Departments of Family Medicine and Obstetrics and Gynecology, Pritzker School of Medicine, The University of Chicago, Chicago, Illinois, USA.
NorthShore University HealthSystem (NSUHS) Research Institute, Evanston, Illinois, USA.
Birth. 2022 Sep;49(3):514-525. doi: 10.1111/birt.12622. Epub 2022 Mar 17.
Perinatal quality improvement lacks valid tools to measure adverse hospital experiences disproportionately impacting Black mothers and birthing people. Measuring and mitigating harm requires using a framework that centers the lived experiences of Black birthing people in evaluating inequitable care, namely, obstetric racism. We sought to develop a valid patient-reported experience measure (PREM) of Obstetric Racism in hospital-based intrapartum care designed for, by, and with Black women as patient, community, and content experts.
PROMIS© instrument development standards adapted with cultural rigor methodology. Phase 1 included item pool generation, modified Delphi method, and cognitive interviews. Phase 2 evaluated the item pool using factor analysis and item response theory.
Items were identified or written to cover 7 previously identified theoretical domains. 806 Black mothers and birthing people completed the pilot test. Factor analysis concluded a 3 factor structure with good fit indices (CFI = 0.931-0.977, RMSEA = 0.087-0.10, R > .3, residual correlation < 0.15). All items in each factor fit the IRT model and were able to be calibrated. Factor 1, "Humanity," had 31 items measuring experiences of safety and accountability, autonomy, communication, and empathy. A 12-item short form was created to ease respondent burden. Factor 2, "Racism," had 12 items measuring experiences of neglect and mistreatment. Factor 3, "Kinship," had 7 items measuring hospital denial and disruption of relationships between Black mothers and their child or support system.
The PREM-OB Scale™ suite is a valid tool to characterize and quantify obstetric racism for use in perinatal improvement initiatives.
围产期质量改进缺乏有效工具来衡量对黑人和生育者产生不成比例影响的不良医院体验。衡量和减轻伤害需要使用一个框架，该框架将黑人生育者的生活体验置于评估不公平护理的中心位置，即产科种族主义。我们旨在为黑人女性患者、社区和内容专家开发一种基于医院的分娩期间产科种族主义的有效患者报告体验测量工具（PREM）。
采用 PROMIS© 工具开发标准，并结合文化严谨性方法。第 1 阶段包括项目池生成、修改后的 Delphi 方法和认知访谈。第 2 阶段使用因子分析和项目反应理论评估项目池。
确定或编写了 7 个先前确定的理论领域的项目。806 名黑人母亲和生育者完成了试点测试。因子分析得出了具有良好拟合指数的 3 因素结构（CFI=0.931-0.977，RMSEA=0.087-0.10，R>.3，残差相关<.15）。每个因素中的所有项目都符合 IRT 模型并能够进行校准。第 1 个因素“人性”有 31 个项目，用于衡量安全性和问责制、自主性、沟通和同理心方面的体验。创建了一个 12 项的简短表格以减轻受访者的负担。第 2 个因素“种族主义”有 12 个项目，用于衡量被忽视和虐待的经历。第 3 个因素“亲情”有 7 个项目，用于衡量医院对黑人母亲及其子女或支持系统之间关系的否认和破坏。
PREM-OB 量表套件是一种有效的工具，可用于描述和量化产科种族主义，用于围产期改进计划。
