Developing and testing of an instrument to assess women-centered care during pregnancy

Abstract

Purpose
The purpose of this study was to develop a "Women-Centered Care (WCC)" pregnancy questionnaire (WCC-preg questionnaire) that measured women's perceptions of care they received during pregnancy and to test its validity and reliability.
Methods
Participants were women who had a single-child birth and were hospitalized at the participating settings.
The WCC-preg questionnaire is a self-administered questionnaire, which was developed based on interviews and substantive studies. This instrument originally contained 60 questions focused on their perceptions of women-centered care they received during pregnancy. Women were asked if they agreed or disagreed using a 5-point Likert-type scale. The higher the points, the more women felt that they received WCC. To examine criterion-related validity, the following scales were used; the Maternal Attachment Questionnaire (MAQ), the Labour Agentry Scale (LAS), and the 10-point Likert-type Care Satisfaction Scale.
To test validity and internal consistency, 591 women from 13 settings were recruited. Among these women, 500 responded and 482 were included in the analysis. To test stability using test-retest, questionnaires were distributed to 100 women at one setting. Among these women, 60 responded and all were included in the analysis.
Results
In testing face validity, the WCC-preg questionnaire ended up to be a 50-item questionnaire. To test the construct validity, factor analysis was conducted. Eventually six factors emerged: "feelings of encouragement", "being respected", "trusting the caregiver", "effective interaction", "help in decision-making", and "non-threatening manner". These were found to be suitable components of WCC. The correlation with WCC-preg questionnaire and MAQ showed low correlation (r=0.22, p=0.00) while LAS showed moderate correlation (r=0.48, p=0.00) and the Care Satisfaction Scale showed high correlation (r=0.79, p=0.00) thus confirming the WCC-preg questionnaire's criterion-related validity.
Cronbach's alpha was 0.98 indicating high internal consistency. However, the correlation of the test-retest was 0.55 and therefore stability remains an issue.
Conclusion
This study developed a questionnaire to measure women's perception of WCC during pregnancy and tested its validity and reliability. As a result, the validity of the WCC-preg questionnaire was confirmed. Although there remained an issue concerning stability, the internal consistency was high.