 2013;13:238.
53. Stephenson J, Patel D, Barrett G, et al. How do women prepare for pregnancy? Preconception experiences of women attending antenatal services and views of health professionals. PLoS One 2014;9(7):e103085.
54. Barrett G, Shawe J, Howden B, et al. Why do women invest in pre-pregnancy health and care? A qualitative investigation with women attending maternity services. BMC Pregnancy Childbirth 2015;15:236.
55. Ojukwu O, Patel D, Stephenson J, et al. General practitioners’ knowledge, attitudes and views of providing preconception care: a qualitative investigation. Ups J Med Sci 2016:1–8.
56. Bye A, Shawe J, Stephenson J, et al. Differences in pre-conception and pregnancy healthy lifestyle advice by maternal BMI: Findings from a cross sectional survey. Midwifery 2016;42:38–45.
57. London Measure of Unplanned Pregnancy: Partner version 2020 [Available from: www.lmup.org.uk/docs/ LMUP_partnerversion.pdf.
58. Loewenthal KM. An Introduction to Psychological Tests and Scales. 2nd Edition ed. London: Psychology Press; 2001.
59. Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika 1951;16:297–334.
60. Streiner DL, Norman GR. Health Measurement Scales: A Practical Guide to their Development and Use. Fourth ed. Oxford: Oxford University Press; 2008.
61. Kline P. A Handbook of Test Construction: Introduction to Psychometric Design. London: Methuen; 1986. 62. Kline P. The New Psychometrics: Science, Psychology
and Measurement. London: Routledge; 1998.
63. Prinsen CAC, Mokkink LB, Bouter LM, et al. COSMIN guideline for systematic reviews of patient-reported outcome measures. Qual Life Res 2018;27(5):1147–57.
64. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33(1):159–74.
65. Mokken RJ. A theory and procedure of scale analysis. Berlin: De Gruyter; 1971.
66. Sijtsma K, Molenaar IW. Introduction to Nonparametric Item Response Theory. Thousand Oaks, CA: Sage; 2002.
67. Fleming TP, Watkins AJ, Velazquez MA, et al. Origins of lifetime health around the time of conception: causes and consequences. Lancet 2018;391(10132):1842–52.
68. Barker M, Dombrowski SU, Colbourn T, et al. Intervention strategies to improve nutrition and health behaviours before conception. Lancet 2018;391(10132):1853–64.
69. Kirkman M, Stubber C, Rowe H, et al. Subjective meanings of ‘unintended’ pregnancy: interviews from understanding fertility management in contemporary Australia. Cult Health Sex 2017;19(2):179–93.
70. Johnson SD, Williams LB. Deference, denial, and exclusion: men talk about contraception and unintended pregnancy. Internat J Men’s Health 2005;4(3):15.
71. Reich JA, Brindis CD. Conceiving risk and responsibility: a qualitative examination of men’s experiences of unintended pregnancy and abortion. Internat J Men’s Health 2006;5(2):133–52.
72. Buston KM. Experiences of, and attitudes towards, pregnancy and fatherhood amongst incarcerated young male offenders: findings from a qualitative study. Soc Sci Med 2010;71(12):2212–8.
73. Olmstead SB, Koon JT, Puhlman DJ, et al. College men, unplanned pregnancy, and marriage: what do they expect? J Sex Res 2013;50(8):808–19.
74. Daugherty J. How young men at high risk of fathering an unintended pregnancy talk about their procreative identities. J Family Issues 2016;37(3):1817–42.
75. Woodhams E, Sipsma H, Hill BJ, Gilliam M. Perceived responsibility for pregnancy and sexually transmitted infection prevention among young African American men: An exploratory focus group study. Sex Reprod Healthc 2018;16:86–91.
76. Hamm M, Miller E, Jackson Foster L, et al. The financial is the main issue, it’s not even the child: exploring the role of finances in men’s concepts of fatherhood and fertility intention. Am J Mens Health 2018;12(4):1074–83.
77. Jackson E, Karasz A, Gold M. Family formation in the inner city: low-income men’s perception of their role in unplanned conception and pregnancy prevention. J Health Care Poor Underserved 2011;22(1):71–82.