The Quality of Contraceptive Counseling (QCC) Scale is a client experience measure developed based on the QCC Framework and qualitative evidence on women’s preferences for contraceptive counseling in Mexico, India, and Ethiopia. Four versions of the QCC Scale are available: QCC-Mexico (Spanish; 22 items), QCC-Ethiopia (Amharic & Afan Oromo; 26 items), QCC-India (Gujarati; 23 items), and the QCC-10 (10 items; constructed with data from each of these countries).
Background
The multi-dimensional QCC Scale was developed by researchers at the Harvard T.H. Chan School of Public Health (Principal Investigator Kelsey Holt, now based at UCSF) and the Mexican Family Planning Association to address gaps in available measures of experience with contraceptive counseling. Widely used client exit interview tools deployed since the 1990’s focus primarily on information receipt rather than the broader counseling experience, do not probe directly for negative experiences, and have not been systematically evaluated for their validity and reliability in diverse settings; the QCC team developed this new measure in response to this opportunity for innovation.
After the original development of the QCC Scale in Mexico, the QCC project expanded to adapt it for use in Ethiopia and India in collaboration with researchers from St. Paul’s Hospital Millennium Medical College (Ethiopia) and the Centre for Operations Research and Training (India). Three subscales were identified for all countries: information exchange (IE), interpersonal relationship (IPR), and disrespect and abuse (DA). The original QCC-Mexico, QCC-Ethiopia, and QCC-India Scales are comprised of a total of 22-26 items across sub-scales. Eighteen items are consistent across settings; four were unique to India and Ethiopia, four unique to Mexico and Ethiopia, and one unique to India. These measures allow for nuanced study of quality in contraceptive counseling where resources are available to field the entire measure. To support integration into routine data collection and facilitate cross-country comparisons of client-reported quality measures of counseling, a shortened version of the QCC scale, the QCC-10, was developed that retains items from each of the three sub-scales.
You can access all versions of the scale on the QCC Scale Versions page and find more information about implementing the QCC Scale on the Implementation page.
We acknowledge the generous support of The David & Lucile Packard Foundation between 2015-2022 for the development and validation of the QCC Scale.
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QCC Publications
QCC Framework:
QCC formative qualitative research:
Suchman L, Vallin J, Quintero Veloz X, Kanchan L, Gebrehanna E, Uttekar B, Reed R, Santos L & Holt K. Balancing client preferences and population-level goals: a qualitative study of the ways in which public health providers and facility administrators interpret and incentivise quality of care in contraceptive counselling in Ethiopia, Mexico and India. Sexual and Reproductive Health Matters 2023, 31:1, DOI: 10.1080/26410397.2023.2229220
QCC Scale validation:
QCC-10: Karp, C., OlaOlorun, F.M., Guiella, G., Gichangi, P., Choi, Y., Anglewicz, P. and Holt, K. (2023), Validation and Predictive Utility of a Person-Centered Quality of Contraceptive Counseling (QCC-10) Scale in Sub-Saharan Africa: A Multicountry Study of Family Planning Clients and a New Indicator for Measuring High-Quality, Rights-Based Care. Studies in Family Planning, 54: 119-143. https://doi.org/10.1111/sifp.12229.
Other research using the QCC Scale: