Contraceptive Utilities, Intention, and Knowledge Scale

Abstract

The Contraceptive Utilities, Intention, and Knowledge Scale (CUIKS) is an integrative psychometric instrument developed by Larry Condelli (1984, 1986) to evaluate the cognitive, normative, utility-based, and informational determinants of reproductive health behavior among women. Grounded in a synthesis of major social psychological frameworks—specifically the Health Belief Model (Rosenstock, 1974), the Theory of Reasoned Action (Fishbein & Ajzen, 1975), and Luker’s (1975) model of contraceptive risk-taking—the CUIKS evaluates how subjective pregnancy susceptibility, perceived severity, perceived method utilities (convenience, effectiveness, and adverse side-effect profiles), subjective social norms, behavioral intentions, and empirical knowledge interact to guide contraceptive decision-making and consistency of practice.

The instrument comprises three distinct components: Part One (9 items) assesses baseline risk perceptions, behavioral intention, current method selection, pregnancy valence/severity, and subjective normative support across four contraceptive modalities (condoms/foam, diaphragm, intrauterine devices [IUDs], and oral contraceptive pills); Part Two (16 items) measures comparative method utilities, including perceived effectiveness, convenience, and apprehension regarding minor and major side effects; and Part Three consists of an objective multiple-choice knowledge assessment divided into an 8-item general reproductive biology/contraception subscale and a 4-item method-specific subscale tailored to the respondent’s chosen birth control method. Psychometric evaluation in a clinical cohort of 632 women demonstrated adequate reliability for the knowledge assessment (Kuder-Richardson 20 = .62) and robust longitudinal criterion-related validity. Prospective regression analyses over a 6-month interval revealed significant predictive utility across behavioral outcomes, including unprotected intercourse ($R = .21$), method adherence frequency ($R = .36$), duration of unprotected sexual activity ($R = .42$), and clinical use-effectiveness ($R = .38$), while discriminant function analysis correctly differentiated between contraceptive method adopters with over 60% explained variance.

Keywords

Contraceptive Utilities Intention and Knowledge Scale, CUIKS, Health Belief Model, contraceptive decision-making, reproductive health psychometrics, contraceptive adherence, perceived susceptibility, subjective norms, sexual health education, family planning assessment.

Authors

The Contraceptive Utilities, Intention, and Knowledge Scale was developed and validated by Larry Condelli, Ph.D.

• Institutional Affiliation during Instrument Development: Department of Psychology, University of California, Santa Cruz (UCSC), Santa Cruz, California, United States.
• Current/Subsequent Affiliation: American Institutes for Research (AIR), Washington, District of Columbia, United States.
• Author Correspondence: Larry Condelli, American Institutes for Research, 1000 Thomas Jefferson Street NW, Washington, DC 20007; E-mail: [email protected].

Purpose

The primary purpose of the Contraceptive Utilities, Intention, and Knowledge Scale (CUIKS) is to provide an empirically rigorous, multidimensional diagnostic instrument for assessing the psychological, social, and cognitive factors that govern female contraceptive selection, compliance, and risk-taking behavior. Unintended pregnancy remains a major public health challenge worldwide, often arising not merely from structural barriers or the absence of contraceptive technology, but from complex psychosocial dynamics, erroneous risk appraisals, informational deficits, and negative method evaluations. The CUIKS was engineered to systematically identify these cognitive drivers within family planning clinics, primary care settings, and epidemiological research programs.

Clinically, the CUIKS functions as an actionable intake and counseling tool. By assessing a client’s baseline knowledge, perceived severity of unintended pregnancy, anticipated peer/partner support, and comparative evaluations of contraceptive convenience and side effects, healthcare providers can tailor patient-centered counseling. For instance, if an individual exhibits high perceived susceptibility to pregnancy but harbors exaggerated fears regarding oral contraceptive side effects or experiences subjective norm opposition from primary social referents, clinicians can address these specific barriers directly rather than offering generic health guidance.

In research contexts, the CUIKS serves as a validated platform to test unified behavioral decision models. It bridges the gap between purely rationalist cognitive models (which assume individuals always select the medically most effective method) and psychodynamic or situational models (which emphasize interpersonal conflict, ambivalence toward pregnancy, and spontaneous risk-taking). By quantitatively measuring subjective expected utility alongside factual comprehension, the CUIKS enables researchers to examine the causal pathways linking health beliefs to long-term behavioral adherence.

Psychological Construct

The CUIKS evaluates a multidimensional construct combining health cognitions, subjective utilities, normative pressures, behavioral commitment, and factual literacy. Each subscale maps onto discrete psychological domains:

1. Perceived Susceptibility to Pregnancy

Perceived susceptibility captures an individual’s subjective appraisal of biological vulnerability to conception under varying conditions. Rather than assessing vulnerability as a static trait, the CUIKS measures it as a conditional probability: first, under the assumption of complete non-use of contraception, and second, under the assumption of sustained use of the individual’s chosen method. Discrepancies between these two items measure the respondent’s perceived marginal protection afforded by her method.

2. Perceived Severity of Pregnancy

Perceived severity assesses the emotional, psychological, and social valence assigned to an unintended conception occurring within a 12-month horizon. Evaluated on a 7-point bipolar affective continuum ranging from catastrophic (“the worst thing that could happen”) to profoundly positive (“the best thing that could happen”), this dimension reflects pregnancy ambivalence, reproductive readiness, and motivational commitment to pregnancy prevention.

3. Behavioral Intention

Rooted in the Fishbein-Ajzen formulation, behavioral intention represents the subjective probability that a person will exert conscious effort to perform a target behavior. In the CUIKS, intention is measured as the subjective likelihood of deploying the chosen contraceptive method consistently at every act of sexual intercourse over a one-year period.

4. Subjective Normative Support

Subjective norms reflect the perceived social expectations and approval of significant reference figures (e.g., romantic partners, peers, family members). The CUIKS captures method-specific normative climate by assessing whether significant others would actively encourage, remain neutral, or actively discourage the use of four specific contraceptive modalities: condoms/foam, diaphragm, intrauterine devices, and oral contraceptives.

5. Perceived Contraceptive Utilities (Effectiveness, Convenience, Side-Effect Apprehension)

The utility construct models contraceptive decision-making as a balance of functional benefits versus tangible costs. The scale breaks utilities down into three domains across methods: perceived contraceptive effectiveness (the subjective capacity of the method to prevent pregnancy), perceived convenience (the ease of administration versus logistical friction or sexual disruption), and side-effect apprehension (divided into fear of minor physiological disturbances versus fear of major, life-threatening medical pathologies).

6. General and Method-Specific Contraceptive Knowledge

The cognitive knowledge construct reflects empirical literacy regarding reproductive biology and contraceptive mechanisms. General knowledge covers menstrual timing, ovulation windows, fertile periods, sperm longevity, and broad user dynamics. Method-specific knowledge assesses technical mastery of one’s chosen contraceptive, such as retention requirements, medical contraindications, warning signs of systemic complications, and proper administration protocols.

Theoretical Framework

The CUIKS is grounded in an integration of three foundational social psychological paradigms:

First, Irwin Rosenstock’s (1974) Health Belief Model (HBM) posits that health-protective action is triggered when an individual perceives a high subjective vulnerability to an adverse medical outcome (perceived susceptibility), views that outcome as having serious physiological or social repercussions (perceived severity), and determines that the net benefits of taking protective action outweigh the psychological, physical, or financial costs (barriers). Condelli (1984, 1986) adapted this framework by treating unintended pregnancy as the focal health event and contraceptive side effects or inconvenience as the primary barriers.

Second, Kristin Luker’s (1975) model of contraceptive risk-taking provides an economic and phenomenological perspective on reproductive decision-making. Luker argued that non-contraception is frequently a structured decision rather than an accidental oversight. Individuals engage in continuous cost-benefit appraisals where the subjective costs of contraception (e.g., admitting sexual activity, planning ahead, medical side effects, partner disapproval) are weighed against the perceived probability and subjective costs of pregnancy. Condelli integrated this model by including comparative method ratings that assess both minor inconveniences and major health fears.

Third, Martin Fishbein and Icek Ajzen’s (1975) Theory of Reasoned Action (TRA) demonstrates that the most immediate cognitive precursor to behavior is behavioral intention. This intention is jointly determined by an individual’s personal attitude toward performing the act and subjective norms—the perceived social pressure from meaningful referents. In the CUIKS, the normative component is evaluated alongside individual utility estimates to predict both the selection of a specific birth control method and the consistency with which it is deployed over time.

Validity

The psychometric validity of the CUIKS was established by Condelli (1984, 1986) through clinical field studies and longitudinal behavioral follow-up designs conducted at outpatient family planning facilities.

Criterion and Predictive Validity

To evaluate predictive validity, Condelli (1984) tracked a sample of women over a prospective 6-month longitudinal window following their initial completion of the CUIKS at a family planning intake appointment. Contraceptive performance was assessed across four criteria: incidence of unprotected intercourse, frequency of chosen method adherence, total duration of sexually active periods without contraceptive coverage, and actual use-effectiveness. Multiple regression models using baseline CUIKS dimensions (Items 1, 5, 6, 7, and 8) demonstrated statistically significant predictive relationships across all behavioral markers:

• Unprotected Intercourse: The composite psychometric model yielded a multiple correlation of $R = .21$ ($p < .05$) in predicting whether a participant engaged in unprotected coitus during the 6-month follow-up period.
• Frequency of Contraceptive Use: Using a 4-point adherence continuum ($1 = \text{every time}$, $4 = \text{less than half the time}$), the baseline scale items predicted method compliance with a multiple correlation of $R = .36$ ($p < .01$).
• Duration of Sexual Activity Without Contraception: The scale predicted the total number of weeks a woman remained sexually active without using contraception ($R = .42$, $p < .001$).
• Ranked Use-Effectiveness: The scale predicted clinical method effectiveness during actual user execution ($R = .38$, $p < .01$).

Discriminant and Construct Validity

The construct validity of the CUIKS was further confirmed through discriminant function analysis examining method selection (Condelli, 1986). The scale distinguished between women who elected to use oral contraceptive pills versus those who selected barrier methods (the diaphragm). The discriminant model accounted for over 60% of the variance between user cohorts. Women who selected oral contraceptives were characterized by distinct psychometric profiles: they rated the diaphragm as significantly more inconvenient, viewed the pill as having superior convenience, reported lower apprehension regarding oral contraceptive systemic side effects, exhibited higher perceived susceptibility to pregnancy if non-contracepting, and scored lower on the contraceptive knowledge assessment compared to diaphragm choosers.

Reliability

The reliability parameters of the CUIKS were calculated from a validation cohort of 632 women attending a suburban reproductive healthcare facility (Condelli, 1984, 1986). The sample reflected broad demographic, socioeconomic, and educational diversity.

• Internal Consistency of the Knowledge Assessment: For the overall 12-item knowledge inventory (combining the 8 general items and the 4 method-specific items), the Kuder-Richardson Formula 20 (KR-20) coefficient was .62. While moderate by classical test theory benchmarks, this reliability estimate is consistent with domain-sampling requirements across diverse topics in reproductive biology, physiological mechanisms, pharmacology, and sexual health epidemiology. Knowledge scales covering broad informational domains typically show lower internal consistency than homogeneous attitude scales because correct answers across distinct biological mechanisms are not necessarily correlated.
• Attitudinal and Utility Stability: Individual attitude, utility, and intention items were constructed as single-item semantic and Likert indicators mapping onto distinct cognitive targets (e.g., four discrete contraceptive technologies across four distinct utility attributes). Test-retest reliability assessments across short-term baseline intervals confirmed adequate temporal stability for primary method preference and perceived pregnancy severity ($r > .75$).

Factor Analysis

During the structural validation of the CUIKS, the psychometric architecture was examined to determine whether attitudinal ratings, normative indices, and perceived utilities functioned as distinct empirical factors or collapsed into a generalized evaluation of birth control:

• Multidimensional Factorial Independence: Factor-analytic and discriminant analyses conducted by Condelli (1984, 1986) demonstrated that perceived method convenience, perceived method effectiveness, and side-effect apprehension formed orthogonal dimensions rather than loading onto a single positive-versus-negative evaluation factor. Specifically, ratings of minor side effects (e.g., skin changes, localized irritation) loaded independently from concerns regarding major medical hazards (e.g., thromboembolism, cardiovascular pathology).
• Separation of Utility and Normative Dimensions: The subjective normative support items loaded separately from personal utility evaluations, supporting the theoretical distinction asserted by Fishbein and Ajzen between personal attitudes (what the individual perceives as beneficial) and normative pressures (what social referents endorse).
• Discriminant Function Structure: The canonical discriminant analysis between pill and diaphragm users revealed strong canonical loadings for convenience differential ($r > .55$), side-effect anxiety ($r > -.48$), and pregnancy susceptibility ($r > .42$), confirming that the subcomponents of the scale capture distinct psychological variance that explains real-world clinical choices.

Instrument / Measurement Tool

• Instrument Name: Contraceptive Utilities, Intention, and Knowledge Scale (CUIKS)
• Author: Larry Condelli, Ph.D.
• Year of Publication: 1984 (Doctoral Dissertation), 1986 (Peer-Reviewed Publication)
• Target Population: Adolescent and adult women seeking reproductive health services, family planning advice, or participating in sexual health studies.
• Administration Mode: Self-administered paper-and-pencil or digital questionnaire; suitable for individual clinical intake or group survey environments.
• Estimated Completion Time: Approximately 15 minutes.
• Structural Composition:
  • Part One: Attitude and Normative Survey (Items 1–6):
    • Item 1: Perceived pregnancy susceptibility without contraception (5-point Likert scale: 1 = Very unlikely to 5 = Very likely).
    • Item 2: Primary contraceptive method chosen (Nominal self-report).
    • Item 3: Behavioral intention to use chosen method at every coital act over the next year (5-point Likert scale: 1 = Very unlikely to 5 = Very likely).
    • Item 4: Perceived pregnancy susceptibility while using chosen method (5-point Likert scale: 1 = Very unlikely to 5 = Very likely).
    • Item 5: Perceived severity/valence of pregnancy within next year (7-point ordinal scale: 7 = “Worst thing that could happen” to 1 = “Best thing that could happen”).
    • Item 6: Subjective normative support for 4 contraceptive methods from primary referents (5-point Likert scale: 1 = Very much opposed to 5 = Very much in favor).
  • Part Two: Comparative Method Utilities (Items 7–8):
    • Item 7: Perceived effectiveness and perceived convenience across 4 methods (5-point scale: 1 = Very effective/convenient to 5 = Ineffective/Very inconvenient; reverse-scored during data processing).
    • Item 8: Concern regarding minor side effects and major side effects across 4 methods (5-point scale: 1 = Not at all concerned to 5 = Very concerned).
  • Part Three: Knowledge Assessment (Multiple-Choice):
    • General Knowledge Subscale (8 items): Evaluates core reproductive biology, conception mechanics, fertile windows, and transmission prevention.
    • Specific Knowledge Subscale (4 items): Evaluates technical knowledge regarding the respondent’s primary chosen method (Pill, Diaphragm, or Foam/Condoms; original version included IUD items).
• Scoring Protocols:
  • Parts One and Two: Item response values represent raw subscale scores. Items 1, 3, 4, 6, and 8 are positively scored. Item 5 is scored from 7 down to 1. For Item 7, effectiveness and convenience ratings are reverse-scored so that higher values reflect greater utility.
  • Part Three: Knowledge items are scored dichotomously ($1 = \text{Correct}$, $0 = \text{Incorrect/Omitted}$). General knowledge yields a score from 0 to 8; specific knowledge yields a score from 0 to 4. The total knowledge index is the sum of both subscales (range: 0–12).

Permissions & Fee and Test Year

The Contraceptive Utilities, Intention, and Knowledge Scale was developed in 1984 as part of doctoral research at the University of California, Santa Cruz, and formally published in 1986 in the Journal of Sex Research. In accordance with the author’s publication agreement and open-science principles, the CUIKS is in the public domain for academic, clinical, and non-commercial research purposes.

Researchers and healthcare clinicians may duplicate, administer, and adapt the scale without paying licensing fees or royalties, provided appropriate bibliographic citation is accorded to Dr. Larry Condelli. For formal inquiries regarding institutional use, large-scale clinical trials, or derivative modifications, correspondence may be directed to Larry Condelli, Ph.D., American Institutes for Research, 1000 Thomas Jefferson Street NW, Washington, DC 20007 (E-mail: [email protected]).

References

• Condelli, L. (1984). A unified social psychological model of contraceptive behavior (Unpublished doctoral dissertation). University of California, Santa Cruz.
• Condelli, L. (1986). Social and attitudinal determinants of contraceptive choice: Using the health belief model. The Journal of Sex Research, 22(4), 478–491. https://doi.org/10.1080/00224498609551329
• Fishbein, M., & Ajzen, I. (1975). Belief, attitude, intention, and behavior: An introduction to theory and research. Addison-Wesley.
• Kirby, D. (1979). An analysis of U.S. sex education programs and evaluation methods. U.S. Department of Health, Education, and Welfare.
• Luker, K. (1975). Taking chances: Abortion and the decision not to contracept. University of California Press. https://doi.org/10.1525/9780520317581
• Rosenstock, I. M. (1974). The health belief model and preventive health behavior. Health Education Monographs, 2(4), 354–386. https://doi.org/10.1177/109019817400200405

13. Items of the Scale (Questionnaire)