نبذة مختصرة : Background Postpartum contraception prevents unintended pregnancies and short interpregnancy intervals. The Pregnancy Risk Assessment Monitoring System (PRAMS) collects population-based data on postpartum contraception nonuse and reasons for not using postpartum contraception. In addition to quantitative questions, PRAMS collects open-text responses that are typically left unused by secondary quantitative analyses. However, abundant preexisting open-text data can serve as a resource for improving quantitative measurement accuracy and qualitatively uncovering unexpected responses. We used PRAMS survey questions to explore unprompted reasons for not using postpartum contraception and offer insight into the validity of categorical responses. Methods and findings We used 31,208 categorical 2012 PRAMS survey responses from postpartum women in the US to calculate original prevalences of postpartum contraception use and nonuse and reasons for contraception nonuse. A content analysis of open-text responses systematically recoded data to mitigate survey bias and ensure consistency, resulting in adjusted prevalence calculations and identification of other nonuse themes. Recoded contraception nonuse slightly differed from original reports (21.5% versus 19.4%). Both calculations showed that many respondents reporting nonuse may be at a low risk for pregnancy due to factors like tubal ligation or abstinence. Most frequent nonuse reasons were not wanting to use birth control (27.1%) and side effect concerns (25.0%). Other open-text responses showed common themes of infertility, and breastfeeding as contraception. Comparing quantitative and qualitative responses revealed contradicting information, suggesting respondent misinterpretation and confusion surrounding the term “pregnancy prevention.” Though this analysis may be limited by manual coding error and researcher biases, we avoided coding exhaustion via 1-hour coding periods and validated reliability through intercoder kappa scores. Conclusions In this study, we observed that respondents reporting contraception nonuse often described other methods of pregnancy prevention and contraception barriers that were not included in categorical response options. Open-text responses shed light on a more comprehensive list of pregnancy prevention methods and nonuse options. Our findings contribute to survey questions that can lead to more accurate depiction of postpartum contraceptive behavior. Additionally, future use of these qualitative methods may be used to improve other health behavior survey development and resulting data.
In a mixed-methods inquiry, Nicole Richards and colleagues investigate how open-text responses can provide insight into categorical reasons for postpartum contraception use and non-use among women in the US.
Author summary Why was this study done? Survey respondents can occasionally provide open-ended answers that may be overlooked during quantitative data analysis. This study was conducted to study how qualitative inquiry of open-text responses to a survey question related to postpartum contraception use can be used to provide insight into data accuracy within quantitative surveys. What did the researchers do and find? Using a mixed-method approach, we calculated descriptive statistics from Pregnancy Risk Assessment Monitoring System (PRAMS) survey responses from 31,208 postpartum women in the US who provided categorized reasons for not using contraception and qualitatively analyzed respondents’ adjacent open-ended written answers to uncover more detailed information about respondents’ postpartum contraception behavior and interpretations of the survey question. Through systematic recategorization, we found that qualitative responses added to and altered quantitative contraception behavior reports and that reasons for contraception nonuse are incompletely captured by existing response categories. What do these findings mean? These findings suggest that researchers may be able to gain a better understanding of postpartum pregnancy prevention by using mixed-method analyses on categorical and open-ended responses. While qualitative inquiry may yield subjective interpretation, rigorous pragmatic data management can strengthen survey questions through open-text responses not captured in existing quantitative data. Family planning professionals may be able to obtain significant and detailed information about contraceptive behavior from open-ended responses, and this information may be useful to adjust clinical approaches to postpartum contraception conversations.
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