Validation of a Spanish language scale to assess the perceived quality of medical abortion care before 9 weeks of gestation | BMC Women’s Health
The results of the validation process of the adapted SERVPERF scale present a valid instrument for measuring the satisfaction and quality of service of patients seeking MA.
The socio-demographic characteristics of the participants are similar to those of the population of Catalonia who apply for an MA, according to 2018 statistics provided by the Ministry of Health . The most relevant difference is that 42% of patients were locals in the statistics reported, whereas in our study 66.3% were. This is most likely due to having included incompetence in Spanish as an exclusion criterion.
Prior to this study, the effectiveness of the MA process had already been demonstrated and supported by protocols , but no data had been collected on patient-perceived quality. In 2019, the first paper on a validated, person-centered abortion care scale was published in Kenya . The lack of data on the quality of abortion care may be due to the highly stigmatized status of the procedure.
McLemore assessed the experience of the outpatient abortion process in the United States: 70% of patients said they had a better experience than expected; the rest mentioned the need to improve pain management and waiting time . These results support the decision to include 5 elements related to the MA process in our proposal.
In 2020, Sudhinaraset et al.  published a validation of a person-centered abortion scale, in private surgical and medical care, in a restrictive legal context of abortion. Respectful care and communication dimensions predominated. They found that these types of scales can be adapted to different sexual and reproductive health services. Our scale also assesses the organization, clinical aspects and impact of the process.
Baynes studied how women experience post-MA visits in Tanzania . Although women were satisfied with the privacy and closeness of care, they identified important areas for improvement: office cleanliness, post-contraception counseling and pain management. In our study, the quality of these aspects was judged to be good. The scale has good metric characteristics as it does not show saturated floor or ceiling effects and there was a high response rate for all items. The non-response rates for items 22 to 24 could be due to their placement on the last page of the questionnaire .
In general, scores were high for all items except 19-23, which were related to the MA process. This is consistent with other studies in which items related to pain management, bleeding, and anxiety during the process received lower scores. [20, 21].
In the factor analysis, 7 dimensions were obtained that explain a total variance of 65.9%, similar to that obtained by Gómez-Besteiro (69.3%) .
Items added to respond to the process were grouped into two specific dimensions, which was found to be consistent.
Overall, item agreement was moderate to excellent, except for items 6, 8, and 11, where it was moderate, likely due to some degree of subjectivity. The predisposition, the time devoted and the sufficient information can be perceived differently according to the patient’s need for support.
Item 17, which asked about information provided to prevent unwanted pregnancies in the future, showed low reliability. This was also observed in the Baynes study as an aspect for improvement. . One solution would be to provide this information at the end of the process with free contraception.
The dimensions obtained are similar to those proposed in other SERVPERF validation processes for health. Gómez-Besteiro obtained the same 5 dimensions but distinguishing medical and nursing staff . In our study, the dimension of health professionals included gynecologists and midwives, as both are involved in the process. Torres obtained 7 dimensions, including security which has already been analyzed in our region .
As for the limits of this study, the important ethical and moral connotation of MAs must be taken into account. Although it is currently legal, it is still an ethical conflict. This factor may have influenced the number of dropouts.
After performing MA, some women did not attend follow-up visits. However, the dropout rate was low (13.2%) and no difference was observed suggesting the existence of any type of risk.