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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2015

Open Access 01-12-2015 | Research article

Quality of prenatal care questionnaire: psychometric testing in an Australia population

Authors: Wendy Sword, Maureen Heaman, Mary Anne Biro, Caroline Homer, Jane Yelland, Noori Akhtar-Danesh, Amanda Bradford-Janke

Published in: BMC Pregnancy and Childbirth | Issue 1/2015

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Abstract

Background

The quality of antenatal care is recognized as critical to the effectiveness of care in optimizing maternal and child health outcomes. However, research has been hindered by the lack of a theoretically-grounded and psychometrically sound instrument to assess the quality of antenatal care. In response to this need, the 46-item Quality of Prenatal Care Questionnaire (QPCQ) was developed and tested in a Canadian context. The objective of this study was to validate the QPCQ and to establish its internal consistency reliability in an Australian population.

Methods

Study participants were recruited from two public maternity services in two Australian states: Monash Health, Victoria and Wollongong Hospital, New South Wales. Women were eligible to participate if they had given birth to a single live infant, were 18 years or older, had at least three antenatal visits during the pregnancy, and could speak, read and write English. Study questionnaires were completed in hospital. A confirmatory factor analysis (CFA) was conducted. Construct validity, including convergent validity, was further assessed against existing questionnaires: the Patient Expectations and Satisfaction with Prenatal Care (PESPC) and the Prenatal Interpersonal Processes of Care (PIPC). Internal consistency reliability of the QPCQ and each of its six subscales was assessed using Cronbach’s alpha.

Results

Two hundred and ninety-nine women participated in the study. CFA verified and confirmed the six factors (subscales) of the QPCQ. A hypothesis-testing approach and an assessment of convergent validity further supported construct validity of the instrument. The QPCQ had acceptable internal consistency reliability (Cronbach’s alpha = 0.97), as did each of the six factors (Cronbach’s alpha = 0.74 to 0.95).

Conclusions

The QPCQ is a valid and reliable self-report measure of antenatal care quality. This instrument fills a scientific gap and can be used in research to examine relationships between the quality of antenatal care and outcomes of interest, and to examine variations in antenatal care quality. It also will be useful in quality assurance and improvement initiatives.
Literature
1.
Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press; 2001.
2.
Donabedian A. Evaluating the quality of medical care. Millbank Q. 1966;44:166–203.CrossRef
3.
Donabedian A. The quality of care. How can it be assessed? JAMA. 1988;260:1743–8.
4.
5.
Bender DE, Harbour C, Thorp J, Morris P. Tell me what you mean by “si”: perceptions of quality of prenatal care among immigrant Latina women. Qual Health Res. 2001;11:780–94.CrossRefPubMed
6.
Oladapo OT, Iyaniwura CA, Sule-Odu AO. Quality of antenatal services at the primary care level in southwest Nigeria. Afr J Reprod Health. 2008;12:71–92.PubMed
7.
Renfrew MJ. Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care. Lancet. 2014;384:1129–45.CrossRefPubMed
8.
Sword W, Heaman MI, Brooks S, Tough S, Janssen PA, Young D, et al. Women’s and care providers’ perspectives of quality prenatal care: a qualitative descriptive study. BMC Pregnancy Childbirth. 2012;12:29.CrossRefPubMedPubMedCentral
9.
Fawole AO, Okunlola MA, Adekunle AO. Clients’ perceptions of the quality of antenatal care. J Natl Med Assoc. 2008;100:1052–8.CrossRefPubMed
10.
Kirkham C, Harris S, Grzybowski S. Evidence-based prenatal care: part II. Third-trimester care and prevention of infectious diseases. Am Fam Physician. 2005;71:1555–60.PubMed
11.
Kirkham C, Harris S, Grzybowski S. Evidence-based prenatal care: Part I. General prenatal care and counseling issues. Am Fam Physician. 2005;71:1307–16.PubMed
12.
Wheatley RR, Kelley MA, Peacock N, Delgado J. Women’s narratives on quality in prenatal care: a multicultural perspective. Qual Health Res. 2008;18:1586–98.CrossRefPubMed
13.
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;14:118–29.CrossRefPubMed
14.
Tillett J. Developing guidelines and maintaining quality in antenatal care. J Midwifery Womens Health. 2009;54:238–40.CrossRefPubMed
15.
Tucker J, Farmer J, Stimpson P. Guidelines and management of mild hypertensive conditions in pregnancy in rural general practices in Scotland: issues of appropriateness and access. Qual Saf Health Care. 2003;12:286–90.CrossRefPubMedPubMedCentral
16.
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;91:105–11.CrossRefPubMedPubMedCentral
17.
Ricketts SA, Murray EK, Schwalberg R. Reducing low birthweight by resolving risks: results from Colorado’s prenatal plus program. Am J Public Health. 2005;95:1952–7.CrossRefPubMedPubMedCentral
18.
Wilkinson SA, McIntyre HD. Evaluation of the ‘healthy start to pregnancy’ early antenatal health promotion workshop: a randomized controlled trial. BMC Pregnancy Childbirth. 2012;12:131.CrossRefPubMedPubMedCentral
19.
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;27:777–92.CrossRefPubMed
20.
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.CrossRefPubMed
21.
Vonderheid SC, Norr KF, Handler AS. Prenatal health promotion content and health behaviors. West J Nurs Res. 2007;29:258–76.CrossRefPubMed
22.
Massey Z, Rising SS, Ickovics J. CenteringPregnancy group prenatal care: promoting relationship-centered care. J Obstet Gynecol Neonatal Nurs. 2006;35:286–94.CrossRefPubMed
23.
Homer CS, Ryan C, Leap N, Foureur M, Teate A, Catling-Paull CJ. Group versus conventional antenatal care for women. Cochrane Database Syst Rev. 2012;11, CD007622.PubMed
24.
Ickovics JR, Kershaw TS, Westdahl C, Magriples U, Massey Z, Reynolds H, et al. Group prenatal care and perinatal outcomes: a randomized controlled trial. Obstet Gynecol. 2007;110(2 Pt 1):330–9.CrossRefPubMedPubMedCentral
25.
Kennedy HP, Farrell T, Paden R, Hill S, Jolivet R, Willetts J, et al. “I wasn’t alone”--a study of group prenatal care in the military. J Midwifery Womens Health. 2009;54:176–83.CrossRefPubMed
26.
Kershaw TS, Magriples U, Westdahl C, Rising SS, Ickovics J. Pregnancy as a window of opportunity for HIV prevention: effects of an HIV intervention delivered within prenatal care. Am J Public Health. 2009;99:2079–86.CrossRefPubMedPubMedCentral
27.
Alexander GR, Kotelchuck M. Assessing the role and effectiveness of prenatal care: history, challenges, and directions for future research. Public Health Rep. 2001;116:306–16.CrossRefPubMedPubMedCentral
28.
Heaman MI, Sword WA, Akhtar-Danesh N, Bradford A, Tough S, Janssen PA, et al. Quality of prenatal care questionnaire: instrument development and testing. BMC Pregnancy Childbirth. 2014;14:188.CrossRefPubMedPubMedCentral
29.
DeVellis RF. Scale development: theory and applications. Thousand Oak, CA: Sage Publications, Inc.; 2003.
30.
Comrey AL, Lee HB. A first course in factor analysis. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum; 1992.
31.
Omar MA, Schiffman RF, Bingham CR. Development and testing of the patient expectations and satisfaction with prenatal care instrument. Res Nurs Health. 2001;24:218–29.CrossRefPubMed
32.
Streiner DL, Norman GR. Health measurement scales: a practical guide to their development and use. Oxford, UK: Oxford University Press; 2003.
33.
Ullman JB. Structural equation modeling. In: Tabachnick BG, Fidell LS, editors. Using multivariate statistics. 4th ed. Boston: Allyn and Bacon; 1996. p. 653–771.
34.
Browne MW, Cudeck R. Alternative ways of assessing model fit. In: Bollen KA, Long JS, editors. Testing structural equation models. Newbury Park, CA: Sage; 1993. p. 136–62.
35.
Hu LT, Bentler PM. Cutoff criteria for fit indices in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model. 1999;6:1–55.CrossRef
36.
Polit DF, Beck CT. Nursing resaerch: generating and assessing evidence for nursing practice. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2012.
37.
Barry OM, Bergh AM, Makin JD, Etsane E, Kershaw TS, Forsyth BW. Development of a measure of the patient-provider relationship in antenatal care and its importance in PMTCT. AIDS Care. 2012;24:680–6.CrossRefPubMed
38.
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.CrossRefPubMedPubMedCentral
39.
Mendoza MD, Smith SG, Eder MM, Hickner J. The seventh element of quality: the doctor-patient relationship. Fam Med. 2011;43:83–9.PubMed
40.
State of Victoria, Department of Health. Victorian maternity services performance indicators. Complete set for 2010–11 and 2011–12. Melbourne: Victorian Government; 2014.
41.
Metadata
Title
Quality of prenatal care questionnaire: psychometric testing in an Australia population
Authors
Wendy Sword
Maureen Heaman
Mary Anne Biro
Caroline Homer
Jane Yelland
Noori Akhtar-Danesh
Amanda Bradford-Janke
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2015
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-015-0644-7

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