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Table 1 Measures of eIMB constructs and other potential correlates of sexual and reproductive health behaviors

From: Reproductive intentions and corresponding use of safer conception methods and contraception among Ugandan HIV clients in serodiscordant relationships

Construct Source of measure Description Item examples Response format
eIMB constructs
 SCM knowledge Woldesadik et al. [32] 18-items measure knowledge of availability of SCM in general, specific SCM (e.g., TCI, MSI), and risk reduction strategies not specific to conception (e.g., circumcision, PrEP); number of correct items is summed. Only having condomless sex during the few days each month when the woman is most fertile helps to limit the risk of HIV transmission to an uninfected partner True, False, Don’t know
 SCM motivation Gerkovich [33] 2 items measure level of commitment and readiness to use SCM; mean item score is calculated and higher scores reflect greater motivation. It is important to me that my partner and I use methods that can limit HIV transmission risks during attempts to conceive a child Strongly agree, agree, disagree, strongly disagree
 SCM self-efficacy Johnson et al. [34] 6 items measure level of confidence to negotiate and utilize SCM; mean item score is calculated and higher scores reflect greater self-efficacy or confidence. I can follow advice about limiting condomless sex to only 2–3 specific days per month Strongly agree, agree, disagree, strongly disagree
 SCM cultural acceptability WHO [35] 6 items measure perception of the cultural acceptability of specific SCM. Respondents indicate their level of agreement with statements about the willingness of HIV-affected couples to engage in specific safer conception strategies. Mean item score is calculated and higher scores reflect greater perceived cultural acceptability. Examples of safer conception strategies enquired about: delaying attempts to conceive until CD4 count is high; use of TCI, MSI, and PrEP Strongly agree, agree, disagree, strongly disagree
 Attitudes towards contraception use   13 items that assess beliefs regarding both positive and negative effects of contraception use. Scoring of negatively worded items is reversed; mean item score is calculated and higher scores reflect more positive attitude towards contraception. Hormonal contraception can cause permanent sterility in women
My religion supports the use of contraception
Strongly agree, agree, disagree, strongly disagree
Other potential correlates
 Demographic characteristics Created in house Measures of client background characteristics Age, gender, education level
 Health management characteristics Created in house Information on patient management of HIV disease and immune status that is either self-reported or chart abstracted Date of HIV diagnosis; most recent CD4 count and HIV viral load; use of HIV antiretroviral therapy
 Reproductive health history Created in house Background on reproductive health history of patient and partner Number of biological children for patient and partner (including with each other), pregnancy history including miscarriages and abortions
Relationship and partner characteristics
 Self-agency in decision making within the relationship Pulerwitz et al. [36] 15-item relationship control measure adapted from Sexual Relationship Power scale to assess self-agency in decision making within the relationship; mean item score is calculated and higher scores reflect greater self-agency. My partner has more say than I do about important decisions that affect us Strongly agree, agree, disagree, strongly disagree
 Reproductive coercion Anderson et al. [37] 5-item scale to measure presence of actions from partner to pressure respondent to have a child in the past year; total score is the sum of all items and reflects greater coercion. Your partner said he/she would leave you if you did not try to have a child Yes, No
Provider support for family planning and safer consumption
 Receipt of family planning counseling Created in house A measure to assess whether the client/couple received any consults from their providers in the past 6 months regarding reproductive health decisions and behaviors Were consults received related to (1) decision to have a child; (2) use of methods to conceive safely; (3) use of contraception to prevent pregnancy Number of consults received in each category
Childbearing stigma and pressure
 Internalized childbearing stigma Created in house A single item to measure internalized stigma or shame for wanting to have a child as someone living with HIV I feel ashamed for wanting a (nother) child Disagree strongly disagree slightly, neutral, agree slightly, agree strongly
 Perceived community stigma towards childbearing Created in house 3-item measure of perceptions of how family, friends and others in community viewed HIV-affected couples who want to have a child or are pregnant; mean item score is calculated and higher scores reflect greater stigma. People in the community look down on HIV+ individuals who want to have a child Disagree strongly disagree slightly, neutral, agree slightly, agree strongly
 Provider stigma toward childbearing Created in house 2-item measure of perceived provider stigma toward childbearing among PLHIV; mean item score is calculated and higher scores reflect greater stigma. Most HIV providers think that HIV+ clients should not have children Disagree strongly disagree slightly, neutral, agree slightly, agree strongly
 Cultural pressure to have a child   5-item measure of beliefs about how the identify of a man, woman and couple are influenced by whether or not they have children, and perceived expectations from family to have children; mean item score is calculated and higher scores reflect greater perceived cultural pressure. It is very important that a married couple has children together in order to legitimize the relationship Strongly disagree, somewhat disagree, somewhat agree, strongly agree
Psychosocial functioning
 Internalized HIV stigma Kalichman et al. [38] 8-item scale measuring stigma about HIV; mean item score is calculated and higher scores reflect greater internalized stigma. I am ashamed that I am HIV positive Strongly disagree, disagree, neutral, agree, strongly agree
 Depression Cox et al. [39] 10-item Edinburgh Post-partum Depression Scale to measure depression in past week. The total score is the sum of all items and reflects severity of depressive symptomatology; scores > = 10 reflect possible clinical depression, and scores > 13 reflect likely clinical depression. In the past 7 days: I have been able to laugh and see the funny side of thing Response options vary by item but all range from 0 to 3