Pre-abortion counselling from women's point of view - artcoss

Pre-abortion counselling in FlandersVandamme et al.Eur J Contracept Reprod Health Care Downloaded from informahealthcare.com by University of Geneva on 10/09/13For personal use only.METHODSProcedureThis cross-sectional study involved women requestingan abortion between March 2010 and June 2010in the LUNA abortion centres. Staff members in thefive abortion centres were invited to systematicallyrecruit every abortion-seeking woman who attendedthe centre. There were no exclusion criteria, exceptfor women who did not speak Dutch, French orEnglish, due to translation difficulties of the questionnaire.The recruitment technique consisted of anoral explanation of the purpose of the study, and aninformation letter. Of all women who refused to participate,their nationality, date of birth, and reason fornon-participation, were noted. Women who agreedto take part needed to sign the informed consentform which mentioned the strict confidentiality ofdata-gathering, the voluntary participation, and theimpossibility for the abortion centres to have accessto the completed questionnaires since each was sealedin an envelope and placed in a closed box. Thisstudy was approved by the Ethical Committee of theFaculty of Psychology and Educational Sciences atthe University of Ghent.MeasuresTwo questionnaires were presented to the participatingwomen: one immediately before, and one immediatelyafter the counselling session. Most questions were purposelyconstructed in accordance with the currentabortion counselling practice in Flanders and theinternational literature on pre-abortion counselling. Inaddition, questions were reviewed and adapted togetherwith experts in the field. After having pilot-tested thequestionnaire with six (female) volunteers, questionscontinued to be revised until comprehensibility andan appropriate length were guaranteed. When parts ofthe questionnaire were not available in English orFrench, they were translated by professionals.Background informationFive background questions were asked in order toknow more about the participants, the counsellors,and the sessions. Information was collected on participants’ age, nationality, and experience with previousinduced abortions. Further, information wasgathered about the counsellor ’ s education level, andabout the persons attending the session (women ’ scompanionship).Counselling contentTwo multiple-choice questions dealt with the contentof the counselling session, asking which themes womenwanted to discuss during the session (pre-counselling),and which themes they eventually did discuss (postcounselling).Based on observation of the participantduring the counselling session and discussion withexperts, a list was made with 11 themes that coveredthe content of the counselling. Three themes concernedthe exchange of information ( ‘ contraceptiveuse ’ , ‘ information about the abortion procedure ’ and‘ information about the consequences of the abortion ’ ).Five themes dealt with aspects of the decision-makingprocess ( ‘ the abortion-decision and possible doubts ’ ,‘ reasons for the abortion request ’ , ‘ alternatives to theabortion ’ , ‘ emotions ’ , and ‘ feelings of guilt ’ ). Thirdpartyinvolvement made up the final denominator,with ‘ experiences of others ’ , ‘ role of significant others ’ ,and ‘ religious aspects ’ as specific themes. A remainingcategory ‘ other themes ’ was added in order to givewomen the opportunity to bring up issues that wereimportant to them but were not on the formulatedlist. In addition, women were asked post-counsellingwhether some themes were not discussed even thoughthey wanted to, and vice versa.Emotional and cognitive stateThe questionnaire contained the Profile Of MoodStates – Short Form (POMS-SF), which measuresmomentary mood states 22 . This shortened version ofthe POMS, consisting of five subscales, showed aninternal consistency of between .77 and .92 in thissample (Cronbach ’ s α ). Besides its reliability, thePOMS-SF was shown to be both convergent and discriminantlyvalid in clinical populations 23,24 . Using a32-item inventory, five mood dimensions were assessed,including ‘ depression ’ (eight items: minimum score 0;maximum score 32), ‘ fatigue ’ (six items: minimumscore 0; maximum score 24), ‘ tension ’ (six items: minimumscore 0; maximum score 24), ‘ anger ’ (seven items:minimum score 0; maximum score 28), and ‘ vigour ’(five items: minimum score 0; maximum score 20).Each item was rated on a scale ranging from zero toThe European Journal of Contraception and Reproductive Health Care 311