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