title: Measuring decisional certainty among women seeking abortion.
abstract: OBJECTIVE
  Evaluating decisional certainty is an important component of medical care, including preabortion care. However, minimal research has examined how to measure certainty with reliability and validity among women seeking abortion. We examine whether the Decisional Conflict Scale (DCS), a measure widely used in other health specialties and considered the gold standard for measuring this construct, and the Taft-Baker Scale (TBS), a measure developed by abortion counselors, are valid and reliable for use with women seeking abortion and predict the decision to continue the pregnancy.
  
  
  METHODS
  Eligible women at four family planning facilities in Utah completed baseline demographic surveys and scales before their abortion information visit and follow-up interviews 3 weeks later. For each scale, we calculated mean scores and explored factors associated with high uncertainty. We evaluated internal reliability using Cronbach's alpha and assessed predictive validity by examining whether higher scale scores, indicative of decisional uncertainty or conflict, were associated with still being pregnant at follow-up.
  
  
  RESULTS
  Five hundred women completed baseline surveys; two-thirds (63%) completed follow-up, at which time 11% were still pregnant. Mean scores on the DCS (15.5/100) and TBS (12.4/100) indicated low uncertainty, with acceptable reliability (α=.93 and .72, respectively). Higher scores on each scale were significantly and positively associated with still being pregnant at follow-up in both unadjusted and adjusted analyses.
  
  
  CONCLUSIONS
  The DCS and TBS demonstrate acceptable reliability and validity among women seeking abortion care. Comparing scores on the DCS in this population to other studies of decision making suggests that the level of uncertainty in abortion decision making is comparable to or lower than other health decisions.
  
  
  CONCLUSIONS
  The high levels of decisional certainty found in this study challenge the narrative that abortion decision making is exceptional compared to other healthcare decisions and requires additional protection such as laws mandating waiting periods, counseling and ultrasound viewing.
authors.affiliation: Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA. Electronic address: Lauren.Ralph@ucsf.edu.
authors.forename: Lauren J
authors.initials: LJ
authors.lastname: Ralph
authors.affiliation: Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA. Electronic address: Diana.Foster@ucsf.edu.
authors.forename: Diana Greene
authors.initials: DG
authors.lastname: Foster
authors.affiliation: Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA. Electronic address: Katrina.Kimport@ucsf.edu.
authors.forename: Katrina
authors.initials: K
authors.lastname: Kimport
authors.affiliation: University of Utah, Department of Obstetrics and Gynecology, 50 N Medical Dr, Salt Lake City, UT 84132, USA. Electronic address: David.Turok@hsc.utah.edu.
authors.forename: David
authors.initials: D
authors.lastname: Turok
authors.affiliation: Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA. Electronic address: Sarah.Roberts@ucsf.edu.
authors.forename: Sarah C M
authors.initials: SCM
authors.lastname: Roberts
mesh_terms: D000028:Abortion, Induced / Q000523:psychology*; D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D003376:Counseling; D003657:Decision Making; D005260:Female; D006801:Humans; D015999:Multivariate Analysis; D011247:Pregnancy; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D035501:Uncertainty; D014589:Utah; D055815:Young Adult
keywords: Abortion; Decisional certainty; Decisional conflict; Decisional uncertainty