Development of Preconception Health Behavior Scale

Gye Jeong Yeom; Il-Ok Kim

doi:10.4069/kjwhn.2019.25.1.31

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Yeom and Kim: Development of Preconception Health Behavior Scale

Original Article

Korean Journal of Women Health Nursing 2019; 25(1): 31-45.

Published online: 14 March 2019

DOI: https://doi.org/10.4069/kjwhn.2019.25.1.31

Development of Preconception Health Behavior Scale

Gye Jeong Yeom¹

, Il-Ok Kim²

¹Assistance Professor, Department of Nursing, JEI University, Incheon, Korea.

²Professor, College of Nursing, Sahmyook University, Seoul, Korea.

Correspondence to Il-Ok Kim. College of Nursing, Sahmyook University, 815 Hwarang-ro, Nowon-gu, Seoul 01795, Korea. Tel: +82-2-3399-1587, Fax: +82-2-3399-1594, kimio@syu.ac.kr

Received 7 November 2018 Revised 26 December 2018 Accepted 7 February 2019

Korean Society of Women Health Nursing

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was designed to develop a valid and reliable scale for the evaluation of preconception health behavior in women preparing for pregnancy.

Methods

The initial strategy included a literature review, interviews, and construction of a conceptual framework. The preliminary items were evaluated twice for content validity by experts, and modified two preliminary investigations. Participants in the 2 main investigations and the confirmation investigation were tested for reliability and validity of the preliminary scale in women preparing for pregnancy. The data were analyzed for different items exploratory and confirmatory factors.

Results

The 5-point Likert scale consisted of 6 factors and 27 items. The 6-factors included ‘hazardous substance factor,’ ‘medical management factor,’ ‘rest and sleep factor,’ ‘stress management factor,’ ‘information acquisition factor,’ and ‘resource preparation factor.’ Goodness of fit of the final research model was very appropriate and based on the following measures: Q=1.98, comparative fit index=.91, Tucker-lewis index=.89, standardized root mean square residual=.07, and root mean square error of approximation=.07. The criterion validity was .64. The reliability coefficient was .92 and the test-retest reliability was .61.

Conclusion

The study findings indicate that the scale can be used for the development of nursing interventions to promote preconception health behavior in women preparing for pregnancy.

Keywords: Preconception care, Health behavior, Behavior rating scale

Figures and Tables

Figure 1

Development procedure of pre-pregnancy health behavior measurement tools.

EFA=exploratory factor analysis; HPLP-II=Health Promotion Lifestyle Profile-II; CFA=confirmatory factor analysis.

Table 1

Exploratory Factor Analysis in Confirmation Investigation (N=215)

Items			Factor 1	Factor 2	Factor 3	Factor 4	Factor 5	Factor 6
Items			Stress management	Rest and sleep	Professional health care	Resource preparation	Avoiding hazardous substances	Information acquisition
Q16			.79	.04	.13	.12	.02	.00
Q15			.78	.09	−.02	.12	.02	.11
Q14			.76	.07	.00	.07	−.03	.16
Q17			.75	.19	.06	.07	.09	−.02
Q3			−.01	.85	−.00	−.03	.13	−.05
Q2			.01	.81	.11	.14	.03	−.11
Q1			.16	.76	.12	.05	−.07	−.02
Q4			.07	.68	−.13	−.11	.03	.18
Q24			.03	.02	.81	−.01	.15	−.09
Q26			−.09	.05	.80	−.02	.01	.11
Q23			.26	−.09	.79	−.03	.10	−.16
Q25			.13	.05	.76	−.18	−.16	.10
Q27			−.09	−.01	.67	.26	−.00	.06
Q22			−.20	.11	.57	.16	−.01	.30
Q6			.11	.12	−.06	.88	−.12	−.05
Q7			.10	−.07	.03	.88	.03	−.02
Q5			.05	−.02	.02	.65	.25	.07
Q8			.26	.00	.17	.40	.12	.22
Q21			.17	.10	.00	−.03	.76	−.15
Q18			.03	−.08	−.05	−.03	.71	.34
Q20			−.22	.16	.07	.07	.69	−.13
Q19			.12	−.01	.04	.06	.68	.19
Q9			.16	.08	.06	−.08	.01	.72
Q10			.20	−.02	.13	−.02	.17	.67
Q11			.16	.02	.14	.15	.07	.64
Q12			.22	−.08	.18	.32	.04	.45
Q13			−.18	.16	.02	.29	−.04	.43
Eigenvalue			9.39	2.40	1.88	1.79	1.56	1.21
Variance (%)			34.8	8.9	7.0	6.6	5.8	4.5
Cumulative variance (%)			34.8	43.7	50.6	57.3	63.1	67.6
KMO value								.88
	Bartlett's test
		Approximate χ² test						3,340.80
		DF						351
		p value						<.001

KMO=Kaiser-Mayer-Olkin; DF=degree of freedom.

Table 2

Path Coefficients by Question in the Confirmatory Factor Analysis (N=215)

Factor	Items	B	SE	β	t	p value
Avoiding hazardous substances	Q19. Avoid radiation exposure (e.g. X-ray, CT).	1.00	-	.87	-	<.001
	Q18. If you are using acne treatment, you should stop it.	.99	.10	.77	9.89	<.001
	Q21. Be careful not to be exposed to secondhand smoke.	.53	.08	.52	7.11	<.001
	Q20. Abstain from drinking or smoking.	.43	.09	.35	4.69	<.001
Professional health care	Q22. Be examined for venereal and infectious diseases (e.g. genital chlamydial infection, syphilis, AIDS etc.).	1.00	-	718	-	<.001
	Q27. If you are over 35 years old, you should consult a medical professional about genetic risks and the need for prenatal care.	1.00	.10	734	9.81	<.001
	Q26. If you or your family (within cousin) have a genetic disorder, you should seek genetic counseling.	.98	.10	774	10.30	<.001
	Q25. If you have a chronic illnesses, you should consult a medical professional (e.g. DM, hypertension, thyroid disease, epilepsy, cardiovascular disease, asthma, cancer etc.).	.89	.10	683	9.17	<.001
	Q24. If there is any oriental (herbal) medicine or health food in use, consult a medical professional.	.87	.09	693	9.28	<.001
	Q23. If you have any medication you are taking, you should consult a medical professional.	.82	.09	662	8.86	<.001
Rest and sleep	Q2. Avoid lifting heavy things.	1.00	-	.85	-	<.001
	Q3. Reduce long standing work.	.91	.07	.83	13.27	<.001
	Q1. Avoid overwork.	.79	.07	.75	11.92	<.001
	Q4. Sleep for more than 7 hours.	.57	.08	.52	7.63	<.001
Stress management	Q15. Have a positive mind.	1.00	-	.88	-	<.001
	Q16. Enjoy good books/music/movie/arts.	1.00	.06	.86	16.59	<.001
	Q17. Try to reduce stress.	.97	.06	.84	16.05	<.001
	Q14. Do leisure activities for relaxation.	.97	.07	.79	14.49	<.001
Information acquisition	Q12. Get information related to pregnancy and childbirth through professional websites and books.	1.00	-	.80	-	<.001
	Q10. Know the medications you should avoid before conception.	.90	.07	.80	12.71	<.001
	Q11. Acquire knowledge of the reproductive organs	.97	.07	.86	13.90	<.001
	Q9. Knows how to calculate the length of time a pregnancy is possible (ovulation date).	.78	.08	.65	9.82	<.001
	Q13. Folic acid is taken every day to prevent fetal nerve damage.	.70	.12	.41	5.82	<.001
Preparation of resources	Q7. Inform the family (relative, in-laws) of the pregnancy and ask for help	1.00	-	.86	-	<.001
	Q6. Ask for work cooperation by informing them of the pregnancy plan.	.96	.08	.79	12.72	<.001
	Q5. Plan a space for the baby.	.73	.07	.70	11.02	<.001
	Q8. Select the hospital to be examined after pregnancy.	.83	.08	.70	10.98	<.001

CFA=confirmatory factor analysis; SE= standard error; AIDS=human immunodeficiency virus; CT=computerized tomography; DM=diabetes mellitus.

Table 3

Conformity of Research Model (N=215)

Model	χ²	DF	p value	Q	CFI	TLI	SRMR	RMSEA (90.0% CI)
Research model (factor 6 correlation)	607.14	307	<.001	1.98	.91	.89	.07	.07 (.06–.08)

DF=degree of freedom; CFI=comparative fit index; CI=confidence interval; RMSEA=root mean square error of approximation; SRMR=standardized root mean square residual; TLI=Tucker-lewis index.

Notes

This manuscript is a condensed form of the first author's doctoral dissertation from Sahmyook University.

^{Conflict of Interest} The authors declared no conflict of interest.

^{Author Contributions}

Conceptualization: Yeom GJ, Kim IO.
Formal analysis: Yeom GJ.
Writing - original draft: Yeom GJ.
Writing - review & editing: Kim IO.

Summary Statement

• What is already known about this topic?

Preconception care is vital for healthy pregnancy outcomes.
• What this paper adds?

This study contributes to the development and validation of health behavior scales in women preparing for pregnancy.
• Implications for practice, education and/or policy

This scale could be used to obtain data for the promotion of preconception care in women contemplating pregnancy.

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ORCID iDs

Gye Jeong Yeom
https://orcid.org/0000-0002-0047-181X

Il-Ok Kim
https://orcid.org/0000-0002-4092-3032

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