Slade P, Balling K, Sheen K, Houghton G
Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Ground Floor Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK.
Natural Sciences and Psychology, Liverpool John Moores University, Liverpool, UK.
BMC Pregnancy Childbirth. 2020 Sep 22;20(1):553. doi: 10.1186/s12884-020-03249-4.
Fear of childbirth is related to but not synonymous with general anxiety, and represents a superior predictor for maternal and infant outcomes. There is a need to improve the identification and provision of support for women experiencing high fear of childbirth. However it is uncertain as to whether existing measurement tools have appropriate content validity (i.e. cover the relevant domains within the construct), practical utility, and whether they are acceptable for use with a UK population. This study aimed to (1) identify the utility and acceptability of existing measures of fear of childbirth (FOC) with a small UK sample and (2) map the content of existing measures to the key concepts of fear of childbirth established by previous research.
Ten pregnant women; five with high and five with low fear of childbirth participated in a cognitive interview covering four most commonly used measures of fear of childbirth: 1. The Wijma Delivery Expectancy Questionnaire (WDEQ A), 2. The Oxford Worries about Labour Scale (OWLS), 3. The Slade-Pais Expectations of Childbirth Scale - fear subscale (SPECS) and 4. The Fear of Birth scale (FOBS). Each measure was also reviewed by participants for ease and clarity of understanding and acceptability. The measures were then reviewed against the key domains identified in the fear of childbirth literature to ascertain the adequacy of content validity of each measure. Interviews were analysed using thematic analysis for each scale item.
All measures except the FOBS, included items that either women did not understand or, if where there was understanding the meanings were inconsistent across women. All measures demonstrated limited acceptability and content validity for the specific construct of FOC. Therefore, none of the measurement tools currently used within the UK met criteria for understanding, acceptability and content validity for measurement of FOC.
Findings emphasise a need to develop a specific fear of childbirth tool with good clarity which demonstrates appropriate content validity, and that is acceptable in presentation and length for pregnant women in a UK population.
对分娩的恐惧与一般焦虑有关，但并非同义词，并且是母婴结局的一个更优预测指标。有必要改进对分娩恐惧程度高的女性的识别和支持。然而，现有测量工具是否具有适当的内容效度（即涵盖该构念中的相关领域）、实际效用，以及它们是否适用于英国人群，尚不确定。本研究旨在：（1）通过一小部分英国样本确定现有分娩恐惧测量方法的效用和可接受性；（2）将现有测量方法的内容与先前研究确立的分娩恐惧关键概念进行映射。
十名孕妇参与了一项认知访谈，其中五名对分娩的恐惧程度高，五名对分娩的恐惧程度低，访谈涉及四种最常用的分娩恐惧测量方法：1. 维伊马分娩期望问卷（WDEQ A）；2. 牛津分娩担忧量表（OWLS）；3. 斯莱德 - 佩斯分娩期望量表 - 恐惧分量表（SPECS）；4. 分娩恐惧量表（FOBS）。参与者还对每种测量方法的易理解性、清晰度和可接受性进行了评估。然后根据分娩恐惧文献中确定的关键领域对这些测量方法进行审查，以确定每种测量方法的内容效度是否充分。对每个量表项目的访谈采用主题分析法进行分析。
除FOBS外，所有测量方法都包含女性不理解的项目，或者即使理解了，不同女性对其含义的理解也不一致。所有测量方法在分娩恐惧这一特定构念的可接受性和内容效度方面都表现有限。因此，英国目前使用的测量工具均未达到理解性、可接受性和测量分娩恐惧的内容效度标准。
研究结果强调需要开发一种清晰度高的特定分娩恐惧工具，该工具应具有适当的内容效度，且在形式和长度上能被英国孕妇接受。
