Sheferaw Ephrem D, Mengesha Teka Z, Wase Solomon B
Jhpiego an affiliate of Johns Hopkins University, 2881, code 1250, Addis Ababa, Ethiopia.
Institute of Psychology, Addis Ababa University, Addis Ababa, Ethiopia.
BMC Pregnancy Childbirth. 2016 Mar 29;16:67. doi: 10.1186/s12884-016-0848-5.
Maternal mortality continues to be the biggest challenge facing Ethiopia and other developing countries. Although progress has been made in making maternity services available closer to the community, the rate of deliveries attended by skilled birth attendants has remained very low. Absence of respectful maternity care (RMC) is believed to have contributed to low utilization of facility delivery services. This study outlines steps undertaken to construct and validate a scale that measures women's perception of respectful maternity care provided in health facilities.
An inductive item generation process that included a literature review and in-depth interviews with labor and delivery clients, followed by an expert review, assured face validity and content validity of the tool. A draft RMC scale with 37 items and two additional measures of global satisfaction items, measured on a five-point Likert scale, were administered to a developmental sample of 509 postnatal care clients visiting facilities immediately after childbirth to 7 weeks postpartum. IBM SPSS 20 was used to perform exploratory factor analysis (EFA) using principal component analysis (PCA) with oblique rotation method.
The final RMC scale with 15 items was loaded on four components. The extracted components were labeled as friendly care, abuse-free care, timely care, and discrimination-free care. The final RMC scale correlated strongly with the global satisfaction measures, indicating criterion-related validity of the scale. Content-related validity was assured by the process of item generation. Construct validity of the RMC scale was confirmed by high average factor loading of the four components ranging from 0.76 to 0.82 and low correlation between the components. Stability of the scale was confirmed by running PCA in a randomly selected split sample of 320 samples from the validation sample. The final 15-item scale showed an adequate reliability with α = 0.845.
The 15-item RMC scale is a valid and reliable measure of women's perception of RMC received in health facilities. We recommend that health facilities use the RMC scale in urban public health facilities and that other researchers conduct further exploratory and confirmatory factor analysis in different geographic areas.
孕产妇死亡率仍然是埃塞俄比亚和其他发展中国家面临的最大挑战。尽管在使孕产妇服务更贴近社区方面已取得进展，但由熟练助产士接生的分娩率仍然很低。据信，缺乏尊重孕产妇护理（RMC）导致了设施分娩服务利用率低下。本研究概述了构建和验证一个衡量妇女对医疗机构提供的尊重孕产妇护理的认知的量表所采取的步骤。
一个归纳性的条目生成过程，包括文献综述以及对分娩客户的深入访谈，随后进行专家评审，确保了该工具的表面效度和内容效度。一个包含37个条目的RMC量表草案以及另外两个总体满意度条目的测量，采用五点李克特量表，对509名产后护理客户的发展样本进行了施测，这些客户在分娩后至产后7周内立即前往医疗机构就诊。使用IBM SPSS 20通过主成分分析（PCA）和斜交旋转法进行探索性因素分析（EFA）。
最终的15个条目的RMC量表加载在四个成分上。提取的成分被标记为友好护理、无虐待护理、及时护理和无歧视护理。最终的RMC量表与总体满意度测量结果高度相关，表明该量表具有与标准相关的效度。条目生成过程确保了与内容相关的效度。RMC量表的结构效度通过四个成分的平均因子载荷较高（范围为0.76至0.82）且成分之间的相关性较低得到证实。通过在验证样本中随机选择的320个样本的分割样本中运行PCA，证实了该量表的稳定性。最终的15个条目的量表显示出足够的信度，α = 0.845。
15个条目的RMC量表是衡量妇女对在医疗机构接受的RMC的认知的有效且可靠的工具。我们建议医疗机构在城市公共卫生机构中使用RMC量表，并且其他研究人员在不同地理区域进行进一步的探索性和验证性因素分析。
