The Impact of Social Cognitive Determinants on First Trimester Abortion Pain Open Access

Abstract

In the United States, nearly 4 in 10 of all unintended pregnancies end in abortion. Adequate pain control for women undergoing abortion is critical as most women experience pain with the procedure. Pain perception is complex and composed of a multitude of elements. Identifying the psychosocial elements that contribute to pain perception will help strategize interventions to improve pain outcomes. The Social Cognitive Theory is utilized to determine if poor coping, decreased self-efficacy, limited social support and decreased collective efficacy will result in increased pain during surgical abortion. A cross-sectional survey was administered to women presenting to an abortion clinic for a first trimester abortion procedure. Participants completed questionnaires, visual analog scales and Likert scales for pain. Logistic regression models were used to analyze data. The results showed that a history of medical abortion was associated with lower pain scores, and white race was associated with higher pain scores. Although not significant, confidence in the staff tended to be associated with increased pain. Coping, self-efficacy, and social support had no bearing on the maximal pain a woman experienced during surgical abortion. Investigating the impact of social cognitive factors on abortion related pain will assist in improving strategies to identify women at increased pain risk. These interventions may potentially improve the pain experience for the many women undergoing surgical abortion each year.

Table of Contents

Introduction...................................................................................................... 1

Abortion......................................................................................................... 1

Theoretical framework.......................................................................................... 4

Hypothesis....................................................................................................... 5

Literature Review............................................................................................... 6

Factors that Influence Coping after Abortion.................................................................. 7

Psychosocial Factors that Influence Pain.......................................................................11

Materials and Methods......................................................................................... 14

Participants and procedure......................................................................................14

Baseline Measures.............................................................................................. 17

General Self-efficacy.......................................................................................... 18

Coping......................................................................................................... 18

Social support...................................................................................................18

Past tobacco, alcohol and drug use.............................................................................................................. 19

Medication use................................................................................................. 19

Psychiatric history............................................................................................ 19

Prior surgical or abortion pain experience..................................................................................................... 20

Access to the abortion clinic........................................................................................................... 21

Abortion decision difficulty, burden, and priority........................................................................................................ 21

Statistical analysis............................................................................................ 22

Results.........................................................................................................23

Baseline characteristics.......................................................................................23

Medical history and drug use.................................................................................24

Abortion History...............................................................................................26

Scales...........................................................................................................28

Evaluation of Pain.............................................................................................30

Dichotomized Predictive Factors and Pain...................................................................31

Discussion.....................................................................................................35

About this Master's Thesis

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Obstetrics and Gynecology
Keyword	Coping Abortion Social support Self-efficacy Pain Predictors of pain
Committee Chair / Thesis Advisor	Sales, Jessica, Emory University
Committee Members	Haddad, Lisa, Emory University Cwiak, Carrie, Emory University

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