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Searching for Needles in a Haystack: Exploring Alternative Operational Approaches to Classify the Safety of Induced Abortions Using Respondent-Driven Sampling Data From Two Sub-Saharan African Settings. 大海捞针:利用来自两个撒哈拉以南非洲地区的受访者驱动的抽样数据,探索对人工流产安全性进行分类的替代操作方法。
IF 2.1 3区 医学 Q2 DEMOGRAPHY Pub Date : 2024-09-26 DOI: 10.1111/sifp.12276
Onikepe O Owolabi,Clémentine Rossier,Rachidatou Compaore,Caron Kim,Bela Ganatra,Ramatou Ouedraogo,Moussa Zan,Martin Bangha,Adama Baguiya,
This study aims to describe the circumstances under which women obtained abortions in two sites, explore more nuanced approaches to classify abortion safety and examine the relationship between safety and self-reported health outcomes. We analyze data on the most recent abortion or only abortion reported by 551 women in Nairobi slums and 479 women in rural Kaya ages 15-49 years within the three years preceding the study, recruited via respondent-driven sampling. Using the most liberal safety classification, there were very few safe abortions (8 percent in Nairobi and 5 percent in Burkina Faso). A significant proportion of women reported using unidentified pills which we hypothesize may be medication abortion. Although a smaller proportion of women with safe abortions reported side effects, more of them reported side effects suggestive of infections and sought care for their symptoms. It is important that we explore and move towards more nuanced global safety classifications that more accurately reflect the risk associated with different methods and can capture women's access to comprehensive abortion care and its impact on their health.
本研究旨在描述两地妇女堕胎的情况,探索更细致的堕胎安全分类方法,并研究堕胎安全与自我报告的健康结果之间的关系。我们分析了内罗毕贫民窟 551 名妇女和卡亚(Kaya)农村地区 479 名 15-49 岁妇女在研究前三年内报告的最近一次堕胎或唯一一次堕胎的数据,这些数据是通过受访者驱动的抽样调查获得的。根据最宽松的安全分类,安全堕胎的比例极低(内罗毕为 8%,布基纳法索为 5%)。很大一部分妇女报告使用了不明药片,我们推测这可能是药物流产。尽管报告有副作用的安全堕胎妇女比例较低,但更多的妇女报告了暗示感染的副作用,并就其症状寻求治疗。重要的是,我们应探索并逐步实现更细致的全球安全分类,以更准确地反映与不同方法相关的风险,并能反映妇女获得全面人工流产护理的情况及其对妇女健康的影响。
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引用次数: 0
Are Contraceptive Method Preferences Stable? Measuring Change in the Preferred Method among Kenyan Women. 避孕方法的偏好是否稳定?衡量肯尼亚妇女首选方法的变化。
IF 1.9 3区 医学 Q2 DEMOGRAPHY Pub Date : 2024-09-01 Epub Date: 2024-07-15 DOI: 10.1111/sifp.12271
Carolina Cardona, Dana Sarnak, Alison Gemmill, Peter Gichangi, Mary Thiongo, Philip Anglewicz

Contraceptive preferences are important for reproductive outcomes, such as contraceptive continuation and pregnancy. Current approaches to measuring reproductive preferences in population surveys are limited to exploring only fertility preferences and implicitly assume that contracepting people are using a method they want. We know that people change their fertility preferences over the life course as a response to life events, but there is no information about changes in contraceptive preferences, given the limited evidence about the measurement and distribution of contraceptive preferences. In this study, we examined the extent of change in women's contraceptive preferences over one year and identified characteristics associated with this change in Kenya using three rounds of nationally representative longitudinal data. Over one year, 18 percent of contraceptive users and 46 percent of contraceptive nonusers reported changes in their preferred contraceptive. Experiencing a pregnancy or birth and changes in marital status were associated with changes in contraceptive preferences for users and nonusers. We found that contraceptive preferences are dynamic, suggesting that family planning programs should ensure people's access to various methods to respond to women's changing circumstances and preferences.

避孕偏好对生殖结果(如避孕持续率和怀孕率)非常重要。目前在人口调查中测量生殖偏好的方法仅限于探讨生育偏好,并隐含地假定避孕者正在使用他们想要的方法。我们知道,随着生活事件的发生,人们的生育偏好会随之改变,但由于有关避孕偏好的测量和分布的证据有限,目前还没有有关避孕偏好变化的信息。在这项研究中,我们利用三轮具有全国代表性的纵向数据,考察了肯尼亚妇女避孕偏好在一年内的变化程度,并确定了与这种变化相关的特征。在一年的时间里,18% 的避孕药具使用者和 46% 的非避孕药具使用者报告了其首选避孕药具的变化。怀孕或生育经历以及婚姻状况的变化与避孕药具使用者和非使用者避孕药具偏好的变化有关。我们发现,避孕偏好是动态的,这表明计划生育计划应确保人们能够获得各种避孕方法,以应对妇女不断变化的情况和偏好。
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引用次数: 0
Men's Willingness to Use and Preferences for Novel Male Contraceptive Methods in Malawi. 马拉维男性对新型男性避孕方法的使用意愿和偏好。
IF 1.9 3区 医学 Q2 DEMOGRAPHY Pub Date : 2024-09-01 Epub Date: 2024-08-08 DOI: 10.1111/sifp.12275
Ann Gottert, Sanyukta Mathur, Mayi Gnofam, Jim Sailer, Julie Pulerwitz, Lisa B Haddad

Evidence is needed in low- and middle-income countries regarding men's willingness to use new male contraceptive methods in development, preferences regarding method attributes, and what shapes willingness/preferences. We analyzed data from cross-sectional surveys with 611 men in Malawi, concerning willingness to use each of four types of new male methods. Mean age was 24.5 years; half (50 percent) were married/cohabiting. Over half (51 percent) of men expressed willingness to use at least one new male method, including a topical contraceptive gel (33 percent), injection (32 percent), pill (29 percent), and implant (14 percent). Many male product attributes were considered important (with 59-67 percent endorsement), including ease of use, comfort of use, side effects, partner approval, type of method, frequency of facility visits, and cost. A prevalent reported reason for willingness was to "share responsibility for family planning with my partner" (44 percent). In multivariate regression analyses, willingness was inversely associated with inequitable gender attitudes (p < 0.001) and was not associated with married/cohabiting status, using condoms, or perceived risk for HIV. These findings add to growing evidence that a majority of men express willingness to use new male contraceptive methods like a topical gel, injectable, or pill. Reflection around gender roles is likely critical within future education about male contraceptive methods.

中低收入国家需要有关男性在发展中使用新型男性避孕方法的意愿、对方法属性的偏好以及影响意愿/偏好的因素的证据。我们分析了对马拉维 611 名男性进行的横断面调查数据,这些数据涉及使用四种新型男性避孕方法的意愿。平均年龄为 24.5 岁;半数(50%)已婚/同居。超过一半(51%)的男性表示愿意使用至少一种新的男性避孕方法,包括外用避孕凝胶(33%)、注射(32%)、避孕药(29%)和皮下埋植(14%)。许多男性产品的属性都被认为是重要的(59%-67%的人表示赞同),包括使用方便、使用舒适、副作用、伴侣认可、方法类型、设施访问频率和成本。据报告,"与伴侣共同承担计划生育责任"(44%)是人们普遍愿意使用的原因。在多变量回归分析中,意愿与不公平的性别态度成反比(p < 0.001),与已婚/同居状况、使用安全套或感知到的 HIV 风险无关。这些发现补充了越来越多的证据,即大多数男性表示愿意使用新的男性避孕方法,如局部凝胶、注射或药丸。在未来的男性避孕方法教育中,围绕性别角色的反思可能至关重要。
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引用次数: 0
Assessing Trends in the Desire to Avoid Pregnancy: A Cautionary Note. 评估避免怀孕愿望的趋势:注意事项。
IF 1.9 3区 医学 Q2 DEMOGRAPHY Pub Date : 2024-09-01 Epub Date: 2024-07-23 DOI: 10.1111/sifp.12270
John B Casterline, Laila El-Zeini, Mobolaji Ibitoye

The desire to avoid pregnancy-to delay the next birth or have no further births-is a fundamental sexual and reproductive health indicator. We show that two readily available measures-prospective fertility preferences and the demand for contraception [Demand] construct-provide substantially different portraits of historical trends. They also yield correspondingly different assessments of the sources of contraceptive change. We argue, with supporting empirical evidence, that Demand enormously overstates the historical trend in the desire to avoid pregnancy because Demand as currently constructed is in part a function of contraceptive prevalence. This makes for "reverse causality" in decompositions of contraceptive change, producing an upward distortion on the order of 25 percentage points in the amount of contraceptive change attributed to a change in fertility desires. Decomposition of contraception change free of the distortion reveals that contraceptive change has been due almost entirely to more complete implementation of fertility preferences. This is explained in part by the surprisingly slight historical change in preferences, a fact we document and then show is a consequence of a historical shift in parity composition toward lower parities.

避免怀孕--推迟下一次生育或不再生育--是一项基本的性健康和生殖健康指标。我们的研究表明,两种现成的测量方法--未来生育偏好和避孕需求[Demand]--对历史趋势的描述大相径庭。它们对避孕药具变化来源的评估也相应不同。我们通过经验证据认为,"需求 "极大地夸大了避孕意愿的历史趋势,因为目前构建的 "需求 "在一定程度上是避孕普及率的函数。这就造成了避孕药具变化分解中的 "反向因果关系",使归因于生育意愿变化的避孕药具变化量向上扭曲了 25 个百分点。对没有扭曲的避孕变化进行分解后发现,避孕变化几乎完全是由于更全面地实施了生育意愿。这在一定程度上是由于历史上偏好的变化出奇地微小,我们记录了这一事实,并证明这是历史上均等构成向低均等转变的结果。
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引用次数: 0
The Global Adolescent Fertility Decline is Counteracted by Increasing Teen Births in Sub-Saharan Africa. 撒哈拉以南非洲青少年生育率的上升抵消了全球青少年生育率的下降。
IF 1.9 3区 医学 Q2 DEMOGRAPHY Pub Date : 2024-09-01 Epub Date: 2024-07-15 DOI: 10.1111/sifp.12273
Thomas Spoorenberg, Ellen Øen Carlsen, Martin Flatø, Marcin Stonawski, Vegard Skirbekk

There is a lack of understanding of the persistence of elevated teen fertility rates in certain regions and countries, in contrast to the significant decline observed in other regions globally. This report considers fertility trends among 15- to 19-year olds in the period 1950-2020 and explores potential driving factors behind the significant shifts that occurred over this period. The countries where teen fertility remains high are those with fast-growing populations, primarily located in sub-Saharan Africa. Countries with higher teen fertility are typically characterized by limited use of modern contraception, lower education levels, and early marriage. Sub-Saharan Africa has emerged as the world region with the most teen births, increasing its proportion of global teen births from 12 percent in 1950 to 47 percent in 2020, a time during which this region's share of the global adolescent (15-19) population grew from 7.5 percent to 19 percent. By 2035, 67 percent of all teen births globally are projected to occur in this region. Consequently, the future number of births to teenage mothers will to a large extent depend on the development in sub-Saharan Africa over the coming decades.

某些地区和国家的青少年生育率持续升高,而全球其他地区的青少年生育率却显著下降,人们对此缺乏了解。本报告研究了 1950-2020 年间 15-19 岁青少年的生育趋势,并探讨了这一时期发生重大变化背后的潜在驱动因素。青少年生育率居高不下的国家是那些人口快速增长的国家,主要位于撒哈拉以南非洲。青少年生育率较高的国家的典型特征是现代避孕措施使用有限、教育水平较低和早婚。撒哈拉以南非洲已成为世界上青少年生育率最高的地区,其占全球青少年生育率的比例从1950年的12%增至2020年的47%,而在此期间,该地区占全球青少年(15-19岁)人口的比例也从7.5%增至19%。到 2035 年,预计全球 67% 的青少年生育将发生在该地区。因此,未来少女母亲的生育数量在很大程度上将取决于撒哈拉以南非洲未来几十年的发展。
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引用次数: 0
There's an App for That: Exploring the Market for Contraceptive Fertility Tracking Apps in the Philippines. 菲律宾避孕生育跟踪应用程序市场探索探索菲律宾避孕生育跟踪应用程序市场。
IF 2.1 3区 医学 Q2 DEMOGRAPHY Pub Date : 2024-06-01 Epub Date: 2024-06-08 DOI: 10.1111/sifp.12265
Kendal Danna, Danielle M Harris, Claire W Rothschild, Beth Brogaard, Elizabeth LaCroix, Mahesh Paudel

For generations, women have relied on fertility awareness methods to plan and prevent pregnancy, for over a decade, many have been aided by digital tools to do so. New contraceptive fertility tracking apps (CFTAs)-that are backed by clinical efficacy trials to support their effectiveness as contraception-have the potential to enhance method choice and offer users a unique contraceptive option, but there is little evidence to inform the decisions around expanding access, particularly in low-and middle-income countries. We conducted a mixed methods study with quantitative online surveys (n = 1600) and qualitative interviews (n = 36) to explore the potential appeal of and demand for a hypothetical CFTA in one such market, the Philippines. Interest in using a CFTA was high among our Internet-engaged, urban study population, with 83.9% "definitely" or "probably" interested in using it. Across demographic profiles, respondents perceived the appeal of the method as "natural" and "convenient." A majority were willing to pay for the method, though notably at a price (5.20 USD) below that of currently available CFTAs. We discuss various important factors to be considered before bringing a method like this to new markets, including the potential implications of equity constraints in reaching a wider market and the unexpected prevalence of other period-tracking apps not intended as contraception being used in this market that could complicate any future roll-out. These issues could be explored further with additional research.

几代人以来,妇女一直依靠生育意识方法来计划和预防怀孕,十多年来,许多妇女在数字工具的帮助下实现了这一目标。新的避孕生育跟踪应用程序(CFTAs)有临床疗效试验支持其避孕效果,有可能增加避孕方法的选择,并为用户提供独特的避孕选择,但几乎没有证据为扩大使用范围的决策提供依据,尤其是在中低收入国家。我们开展了一项混合方法研究,通过定量在线调查(n = 1600)和定性访谈(n = 36)来探讨假设的 CFTA 在菲律宾这一市场的潜在吸引力和需求。在我们的研究对象中,有 83.9% 的人 "肯定 "或 "可能 "有兴趣使用 CFTA。从不同的人口统计学特征来看,受访者认为这种方法的吸引力在于 "自然 "和 "方便"。大多数人愿意为这种方法付费,但价格(5.20 美元)明显低于目前可用的 CFTA。我们讨论了将这种方法推向新市场之前需要考虑的各种重要因素,包括在进入更广泛的市场时可能受到的公平性限制的影响,以及在该市场上使用的其他非避孕目的的月经跟踪应用程序的意外普遍性,这可能会使未来的推广工作复杂化。这些问题可以通过更多的研究来进一步探讨。
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引用次数: 0
Continuation of Reversible Contraception Following Enrollment in the Zika Contraception Access Network (Z‐CAN) in Puerto Rico, 2016–2020 2016-2020 年波多黎各加入寨卡避孕普及网络 (Z-CAN) 后继续使用可逆避孕药具的情况
IF 2.1 3区 医学 Q2 DEMOGRAPHY Pub Date : 2024-04-25 DOI: 10.1111/sifp.12262
Lauren B. Zapata, Katherine Kortsmit, Kathryn M. Curtis, Lisa Romero, Stacey Hurst, Eva Lathrop, Edna Acosta Perez, Marizaida Sánchez Cesáreo, Maura K. Whiteman
The Zika Contraception Access Network (Z‐CAN) provided access to high‐quality client‐centered contraceptive services across Puerto Rico during the 2016–2017 Zika virus outbreak. We sent online surveys during May 2017–August 2020 to a subset of Z‐CAN patients at 6, 24, and 36 months after program enrollment (response rates: 55–60 percent). We described contraceptive method continuation, method satisfaction, and method switching, and we identified characteristics associated with discontinuation using multivariable logistic regression. Across all contraceptive methods, continuation was 82.5 percent, 64.2 percent, and 49.9 percent at 6, 24, and 36 months, respectively. Among continuing users, method satisfaction was approximately ≥90 percent. Characteristics associated with decreased likelihood of discontinuation included: using an intrauterine device or implant compared with a nonlong‐acting reversible contraceptive method (shot, pills, ring, patch, or condoms alone); wanting to prevent pregnancy at follow‐up; and receiving as their baseline method the same method primarily used before Z‐CAN. Other associated characteristics included: receiving the method they were most interested in postcounseling (6 and 24 months) and being very satisfied with Z‐CAN services at the initial visit (6 months). Among those wanting to prevent pregnancy at follow‐up, about half reported switching to another method. Ongoing access to contraceptive services is essential for promoting reproductive autonomy, including supporting patients with continued use, method switching, or discontinuation.
在 2016-2017 年寨卡病毒爆发期间,寨卡避孕网络(Z-CAN)在波多黎各各地提供了以客户为中心的高质量避孕服务。我们在 2017 年 5 月至 2020 年 8 月期间向 Z-CAN 患者子集发送了在线调查,调查时间为项目注册后的 6、24 和 36 个月(回复率:55%-60%)。我们对避孕方法的持续性、方法满意度和方法转换进行了描述,并使用多变量逻辑回归确定了与停止使用相关的特征。在所有避孕方法中,6 个月、24 个月和 36 个月的持续率分别为 82.5%、64.2% 和 49.9%。在持续使用者中,避孕方法满意度约为≥90%。与中止使用避孕方法的可能性降低相关的特征包括:使用宫内节育器或皮下埋植避孕药与使用非长效可逆避孕方法(针剂、药片、避孕环、避孕贴或单独使用避孕套)相比;希望在随访时避孕;基线使用的方法与 Z-CAN 使用前主要使用的方法相同。其他相关特征包括:在咨询后(6 个月和 24 个月)接受了她们最感兴趣的避孕方法,以及在初次就诊时(6 个月)对 Z-CAN 服务非常满意。在随访时希望避孕的人群中,约有一半人表示改用了其他避孕方法。持续获得避孕服务对于促进生殖自主权至关重要,包括支持患者继续使用、更换或停止使用避孕方法。
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引用次数: 0
Effects of performance‐based financing on availability, quality, and use of family planning services in the Democratic Republic of Congo: An Impact Evaluation 基于绩效的融资对刚果民主共和国计划生育服务的可用性、质量和使用的影响:影响评估
IF 2.1 3区 医学 Q2 DEMOGRAPHY Pub Date : 2024-04-17 DOI: 10.1111/sifp.12264
Salomé Henriette Paulette Drouard, Stephan Brenner, Delphin Antwisi, Ndeye Khady Toure, Supriya Madhavan, Günther Fink, Gil Shapira
Access to high‐quality family planning services remains limited in many low‐ and middle‐income countries, resulting in a high burden of unintended pregnancies and adverse health outcomes. We used data from a large randomized controlled trial in the Democratic Republic of Congo to test whether performance‐based financing (PBF) can increase the availability, quality, and use of family planning services. Starting at the end of 2016, 30 health zones were randomly assigned to a PBF program, in which health facilities received financing conditional on the quantity and quality of offered services. Twenty‐eight health zones were assigned to a control group in which health facilities received unconditional financing of a similar magnitude. Follow‐up data collection took place in 2021–2022 and included 346 health facility assessments, 476 direct clinical observations of family planning consultations, and 9,585 household surveys. Findings from multivariable regression models show that the PBF program had strong positive impacts on the availability and quality of family planning services. Specifically, the program increased the likelihood that health facilities offered any family planning services by 20 percentage points and increased the likelihood that health facilities had contraceptive pills, injectables, and implants available by 23, 24, and 20 percentage points, respectively. The program also improved the process quality of family planning consultations by 0.59 standard deviations. Despite these improvements, and in addition to reductions in service fees, the program had a modest impact on contraceptive use, increasing the modern method use among sexually active women of reproductive age by 4 percentage points (equivalent to a 37 percent increase), with no significant impact on adolescent contraceptive use. These results suggest that although PBF can be an effective approach for improving the supply of family planning services, complementary demand‐side interventions are likely needed in a setting with very low baseline utilization.
在许多中低收入国家,获得高质量计划生育服务的机会仍然有限,导致意外怀孕和不良健康后果的负担沉重。我们利用刚果民主共和国一项大型随机对照试验的数据,检验了基于绩效的融资(PBF)能否提高计划生育服务的可用性、质量和使用率。从 2016 年底开始,30 个卫生区被随机分配到一个 PBF 项目中,在该项目中,卫生设施获得资助的条件是所提供服务的数量和质量。28 个卫生区被分配到对照组,在对照组中,医疗机构获得类似规模的无条件资助。后续数据收集工作于 2021-2022 年进行,包括 346 次医疗机构评估、476 次计划生育咨询的直接临床观察和 9585 次家庭调查。多变量回归模型的研究结果表明,"计划生育家庭基金 "项目对计划生育服务的可用性和质量产生了巨大的积极影响。具体而言,该计划将医疗机构提供任何计划生育服务的可能性提高了 20 个百分点,将医疗机构提供避孕药、注射剂和皮下埋植剂的可能性分别提高了 23、24 和 20 个百分点。该计划还将计划生育咨询的过程质量提高了 0.59 个标准差。尽管有了这些改进,而且服务费也有所降低,但该计划对避孕药具使用率的影响不大,育龄性活跃妇女的现代避孕方法使用率提高了 4 个百分点(相当于提高了 37%),但对青少年避孕药具使用率的影响不大。这些结果表明,尽管 PBF 是改善计划生育服务供应的有效方法,但在基线使用率非常低的情况下,很可能需要辅助性的需求方干预措施。
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引用次数: 0
Confirmatory Factor Analysis and Validation of the Sexual and Reproductive Empowerment Scale for Adolescents and Young Adults in Kenya 肯尼亚青少年性与生殖赋权量表的确认因素分析与验证
IF 2.1 3区 医学 Q2 DEMOGRAPHY Pub Date : 2024-04-12 DOI: 10.1111/sifp.12263
Yasaman Zia, Ushma Upadhyay, Isaac Rhew, Syovata Kimanthi, Ouma Congo, Maricianah Onono, Ruanne Barnabas, Nelly Mugo, Elizabeth A. Bukusi, Elizabeth K. Harrington
Understanding the levels of power that adolescent girls and young women exercise in their sexual and reproductive lives is imperative to inform interventions to help them meet their goals. We implemented an adapted version of the Sexual and Reproductive Health Empowerment (SRE) Scale for Adolescents and Young Adults among 500 adolescent girls and young women aged 15–20 in Kisumu, Kenya. We used confirmatory factor analysis (CFA) to assess factor structure, and logistic regression to examine construct validity through the relationship between empowerment scores and ability to mitigate risk of undesired pregnancy through consistent contraceptive use. Participants had a mean age of 17.5, and most were students (61 percent), were currently partnered (94 percent), and reported having sex in the past 3 months (70 percent). The final, 26‐item CFA model had acceptable fit. All subscales had Cronbach's alpha scores >0.7, and all items had rotated factor loadings >0.5, indicating good internal consistency and robust factor‐variable associations. The total SRE‐Kenya (SRE‐K) score was associated with increased odds of the consistent method used in the past three months (adjusted odds ratio: 1.98, 95 percent CI: 1.29–3.10). The SRE‐K scale is a newly adapted and valid measure of sexual and reproductive empowerment specific to adolescent girls and young women in an East African setting.
了解少女和年轻女性在其性生活和生育生活中的权力水平,对于采取干预措施帮助她们实现目标至关重要。我们在肯尼亚基苏木 500 名 15-20 岁的少女和年轻女性中实施了经过改编的青少年和年轻成年人性与生殖健康赋权(SRE)量表。我们采用确证因子分析(CFA)来评估因子结构,并通过逻辑回归来检验赋权得分与通过坚持使用避孕药具来降低意外怀孕风险的能力之间的建构效度。参与者的平均年龄为 17.5 岁,大多数是学生(61%),目前有伴侣(94%),并报告在过去 3 个月内有过性行为(70%)。最终的 26 项 CFA 模型的拟合度可以接受。所有子量表的 Cronbach's alpha 得分均为 0.7,所有项目的旋转因子载荷均为 0.5,表明具有良好的内部一致性和稳健的因子变量关联。SRE-K(SRE-K)总分与过去三个月中使用一致方法的几率增加有关(调整后的几率比:1.98,95% CI:1.29-3.10)。SRE-K量表是针对东非地区少女和年轻妇女的性与生殖赋权的一种新的有效测量方法。
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引用次数: 0
ACKNOWLEDGMENTS. 致谢。
IF 2.1 3区 医学 Q2 DEMOGRAPHY Pub Date : 2024-03-06 DOI: 10.1111/sifp.12261
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引用次数: 0
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Studies in Family Planning
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