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

Patience A Afulani, Nadia Diamond-Smith, Ginger Golub, May Sudhinaraset, Patience A Afulani, Nadia Diamond-Smith, Ginger Golub, May Sudhinaraset

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.

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

References

    1. Alkema L, Chou D, Hogan D, Zhang S, Moller A-B, Gemmill A, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet. 2016;387:462–474. doi: 10.1016/S0140-6736(15)00838-7.
    1. WHO . Making pregnancy safer: the critical role of the skilled attendant. Jt. Statement. Geneva: WHO ICM FIGO; 2004.
    1. Kinney MV, Kerber KJ, Black RE, Cohen B, Nkrumah F, Coovadia H, et al. Sub-Saharan Africa’s Mothers, Newborns, and Children: Where and Why Do They Die? PLoS Med. 2010;7:e1000294. doi: 10.1371/journal.pmed.1000294.
    1. Friberg IK, Kinney MV, Lawn JE, Kerber KJ, Odubanjo MO, Bergh A-M, et al. Sub-Saharan Africa’s mothers, newborns, and children: how many lives could be saved with targeted health interventions? PLoS Med. 2010;7:e1000295. doi: 10.1371/journal.pmed.1000295.
    1. Koblinsky M, Moyer CA, Calvert C, Campbell J, Campbell OMR, Feigl AB, et al. Quality maternity care for every woman, everywhere: a call to action. The Lancet [Internet]. 2016 [cited 2016 Sep 24]; Available from:
    1. van den Broek NR, Graham WJ. Quality of care for maternal and newborn health: the neglected agenda. BJOG Int J Obstet Gynaecol. 2009;116(Suppl 1):18–21. doi: 10.1111/j.1471-0528.2009.02333.x.
    1. Graham WJ, Varghese B. Quality, quality, quality: gaps in the continuum of care. Lancet. 2012;379:e5–e6. doi: 10.1016/S0140-6736(10)62267-2.
    1. Ceschia A, Horton R. Maternal health: time for a radical reappraisal. The Lancet [Internet]. 2016 [cited 2016 Sep 24]; Available from:
    1. Souza JP, Gülmezoglu AM, Vogel J, Carroli G, Lumbiganon P, Qureshi Z, et al. Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): a cross-sectional study. Lancet. 2013;381:1747–1755. doi: 10.1016/S0140-6736(13)60686-8.
    1. Miller S, Abalos E, Chamillard M, Ciapponi A, Colaci D, Comandé D, et al. Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide. The Lancet [Internet]. 2016 [cited 2016 Sep 24]; Available from:
    1. The White Ribbon Alliance. Respectful Maternity Care: The Universal Rights of Childbearing Women (Full charter) [Internet]. [cited 2017 Mar 28]. Available from:
    1. Kinney MV, Boldosser-Boesch A, McCallon B. Quality, equity, and dignity for women and babies. The Lancet [Internet]. 2016 [cited 2016 Sep 24]; Available from:
    1. Abuya T, Warren CE, Miller N, Njuki R, Ndwiga C, Maranga A, et al. Exploring the Prevalence of Disrespect and Abuse during Childbirth in Kenya. PLoS ONE [Internet]. 2015 [cited 2015 Aug 31];10. Available from:
    1. Bowser D, Hill K. Exploring Evidence for Disrespect and Abuse in Facility-Based Childbirth: Report of a Landscape Analysis | Traction Project [Internet]. 2010 [cited 2015 Aug 31]. Available from:
    1. Freedman LP, Ramsey K, Abuya T, Bellows B, Ndwiga C, Warren CE, et al. Defining disrespect and abuse of women in childbirth: a research, policy and rights agenda. Bull World Health Organ. 2014;92:915–917. doi: 10.2471/BLT.14.137869.
    1. Freedman LP, Kruk ME. Disrespect and abuse of women in childbirth: challenging the global quality and accountability agendas. Lancet. 2014;384:e42–e44. doi: 10.1016/S0140-6736(14)60859-X.
    1. Okafor II, Ugwu EO, Obi SN. Disrespect and abuse during facility-based childbirth in a low-income country. Int J Gynaecol Obstet. 2015;128:110–113. doi: 10.1016/j.ijgo.2014.08.015.
    1. Pérez D’GR. Obstetric violence: a new legal term introduced in Venezuela. Int J Gynaecol Obstet. 2010;111:201–202. doi: 10.1016/j.ijgo.2010.09.002.
    1. Zacher DL. Obstetrics in a Time of Violence: Mexican Midwives Critique Routine Hospital Practices. Med Anthropol Q. 2015;29:437–454. doi: 10.1111/maq.12174.
    1. Hatamleh R, Shaban IA, Homer C. Evaluating the experience of Jordanian women with maternity care services. Health Care Women Int. 2013;34:499–512. doi: 10.1080/07399332.2012.680996.
    1. Miller S, Cordero M, Coleman AL, Figueroa J, Brito-Anderson S, Dabagh R, et al. Quality of care in institutionalized deliveries: the paradox of the Dominican Republic. Int J Gynaecol Obstet. 2003;82:89-103-88.
    1. Bohren MA, Vogel JP, Hunter EC, Lutsiv O, Makh SK, Souza JP, et al. The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review. PLoS Med. 2015;12:e1001847. doi: 10.1371/journal.pmed.1001847.
    1. Bohren MA, Vogel JP, Tunçalp Ö, Fawole B, Titiloye MA, Olutayo AO, et al. Mistreatment of women during childbirth in Abuja, Nigeria: a qualitative study on perceptions and experiences of women and healthcare providers. Reprod Health. 2017;14:9. doi: 10.1186/s12978-016-0265-2.
    1. Tunçalp Ӧ, Were W, MacLennan C, Oladapo O, Gülmezoglu A, Bahl R, et al. Quality of care for pregnant women and newborns—the WHO vision. BJOG Int J Obstet Gynaecol. 2015;122:1045–1049. doi: 10.1111/1471-0528.13451.
    1. Sixma HJ, Kerssens JJ, van Campen C, Peters L. Quality of care from the patients’ perspective: from theoretical concept to a new measuring instrument. Health Expect. 1998;1:82–95. doi: 10.1046/j.1369-6513.1998.00004.x.
    1. Groene O. Patient centredness and quality improvement efforts in hospitals: rationale, measurement, implementation. Int J Qual Health Care. 2011;23:531–537. doi: 10.1093/intqhc/mzr058.
    1. Sun BC, Adams J, Orav EJ, Rucker DW, Brennan TA, Burstin HR. Determinants of patient satisfaction and willingness to return with emergency care. Ann Emerg Med. 2000;35:426–434. doi: 10.1016/S0196-0644(00)70003-5.
    1. Srivastava A, Avan BI, Rajbangshi P, Bhattacharyya S. Determinants of women’s satisfaction with maternal health care: a review of literature from developing countries. BMC Pregnancy Childbirth. 2015;15:97. doi: 10.1186/s12884-015-0525-0.
    1. Kruk ME, Vail D, Austin-Evelyn K, Atuyambe L, Greeson D, Grépin KA, et al. Evaluation Of A Maternal Health Program In Uganda And Zambia Finds Mixed Results On Quality Of Care And Satisfaction. Health Aff (Millwood) 2016;35:510–519. doi: 10.1377/hlthaff.2015.0902.
    1. Larson E, Hermosilla S, Kimweri A, Mbaruku GM, Kruk ME. Determinants of perceived quality of obstetric care in rural Tanzania: a cross-sectional study. BMC Health Serv. Res. [Internet]. 2014 [cited 2015 Oct 29];14. Available from:
    1. Gilson L. Trust and the development of health care as a social institution. Soc Sci Med 1982. 2003;56:1453–1468.
    1. Isaac T, Zaslavsky AM, Cleary PD, Landon BE. The Relationship between Patients’ Perception of Care and Measures of Hospital Quality and Safety. Health Serv Res. 2010;45:1024–1040. doi: 10.1111/j.1475-6773.2010.01122.x.
    1. Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open [Internet]. 2013 [cited 2013 Jul 30];3. Available from:
    1. Bohren MA, Hunter EC, Munthe-Kaas HM, Souza JP, Vogel JP, Gülmezoglu AM. Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis. Reprod Health. 2014;11:71. doi: 10.1186/1742-4755-11-71.
    1. Kruk ME, Mbaruku G, McCord CW, Moran M, Rockers PC, Galea S. Bypassing primary care facilities for childbirth: a population-based study in rural Tanzania. Health Policy Plan. 2009;24:279–288. doi: 10.1093/heapol/czp011.
    1. Larson E, Vail D, Mbaruku GM, Kimweri A, Freedman LP, Kruk ME. Moving Toward Patient-Centered Care in Africa: A Discrete Choice Experiment of Preferences for Delivery Care among 3,003 Tanzanian Women. PLoS One. 2015;10:e0135621. doi: 10.1371/journal.pone.0135621.
    1. Kenya National Bureau of Statistics, Ministry of Health, National AIDS Control Council, Kenya Medical Research Institute, National Council for Population and Development, Nairobi, Kenya, and The DHS Program, ICF International, Rockville, Maryland, USA. The DHS Program - Kenya: DHS, 2014 - Final Report (English) [Internet]. [cited 2016 Feb 18]. Available from:
    1. Afulani PA, Moyer C. Explaining Disparities in Use of Skilled Birth Attendants in Developing Countries: A Conceptual Framework. PLoS One. 2016;11:e0154110. doi: 10.1371/journal.pone.0154110.
    1. Liambila WN, Kuria SN. Birth attendance and magnitude of obstetric complications in Western Kenya: a retrospective case–control study. BMC Pregnancy Childbirth. 2014;14:311. doi: 10.1186/1471-2393-14-311.
    1. Wamalwa EW. Implementation challenges of free maternity services policy in Kenya: the health workers’ perspective. Pan Afr. Med. J. [Internet]. 2015 [cited 2017 Apr 3];22. Available from:
    1. Sharma J, Leslie HH, Kundu F, Kruk ME. Poor Quality for Poor Women? Inequities in the Quality of Antenatal and Delivery Care in Kenya. PLOS ONE. 2017;12:e0171236. doi: 10.1371/journal.pone.0171236.
    1. Shaw D, Guise J-M, Shah N, Gemzell-Danielsson K, Joseph K, Levy B, et al. Drivers of maternity care in high-income countries: can health systems support woman-centred care? The Lancet [Internet]. 2016 [cited 2016 Sep 24]; Available from:
    1. Sando D, Ratcliffe H, McDonald K, Spiegelman D, Lyatuu G, Mwanyika-Sando M, et al. The prevalence of disrespect and abuse during facility-based childbirth in urban Tanzania. BMC Pregnancy Childbirth. 2016;16:236. doi: 10.1186/s12884-016-1019-4.
    1. Sheferaw ED, Mengesha TZ, Wase SB. Development of a tool to measure women’s perception of respectful maternity care in public health facilities. BMC Pregnancy Childbirth. 2016;16:67. doi: 10.1186/s12884-016-0848-5.
    1. Hinkin T, Tracey J, Enz C. Scale Construction: Developing Reliable and Valid Measurement Instruments. Artic. Chapters [Internet]. 1997; Available from:
    1. DeVellis RF. Scale Development: Theory and Applications. 4. Los Angeles: SAGE Publications, Inc; 2016.
    1. Rice N, Robone S, Smith PC. The measurement and comparison of health system responsiveness [Internet]. HEDG, c/o Department of Economics, University of York; 2008. Report No.: 08/05. Available from: .
    1. Robone S, Rice N, Smith PC. Health Systems’ Responsiveness and Its Characteristics: A Cross-Country Comparative Analysis. Health Serv Res. 2011;46:2079–2100. doi: 10.1111/j.1475-6773.2011.01291.x.
    1. WHO. The Health Systems Responsiveness Analytical Guidelines for Surveys in the MCSS [Internet]. WHO; 2005 [cited 2013 Jun 20]. Available from: .
    1. D van D, Binns CW, Lee AH, Hipgrave DB. Measuring client-perceived quality of maternity services in rural Vietnam. Int J Qual Health Care. 2004;16:447–452. doi: 10.1093/intqhc/mzh073.
    1. Haddad S, Fournier P, Potvin L. Measuring lay people’s perceptions of the quality of primary health care services in developing countries. Validation of a 20-item scale. Int. J Qual Health Care. 1998;10:93–104. doi: 10.1093/intqhc/10.2.93.
    1. Donabedian A. The quality of care. How can it be assessed? JAMA J. Am. Med. Assoc. 1988;260:1743–1748. doi: 10.1001/jama.1988.03410120089033.
    1. Hulton LA, Matthew Z, Stones RW. A framework for the evaluation of quality care in maternity services. [Internet]. University of Southampton; 2000 [cited 2013 Aug 1]. Available from:
    1. Lawrence HC, Copel JA, O’Keeffe DF, Bradford WC, Scarrow PK, Kennedy HP, et al. Quality patient care in labor and delivery: a call to action. Am J Obstet Gynecol. 2012;207:147–148. doi: 10.1016/j.ajog.2012.07.018.
    1. Bechtel C, Ness DL. If You Build It, Will They Come? Designing Truly Patient-Centered Health Care. Health Aff. (Millwood) 2010;29:914–920. doi: 10.1377/hlthaff.2010.0305.
    1. Berwick DM. What “Patient-Centered” Should Mean: Confessions Of An Extremist. Health Aff (Millwood) 2009;28:w555–w565. doi: 10.1377/hlthaff.28.4.w555.
    1. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century [Internet]. 2001. Available from: .
    1. Jenkinson C, Coulter A, Bruster S. The Picker Patient Experience Questionnaire: development and validation using data from in-patient surveys in five countries. Int J Qual Health Care. 2002;14:353–358. doi: 10.1093/intqhc/14.5.353.
    1. Saris W, Revilla M, Krosnick JA, Shaeffer EM. Comparing Questions with Agree/Disagree Response Options to Questions with Item-Specific Response Options. Surv Res Methods. 2010;4:61–79.
    1. Collins D. Pretesting survey instruments: an overview of cognitive methods. Qual. Life Res. Int. J. Qual. Life Asp. Treat. Care Rehabil. 2003;12:229–238.
    1. Jobe JB, Mingay DJ. Cognitive research improves questionnaires. Am J Public Health. 1989;79:1053–1055. doi: 10.2105/AJPH.79.8.1053.
    1. Nápoles-Springer AM, Santoyo-Olsson J, O’Brien H, Stewart AL. Using cognitive interviews to develop surveys in diverse populations. Med Care. 2006;44:S21–S30. doi: 10.1097/01.mlr.0000245425.65905.1d.
    1. Population and Household Characteristics of Kenya, 2009 - Kenya Data Portal [Internet]. Knoema. [cited 2017 Apr 4]. Available from:
    1. Crosby RA. DiClemente, Salazar LF. Research methods in health promotion. San Francisco, CA: Jossey-Bass; 2006.
    1. Afifi AA, Clark V, May S. Computer-aided Multivariate Analysis. 4th ed. CRC Press; 2004.
    1. Katchova A. Principal Component Analysis - Econometrics Academy [Internet]. [cited 2017 Mar 14]. Available from:
    1. Spector PE. Summated Rating Scale Construction: An Introduction. 1. Newbury Park: SAGE Publications, Inc; 1991.
    1. DeVellis RF. Scale Development: Theory and Applications. 4 edition. Los Angeles: SAGE Publications, Inc; 2016.
    1. Diamond-Smith N, Sudhinaraset M, Melo J, Murthy N. The relationship between women’s experiences of mistreatment at facilities during childbirth, types of support received and person providing the support in Lucknow. India Midwifery. 2016;40:114–123. doi: 10.1016/j.midw.2016.06.014.
    1. Alexander A, Mustafa A, Emil SAV, Amekah E, Engmann C, Adanu R, et al. Social support during delivery in rural central Ghana: a mixed methods study of women’s preferences for and against inclusion of a lay companion in the delivery room. J Biosoc Sci. 2013:1–17.
    1. Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. Continuous support for women during childbirth. In: The Cochrane Collaboration, Hodnett ED, editors. Cochrane Database Syst. Rev. [Internet]. Chichester: John Wiley & Sons, Ltd; 2013 [cited 2013 Aug 6]. Available from: .
    1. Kruk ME, Kujawski S, Mbaruku G, Ramsey K, Moyo W, Freedman LP. Disrespectful and abusive treatment during facility delivery in Tanzania: a facility and community survey. Health Policy Plan. [Internet]. [cited 2017 Sep 20]. Available from: .
    1. Omar MA, Schiffman RF, Bingham CR. Development and testing of the patient expectations and satisfaction with prenatal care instrument. Res Nurs Health. 2001;24:218–229. doi: 10.1002/nur.1024.
    1. Byrne A, Caulfield T, Onyo P, Nyagero J, Morgan A, Nduba J, et al. Community and provider perceptions of traditional and skilled birth attendants providing maternal health care for pastoralist communities in Kenya: a qualitative study. BMC Pregnancy Childbirth. 2016;16:43. doi: 10.1186/s12884-016-0828-9.
    1. Benova L, Cumming O, Campbell OMR. Systematic review and meta-analysis: association between water and sanitation environment and maternal mortality. Tropical Med Int Health. 2014;19:368–387. doi: 10.1111/tmi.12275.

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