Development of an Instrument to Assess the Quality of Childbirth Care from the Mother's Perspective

Geum Hee Jeong; Hyun Kyoung Kim; Young Hee Kim; Sun-Hee Kim; Sun Hee Lee; Kyung Won Kim

doi:10.4040/jkan.2018.48.1.38

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Jeong, Kim, Kim, Kim, Lee, and Kim: Development of an Instrument to Assess the Quality of Childbirth Care from the Mother's Perspective

Original Article

J Korean Acad Nurs 2018;48(1):38-49.

Published online: 15 January 2018

DOI: https://doi.org/10.4040/jkan.2018.48.1.38

Development of an Instrument to Assess the Quality of Childbirth Care from the Mother's Perspective

Geum Hee Jeong¹, Hyun Kyoung Kim^2,, Young Hee Kim³, Sun-Hee Kim⁴, Sun Hee Lee⁵, Kyung Won Kim⁶

¹Division of Nursing, Hallym University, Chuncheon

²Department of Nursing, Korea Christian University, Seoul

³Department of Nursing, Dongguk University, Gyeongju

⁴College of Nursing, Daegu Catholic University, Daegu

⁵Department of Nursing Science, Gimcheon University, Gimcheon

⁶Department of Nursing, Daegu Haany University, Daegu, Korea

Address reprint requests to : Kim, Hyun Kyoung Department of Nursing, Korea Christian University, 47 24-gil, Kkachisan-ro, Gangseo-gu, Seoul 07661, Korea Tel: +82-2-2600-2556 Fax: +82-2-2600-2524 E-mail: leomommy@hanmail.net

Received 24 August 2017 Revised 11 January 2018 Accepted 14 January 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

This study aimed to develop an instrument to assess the quality of childbirth care from the perspective of a mother after delivery.

Methods

The instrument was developed from a literature review, interviews, and item validation. Thirty-eight items were compiled for the instrument. The data for validity and reliability testing were collected using a questionnaire survey conducted on 270 women who had undergone normal vaginal delivery in Korea and analyzed with descriptive statistics, exploratory factor analysis, and reliability coefficients.

Results

The exploratory factor analysis reduced the number of items in the instrument to 28 items that were factored into four subscales: family-centered care, personal care, emotional empowerment, and information provision. With respect to convergence validation, there was positive correlation between this instrument and birth satisfaction scale (r=.34, p<.001). The internal consistency reliability was acceptable (Cronbach's alpha =.96).

Conclusion

This instrument could be used as a measure of the quality of nursing care for women who have a normal vaginal delivery.

Keywords: Mothers, Quality of health care, Reproducibility of results, Statistical factor analysis, Surveys and questionnaire

References

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Figure 1.

Steps of instrument development.

Table 1.

Characteristics of Subjects (N=251)

Variables	Categories	n (%)	M (SD)
Age (yr)	20~29	69 (27.4)	31.75 (4.12)
	30~39	172 (68.6)
	≥40	10 (4.0)
Education	≤High school	37 (14.7)
	College	197 (78.5)
	≥Graduate school	17 (6.8)
Economic	High	7 (2.8)
status	Middle	226 (90.1)
	Low	18 (7.1)
Parity	1	139 (55.4)	1.52 (0.70)
	2	98 (39.0)
	3	12 (4.8)
	4	2 (0.8)
Received	Enema	174 (69.0)
treatment	Episiotomy	170 (67.5)
during	Epidural anethesia	167 (66.3)
delivery	Shaving	145 (57.5)
	Nelaton	136 (54.0)
	Oxytocin	132 (52.4)
Participation	Yes	91 (36.3)
in prenatal	No	160 (63.7)
education
Place of birth	General hospital	105 (41.7)
	Women hospital	146 (58.3)
Exercise during	Regular (≥3 times a	45 (17.9)
pregnancy	week)
	Sometimes	149 (59.4)
	No	57 (22.7)

M=Mean; SD=Standard deviation.

Table 2.

Factor Analysis of QUOTE-Birth (N=251)

Item no	Abbreviated descriptors of items	Item-total correlation	Factor loading
	(Nurse~)	r	1	2	3	4	Total
35.	Obtained my family’s consent before treatment and care.	.72	.73	.24	.12	.24
34.	Obtained my consent before treatment and care.	.73	.72	.28	.04	.31
33.	Explained how to care for myself.	.75	.71	.30	.19	.20
28.	Explained the progress of the delivery to my family.	.78	.70	.22	.26	.29
27.	Helped my family support me in labor.	.74	.68	.25	.34	.10
38.	Allowed my husband see the baby right I gave birth.	.74	.67	.22	.24	.19
37.	Allowed my husband to participate in the birth.	.68	.67	.21	.25	.10
32.	Let me rest comfortably.	.75	.64	.34	.22	.24
26.	Was kind to my family.	.74	.63	.30	.35	.10
24.	Celebrated my baby's birth with great joy.	.65	.55	.08	.45	.13
3.	Took care of my body gently.	.69	.30	.73	.21	.11
1.	Took care of me all the time.	.67	.31	.68	.19	.12
2.	Spent a lot of time with me during labor.	.65	.31	.67	.26	.01
5.	Responded appropriately to my needs.	.71	.31	.63	.19	.29
4.	Quickly helped me when I needed something.	.60	.16	.62	.06	.55
7.	Conducted vaginal examinations gently.	.61	.24	.61	.19	.16
13.	Listened to me carefully.	.74	.20	.60	.51	.26
11.	Helped me get into comfortable positions.	.68	.15	.48	.50	.29
19.	Comforted me psychologically by staying by my side.	.74	.38	.29	.65	.15
12.	Encouraged me.	.74	.25	.43	.65	.17
20.	Provided me with a comfortable environment.	.77	.44	.22	.60	.27
17.	Got to know me and helped me before telling me what I needed to do.	.58	.31	.06	.56	.22
16.	Gave me courage when I tried to give up.	.62	.16	.26	.54	.34
23.	Periodically checked the condition of my fetus.	.62	.29	.11	.18	.75
21.	Told me how to push hard during labor.	.63	.24	.08	.32	.72
22.	Explained how to help in the progress of my childbirth.	.68	.32	.11	.29	.72
15.	Explained my delivery progress.	.63	.08	.40	.23	.68
18.	Fully answered all my questions.	.80	.38	.37	.46	.42
	Eigen value		6.07	4.52	3.82	3.61
	% of variance		21.7	16.2	13.7	12.9
	% of cumulated variance		21.7	37.9	51.5	64.4	64.4
	Number of items		10	8	5	5	28
	Correlation r factor-total score		.93	.89	.88	.83
	p		<.001	<.001	<.001	<.001
	Cronbach’s alpha	.	.94	.91	.88	.85	.96

QUOTE-Birth=QUality Of care Through patients’ Eyes-Birth.

Table 3.

Correlation between QUOTE-Birth and Birth Satisfaction Scale-Revised (N=251)

QUOTE-Birth	Birth satisfaction scale-revised
	r (p)
Factor 1. Family-centered care	.37 (<.001)
Factor 2. Personal care	.30 (<.001)
Factor 3. Emotional empowerment	.26 (<.001)
Factor 4. Information provision	.23 (<.001)
Total	.34 (<.001)

QUOTE-Birth=QUality Of care Through patients’ Eyes-Birth.

Table 4.

Importance Score, Performance Score and Quality Index of QUOTE-Birth (N=251)

Item no	Abbreviated descriptors of items	Importance score	Performance score	Quality index
	(Nurse~)	M±SD	M±SD	M±SD
Factor 1	1. Family-centered care
35.	Obtained my family’s consent before treatment and care.	3.28±0.66	0.86±0.34	2.86±1.29
34.	Obtained my consent before treatment and care.	3.39±0.57	0.86±0.34	3.15±1.01
33.	Explained how to care for myself.	3.41±0.56	0.78±0.41	2.69±1.51
28.	Explained the progress of the delivery to my family.	3.35±0.56	0.79±0.40	2.70±1.45
27.	Helped my family support me in labor.	3.27±0.61	0.75±0.42	2.56±1.53
38.	Allowed my husband see the baby right I gave birth.	3.40±0.60	0.93±0.25	3.19±1.03
37.	Allowed my husband to participate in the birth.	3.30±0.66	0.87±0.33	2.90±1.26
32.	Let me rest comfortably.	3.45±0.53	0.93±0.24	3.21±1.00
26.	Was kind to my family.	3.27±0.56	0.85±0.35	2.81±1.28
24.	Celebrated my baby’s birth with great joy.	3.26±0.64	0.84±0.36	2.77±1.33
	Subtotal	3.38±0.75	0.84±0.38	2.88±1.26
Factor 2.	Personal care
3.	Took care of my body gently.	3.36±0.60	0.80±0.39	2.75±1.45
1.	Took care of me all the time.	3.38±0.56	0.89±0.30	3.05±1.19
2.	Spent a lot of time with me during labor.	3.29±0.61	0.77±0.41	2.59±1.50
5.	Responded appropriately to my needs.	3.55±0.53	0.82±0.37	2.96±1.43
4.	Quickly helped me when I needed something.	3.71±0.47	0.90±0.29	3.36±1.20
7.	Conducted vaginal examinations gently.	3.46±0.56	0.67±0.47	2.31±1.69
13.	Listened to me carefully.	3.54±0.52	0.86±0.33	3.11±1.30
11.	Helped me get into comfortable positions.	3.54±0.54	0.89±0.30	3.19±1.21
	Subtotal	3.47±0.54	0.71±0.35	2.91±1.37
Factor 3.	Emotional empowerment
19.	Comforted me psychologically by staying by my side.	3.37±0.60	0.75±0.43	2.59±1.58
12.	Encouraged me.	3.48±0.54	0.88±0.31	3.12±1.21
20.	Provided me with a comfortable environment.	3.48±0.54	0.83±0.36	2.93±1.39
17.	Got to know me and helped me before telling me what I needed to do.	3.28±0.64	0.61±0.48	2.09±1.73
16.	Gave me courage when I tried to give up.	3.51±0.59	0.81±0.39	2.83±1.46
	Subtotal	3.42±0.58	0.77±0.39	2.71±1.99
Factor 4.	Information provision
23.	Periodically checked the condition of my fetus.	3.47±0.46	0.90±0.29	3.38±1.18
21.	Told me how to push hard during labor.	3.68±0.49	0.95±0.21	3.53±0.92
22.	Explained how to help in the progress of my childbirth.	3.65±0.52	0.89±0.30	3.29±1.23
15.	Explained my delivery progress.	3.72±0.48	0.89±0.30	3.33±1.24
18.	Fully answered all my questions.	3.52±0.53	0.86±0.34	3.05±1.32
	Subtotal	3.60±0.47	0.90±0.28	3.31±1.17
Total		3.47±0.59	0.80±0.28	2.95±1.45

QUOTE-Birth=QUality Of care Through patients’ Eyes-Birth; M±SD=Mean±standard deviation.

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