Heaman Maureen I, Sword Wendy A, Akhtar-Danesh Noori, Bradford Amanda, Tough Suzanne, Janssen Patricia A, Young David C, Kingston Dawn A, Hutton Eileen K, Helewa Michael E
College of Nursing and Departments of Community Health Sciences and Obstetrics, Gynecology and Reproductive Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg R3T 2N2, Manitoba, Canada.
BMC Pregnancy Childbirth. 2014 Jun 3;14:188. doi: 10.1186/1471-2393-14-188.
Utilization indices exist to measure quantity of prenatal care, but currently there is no published instrument to assess quality of prenatal care. The purpose of this study was to develop and test a new instrument, the Quality of Prenatal Care Questionnaire (QPCQ).
Data for this instrument development study were collected in five Canadian cities. Items for the QPCQ were generated through interviews with 40 pregnant women and 40 health care providers and a review of prenatal care guidelines, followed by assessment of content validity and rating of importance of items. The preliminary 100-item QPCQ was administered to 422 postpartum women to conduct item reduction using exploratory factor analysis. The final 46-item version of the QPCQ was then administered to another 422 postpartum women to establish its construct validity, and internal consistency and test-retest reliability.
Exploratory factor analysis reduced the QPCQ to 46 items, factored into 6 subscales, which subsequently were validated by confirmatory factor analysis. Construct validity was also demonstrated using a hypothesis testing approach; there was a significant positive association between women's ratings of the quality of prenatal care and their satisfaction with care (r = 0.81). Convergent validity was demonstrated by a significant positive correlation (r = 0.63) between the "Support and Respect" subscale of the QPCQ and the "Respectfulness/Emotional Support" subscale of the Prenatal Interpersonal Processes of Care instrument. The overall QPCQ had acceptable internal consistency reliability (Cronbach's alpha = 0.96), as did each of the subscales. The test-retest reliability result (Intra-class correlation coefficient = 0.88) indicated stability of the instrument on repeat administration approximately one week later. Temporal stability testing confirmed that women's ratings of their quality of prenatal care did not change as a result of giving birth or between the early postpartum period and 4 to 6 weeks postpartum.
The QPCQ is a valid and reliable instrument that will be useful in future research as an outcome measure to compare quality of care across geographic regions, populations, and service delivery models, and to assess the relationship between quality of care and maternal and infant health outcomes.
存在一些利用指标来衡量产前护理的数量，但目前尚无已发表的工具来评估产前护理的质量。本研究的目的是开发并测试一种新工具——产前护理质量问卷（QPCQ）。
本工具开发研究的数据收集于加拿大的五个城市。通过对40名孕妇和40名医疗服务提供者进行访谈，并回顾产前护理指南来生成QPCQ的条目，随后评估内容效度并对条目重要性进行评级。将初步的100条目QPCQ施用于422名产后妇女，使用探索性因子分析进行条目删减。然后将最终的46条目版本的QPCQ施用于另外422名产后妇女，以确立其结构效度、内部一致性和重测信度。
探索性因子分析将QPCQ缩减至46个条目，分为6个分量表，随后通过验证性因子分析进行了验证。还使用假设检验方法证明了结构效度；妇女对产前护理质量的评分与她们对护理的满意度之间存在显著正相关（r = 0.81）。QPCQ的“支持与尊重”分量表与产前人际护理过程工具的“尊重/情感支持”分量表之间存在显著正相关（r = 0.63），证明了收敛效度。总体QPCQ具有可接受的内部一致性信度（Cronbach's alpha = 0.96），各个分量表也是如此。重测信度结果（组内相关系数 = 0.88）表明该工具在大约一周后重复施测时具有稳定性。时间稳定性测试证实，妇女对其产前护理质量的评分不会因分娩或产后早期与产后4至6周之间而改变。
QPCQ是一种有效且可靠的工具，在未来研究中作为一种结果指标将很有用，可用于比较不同地理区域、人群和服务提供模式的护理质量，并评估护理质量与母婴健康结果之间的关系。
