Background
Methods
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1st Stage: Methodological study. The translation and transcultural adaptation of the Childbirth Experience Questionnaire 2.0 (CEQ 2.0) were carried out, with an assessment of content validity through expert testing and facial validity, through cognitive interviews and a pilot test in the target population.
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2nd Stage: Cross-sectional study in a validation sample for the evaluation of construct validity and reliability (internal consistency and temporal stability).
Stage 1
Starting Instrument
Translation procedure
Content validity
Face validity
Stage 2
Design
Setting and study population
Sample size
Variables studied
Instrument and data collection system
Data analysis and interpretation
Construct validity through confirmatory factor analysis
Reliability
Validation by known groups and final proposal for CEQ-E 2.0
Ethical considerations
Results
Stage 1
Translation procedure
Content validity
Item CEQ-E 2.0 | Expert 1 | Expert 2 | Expert 3 | Expert 4 | Expert 5 | Expert 6 | Expert 7 | Expert 8 | Expert 9 | Expert 10 | V Aiken Coefficient [95% CI] |
---|---|---|---|---|---|---|---|---|---|---|---|
1.Labour and birth went as I had expected | 4 | 4 | 3 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 0.97 [0.83–0.99] |
2. I felt strong during labour and birth | 4 | 2 | 4 | 4 | 1 | 4 | 4 | 4 | 4 | 4 | 0.83 [0.66–0.93] |
3. I felt scared during labour and birth. R | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 3 | 0.97 [0.83–0.99] |
4. I felt capable during labour and birth | 4 | 2 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 0.90 [0.74–0.97] |
5. I was tired during labour and birth. R | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 1.00 [0.89–1.00] |
6. I felt happy during labour and birth | 4 | 4 | 4 | 2 | 4 | 4 | 4 | 4 | 4 | 4 | 0.90 [0.74–0.97] |
7. I felt that I handled the situation well | 4 | 4 | 4 | 4 | 1 | 4 | 4 | 4 | 4 | 4 | 0.90 [0.74–0.97] |
8. I wish the staff had listened to me more during labour and birth R | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 3 | 0.97 [0.83–0.99] |
9. I took part in decisions regarding my care and treatments as much I wanted | 4 | 4 | 4 | 4 | 3 | 4 | 4 | 4 | 4 | 4 | 0.97 [0.83–0.99] |
10. Both my partner and I were treated with warmth and respect | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 1.00 [0.89–1.00] |
11. I received the information I needed during labour and birth | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 1.00 [0.89–1.00] |
12. I would have preferred the midwife to be more present during labour and birth R | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 1.00 [0.89–1.00] |
13. I would have preferred more encouragement from the midwife R | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 3 | 0.97 [0.83–0.99] |
14. The midwife conveyed an atmosphere of clam | 4 | 4 | 4 | 4 | 4 | 4 | 2 | 4 | 4 | 3 | 0.87 [0.70–0.95] |
15. The midwife helped me to find my inner strength | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 3 | 0.97 [0.83–0.99] |
16. My impression of the team`s medical skill made me feel secure | 4 | 4 | 4 | 3 | 4 | 4 | 4 | 4 | 4 | 4 | 0.97 [0.83–0.99] |
17. I have many positive memories from childbirth | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 1.00 [0.89–1.00] |
18. I have many negative memories from childbirth R | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 1.00 [0.89–1.00] |
19. Some of my memories from childbirth make me feel depressed R | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 1.00 [0.89–1.00] |
20. As a whole, how painful did you feel during childbirth? R | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 1.00 [0.89–1.00] |
21. As a whole, how much control did you feel you had during childbirth? | 4 | 4 | 4 | 4 | 3 | 4 | 4 | 4 | 4 | 3 | 0.93 [0.79–0.98] |
22. As a whole, how secure did you feel during childbirth? | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 1.00 [0.89–1.00] |
Face validity
Stage 2
Descriptive analysis of the sample and CEQ-E 2.0 items
Items CQE-E 2.0 | M [95%CI]a | SDb | Symmetry | Kurtosis | Floor totally Disagreec N (%) | Ceiling totally Agreec N (%) |
---|---|---|---|---|---|---|
1.Labour and birth went as I had expected | 2.94 [2.85–3.02] | 0.991 | -0.591 | -0.698 | 58 (11.6%) | 172 (34.4%) |
2. I felt strong during labour and birth | 3.25 [3.18–3.32] | 0.763 | -0.732 | -0.067 | 10 (2.0%) | 214 (42.8%) |
3. I felt scared during labour and birth R | 2.65 [2.56–2.75] | 1.085 | -0.131 | -1.284 | 90 (18.0%) | 147 (29.4%) |
4. I felt capable during labour and birth | 3.28 [3.22–3.35] | 0.737 | -0.772 | 0.138 | 9 (1.8%) | 217 (43.4%) |
5. I was tired during labour and birth R | 2.09 [2.00–2.18] | 1.023 | 0.616 | -0.734 | 169 (33.8%) | 71 (14.2%) |
6. I felt happy during labour and birth | 3.26 [3.18–3.33] | 0.861 | -0.902 | -0.106 | 20 (4.0%) | 246 (49.2%) |
7. I felt that I handled the situation well | 3.25 [3.18–3.32] | 0.789 | -0.946 | 0.561 | 19 (3.8%) | 215 (43.0%) |
8. I wish the staff had listened to me more during labour and birth R | 3.60 [3.53–3.67] | 0.790 | -2.050 | 3.345 | 22 (4.4%) | 375 (75.0%) |
9. I took part in decisions regarding my care and treatments as much I wanted | 3.51 [3.44–3.59] | 0.829 | -0.903 | 5.289 | 21 (4.2%) | 324 (64.8%) |
10. Both my partner and I were treated with warmth and respect | 3.86 [3.82–3.90] | 0.454 | -3.904 | 17.442 | 5 (1.0%) | 445 (89.0%) |
11. I received the information I needed during labour and birth | 3.76 [3.71–3.81] | 0.590 | -2.819 | 8.322 | 9 (1.8%) | 411 (82.2%) |
12. I would have preferred the midwife to be more present during labour and birth R | 3.55 [3.48–3.63] | 0.832 | -1.893 | 2.652 | 27 (5.4%) | 360 (72.0%) |
13. I would have preferred more encouragement from the midwife R | 3.65 [3.59–3.72] | 0.721 | -2.297 | 4.876 | 18 (3.6%) | 381 (76.2%) |
14. The midwife conveyed an atmosphere of clam | 3.82 [3.77–3.86] | 0.497 | -3.400 | 14.524 | 1 (0.2%) | 426 (85.2%) |
15. The midwife helped me to find my inner strength | 3.71 [3.66–3.76] | 0.572 | -2.217 | 5.566 | 6 (1.2%) | 378 (75.6%) |
16. My impression of the team`s medical skill made me feel secure | 3.74 [3.70–3.79] | 0.543 | -2.342 | 5.950 | 4 (0.8%) | 394 (78.8%) |
17. I have many positive memories from childbirth | 3.51 [3.44–3.58] | 0.758 | -1.598 | 2.096 | 16 (3.2%) | 320 (64.0%) |
18. I have many negative memories from childbirth R | 3.31 [3.24–3.39] | 0.897 | -1.111 | 0.216 | 27 (5.4%) | 277 (55.4%) |
19. Some of my memories from childbirth make me feel depressed R | 3.41 [3.33–3.49] | 0.940 | -1.453 | 0.893 | 38 (7.6%) | 327 (65.4%) |
20. As a whole, how painful did you feel during childbirth? R | 1.71 [1.63–1.79] | 0.967 | 1.181 | 0.230 | 284 (56.8%) | 43 (8.6%) |
21. As a whole, how much control did you feel you had during childbirth? | 3.40 [3.33–3.48] | 0.894 | -1.393 | 0.910 | 30 (6.0%) | 311 (62.2%) |
22. As a whole, how secure did you feel during childbirth? | 3.71 [3.65–3.77] | 0.663 | -2.495 | 5.923 | 12 (2.4%) | 400 (80.0%) |
Construct validity through confirmatory factor analysis
Items CEQ-E 2.0 | Domain 1 Own Capacity | Domain 2 Perceived safety | Domain 3 Participation | Domain 4 Professional support |
---|---|---|---|---|
1.Labour and birth went as I had expected | 0.460 [0.305–0.624] | |||
2. I felt strong during labour and birth | 0.668[0.525–0.861] | |||
3. I felt scared during labour and birth R | 0.279 [0.087–0.449] | |||
4. I felt capable during labour and birth | 0.841 [0.759–0.978] | |||
5. I was tired during labour and birth R | 0.416 [0.144–0.632] | |||
6. I felt happy during labour and birth | 0.319 [0.176–0.435] | 0.434 [0.288–0.555] | ||
7. I felt that I handled the situation well | 0.797 [0.607–0.935] | |||
8. I wish the staff had listened to me more during labour and birth R | 0.598 [0.399–0.739] | |||
9. I took part in decisions regarding my care and treatments as much I wanted | 0.425 [0.227–0.557] | |||
10. Both my partner and I were treated with warmth and respect | 0.534 [0.309–0.716] | |||
11. I received the information I needed during labour and birth | 0.679 [0.507–0.853] | |||
12. I would have preferred the midwife to be more present during labour and birth R | 0.851 [0.751–0.968] | |||
13. I would have preferred more encouragement from the midwife R | 0.845 [0.614–0.970] | |||
14. The midwife conveyed an atmosphere of clam | 0.687 [0.392–0.875] | |||
15. The midwife helped me to find my inner strength | 0.689 [0.453–0.847] | |||
16. My impression of the team`s medical skill made me feel secure | 0.673 [0.481–0.815] | |||
17. I have many positive memories from childbirth | 0.739 [0.654–0.887] | 0.304 [0.182–0.412] | ||
18. I have many negative memories from childbirth R | 0.836 [0.513–1.023] | |||
19. Some of my memories from childbirth make me feel depressed R | 0.737 [0.584–0.917] | |||
20. As a whole, how painful did you feel during childbirth? R | 0.275 [0.038–0.517] | |||
21. As a whole, how much control did you feel you had during childbirth? | 0.438 [0.035–0.657] | |||
22. As a whole, how secure did you feel during childbirth? | 0.310 [0.017–0.595] | 0.319 [0.110–0.497] |
Domain | ORIONa [95%CI] | FDIb [95%CI] | H-Latentc [95%CI] |
---|---|---|---|
Own capacity | 0.843 [0.809–0.877] | 0.918 [0.899–0.937] | 0.843 [0.806–0.878] |
Perceived safety | 0.880 [0.833–0.911] | 0.938 [0.913–0.955] | 0.879 [0.827–0.911] |
Participation | 0.859 [0.802–0.891] | 0.927 [0.896–0.944] | 0.859 [0.803–0.893] |
Professional support | 0.849 [0.769–0.898] | 0.922 [0.877–0.948] | 0.849 [0.769–0.897] |
Reliability
Final proposal of CEQ-E 2.0 and validation by known groups
Domain 1 Own Capacity | Domain 2 Perceived safety | Domain 3 Participation | Domain 4 Professional support | CEQ-E 2.0 Total Score | |
---|---|---|---|---|---|
M(SD)a | M(SD)a | M(SD)a | M(SD)a | M(SD)a | |
Parity | |||||
Primiparous n = 289 | 3.29 (0.58) | 2.91 (0.58) | 3.76 (0.38) | 3.66 (0.56) | 3.31 (0.40) |
Multiparous n = 211 | 3.31 (0.61) | 3.02 (0.52) | 3.69 (0.46) | 3.52 (0.77) | 3.32 (0.43) |
p-valueb | 0.526 | 0.059 | 0.122 | 0.295 | 0.578 |
Effect sizec | 0.033 | 0.198 | 0.168 | 0.213 | 0.024 |
Type of labour onset | |||||
Spontaneous n = 248 | 3.33 (0.57) | 3.04(0.50) | 3.75 (0.42) | 3.63 (0.64) | 3.37 (0.39) |
Induced n = 252 | 3.26 (0.61) | 2.87 (0.60) | 3.72 (0.41) | 3.57 (0.69) | 3.27 (0.43) |
p-valueb | 0.271 | 0.003* | 0.239 | 0.280 | 0.010* |
Effect sizec | 0.118 | 0.307 | 0.072 | 0.090 | 0.243 |
Use of oxytocin | |||||
No n = 215 | 3.35 (0.56) | 3.05 (0.51) | 3.73 (0.43) | 3.61 (0.68) | 3.37 (0.40) |
Yes n = 285 | 3.26 (0.60) | 2.88 (0.58) | 3.73 (0.40) | 3.60 (0.66) | 3.28 (0.42) |
p-valueb | 0.108 | 0.003* | 0.986 | 0.497 | 0.023* |
Effect sizec | 0.154 | 0.308 | 0.000 | 0.014 | 0.218 |
Time in the delivery room | |||||
Less than 12 h n = 378 | 3.32 (0.58) | 3.03 (0.53) | 3.73 (0.43) | 3.62 (0.66) | 3.35 (0.42) |
More than or equal to 12 h n = 122 | 3.24 (0.60) | 2.72 (0.58) | 3.73 (0.37) | 3.56 (0.67) | 3.21 (0.39) |
p-valueb | 0.138 | < 0.001* | 0.664 | 0.199 | < 0.001* |
Effect sizec | 0.136 | 0.571 | 0.000 | 0.090 | 0.339 |
Existence of perineal trauma | |||||
No n = 140 | 3.28 (0.60) | 2.88 (0.62) | 3.68 (0.44) | 3.52 (0.67) | 3.26 (0.44) |
Yes n = 360 | 3.30 (0.59) | 2.98 (0.53) | 3.75 (0.40) | 3.63 (0.66) | 3.34 (0.40) |
p-value2 | 0.694 | 0.119 | 0.181 | 0.031* | 0.038* |
Effect size3 | 0.033 | 0.179 | 0.170 | 0.165 | 0.194 |
Use of epidural analgesia | |||||
No n = 125 | 3.35 (0.53) | 3.03 (0.48) | 3.70 (0.47) | 3.49 (0.79) | 3.33 (0.40) |
Yes n = 375 | 3.28 (0.61) | 2.93 (0.58) | 3.74 (0.40) | 3.64 (0.62) | 3.31 (0.42) |
p-valueb | 0.434 | 0.138 | 0.383 | 0.300 | 0.671 |
Effect sizec | 0.118 | 0.179 | 0.095 | 0.225 | 0.048 |