What is new?
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A deliberative process was conducted to develop an instrument to measure the Informed Choice of contraceptive methods as a means of assessing the decision-making process in family planning programs throughout Chile.
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Informed Choice in these women is a multidimensional construct made up of the following domains: orientation, information, communication, and the quality of treatment.
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Different sources and methods for generating items provide the necessary foundation to develop a construct that can be measured in a culturally appropriate manner.
The decisions that women make with respect to their family planning methods reflect a variety of influences. They include, but are not limited to, the information available in the media; access to family planning methods and services; cultural, religious, and social influences; socioeconomic status; and community standards [1]. The effect of all these influences is embedded in the principle of Informed Choice in family planning. This is defined as a process of deciding on a contraceptive method based on the complete understanding of all the available information [2], [3], [4]. This process should lead to a free, independent, and effective decision about the method of contraception [5], [6], [7].
At the international level, there are unrealistic expectations for this process in the context of primary health care centers in the developing world because of the scarcity of human and material resources [8], [9].
The Informed Choice concept encompasses three dimensions that are debated. The first is the theory that sustains this principle; the second, the definition of the elements that comprise it; and the third to the objective measurement of its implementation.
It is generally maintained that the principle of Informed Choice is based on the liberal philosophy that focuses on individual rights [10], [11]. This supposes that a person as an individual understands the potential risks, limitations, and scientific uncertainty of the procedure that he or she is choosing and is able to align his or her own beliefs and values with the information provided to make the correct decision [12], [13], [14]. This position is based on a normative theoretical model with respect to human behavior [15], [16].
The elements that constitute Informed Choice include the following: (1) affectivity, which involves aspects specific to the patient such as the individual understanding of the process, values, beliefs, personal disposition, and so on; (2) the patient’s view of the acceptability, use, and the effectiveness of the implementation of procedures; and (3) quality of the interaction between the client and the health provider, among others [17], [18].
We were unable to find an Informed Choice instrument for assessing contraceptive needs in primary care in a lower or middle income country. To date, measurements validated in Informed Choice have evaluated the results or effects of the information on the patients' decisions about other specific procedures [19], [20]. Useful studies have shown that individualized information contributes to more informed decision making than group information; and that it is necessary to provide not only written information but also verbal information [21], [22], [23], [24]. The OPTION instrument has been proposed by the World Health Organization, for assessing patients' decision making: doctor–client information and interaction [25], [26].
However, despite partial attempts [27], [28], one aspect in the Informed Choice measurement not yet adequately explored in a low/middle income country setting similar to our setting in Chile, is the affective or personal dimension of this concept, which involves the individual factors, ideas, beliefs, and sometimes unpredictable feelings that affect the patients' decisions. There are measurements of quality of information received, opportunity to make decisions, and quality of provider–user interaction, but there is no instrument that measures the entire Informed Choice process [29], [30], [31], [32] in family planning, from an integrated perspective.
In Chile, the Informed Choice concept is not well known, and less still is patient decision making measured. We therefore propose generating a measurement of Informed Choice that takes three fundamental dimensions into consideration. The first dimension is based on the principle of health as a basic human right, which implies right to information and quality of attention. Second is the affective dimension of patients' culture and beliefs in the context of a Latin population, whose values regarding the family, the ideal number of children, and participation of women are very different from the Anglo-American estimations. And third is the assessment of provider–user interaction from the patients' point of view, modeled on the values of Latin culture.
The objective of this study was to design and validate a scale to measure the Informed Choice of contraceptive methods among women attending the family planning program (FPP) in Chile. The purpose was to show the process of constructing a valid and reliable scale combining health and social sciences methods and tools.
Having a valid and reliable instrument to measure Informed Choice would allow clinicians and health personnel to maximize the delivery of quality and ethical health care to women of reproductive age.
