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. 2017 Sep 22;14(1):118.
doi: 10.1186/s12978-017-0381-7.

Development of a tool to measure person-centered maternity care in developing settings: validation in a rural and urban Kenyan population

Patience A Afulani  1 , Nadia Diamond-Smith  2 , Ginger Golub  3 , May Sudhinaraset  2   4
Affiliations

Development of a tool to measure person-centered maternity care in developing settings: validation in a rural and urban Kenyan population

Patience A Afulani et al. Reprod Health. .

Abstract

Background: Person-centered reproductive health care is recognized as critical to improving reproductive health outcomes. Yet, little research exists on how to operationalize it. We extend the literature in this area by developing and validating a tool to measure person-centered maternity care. We describe the process of developing the tool and present the results of psychometric analyses to assess its validity and reliability in a rural and urban setting in Kenya.

Methods: We followed standard procedures for scale development. First, we reviewed the literature to define our construct and identify domains, and developed items to measure each domain. Next, we conducted expert reviews to assess content validity; and cognitive interviews with potential respondents to assess clarity, appropriateness, and relevance of the questions. The questions were then refined and administered in surveys; and survey results used to assess construct and criterion validity and reliability.

Results: The exploratory factor analysis yielded one dominant factor in both the rural and urban settings. Three factors with eigenvalues greater than one were identified for the rural sample and four factors identified for the urban sample. Thirty of the 38 items administered in the survey were retained based on the factors loadings and correlation between the items. Twenty-five items load very well onto a single factor in both the rural and urban sample, with five items loading well in either the rural or urban sample, but not in both samples. These 30 items also load on three sub-scales that we created to measure dignified and respectful care, communication and autonomy, and supportive care. The Chronbach alpha for the main scale is greater than 0.8 in both samples, and that for the sub-scales are between 0.6 and 0.8. The main scale and sub-scales are correlated with global measures of satisfaction with maternity services, suggesting criterion validity.

Conclusions: We present a 30-item scale with three sub-scales to measure person-centered maternity care. This scale has high validity and reliability in a rural and urban setting in Kenya. Validation in additional settings is however needed. This scale will facilitate measurement to improve person-centered maternity care, and subsequently improve reproductive outcomes.

Keywords: Developing settings; Kenya; Maternity care; Measurement; Person-centered care; Sub-Saharan Africa; Validation.

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Conflict of interest statement

Ethics approval and consent to participate

The proposal and study materials for the two projects that provide data for this manuscript were reviewed and approved by the UCSF Committee for Human Subjects research (IRB numbers 15-18,458 and 15-18,008) and the Kenya Medical Research Institute Scientific and Ethics Review Unit (protocol IDs KEMRI/SERU/CCR/039/3286 and non-KEMRI 526). All participants provided written informed consent prior to participation.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Scree plot of eigenvalues after factor analysis for the rural, urban, and combined samples
See this image and copyright information in PMC

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