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: 

Holt K, Dehlendorf C, Langer A. Defining quality in contraceptive counseling to improve measurement of individuals’ experiences and enable service delivery improvement. Contraception. 2017 Sep;96(3):133–7. 

QCC formative qualitative research:

Holt K, Zavala I, Quintero X, Mendoza D, McCormick MC, Dehlendorf C, et al. Women’s preferences for contraceptive counselling in Mexico: Results from a focus group study. Reprod Health. 2018 Jul 16;15(1):128.

Holt K, Uttekar BV, Reed R, et al Understanding quality of contraceptive services from women’s perspectives in Gujarat, India: a focus group study. BMJ Open 2021;11:e049260. Doi: 10.1136/bmjopen-2021-049260

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:

Mexico: Holt K, Zavala I, Quintero X, Hessler D, Langer A. Development and Validation of the Client-Reported Quality of Contraceptive Counseling Scale to Measure Quality and Fulfillment of Rights in Family Planning Programs. Stud Fam Plann. 2019 Jun;50(2):137–58. 

India and Ethiopia: Holt K, Gebrehanna E, Sarnaik S, Kanchan L, Reed R, Yesuf A, et al. (2023) Adaptation and validation of the quality of contraceptive counseling (QCC) scale for use in Ethiopia and India. PLoS ONE 18(3): e0283925. https://doi.org/10.1371/journal.pone.0283925.

QCC-10: Holt K, Karp C, Uttekar B, Quintero X, Gebrehanna E, Kanchan L, Zavala I. Reduction of the Quality of Contraceptive Counseling (QCC) Scale to a Short Version (QCC-10) in Ethiopia, India, and Mexico. Contraception. 2022 Oct 13

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.

Portugal: Palma, S., Presado, H., & Ayres-de-Campos, D. (2021). Transcultural validation, adaptation of quality of contraceptive counselling scale for the Portuguese population. Millennium Journal of Education, Technologies, and Health, 2(16), 83–92.

Other research using the QCC Scale: 

Walker K, Prata N, Lahiff M, Quintero X, Holt K. Client, provider, and visit factors associated with quality in contraceptive counseling in Mexico: an exploratory cross-sectional analysis. Reproductive Health. 2021 Dec;18(1):1-4.

Yokabed E, Averbach S, Dey A, Gebrehanna E, Holt. The Association Between Quality of Contraceptive Counseling and Selection of Contraceptive Method Post- counseling Among Women in Ethiopia. Contraception. 2023 May 11.