Women's experiences of and satisfaction with childbirth: Development and validation of a measurement scale for low- and middle-income countries.

<h4>Background</h4>Measuring person-centered maternity care outcomes typically consists of two types of measures: experiences of care and satisfaction with care. There are limited validated measurement tools for these measures, particularly in low- and middle-income countries (LMICs). Th...

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Main Authors: Meghan A Bohren, Charbel Abi Saad, Charles Kabore, Kristi Sidney Annerstedt, Claudia Hanson, Myriam de Loenzien, Simon Tiendrebeogo, Fadima Bocoum, Marion Ravit, Camille Etcheverry, Pisake Lumbiganon, Nampet Jampathong, Guillermo Carroli, Celina Gialdini, Quoc Nhu Hung Mac, Helle Mölsted Alvesson, Andrainolo Ravalihasy, Alexandre Dumont, Ana Pilar Betrán
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2025-01-01
Series:PLoS ONE
Online Access:https://doi.org/10.1371/journal.pone.0322132
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author Meghan A Bohren
Charbel Abi Saad
Charles Kabore
Kristi Sidney Annerstedt
Claudia Hanson
Myriam de Loenzien
Simon Tiendrebeogo
Fadima Bocoum
Marion Ravit
Camille Etcheverry
Pisake Lumbiganon
Nampet Jampathong
Guillermo Carroli
Celina Gialdini
Quoc Nhu Hung Mac
Helle Mölsted Alvesson
Andrainolo Ravalihasy
Alexandre Dumont
Ana Pilar Betrán
author_facet Meghan A Bohren
Charbel Abi Saad
Charles Kabore
Kristi Sidney Annerstedt
Claudia Hanson
Myriam de Loenzien
Simon Tiendrebeogo
Fadima Bocoum
Marion Ravit
Camille Etcheverry
Pisake Lumbiganon
Nampet Jampathong
Guillermo Carroli
Celina Gialdini
Quoc Nhu Hung Mac
Helle Mölsted Alvesson
Andrainolo Ravalihasy
Alexandre Dumont
Ana Pilar Betrán
author_sort Meghan A Bohren
collection DOAJ
description <h4>Background</h4>Measuring person-centered maternity care outcomes typically consists of two types of measures: experiences of care and satisfaction with care. There are limited validated measurement tools for these measures, particularly in low- and middle-income countries (LMICs). The QUALI-DEC study aims to improve decision-making around caesarean section. We describe development of the QUALI-DEC Study Birth Experience and Satisfaction (QD-BES) scale, and scale validation in Argentina, Burkina Faso, Thailand, and Viet Nam.<h4>Methods</h4>We used a three-phase scale development and validation approach: 1) item development, 2) scale development, and 3) scale evaluation. We systematically identified existing tools, and assessed them using the QUALI-DEC theory of change, study context, and psychometric qualities. We proposed the 10-item QD-BES scale to balance feasibility, theoretical coverage, and comprehensiveness. We conducted a baseline exit survey with post-partum women in 32 hospitals in 4 countries. We conducted exploratory factor analysis (EFA), and confirmatory factor analysis (CFA).<h4>Results</h4>3127 women participated, most were multiparous (61.0%), without previous caesarean section (77.2%), and preferred vaginal birth (72.8%) despite high rates of caesarean section (39.4%). EFA identified three dimensions: emotional satisfaction (3-items), support and respect by providers (4-items), and communication with providers (3-items), with high loading coefficients (0.5-0.97). CFA confirmed the three-dimension scale, with good model fit (CFI and IFI: 0.95, Cronbach's alpha: 0.70-0.90). Criterion validity was assessed by exploring characteristics of women, obstetric histories, and birth experiences.<h4>Conclusions</h4>We present psychometric validation of a scale measuring women's satisfaction with care and experiences of childbirth care, using a systematic approach to development and validation in four LMICs. The 10-item QD-BES-scale is short, easily-administered, valid, and reliable. The QD-BES-scale is useful to contribute to the generation of new knowledge about quality of maternity care in LMICs, as well as help to meet the major challenge of implementing and measuring respectful care at scale.
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spelling doaj-art-b1600df8d19241ca8264c20a508fb5792025-08-20T03:50:07ZengPublic Library of Science (PLoS)PLoS ONE1932-62032025-01-01205e032213210.1371/journal.pone.0322132Women's experiences of and satisfaction with childbirth: Development and validation of a measurement scale for low- and middle-income countries.Meghan A BohrenCharbel Abi SaadCharles KaboreKristi Sidney AnnerstedtClaudia HansonMyriam de LoenzienSimon TiendrebeogoFadima BocoumMarion RavitCamille EtcheverryPisake LumbiganonNampet JampathongGuillermo CarroliCelina GialdiniQuoc Nhu Hung MacHelle Mölsted AlvessonAndrainolo RavalihasyAlexandre DumontAna Pilar Betrán<h4>Background</h4>Measuring person-centered maternity care outcomes typically consists of two types of measures: experiences of care and satisfaction with care. There are limited validated measurement tools for these measures, particularly in low- and middle-income countries (LMICs). The QUALI-DEC study aims to improve decision-making around caesarean section. We describe development of the QUALI-DEC Study Birth Experience and Satisfaction (QD-BES) scale, and scale validation in Argentina, Burkina Faso, Thailand, and Viet Nam.<h4>Methods</h4>We used a three-phase scale development and validation approach: 1) item development, 2) scale development, and 3) scale evaluation. We systematically identified existing tools, and assessed them using the QUALI-DEC theory of change, study context, and psychometric qualities. We proposed the 10-item QD-BES scale to balance feasibility, theoretical coverage, and comprehensiveness. We conducted a baseline exit survey with post-partum women in 32 hospitals in 4 countries. We conducted exploratory factor analysis (EFA), and confirmatory factor analysis (CFA).<h4>Results</h4>3127 women participated, most were multiparous (61.0%), without previous caesarean section (77.2%), and preferred vaginal birth (72.8%) despite high rates of caesarean section (39.4%). EFA identified three dimensions: emotional satisfaction (3-items), support and respect by providers (4-items), and communication with providers (3-items), with high loading coefficients (0.5-0.97). CFA confirmed the three-dimension scale, with good model fit (CFI and IFI: 0.95, Cronbach's alpha: 0.70-0.90). Criterion validity was assessed by exploring characteristics of women, obstetric histories, and birth experiences.<h4>Conclusions</h4>We present psychometric validation of a scale measuring women's satisfaction with care and experiences of childbirth care, using a systematic approach to development and validation in four LMICs. The 10-item QD-BES-scale is short, easily-administered, valid, and reliable. The QD-BES-scale is useful to contribute to the generation of new knowledge about quality of maternity care in LMICs, as well as help to meet the major challenge of implementing and measuring respectful care at scale.https://doi.org/10.1371/journal.pone.0322132
spellingShingle Meghan A Bohren
Charbel Abi Saad
Charles Kabore
Kristi Sidney Annerstedt
Claudia Hanson
Myriam de Loenzien
Simon Tiendrebeogo
Fadima Bocoum
Marion Ravit
Camille Etcheverry
Pisake Lumbiganon
Nampet Jampathong
Guillermo Carroli
Celina Gialdini
Quoc Nhu Hung Mac
Helle Mölsted Alvesson
Andrainolo Ravalihasy
Alexandre Dumont
Ana Pilar Betrán
Women's experiences of and satisfaction with childbirth: Development and validation of a measurement scale for low- and middle-income countries.
PLoS ONE
title Women's experiences of and satisfaction with childbirth: Development and validation of a measurement scale for low- and middle-income countries.
title_full Women's experiences of and satisfaction with childbirth: Development and validation of a measurement scale for low- and middle-income countries.
title_fullStr Women's experiences of and satisfaction with childbirth: Development and validation of a measurement scale for low- and middle-income countries.
title_full_unstemmed Women's experiences of and satisfaction with childbirth: Development and validation of a measurement scale for low- and middle-income countries.
title_short Women's experiences of and satisfaction with childbirth: Development and validation of a measurement scale for low- and middle-income countries.
title_sort women s experiences of and satisfaction with childbirth development and validation of a measurement scale for low and middle income countries
url https://doi.org/10.1371/journal.pone.0322132
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