Centre for Family Research, University of Cambridge, Cambridge, UK.
Department of Psychology, University of Edinburgh, Edinburgh, UK.
Arch Womens Ment Health. 2021 Aug;24(4):619-625. doi: 10.1007/s00737-021-01105-8. Epub 2021 Feb 9.
Studies in high-income countries (HICs) have shown that variability in maternal-fetal attachment (MFA) predict important maternal health and child outcomes. However, the validity of MFA ratings in low- and middle-income countries (LMICs) remains unknown. Addressing this gap, we assessed measurement invariance to test the conceptual equivalence of the Prenatal Attachment Inventory (PAI: Muller, 1993) across eight LMICs. Our aim was to determine whether the PAI yields similar information from pregnant women across different cultural contexts. We administered the 18-item PAI to 1181 mothers in the third trimester (Mean age = 28.27 years old, SD = 5.81 years, range = 18-48 years) expecting their first infant (n = 359) or a later-born infant (n = 820) as part of a prospective birth cohort study involving eight middle-income countries: Ghana, Jamaica, Pakistan, Philippines, Romania, South Africa, Sri Lanka and Vietnam. We used Multiple Group Confirmatory Factor Analyses to assess across-site measurement invariance. A single latent factor with partial measurement invariance was found across all sites except Pakistan. Group comparisons showed that mean levels of MFA were lowest for expectant mothers in Vietnam and highest for expectant mothers in Sri Lanka. MFA was higher in first-time mothers than in mothers expecting a later-born child. The PAI yields similar information about MFA across culturally distinct middle-income countries. These findings strengthen confidence in the use of the tool across different settings; future studies should explore the use of the PAI as a screen for maternal behaviour that place children at risk.
在高收入国家（HIC）的研究表明，母婴依恋（MFA）的变异性可预测重要的母婴健康和儿童结局。然而，MFA 评分在中低收入国家（LMIC）的有效性尚不清楚。为了填补这一空白，我们评估了测量不变性，以测试产前依恋量表（PAI：Muller，1993）在八个 LMIC 中的概念等效性。我们的目的是确定 PAI 是否能从不同文化背景的孕妇中获得相似的信息。我们对 1181 名处于妊娠晚期的母亲（平均年龄 28.27 岁，标准差 5.81 岁，范围 18-48 岁）进行了 18 项 PAI 测试，其中 359 名孕妇期待第一胎，820 名孕妇期待后续出生的婴儿，作为涉及八个中等收入国家的前瞻性出生队列研究的一部分：加纳、牙买加、巴基斯坦、菲律宾、罗马尼亚、南非、斯里兰卡和越南。我们使用多组验证性因素分析来评估跨站点的测量不变性。除了巴基斯坦，所有地点都发现了一个具有部分测量不变性的单一潜在因素。组间比较显示，母婴依恋程度最低的是越南的预期母亲，最高的是斯里兰卡的预期母亲。初产妇的 MFA 高于期待后续出生婴儿的母亲。PAI 在文化上不同的中等收入国家之间提供了关于 MFA 的相似信息。这些发现增强了在不同环境中使用该工具的信心；未来的研究应探讨使用 PAI 作为一种筛查工具，以识别可能对儿童构成风险的母亲行为。
