This page includes publications on measurement and the Person-Centered Contraceptive Counseling (PCCC) measure, news articles and op-eds published on the PCCC, and additional readings that provide context on topics such as person-centeredness. If a publication linked or included on this page is not accessible, please contact us for access.
Foundational Publications
- Using the Person-Centered Contraceptive Counseling (PCCC) Measure for Quality Improvement. Contraception. 2023 Apr 12; 110040. Jones EJ, Dehlendorf C, Kriz R, Grzeniewski M, Decker E, Eikner D. PMID: 37059346.
This commentary describes the PCCC pilot in 2018-2019 and how organizations have since expressed the value of using the PCCC measure as it provides the opportunity to leverage information for quality improvement and center patient voices in contraceptive care. The PCCC is a standalone patient-reported outcome performance measure that uses a 4-item survey to assess the three domains of person-centered contraceptive counseling (interpersonal connection, decision support, and adequate information). This measure was piloted by UCSF following NQF’s call to develop measures that focused on patient-centeredness. Claims-based measures, endorsed by the NQF in 2016, played an important role in prioritizing quality of contraceptive care at the state and federal level but also raised a few concerns. These measures could hinder patient centeredness by incentivizing counseling towards specific methods, and inadvertently neglect patient preferences related to reproduction and pregnancy prevention. The PCCC measure can be integrated into existing patient experience surveys to provide quality improvement insights.
- Prioritizing Patient Experience: Validation of the Person-Centered Contraceptive Counseling Measure as a Performance Measure. Contraception. 2023 Mar 17; 110010. Dehlendorf C, Vittinghoff E, Silverstein I, Fox E, Logan R, Reed R, Jones DH. PMID: 36934954.
This paper goes over the process of testing the validity and reliability of the PCCC measure as a performance measure, in preparation for application for endorsement from the National Quality Forum. We combined data from two research studies, a statewide quality improvement assessment, and a dedicated data collection effort at nine sites, all collected between 2009 and 2019 at 22 total sites in the United States, to evaluate the validity and reliability of the four-item PCCC measure aggregated at the provider and facility level. The development and use of the measures of patient experience, like the PCCC, is critical for prioritizing patient-centeredness in reproductive health care. The PCCC measure can facilitate the identification of gaps and disparities in patient-centered contraceptive counseling and enable quality improvement to promote quality, equitable contraceptive care.
- Development of the Person-Centered Contraceptive Counseling scale (PCCC), a short form of the Interpersonal Quality of Family Planning care scale. Contraception. 2021 05; 103(5):310-315. Dehlendorf C, Fox E, Silverstein IA, Hoffman A, Campora Pérez MP, Holt K, Reed R, Hessler D. PMID: 33508252.
The PCCC measure was developed from the 11-item Interpersonal Quality of Family Planning (IQFP) scale. This paper outlines the creation of the PCCC, a 4-item patient-reported outcome performance measure. To explore clarity and importance of each of the IQFP’s 11 items, we conducted English and Spanish cognitive interviews with patients who received contraceptive counseling at 3 publicly funded California clinics. The 11-item IQFP scale was reduced to a 4-item scale (the PCCC) that includes items evaluating provider performance regarding respect for patients, information provision, and eliciting and honoring patient preferences for birth control.
- Development of a patient-reported measure of the interpersonal quality of family planning care. Contraception. 2018 Jan; 97(1):34-40. Dehlendorf C, Henderson JT, Vittinghoff E, Steinauer J, Hessler D. PMID: 28935217.
The objective of this paper was to describe the development of the Interpersonal Quality of Family Planning (IQFP) scale. We performed initial item selection based on qualitative work regarding patient preferences for contraceptive counseling and a review of patient-reported measures of communication. We then tested the scale with women receiving contraceptive counseling visits and coded the audio recordings with a focus on patient-centered communication. We determined the final scale based on interitem correlations and exploratory factor analysis. Content, construct, convergent and discriminant validity were all tested by investigating associations between the final scale and the satisfaction and audio-recording-derived measures using mixed effects logistic regression. We selected an 11-item, 1-factor IQFP scale, with a Cronbach's alpha of 0.95. This scale showed positive associations with measures of satisfaction with counseling and with the chosen method.
- Performance measures for contraceptive care: what are we actually trying to measure? Contraception. 2015 Jun; 91(6):433-7. Dehlendorf C, Bellanca H, Policar M. PMID: 25677992.
Performance measures for contraceptive care should prioritize quality of contraceptive care that is reflective of women’s needs and preferences. This commentary reflects on how standardized measures of contraceptive care seem to focus on the use and uptake of long-acting reversible contraception (LARCs). From a public health perspective, the increase of LARCS has the potential to reduce unintended pregnancy rates and has been suggested to decreasing pregnancy complications. However, there are inadvertent risks involved in measurement that associates uptake in LARCS with higher quality of care. Incentivizing counseling for LARC based methods is especially problematic among disadvantaged populations, considering the United States’ history of forced sterilization and coercive practices in these groups. These measures may lead to more directive counseling that neglects patients’ preferences and priorities regarding their reproductive health. A measure that centers patient experience and preferences of contraceptive counseling may yield better clinical outcomes and patient satisfaction.
Measurement and the PCCC
- Using the Person-Centered Contraceptive Counseling (PCCC) Measure for Quality Improvement. Contraception. 2023 Apr 12; 110040. Jones EJ, Dehlendorf C, Kriz R, Grzeniewski M, Decker E, Eikner D. PMID: 37059346.
- Prioritizing Patient Experience: Validation of the Person-Centered Contraceptive Counseling Measure as a Performance Measure. Contraception. 2023 Mar 17; 110010. Dehlendorf C, Vittinghoff E, Silverstein I, Fox E, Logan R, Reed R, Jones DH. PMID: 36934954.
- Development of the Person-Centered Contraceptive Counseling scale (PCCC), a short form of the Interpersonal Quality of Family Planning care scale. Contraception. 2021 05; 103(5):310-315. Dehlendorf C, Fox E, Silverstein IA, Hoffman A, Campora Pérez MP, Holt K, Reed R, Hessler D. PMID: 33508252.
- Adapting the Interpersonal Quality in Family Planning care scale to assess patient perspectives on abortion care. J Patient Rep Outcomes. 2019 Jan 21; 3(1):3. Donnelly KZ, Dehlendorf C, Reed R, Agusti D, Thompson R. PMID: 30666466; PMCID: PMC6340910.
- Development of a patient-reported measure of the interpersonal quality of family planning care. Contraception. 2018 Jan; 97(1):34-40. Dehlendorf C, Henderson JT, Vittinghoff E, Steinauer J, Hessler D. PMID: 28935217.
- Future directions in performance measures for contraceptive care: a proposed framework. Contraception. 2017 09; 96(3):138-144. Gavin LE, Ahrens KA, Dehlendorf C, Frederiksen BN, Decker E, Moskosky S. PMID: 28666795.
- Performance measures for contraceptive care: what are we actually trying to measure? Contraception. 2015 Jun; 91(6):433-7. Dehlendorf C, Bellanca H, Policar M. PMID: 25677992.
PCCC in the News
- 6 Principles To Support Comprehensive Contraceptive Care. May 2, 2023. https://www.americanprogress.org/article/6-principles-to-support-comprehensive-contraceptive-care/
- Advancing Access to Contraception in States Through Quality Measures and Person-Centered Contraceptive Counseling. March 29, 2023. https://www.americanprogress.org/article/advancing-access-to-contraception-in-states-through-quality-measures-and-person-centered-contraceptive-counseling/
- Fact Sheet: Advancing Contraceptive Access in the States Through Quality Measures and Person-Centered Contraceptive Counseling. Feb. 28, 2023. https://www.americanprogress.org/article/fact-sheet-advancing-contraceptive-access-in-the-states-through-quality-measures-and-person-centered-contraceptive-counseling/
Additional Readings
- Elevating the patient voice in contraceptive care quality improvement: A qualitative study of patient preferences for peripartum contraceptive care. Contraception. 2023 Feb 02; 109960. Minns A, Dehlendorf C, Peahl AF, Heisler M, Owens LE, van Kainen B, Bonawitz K, Moniz MH. PMID: 36736716.
- Reproductive Life Planning and Patient-Centered Care: Can the Inconsistencies be Reconciled? Matern Child Health J. 2019 07; 23(7):869-870. Callegari LS, Aiken ARA, Dehlendorf C, Borrero S. PMID: 31152282.
- An in-depth analysis of the use of shared decision making in contraceptive counseling. Contraception. 2019 03; 99(3):187-191. Chen M, Lindley A, Kimport K Dehlendorf C. PMID: 30471263.
- Contraceptive Counseling in Clinical Settings: An Updated Systematic Review. Am J Prev Med. 2018 11; 55(5):677-690. Zapata LB, Pazol K, Dehlendorf C, Curtis KM, Malcolm NM, Rosmarin RB, Frederiksen BN. PMID: 30342631; PMCID: PMC6613590.
- Client Preferences for Contraceptive Counseling: A Systematic Review. Am J Prev Med. 2018 11; 55(5):691-702. Fox E, Reyna A, Malcolm NM, Rosmarin RB, Zapata LB, Frederiksen BN, Moskosky SB, Dehlendorf C. PMID: 30342632; PMCID: PMC6655529.
- Addressing potential pitfalls of reproductive life planning with patient-centered counseling. Am J Obstet Gynecol. 2017 Feb; 216(2):129-134. Callegari LS, Aiken AR, Dehlendorf C, Cason P, Borrero S. PMID: 27776920.
- Provider self-disclosure during contraceptive counseling. Contraception. 2017 Feb; 95(2):161-166. McLean M, Steinauer J, Schmittdiel J, Chan P, Dehlendorf C. PMID: 27642154; PMCID: PMC5239732.
- Shared decision making in contraceptive counseling. Contraception. 2017 May; 95(5):452-455. Dehlendorf C, Grumbach K, Schmittdiel JA, Steinauer J. PMID: 28069491; PMCID: PMC5466847.
- Quality and Content of Patient-Provider Communication About Contraception: Differences by Race/Ethnicity and Socioeconomic Status. Womens Health Issues. 2017 Sep - Oct; 27(5):530-538. Dehlendorf C, Anderson N, Vittinghoff E, Grumbach K, Levy K, Steinauer J. PMID: 28601368.
- Association of the quality of interpersonal care during family planning counseling with contraceptive use. Am J Obstet Gynecol. 2016 07; 215(1):78.e1-9. Dehlendorf C, Henderson JT, Vittinghoff E, Grumbach K, Levy K, Schmittdiel J, Lee J, Schillinger D, Steinauer J. PMID: 26827879.
- Racial and ethnic differences in women's preferences for features of contraceptive methods. Contraception. 2016 05; 93(5):406-11. Jackson AV, Karasek D, Dehlendorf C, Foster DG. PMID: 26738619.
- Contraceptive counseling: best practices to ensure quality communication and enable effective contraceptive use. Clin Obstet Gynecol. 2014 Dec; 57(4):659-73. Dehlendorf C, Krajewski C, Borrero S. PMID: 25264697; PMCID: PMC4216627.
- A qualitative analysis of approaches to contraceptive counseling. Perspect Sex Reprod Health. 2014 Dec; 46(4):233-40. Dehlendorf C, Kimport K, Levy K, Steinauer J. PMID: 25040686; PMCID: PMC4487742.