Department of Native Hawaiian Health, University of Hawai'i, John A. Burns School of Medicine, Honolulu, HI, 96813, USA.
Department of Quantitative Health Sciences, University of Hawai'i, John A. Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA.
BMC Pregnancy Childbirth. 2024 Oct 25;24(1):702. doi: 10.1186/s12884-024-06856-7.
Native Hawaiian and Pacific Islanders (NHPI) are disproportionately burdened by pregnancy-related deaths in the United States and have the lowest engagement in prenatal care compared to all other US racial groups. Aside from access barriers, studies suggest that NHPI face challenges with patient-clinician communication, perceived discrimination, and cultural conflicts within healthcare settings. This paper describes the cultural adaptation of the 14-item Mothers On Respect index for NHPI, originally developed by Vedam et al. (2017) for diverse communities in British Columbia, Canada, and reports the findings of the preliminary psychometric assessment of the adapted measure.
Data from 26 interviews with NHPI women, expert, and cognitive interviews were conducted to inform the adaptation. An online survey was administered to a sample of 90 NHPI women to assess construct validity, convergent validity, and internal reliability of the adapted measure using exploratory and confirmatory factor analyses.
The adaptation resulted in substantial changes to the original measure, mainly by the addition of items related to 'feeling cared for by and connected to the provider' and 'perceived threats hindering communication.' The psychometric analyses identified a three-factor structure for the culturally adapted index and confirmatory factor analyses were employed to refine the measure. The result was a 25-item index with acceptable goodness of fit indices, high internal reliability (Cronbach's alpha of 0.96, 95% CI = .94-.97) and convergent validity with a related scale. Overall, participants in this sample indicated high levels of respectful care; however, people who received < 8 prenatal care visits had significantly lower ratings on average.
Our findings suggest that the elements valued by NHPI are not fully captured in existing measures of respectful maternity care. Efforts to assess more discrete aspects of the patient-provider relationship for culturally distinct and racialized groups could help improve the quality of care and advance equity in maternal and perinatal health marginalized communities.
在美国，夏威夷原住民和太平洋岛民（NHPI）与所有其他美国种族群体相比，妊娠相关死亡的负担不成比例，参与产前保健的比例最低。除了获取障碍外，研究表明，NHPI 在医患沟通、感知歧视和医疗保健环境中的文化冲突方面面临挑战。本文描述了 Vedam 等人（2017 年）为加拿大不列颠哥伦比亚省多元化社区开发的 14 项“母亲尊重指数”（Mothers On Respect index）的文化适应性，报告了经过适应性调整后的初步心理测量评估结果。
对 26 名 NHPI 女性、专家和认知访谈者进行访谈，为改编提供信息。对 90 名 NHPI 女性进行了在线调查，以使用探索性和验证性因素分析评估改编后测量的结构效度、收敛效度和内部信度。
改编导致原始测量发生了重大变化，主要是通过添加与“感到被提供者照顾和联系”和“感知到阻碍沟通的威胁”相关的项目。心理测量分析确定了文化适应性指数的三因素结构，并进行了验证性因素分析以进一步改进该指数。结果是一个 25 项的指数，具有可接受的拟合优度指数、高内部信度（Cronbach 的 alpha 为 0.96，95%置信区间为 0.94-0.97）和与相关量表的收敛效度。总体而言，该样本中的参与者表示得到了高度的尊重性护理；然而，接受的产前护理次数<8 次的人平均评分显著较低。
我们的研究结果表明，现有的尊重产妇护理测量工具并未充分捕捉到 NHPI 重视的因素。为文化独特和种族化群体评估医患关系的更离散方面的努力，有助于改善护理质量，促进边缘化母婴和围产期健康社区的公平。
