Student Research Comittee, Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
Cabrini Research, Cabrini Health, Malvern, VIC, 3144, Australia.
BMC Health Serv Res. 2024 May 11;24(1):619. doi: 10.1186/s12913-024-11065-1.
Assessing women's perceptions of the care they receive is crucial for evaluating the quality of maternity care. Women's perceptions are influenced by the care received during pregnancy, labour and birth, and the postpartum period, each of which with unique conditions, expectations, and requirements. In England, three Experience of Maternity Care (EMC) scales - Pregnancy, Labour and Birth, and Postnatal - have been developed to assess women's experiences from pregnancy through the postpartum period. This study aimed to validate these scales within the Iranian context.
A methodological cross-sectional study was conducted from December 2022 to August 2023 at selected health centers in Tabriz, Iran. A panel of 16 experts assessed the qualitative and quantitative content validity of the scales and 10 women assessed the face validity. A total of 540 eligible women, 1-6 months postpartum, participated in the study, with data from 216 women being used for exploratory factor analysis (EFA) and 324 women for confirmatory factor analysis (CFA) and other analyses. The Childbirth Experience Questionnaire-2 was employed to assess the convergent validity of the Labour and Birth Scale, whereas women's age was used to assess the divergent validity of the scales. Test-retest reliability and internal consistency were also examined.
All items obtained an impact score above 1.5, with Content Validity Ratio and Content Validity Index exceeding 0.8. EFA demonstrated an excellent fit with the data (all Kaiser-Meyer-Olkin measures > 0.80, and all Bartlett's p < 0.001). The Pregnancy Scale exhibited a five-factor structure, the Labour and Birth Scale a two-factor structure, and the Postnatal Scale a three-factor structure, explaining 66%, 57%, and 62% of the cumulative variance, respectively, for each scale. CFA indicated an acceptable fit with RMSEA ≤ 0.08, CFI ≥ 0.92, and NNFI ≥ 0.90. A significant correlation was observed between the Labour and Birth scale and the Childbirth Experience Questionnaire-2 (r = 0.82, P < 0.001). No significant correlation was found between the scales and women's age. All three scales demonstrated good internal consistency (all Cronbach's alpha values > 0.9) and test-retest reliability (all interclass correlation coefficient values > 0.8).
The Persian versions of all three EMC scales exhibit robust psychometric properties for evaluating maternity care experiences among urban Iranian women. These scales can be utilized to assess the quality of current care, investigate the impact of different care models in various studies, and contribute to maternal health promotion programs and policies.
评估女性对所接受护理的看法对于评估产妇护理质量至关重要。女性的看法受到怀孕期间、分娩期间和产后期间所接受的护理的影响，每个阶段都有独特的条件、期望和要求。在英国，已经开发了三种产妇护理体验（EMC）量表——妊娠、分娩和产后，用于评估女性从妊娠到产后期间的体验。本研究旨在验证这些量表在伊朗背景下的适用性。
这是一项 2022 年 12 月至 2023 年 8 月在伊朗大不里士选定的医疗中心进行的方法学横断面研究。一个由 16 名专家组成的小组评估了这些量表的定性和定量内容效度，10 名女性评估了表面效度。共有 540 名符合条件的女性参与了研究，她们在产后 1-6 个月，其中 216 名女性的数据用于探索性因子分析（EFA），324 名女性的数据用于验证性因子分析（CFA）和其他分析。采用分娩体验问卷-2 评估分娩量表的聚合效度，而女性的年龄用于评估量表的离散效度。还检查了重测信度和内部一致性。
所有项目的影响得分均高于 1.5，内容效度比和内容效度指数均超过 0.8。EFA 与数据拟合良好（所有 Kaiser-Meyer-Olkin 测量值均>0.80，所有 Bartlett's p<0.001）。妊娠量表呈现出五因素结构，分娩量表呈现出两因素结构，产后量表呈现出三因素结构，分别解释了每个量表 66%、57%和 62%的累积方差。CFA 表明具有可接受的拟合度，RMSEA≤0.08、CFI≥0.92 和 NNFI≥0.90。分娩量表与分娩体验问卷-2 之间存在显著相关性（r=0.82，P<0.001）。量表与女性年龄之间无显著相关性。三个量表的内部一致性均良好（所有 Cronbach's alpha 值均>0.9），重测信度也较好（所有组内相关系数值均>0.8）。
所有三种 EMC 量表的波斯语版本均具有评估伊朗城市女性产妇护理体验的强大心理测量学特性。这些量表可用于评估当前护理质量，研究不同护理模式在不同研究中的影响，并为促进母婴健康的方案和政策做出贡献。
