Observational Study

. 2022 Apr 8;12(4):e056753.

doi: 10.1136/bmjopen-2021-056753.

WHO Standards-based questionnaire to measure health workers' perspective on the quality of care around the time of childbirth in the WHO European region: development and mixed-methods validation in six countries

Emanuelle Pessa Valente¹, Benedetta Covi², Ilaria Mariani², Sandra Morano³, Marina Otalea^{4

5}, Ioana Nanu⁶, Micaela Iuliana Nanu⁶, Helen Elden^{7

8}, Karolina Linden⁷, Mehreen Zaigham⁹, Eline Skirnisdottir Vik¹⁰, Sigrun Kongslien¹¹, Ingvild Nedberg¹¹, Raquel Costa^{12

13

14}, Carina Rodrigues^{12

13}, Heloísa Dias¹⁵, Daniela Drandić¹⁶, Magdalena Kurbanović¹⁷, Emma Sacks¹⁸, Moise Muzigaba¹⁹, Ornella Lincetto¹⁹, Marzia Lazzerini²; IMAgiNE EURO Study Group

Collaborators, Affiliations

Collaborators

IMAgiNE EURO Study Group:
Amira Ćerimagic, Rozée Virginie, Elise deLa Rochebrochard, Kristina Löfgren, Céline Miani, Stephanie Batram-Zantvoort, Lisa Wandschneider, Giuseppa Verardi, Beatrice Zanin, Ilana Chertok, Rada Artzi-Medvedik, Elizabete Pumpure, Dace Rezeberga, Agnija Vaska, Dārta Jakovicka, Paula Rudzīte, Elīna Ērmane, Katrīna Paula Vilcāne, Maryse Arendt, Barbara Tasch, Barbara Baranowska, Urszula Tataj-Puzyna, Maria Węgrzynowska, Catarina Barata, Teresa Santos, Ekaterina Yarotskaya, Jelena Radetić, Jovana Ružičić, Zalka Drglin, Barbara Mihevc Ponikvar, Anja Bohinec, Serena Brigidi, Lara Martín Castañeda, Ana Canales Viver, Verena Sengpiel, Claire De Labrusse, Alessia Abderhalden, Anouck Pfund, Harriet Thorn

Affiliations

¹ WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy emanuelle.pessavalente@burlo.trieste.it.
² WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.
³ Medical School and Midwifery School, Genoa University, Genoa, Italy.
⁴ University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.
⁵ SAMAS Association, Bucharest, Romania.
⁶ National Institute for Mother and Child Health "Alessandrescu - Rusescu", Bucharest, Romania.
⁷ Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁸ Region Västra Götaland, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁹ Department of Obstetrics and Gynecology - Institution of Clinical Sciences Lund, Lund University, Lund and Skåne University Hospital, Malmö, Sweden.
¹⁰ Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
¹¹ Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
¹² EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal.
¹³ Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal.
¹⁴ Human-Environment Interaction Lab, Universidade Lusófona, Porto, Portugal.
¹⁵ Regional Health Administration of the Algarve, IP (ARS - Algarve), Albufeira, Portugal.
¹⁶ Roda - Parents in Action, Zagreb, Croatia.
¹⁷ Faculty of Health Studies, University of Rijeka, Rijeka, Croatia.
¹⁸ Department of International Health, Johns Hopkins University, Baltimore, Maryland, USA.
¹⁹ Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland.

PMID: 35396296
PMCID: PMC8995570
DOI: 10.1136/bmjopen-2021-056753

Observational Study

WHO Standards-based questionnaire to measure health workers' perspective on the quality of care around the time of childbirth in the WHO European region: development and mixed-methods validation in six countries

Emanuelle Pessa Valente et al. BMJ Open. 2022.

. 2022 Apr 8;12(4):e056753.

doi: 10.1136/bmjopen-2021-056753.

Authors

Collaborators

IMAgiNE EURO Study Group:
Amira Ćerimagic, Rozée Virginie, Elise deLa Rochebrochard, Kristina Löfgren, Céline Miani, Stephanie Batram-Zantvoort, Lisa Wandschneider, Giuseppa Verardi, Beatrice Zanin, Ilana Chertok, Rada Artzi-Medvedik, Elizabete Pumpure, Dace Rezeberga, Agnija Vaska, Dārta Jakovicka, Paula Rudzīte, Elīna Ērmane, Katrīna Paula Vilcāne, Maryse Arendt, Barbara Tasch, Barbara Baranowska, Urszula Tataj-Puzyna, Maria Węgrzynowska, Catarina Barata, Teresa Santos, Ekaterina Yarotskaya, Jelena Radetić, Jovana Ružičić, Zalka Drglin, Barbara Mihevc Ponikvar, Anja Bohinec, Serena Brigidi, Lara Martín Castañeda, Ana Canales Viver, Verena Sengpiel, Claire De Labrusse, Alessia Abderhalden, Anouck Pfund, Harriet Thorn

Affiliations

¹ WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy emanuelle.pessavalente@burlo.trieste.it.
² WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.
³ Medical School and Midwifery School, Genoa University, Genoa, Italy.
⁴ University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.
⁵ SAMAS Association, Bucharest, Romania.
⁶ National Institute for Mother and Child Health "Alessandrescu - Rusescu", Bucharest, Romania.
⁷ Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁸ Region Västra Götaland, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁹ Department of Obstetrics and Gynecology - Institution of Clinical Sciences Lund, Lund University, Lund and Skåne University Hospital, Malmö, Sweden.
¹⁰ Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
¹¹ Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
¹² EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal.
¹³ Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal.
¹⁴ Human-Environment Interaction Lab, Universidade Lusófona, Porto, Portugal.
¹⁵ Regional Health Administration of the Algarve, IP (ARS - Algarve), Albufeira, Portugal.
¹⁶ Roda - Parents in Action, Zagreb, Croatia.
¹⁷ Faculty of Health Studies, University of Rijeka, Rijeka, Croatia.
¹⁸ Department of International Health, Johns Hopkins University, Baltimore, Maryland, USA.
¹⁹ Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland.

PMID: 35396296
PMCID: PMC8995570
DOI: 10.1136/bmjopen-2021-056753

Abstract

Objectives: Develop and validate a WHO Standards-based online questionnaire to measure the quality of maternal and newborn care (QMNC) around the time of childbirth from the health workers' perspective.

Design: Mixed-methods study.

Setting: Six countries of the WHO European Region.

Participants and methods: The questionnaire is based on lessons learnt in previous studies, and was developed in three sequential phases: (1) WHO Quality Measures were prioritised and content, construct and face validity were assessed through a Delphi involving a multidisciplinary board of experts from 11 countries of the WHO European Region; (2) translation/back translation of the English version was conducted following The Professional Society for Health Economics and Outcomes Research guidelines; (3) internal consistency, intrarater reliability and acceptability were assessed among 600 health workers in six countries.

Results: The questionnaire included 40 items based on WHO Standards Quality Measures, equally divided into four domains: provision of care, experience of care, availability of human and physical resources, organisational changes due to COVID-19; and its organised in six sections. It was translated/back translated in 12 languages: Bosnian, Croatian, French, German, Italian, Norwegian, Portuguese, Romanian, Russian, Slovenian, Spanish and Swedish. The Cronbach's alpha values were ≥0.70 for each questionnaire section where questions were hypothesised to be interrelated, indicating good internal consistence. Cohen K or Gwet's AC1 values were ≥0.60, suggesting good intrarater reliability, except for one question. Acceptability was good with only 1.70% of health workers requesting minimal changes in question wording.

Conclusions: Findings suggest that the questionnaire has good content, construct, face validity, internal consistency, intrarater reliability and acceptability in six countries of the WHO European Region. Future studies may further explore the questionnaire's use in other countries, and how to translate evidence generated by this tool into policies to improve the QMNC.

Trail registration number: NCT04847336.

Keywords: NEONATOLOGY; OBSTETRICS; Quality in health care.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

**Figure 1**
Phases of questionnaire development and multicountry validation.

See this image and copyright information in PMC

References

1. World Health Organization . Every woman every child. Global strategy for women’s, children’s and adolescents health 2016–2030, 2016. Available: http://www.who.int/life-course/partners/global-strategy/global-strategy-... [Accessed 14 Apr 2021].
1. United Nations . The Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030). Every Woman Every Child, 2015. Available: https://www.who.int/life-course/partners/global-strategy/globalstrategyr... [Accessed 14 Apr 2021].
1. The White Ribbon Alliance . Respectful maternity care charter: universal rights of women and newborns, 2021. Available: https://www.whiteribbonalliance.org/rmcresources/ [Accessed 14 Apr 2021].
1. Graham WJ, Varghese B. Quality, quality, quality: gaps in the continuum of care. Lancet 2012;379:e5–6. 10.1016/S0140-6736(10)62267-2 - DOI - PubMed
1. Bohren MA, Vogel JP, Hunter EC, et al. . The mistreatment of women during childbirth in health facilities globally: a mixed-methods systematic review. PLoS Med 2015;12:e1001847. 10.1371/journal.pmed.1001847 - DOI - PMC - PubMed

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WHO Standards-based questionnaire to measure health workers' perspective on the quality of care around the time of childbirth in the WHO European region: development and mixed-methods validation in six countries

Collaborators

Affiliations

WHO Standards-based questionnaire to measure health workers' perspective on the quality of care around the time of childbirth in the WHO European region: development and mixed-methods validation in six countries

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Associated data

Grants and funding

LinkOut - more resources

Full Text Sources

Medical