Quality of prenatal care questionnaire: instrument development and testing

BMC Pregnancy and Childbirth

Michael E Helewa¹  Eileen K Hutton⁷  Dawn A Kingston⁸  David C Young²  Patricia A Janssen⁹  Suzanne Tough³  Amanda Bradford⁵  Noori Akhtar-Danesh⁶  Wendy A Sword⁶  Maureen I Heaman⁴ 

[1] Department of Obstetrics, Gynecology and Reproductive Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, 735 Notre Dame Avenue, University of Manitoba, Winnipeg R3T 2N2, Manitoba, Canada;Department of Obstetrics and Gynecology, IWK Health Centre, Dalhousie University, 5980 University Avenue, P.O. Box 9700, Halifax B3K 6R8, Nova Scotia, Canada;Departments of Paediatrics and Community Health Sciences, Faculty of Medicine, University of Calgary, 2888 Shaganappi Trail NW, Calgary T3B 6A8, Alberta, Canada;College of Nursing and Departments of Community Health Sciences and Obstetrics, Gynecology and Reproductive Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg R3T 2N2, Manitoba, Canada;Gilbrea Centre for Studies in Aging, McMaster University, 1280 Main Street West, Hamilton L8S 4M4, Ontario, Canada;School of Nursing and Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton L8S 4K1, Ontario, Canada;Department of Obstetrics and Gynecology and Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton L8S 4K, Ontario, Canada;Faculty of Nursing, University of Alberta, 5-258 Edmonton Clinic Health Academy, 11405-87th Avenue, Edmonton T6G 1C9, Alberta, Canada;School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver V6N 1Z3, British Columbia, Canada

关键词: Psychometric testing;    Validity;    Reliability;    Instrument;    Measurement;    Quality of care;    Prenatal care;   

Others  :  1127270
DOI  :  10.1186/1471-2393-14-188

 received in 2013-09-16, accepted in 2014-05-16,  发布年份 2014

【 摘 要 】

Background

Utilization indices exist to measure quantity of prenatal care, but currently there is no published instrument to assess quality of prenatal care. The purpose of this study was to develop and test a new instrument, the Quality of Prenatal Care Questionnaire (QPCQ).

Methods

Data for this instrument development study were collected in five Canadian cities. Items for the QPCQ were generated through interviews with 40 pregnant women and 40 health care providers and a review of prenatal care guidelines, followed by assessment of content validity and rating of importance of items. The preliminary 100-item QPCQ was administered to 422 postpartum women to conduct item reduction using exploratory factor analysis. The final 46-item version of the QPCQ was then administered to another 422 postpartum women to establish its construct validity, and internal consistency and test-retest reliability.

Results

Exploratory factor analysis reduced the QPCQ to 46 items, factored into 6 subscales, which subsequently were validated by confirmatory factor analysis. Construct validity was also demonstrated using a hypothesis testing approach; there was a significant positive association between women’s ratings of the quality of prenatal care and their satisfaction with care (r = 0.81). Convergent validity was demonstrated by a significant positive correlation (r = 0.63) between the “Support and Respect” subscale of the QPCQ and the “Respectfulness/Emotional Support” subscale of the Prenatal Interpersonal Processes of Care instrument. The overall QPCQ had acceptable internal consistency reliability (Cronbach’s alpha = 0.96), as did each of the subscales. The test-retest reliability result (Intra-class correlation coefficient = 0.88) indicated stability of the instrument on repeat administration approximately one week later. Temporal stability testing confirmed that women’s ratings of their quality of prenatal care did not change as a result of giving birth or between the early postpartum period and 4 to 6 weeks postpartum.

Conclusion

The QPCQ is a valid and reliable instrument that will be useful in future research as an outcome measure to compare quality of care across geographic regions, populations, and service delivery models, and to assess the relationship between quality of care and maternal and infant health outcomes.

【 授权许可】

   
2014 Heaman et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Alexander GR, Kotelchuck M: Assessing the role and effectiveness of prenatal care: history, challenges, and directions for future research. Public Health Rep 2001, 116(4):306-316.
• [2]Lu MC, Tache V, Alexander GR, Kotelchuck M, Halfon N: Preventing low birth weight: is prenatal care the answer? J Matern Fetal Neonatal Med 2003, 13(6):362-380.
• [3]Moos MK: Prenatal care: limitations and opportunities. J Obstet Gynecol Neonatal Nurs 2006, 35(2):278-285.
• [4]Heaman MI, Newburn-Cook CV, Green CG, Elliott LJ, Helewa ME: Inadequate prenatal care and its association with adverse pregnancy outcomes: a comparison of indices. BMC Pregnancy Childbirth 2008, 8:15.
• [5]VanderWeele TJ, Lantos JD, Siddique J, Lauderdale DS: A comparison of four prenatal care indices in birth outcome models: comparable results for predicting small-for-gestational-age outcome but different results for preterm birth or infant mortality. J Clin Epidemiol 2009, 62(4):438-445.
• [6]Partridge S, Balayla J, Holcroft CA, Abenhaim HA: Inadequate prenatal care utilization and risks of infant mortality and poor birth outcome: a retrospective analysis of 28,729,765 U.S. deliveries over 8 years. Am J Perinatol 2012, 29(10):787-794.
• [7]Korenbrot CC, Wong ST, Stewart AL: Health promotion and psychosocial services and women’s assessments of interpersonal prenatal care in Medicaid managed care. Matern Child Health J 2005, 9(2):135-149.
• [8]Beeckman K, Louckx F, Masuy-Stroobant G, Downe S, Putman K: The development and application of a new tool to assess the adequacy of the content and timing of antenatal care. BMC Health Serv Res 2011, 11:213.
• [9]Kogan MD, Alexander GR, Kotelchuck M, Nagey DA: Relation of the content of prenatal care to the risk of low birth weight. Maternal reports of health behavior advice and initial prenatal care procedures. JAMA 1994, 271(17):1340-1345.
• [10]White DE, Fraser-Lee NJ, Tough S, Newburn-Cook CV: The content of prenatal care and its relationship to preterm birth in Alberta. Canada Health Care Women Int 2006, 27(9):777-792.
• [11]Handler A, Rankin K, Rosenberg D, Sinha K: Extent of documented adherence to recommended prenatal care content: provider site differences and effect on outcomes among low-income women. Matern Child Health J 2012, 16(2):393-405.
• [12]Klerman LV, Ramey SL, Goldenberg RL, Marbury S, Hou J, Cliver SP: A randomized trial of augmented prenatal care for multiple-risk, Medicaid-eligible African American women. Am J Public Health 2001, 91(1):105-111.
• [13]Ricketts SA, Murray EK, Schwalberg R: Reducing low birthweight by resolving risks: results from Colorado’s prenatal plus program. Am J Public Health 2005, 95(11):1952-1957.
• [14]Carlson NS, Lowe NK: Centering pregnancy: a new approach in prenatal care. MCN Am J Matern Child Nurs 2006, 31(4):218-223.
• [15]Wilkinson DS, Korenbrot CC, Greene J: A performance indicator of psychosocial services in enhanced prenatal care of Medicaid-eligible women. Matern Child Health J 1998, 2(3):131-143.
• [16]Ruiz-Mirazo E, Lopez-Yarto M, McDonald SD: Group prenatal care versus individual prenatal care: a systematic review and meta-analyses. J Obstet Gynaecol Can 2012, 34(3):223-229.
• [17]Goberna-Tricas J, Banus-Gimenez MR, Palacio-Tauste A, Linares-Sancho S: Satisfaction with pregnancy and birth services: the quality of maternity care services as experienced by women. Midwifery 2011, 27(6):e231-e237.
• [18]Wheatley RR, Kelley MA, Peacock N, Delgado J: Women’s narratives on quality in prenatal care: a multicultural perspective. Qual Health Res 2008, 18(11):1586-1598.
• [19]Hildingsson I, Thomas JE: Women’s perspectives on maternity services in Sweden: processes, problems, and solutions. J Midwifery Womens Health 2007, 52(2):126-133.
• [20]Vause S, Maresh M: Indicators of quality of antenatal care: a pilot study. Br J Obstet Gynaecol 1999, 106(3):197-205.
• [21]Boller C, Wyss K, Mtasiwa D, Tanner M: Quality and comparison of antenatal care in public and private providers in the United Republic of Tanzania. Bull World Health Organ 2003, 81(2):116-122.
• [22]Wong ST, Korenbrot CC, Stewart AL: Consumer assessment of the quality of interpersonal processes of prenatal care among ethnically diverse low-income women: development of a new measure. Womens Health Issues 2004, 14(4):118-129.
• [23]Vinagre MH, Neves J: The influence of service quality and patients’ emotions on satisfaction. Int J Health Care Qual Assur 2008, 21(1):87-103.
• [24]Gotlieb JB, Grewal D, Brown SW: Consumer satisfaction and perceived quality: complementary or divergent constructs? J Appl Psychol 1994, 79(6):875.
• [25]Handler A, Rosenberg D, Raube K, Lyons S: Prenatal care characteristics and African-American women’s satisfaction with care in a managed care organization. Womens Health Issues 2003, 13(3):93-103.
• [26]Lawrence JM, Ershoff D, Mendez C, Petitti DB: Satisfaction with pregnancy and newborn care: development and results of a survey in a health maintenance organization. Am J Manag Care 1999, 5(11):1407-1413.
• [27]Omar MA, Schiffman RF, Bingham CR: Development and testing of the patient expectations and satisfaction with prenatal care instrument. Res Nurs Health 2001, 24(3):218-229.
• [28]Clement S, Sikorski J, Wilson J, Das S, Smeeton N: Women’s satisfaction with traditional and reduced antenatal visit schedules. Midwifery 1996, 12(3):120-128.
• [29]Seguin L, Therrien R, Champagne F, Larouche D: The components of women’s satisfaction with maternity care. Birth 1989, 16(3):109-113.
• [30]Erci B, Ivanov L: The relationship between women’s satisfaction with prenatal care service and the characteristics of the pregnant women and the service. Eur J Contracept Reprod Health Care 2004, 9(1):16-28.
• [31]Ivanov LL, Flynn BC: Utilization and satisfaction with prenatal care services. West J Nurs Res 1999, 21(3):372-386.
• [32]Ivanov LL, Champion VL: Development of a Russian satisfaction with prenatal care scale. J Nurs Meas 2000, 8(2):117-129.
• [33]Donabedian A: Evaluating the quality of medical care. Milbank Mem Fund Q 1966, 44(Suppl 3):206.
• [34]Donabedian A: The quality of care. How can it be assessed? JAMA 1988, 260(12):1743-1748.
• [35]Aday LA, Andersen R: A framework for the study of access to medical care. Health Serv Res 1974, 9(3):208-220.
• [36]Andersen RM: Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav 1995, 36(1):1-10.
• [37]Campbell SM, Roland MO, Buetow SA: Defining quality of care. Soc Sci Med 2000, 51(11):1611-1625.
• [38]Bennett I, Switzer J, Aguirre A, Evans K, Barg F: ‘Breaking it down’: patient-clinician communication and prenatal care among African American women of low and higher literacy. Ann Fam Med 2006, 4(4):334-340.
• [39]Moore ML, Ketner M, Walsh K, Wagoner S: Listening to women at risk for preterm birth. MCN Am J Matern Child Nurs 2004, 29(6):391-397.
• [40]Tandon SD, Parillo KM, Keefer M: Hispanic women’s perceptions of patient-centeredness during prenatal care: a mixed-method. Birth-Issues Perinatal Care 2005, 32(4):312-317.
• [41]Bloom KC, Bednarzyk MS, Devitt DL, Renault RA, Teaman V, Van Loock DM: Barriers to prenatal care for homeless pregnant women. J Obstet Gynecol Neonatal Nurs 2004, 33(4):428-435.
• [42]Sword W: Prenatal care use among women of low income: a matter of “taking care of self”. Qual Health Res 2003, 13(3):319-332.
• [43]Chew-Graham CA, Sharp D, Chamberlain E, Folkes L, Turner KM: Disclosure of symptoms of postnatal depression, the perspectives of health professionals and women: a qualitative study. BMC Fam Pract 2009, 10:7.
• [44]Al-Qutob R, Mawajdeh S, Bin RF: The assessment of reproductive health services: a conceptual framework for prenatal care. Health Care Women Int 1996, 17(5):423-434.
• [45]Langer A, Nigenda G, Romero M, Rojas G, Kuchaisit C, Al-Osimi M, for the WHO Antenatal Care Trial Research Group: Conceptual bases and methodology for the evaluation of women’s and providers’ perception of the quality of antenatal care in the WHO Antenatal Care Randomised Controlled Trial. Paediatr Perinat Epidemiol 1998, 12(Suppl 2):98-115.
• [46]Streiner DL, Norman GR: Health measurement scales: a practical guide to their development and use. 3rd edition. Oxford: Oxford University Press; 2003.
• [47]Pett MA, Lackey NR, Sullivan J: Making sense of factor analysis: the use of factor analysis for instrument development in health care research. Thousand Oaks, CA: Sage Publications; 2003.
• [48]Sword W, Heaman MI, Brooks S, Tough S, Janssen PA, Young D, Kingston D, Helewa ME, Akhtar-Danesh N, Hutton E: Women’s and care providers’ perspectives of quality prenatal care: a qualitative descriptive study. BMC Pregnancy Childbirth 2012, 12:29.
• [49]Feinstein AR: Clinimetrics. New Haven: New Haven: Yale University Press; 1987.
• [50]Marx RG, Bombardier C, Hogg-Johnson S, Wright JG: Clinimetric and psychometric strategies for development of a health measurement scale. J Clin Epidemiol 1999, 52(2):105-111.
• [51]Dillman DA, Smyth JD, Christian LM: Internet, mail, and mixed-mode surveys: the tailored design method. 3rd edition. Hoboken, N.J: John Wiley & Sons Inc; 2009.
• [52]Waltz CF, Strickland OL, Lenz ER: Measurement in nursing and health research. New York: New York: Springer Pub; 2005.
• [53]DeVellis RF: Scale development : theory and applications. Thousand Oaks, CA: Sage Publications, Inc.; 2003.
• [54]Comrey AL, Lee HB: A first course in factor analysis. 2nd edition. Hillsdale, NJ: Lawrence Erlbaum; 1992.
• [55]Pedhazur EJ, Schmelkin LP: Measurement, design, and analysis: an integrated approach. Hillsdale, N.J.: Lawrence Erlbaum Associates; 1991.
• [56]Strickland OL: Using factor analysis for validity assessment: practical considerations. J Nurs Meas 2003, 11(3):203-205.
• [57]Mishel MH: Methodological studies: instrument development. In Advanced designs in nursing research. 2nd edition. Edited by Brink PJ, Wood MJ. Thousand Oaks, CA: Sage Publications; 1998:235-282.
• [58]Polit DF, Beck CF: Nursing research: principles and methods. 8th edition. Philadelphia: Lippincott Williams & Wilkins; 2004.
• [59]Nunnally JC, Bernstein IH: Psychometric theory. 3rd edition. New York: McGraw-Hill; 1994.
• [60]Walter SD, Eliasziw M, Donner A: Sample size and optimal designs for reliability studies. Stat Med 1998, 17(1):101-110.
• [61]U.S.Preventive Services Task Force: U.S. Preventive services task force grade definitions. 2012. http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm webcite
• [62]Donabedian A: The Lichfield lecture. Quality assurance in health care: consumers’ role. Qual Health Care 1992, 1(4):247-251.
• [63]Lees C: Measuring the patient experience. Nurse Res 2011, 19(1):25-28.
• [64]Novick G: Women’s experience of prenatal care: an integrative review. J Midwifery Womens Health 2009, 54(3):226-237.
• [65]Heaman M, O’Brien B: Prenatal care provider. In What mothers say: the Canadian maternity experiences survey. Edited by Public Health Agency of Canada. Ottawa: Public Health Agency of Canada; 2009:37-41.
• [66]Tough SC, Johnston DW, Siever JE, Jorgenson G, Slocombe L, Lane C, Clarke M: Does supplementary prenatal nursing and home visitation support improve resource use in a universal health care system? A randomized controlled trial in Canada. Birth-Issues Perinatal Care 2006, 33(3):183-194.
• [67]Carifio J, Perla R: Ten common misunderstandings, misconceptions, persistent myths and urban legends about Likert scales and Likert response formats and their antidotes. J Soc Sci 2007, 3(3):106-116.
• [68]Carifio J, Perla R: Resolving the 50-year debate around using and misuing Likert scales. Med Educ 2008, 42:1150-1151.
• [69]Rosenberg KD: Benefits and limitations of prenatal care. JAMA 1998, 280(24):2072.