Development of measures for assessing mistreatment of women during facility-based childbirth based on labour observations
Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
BMJ GLOBAL HEALTH
Abstract
Introduction Mistreatment of women during childbirth
is increasingly recognised as a significant issue globally.
Research and programmatic efforts targeting this phenomenon
have been limited by a lack of validated measurement tools.
This study aimed to develop a set of concise, valid and reliable
multidimensional measures for mistreatment using labour
observations applicable across multiple settings.
Methods Data from continuous labour observations of
1974 women in Nigeria (n=407), Ghana (n=912) and
Guinea (n=655) were used from the cross-sectional
WHO’s
multicountry study ‘How women are treated during facility-based
childbirth’ (2016–2018). Exploratory factor analysis was
conducted to develop a scale measuring interpersonal abuse.
Two indexes were developed through a modified Organisation
for Economic Co-operation
and Development approach for
generating composite indexes. Measures were evaluated for
performance, validity and internal reliability.
Results Three mistreatment measures were developed:
a 7-item
Interpersonal Abuse Scale, a 3-item
Exams
& Procedures Index and a 12-item
Unsupportive Birth
Environment Index. Factor analysis results showed
a consistent unidimensional factor structure for the
Interpersonal Abuse Scale in all three countries based
on factor loadings and interitem correlations, indicating
good structural construct validity. The scale had a
reliability coefficient of 0.71 in Nigeria and approached
0.60 in Ghana and Guinea. Low correlations (Spearman
correlation range: −0.06–0.19; p≥0.05) between
mistreatment measures supported our decision to develop
three separate measures. Predictive criterion validation
yielded mixed results across countries. Both items within
measures and measure scores were internally consistent
across countries; each item co-occurred
with other items
in a measure, and scores consistently distinguished
between ‘high’ and ‘low’ mistreatment levels.
Conclusion The set of concise, comprehensive
multidimensional measures of mistreatment can be used in
future research and quality improvement initiatives targeting
mistreatment to quantify burden, identify risk factors and
determine its impact on health and well-being
outcomes.
Further validation and reliability testing of the measures in
other contexts is needed.
Description
Research Article
Keywords
labour observations, mistreatment of women, childbirth, mistreatment