Validation of a measure of contraceptive self-injection self-efficacy in Uganda

Sexual and reproductive health self-care interventions, including self-administered injectable contraception, can promote individual agency and health. As an increasing number of programs seek to introduce and expand access to self-injectable contraception, it's imperative to develop measures that define programmatic success based on whether people have the opportunity to make a decision about self-injectable use with agency, rather than relying on measures of self-injectable uptake. We performed psychometric evaluation to validate a self-injectable self-efficacy scale using cross-sectional survey data collected among 2,369 sexually active, reproductive aged women in Uganda. We examined descriptive statistics of a pool of five potential items before conducting an Exploratory Factor Analysis to determine factor structure and reduce the item pool. We ran a Confirmatory Factor Analysis to confirm the factor structure and performed a correlation analysis to determine whether the final self-injectable self-efficacy scale was correlated with items related to contraceptive decision-making self-efficacy and previous self-injectable use. Our final measure of self-injectable self-efficacy is a unidimensional scale that contains three items: 1) "I feel confident that I could self-inject on my own at the end of training," 2) "I feel confident that I can do all the steps correctly and will be protected from pregnancy," and 3) "I can manage to self-inject even if I feel very scared at first." Self-injectable self-efficacy was positively and significantly correlated with prior self-injectable use and items related to contraceptive decision-making self-efficacy. We validated a novel self-care focused measure of self-injectable self-efficacy in Uganda. Self-injectable self-efficacy, which can be measured among all reproductive-aged women regardless of prior self-injectable training or use, can be used to evaluate self-injectable programs to determine whether programs equip people with the tools needed to successfully use self-injectable contraception if they desire.