Introduction to Abortion Values Clarification and Attitude Transformation

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Introduction to Abortion Values Clarification
and Attitude Transformation
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Overview

• Introduction to Abortion Values Clarification and
  Attitude Transformation (VCAT)
• Theoretical framework
• Teaching methods and facilitation
• Goal and objectives
• Toolkit contents
• VC evaluations, programmatic uses and next steps
• Questions and discussion

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What is values clarification (VC)?

• Both a theory and an intervention
• People discovering their values through a process
  of honest self-examination and open-minded search
  for lifes truths (Maslow, 1959 Rogers, 1961)
• VC is the process of examining ones basic
  values and reasoning for the purpose of
  understanding oneself, to discover what is
  important and meaningful (Rokeach, 1973 Steele,
  1979).
• Valuing occurs when the head and heart unite
  in the direction of action (Dewey, 1939).

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VC process

• Choosing a value freely, from alternatives, with
  understanding of positive and negative
  consequences of that choice
• Prizing that chosen value, as it is associated
  with some level of satisfaction, affirmation and
  confidence
• Acting repeatedly upon that freely chosen,
  affirmed value, which leads to positive outcomes.
• (Raths et al., 1966)

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Choosing

• A value must be chosen freely, from alternatives,
  with an understanding of both positive and
  negative consequences of that choice.

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Choosing

• Some questions to consider
• What are the alternatives?
• What made you decide on this particular choice?
• What will the results of this choice be?
• What assumptions are you making?
• How did you arrive at this choice?
• Did anyone suggest this to you, or did you make
  this choice on your own?
• Were you pressured or coerced into this choice?

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Prizing

• A chosen value must be associated with some level
  of satisfaction and affirmation, as well as
  confidence in the value.

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Prizing

• Some questions to consider
• How do you feel about your choice?
• Is this something that is really important to
  you?
• How satisfied are you with this decision?
• Would you be prepared to stand up and announce
  your choice in public?
• Are you willing to put it in writing?

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Acting

• A freely chosen, affirmed value must translate
  into action. Ideally, the action will lead to
  some kind of positive outcome and be done
  repeatedly.

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Acting

• Some questions to consider
• What are the first steps you will take, or have
  taken, to make this choice a reality?
• Have you made definite plans to act on this
  value?
• Is your decision definite or tentative?
• Have you acted on your value and will you act on
  it regularly?
• Have you been consistent in your actions?

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VC to resolve values conflicts

• Values conflict is two or more opposing value
  positions within an issue.
• Values conflicts range from highly conflicted to
  resolved.
• A person who is confused or unclear about her
  values will tend to act in immature, overly
  conforming or dissenting ways.
• The clarified person will exhibit characteristics
  of Maslows self-actualized person, acting in a
  calmly confident and purposeful way (Kinnier,
  1995).

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Abortion VCAT interventions

• Honest, open-minded and critical reflection and
  evaluation of new or reframed abortion
  information and situations
• Content is accessible, setting specific and
  personally relevant
• Challenge deeply-held assumptions and myths about
  abortion and related issues
• Discover values and potentially transform
  attitudes
• Express intentions to convey attitudes and act in
  a manner consistent with affirmed values.
• VCAT is VC plus advocacy.
• (Turner et al., 2008)

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Values Clarification for Abortion Attitude
Transformation Theoretical Framework
Takes place within existing cultural and social
structures and ideologies
Performance
(Turner et al., 2008). Informed by Ajzens Theory
of Planned Behavior (Ajzen, 1985 1988 1991),
Values Theory (Rokeach, 1973 1979) and theories
of the values clarification process (Raths et
al., 1966 Rokeach, 1973).
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VCAT teaching methods

• Large- and small-group discussion
• Individual and group work
• Hypothetical and real dilemmas and case studies
• Rank ordering and forced choices
• Empathy-evoking experiences
• Active listening techniques
• Expressive activities, such as songs, skits, and
  artwork
• Games
• Simulations such as role plays and visualizations
• Journaling and interviewing
• Self-analysis

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The role of the VCAT facilitator

• Does not attempt to influence the selection of
  values
• Respects that the values clarification process is
  internal and relative
• Does not posit any universal set of appropriate
  values
• Assists the individual to develop his or her
  internal processes
• Allows the person, rather than external factors,
  to be the prime determinants of their behavior
• Respects that the individual should be free to
  change the environment to meet his or her needs.

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Abortion VCAT intervention Goal

• For individuals to learn, question, affirm and
  support their positions with respect to the need
  for and provision of abortion and related care,
  such that awareness of and access to
  comprehensive, woman-centered, high-quality
  abortion care is increased.

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Abortion VCAT intervention Objectives

• By the end of an abortion values clarification
  and attitude transformation workshop,
  participants will be able to
• Distinguish between assumptions, myths and
  realities about unwanted pregnancy and abortion
  and the women and families who experience them
• Explain correct information about abortion and
  the circumstances surrounding it
• Demonstrate empathy toward the women, families
  and health-care workers who experience abortion

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Abortion VCAT intervention Objectives

• Identify the values that inform their current
  beliefs and attitudes about abortion
• Describe alternative values and their
  consequences
• Choose and affirm values that inform their
  attitudes and beliefs towards abortion services
  and the women who seek them
• State their abortion-related behavioral
  intentions that are consistent with their
  affirmed values
• Demonstrate a separation of their personal
  beliefs from their professional roles and
  responsibilities in the provision of abortion
  services (for service providers).

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VCAT toolkit contents

• Introduction to VCAT
• Abortion VCAT theoretical framework
• 14 VCAT activities with instructions and
  materials
• Trainers workshop sessions
• Tips for effective VCAT facilitation
• Sample workshop agendas
• Sample evaluation tools
• Certificates of completion
• Literature review
• Additional VCAT resources

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Evaluation of VCAT

• More empirical research is needed
• VC principles used to affect and measure
  cognitive and behavioral changes (Karel et al.,
  2004 Schwartz et al., 1988 Mosconi et al.,
  2003)
• Improvements in attitudes toward women who have
  abortions (Marais, 1996)
• VC participants behavioral changes six-months
  post workshop (Mitchell et al., 2005)
• VC participants increased compassion for
  abortion clients and providers (Mitchell et al.,
  2005).

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Attitudinal changes using VCAT toolkitResults
from four workshops Ghana (2), Ethiopia and
Kenya (12 countries represented) in 2006-2007
Actual counts vary by item 1 strongly
disagree and 5strongly agree All are
statistically significant at the alpha lt.05 level
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Post-workshop survey comments

• The workshop has really changed my values.
• I have learned not to be judgmental.
• Practical tools that could be applied to other
  areas, too.
• A very timely program to equip a group of people
  that will educate others on the importance of
  unsafe abortion.
• Using experiences of colleagues encouraged me to
  be bold about issues on abortion.

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Programmatic uses for abortion VCAT

• Secure key stakeholders buy in of abortion
  program
• Preparation for developing abortion clinical
  standards and guidelines that allow broad access
• Screening, selection and preparation of
  clinicians and health workers for abortion
  training and service provision (first and/or
  second trimester)
• Preparation for abortion advocacy training
• Community stakeholders buy in to create enabling
  environment for womens use of abortion services
  
• Many others.

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Acknowledgments

• Toolkit development and data analysis Katherine
  Turner, Kimberly Chapman Page, Ellen Mitchell,
  Kathryn Andersen Clark, Alyson Hyman, Monica
  Yungeberg, Kym Register, Debbie Billings, Traci
  Baird, Joan Healy, Erika Steibelt, Luz
  McNaughton, Maria de Bruyn, Cynthia
  Greenlee-Donnell, Marty Jarrell and Elizabeth
  Randall-David
• Ipas offices and intervention partners in Africa
  Alliance countries, Brazil, Ethiopia, Ghana,
  Nepal and South Africa
• International reviewers Leila Adesse, Traci
  Baird, Kapila Bharucha, Daniela Draghici, Beatriz
  Galli, Jessica Meyer, Monica Oguttu, Lynne
  Randall and Karen Trueman

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References

• Ajzen, I. 1985. From intentions to actions A
  theory of planned behavior. In Kuhl, J. , and J.
  Beckman eds., Action-control From cognition to
  behavior. Heidelberg, Springer.
• Ajzen, I. 1988. Attitudes, personality, and
  behavior. Chicago, Dorsey Press.
• Ajzen, I. 1991. The theory of planned behavior.
  Organizational Behavior and Human Decision
  Processes, 50179-211.
• Dewey, J. 1939. Theory of valuation. Chicago,
  University of Chicago Press.
• Karel, M., J. Powell, and M. Cantor. 2004. Using
  a values discussion guide to facilitate
  communication in advance care planning. Patient
  Education and Counseling, 5522-31.
• Kinnier, R.T. 1995. A reconceptualization of
  values clarification Values conflict resolution.
  Journal of Counseling Development, 7418-24.
• Marais, T. 1996. Abortion values clarification
  training manual. Melrose, South Africa, Planned
  Parenthood Association of South Africa.
• Mosconi, J., and J. Emmett. 2003. Effects of a
  values clarification curriculum on high school
  students' definitions of success. ASCA, 7(2),
  68-78.
• Maslow, A.H. 1959. New knowledge in human
  values. New York, Harper Brothers.

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References

• Raths, L., M. Harmin, and S. Simon. 1966. Values
  and teaching Working with values in the
  classroom. Columbus, OH, Charles E. Merrill
  Publishing Co.
• Raths, L., M. Harmin, and S. Simon. 1978. Values
  and teaching Working with values in the
  classroom (2nd ed.). Columbus, OH, Charles E.
  Merrill.
• Mitchell, E., K. Trueman, M. Gabriel, and L.
  Bickers Bock. 2005. Building alliances from
  ambivalence Evaluation of values clarification
  workshops with stakeholders in South Africa.
  African Journal of Reproductive Health,
  9(3)88-89.
• Rogers, C.R. 1961. On becoming a person. Boston,
  Houghton Mifflin.
• Rokeach, M. 1973. The nature of human values. New
  York, Free Press.
• Rokeach, M. 1979. Understanding human values
  Individual and societal. New York, Free Press.
• Schwartz, S.H. , and W. Bilsky. 1987. Toward a
  universal psychological structure of human
  values. Journal of Personality and Social
  Psychology, 53550-562.
• Schwartz, S., and N. Inbar-Saban,. 1988. Values
  self-confrontation as a method to aid in weight
  loss. Journal of Personality and Social
  Psychology, 54(3), 396-404.
• Steele, S. 1979. Values clarification in nursing.
  New York, Appleton-Century-Crofts.
• Turner, K.L., and K. Chapman. 2008. Abortion
  attitude transformation A values clarification
  toolkit for global audiences. Chapel Hill, NC,
  Ipas.

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Questions and discussion
The photographs used in this presentation are for
illustrative purposes only they do not imply any
particular attitudes, behaviors, or actions on
the part of the any person who appears in the
photographs.