Content validation and use of mothers on respect index to determine levels of respectful maternity care among women facing disadvantage, birthing in the Top End of the Northern Territory: a cross-sectional study

IntroductionAlthough recognised as important, few validated tools are available to measure respectful maternity care. In Australia, First Nations, migrant and refugee women have fewer antenatal attendances and poorer outcomes compared to others, with disrespectful maternity care a known barrier to c...

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Main Authors: Emily Rebecca Bowden, Maree R. Toombs, Robyn L. Williams, Anne B. Chang, Deborah Richards, Meredith Porte, Stephanie Yerkovich, Gabrielle Britt McCallum
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-04-01
Series:Frontiers in Global Women's Health
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Online Access:https://www.frontiersin.org/articles/10.3389/fgwh.2025.1531904/full
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author Emily Rebecca Bowden
Maree R. Toombs
Maree R. Toombs
Robyn L. Williams
Anne B. Chang
Anne B. Chang
Anne B. Chang
Deborah Richards
Meredith Porte
Stephanie Yerkovich
Stephanie Yerkovich
Gabrielle Britt McCallum
author_facet Emily Rebecca Bowden
Maree R. Toombs
Maree R. Toombs
Robyn L. Williams
Anne B. Chang
Anne B. Chang
Anne B. Chang
Deborah Richards
Meredith Porte
Stephanie Yerkovich
Stephanie Yerkovich
Gabrielle Britt McCallum
author_sort Emily Rebecca Bowden
collection DOAJ
description IntroductionAlthough recognised as important, few validated tools are available to measure respectful maternity care. In Australia, First Nations, migrant and refugee women have fewer antenatal attendances and poorer outcomes compared to others, with disrespectful maternity care a known barrier to care-seeking. Our primary aim was to determine content validity of the Mothers on Respect index (MORi) for use with women facing disadvantage birthing in the Top End of the Northern Territory. Our secondary aim was to determine the extent of respectful maternity care amongst these women in our setting.MethodsFifteen First Nations women participated in an iterative process, rating and commenting on the original MORi items using content-validation-index for items. 195 First Nations, migrant, refugee women subsequently completed the content-validated MORi, within 12-months postpartum.ResultsContent validity was established for all items; The overall median MORi score was high at 78 [interquartile range (IQR) 72–83]. Migrant women had the highest median score of 80 (IQR 76–83), remote-living First Nations women had the lowest at 63.5 (IQR 55–76). There were no significant differences across antenatal attendance, educational attainment, or primary caregiver.DiscussionOverall, high levels of respectful maternity care were observed. First Nations women from remote communities, and refugee women within some domains, experienced lower levels of respect than others, perhaps resulting from ongoing systemic disadvantage. MORi content-validity was established for First Nations Australians, migrant and refugee women with disparity between cohorts observed. Continuity-of-carer, increased access to interpreters, and companion of choice may address some of these disparities.
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spelling doaj-art-af534e2aa7014927a6543aa09a8126082025-08-20T01:55:12ZengFrontiers Media S.A.Frontiers in Global Women's Health2673-50592025-04-01610.3389/fgwh.2025.15319041531904Content validation and use of mothers on respect index to determine levels of respectful maternity care among women facing disadvantage, birthing in the Top End of the Northern Territory: a cross-sectional studyEmily Rebecca Bowden0Maree R. Toombs1Maree R. Toombs2Robyn L. Williams3Anne B. Chang4Anne B. Chang5Anne B. Chang6Deborah Richards7Meredith Porte8Stephanie Yerkovich9Stephanie Yerkovich10Gabrielle Britt McCallum11Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, AustraliaChild and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, AustraliaSchool of Population Health, University or New South Wales, Sydney, NSW, AustraliaChild and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, AustraliaChild and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, AustraliaAustralian Centre for HealthServices Innovation, Queensland University of Technology, Brisbane, QLD, AustraliaDepartment of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Brisbane, QLD, AustraliaDepartment of Computing, Faculty of Science and Engineering, Macquarie University, Sydney, NSW, AustraliaDepartment of Computing, Faculty of Science and Engineering, Macquarie University, Sydney, NSW, AustraliaChild and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, AustraliaAustralian Centre for HealthServices Innovation, Queensland University of Technology, Brisbane, QLD, AustraliaChild and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, AustraliaIntroductionAlthough recognised as important, few validated tools are available to measure respectful maternity care. In Australia, First Nations, migrant and refugee women have fewer antenatal attendances and poorer outcomes compared to others, with disrespectful maternity care a known barrier to care-seeking. Our primary aim was to determine content validity of the Mothers on Respect index (MORi) for use with women facing disadvantage birthing in the Top End of the Northern Territory. Our secondary aim was to determine the extent of respectful maternity care amongst these women in our setting.MethodsFifteen First Nations women participated in an iterative process, rating and commenting on the original MORi items using content-validation-index for items. 195 First Nations, migrant, refugee women subsequently completed the content-validated MORi, within 12-months postpartum.ResultsContent validity was established for all items; The overall median MORi score was high at 78 [interquartile range (IQR) 72–83]. Migrant women had the highest median score of 80 (IQR 76–83), remote-living First Nations women had the lowest at 63.5 (IQR 55–76). There were no significant differences across antenatal attendance, educational attainment, or primary caregiver.DiscussionOverall, high levels of respectful maternity care were observed. First Nations women from remote communities, and refugee women within some domains, experienced lower levels of respect than others, perhaps resulting from ongoing systemic disadvantage. MORi content-validity was established for First Nations Australians, migrant and refugee women with disparity between cohorts observed. Continuity-of-carer, increased access to interpreters, and companion of choice may address some of these disparities.https://www.frontiersin.org/articles/10.3389/fgwh.2025.1531904/fullrespectful maternity caremigrantrefugeeFirst NationsMORiNorthern Territory
spellingShingle Emily Rebecca Bowden
Maree R. Toombs
Maree R. Toombs
Robyn L. Williams
Anne B. Chang
Anne B. Chang
Anne B. Chang
Deborah Richards
Meredith Porte
Stephanie Yerkovich
Stephanie Yerkovich
Gabrielle Britt McCallum
Content validation and use of mothers on respect index to determine levels of respectful maternity care among women facing disadvantage, birthing in the Top End of the Northern Territory: a cross-sectional study
Frontiers in Global Women's Health
respectful maternity care
migrant
refugee
First Nations
MORi
Northern Territory
title Content validation and use of mothers on respect index to determine levels of respectful maternity care among women facing disadvantage, birthing in the Top End of the Northern Territory: a cross-sectional study
title_full Content validation and use of mothers on respect index to determine levels of respectful maternity care among women facing disadvantage, birthing in the Top End of the Northern Territory: a cross-sectional study
title_fullStr Content validation and use of mothers on respect index to determine levels of respectful maternity care among women facing disadvantage, birthing in the Top End of the Northern Territory: a cross-sectional study
title_full_unstemmed Content validation and use of mothers on respect index to determine levels of respectful maternity care among women facing disadvantage, birthing in the Top End of the Northern Territory: a cross-sectional study
title_short Content validation and use of mothers on respect index to determine levels of respectful maternity care among women facing disadvantage, birthing in the Top End of the Northern Territory: a cross-sectional study
title_sort content validation and use of mothers on respect index to determine levels of respectful maternity care among women facing disadvantage birthing in the top end of the northern territory a cross sectional study
topic respectful maternity care
migrant
refugee
First Nations
MORi
Northern Territory
url https://www.frontiersin.org/articles/10.3389/fgwh.2025.1531904/full
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