Reliability and Validity of a Perinatal Shared Decision-Making Measure: The Childbirth Options, Information, and Person-Centered Explanation

Elsevier

Available online 23 August 2022

Journal of Obstetric, Gynecologic & Neonatal NursingAbstractObjective

To develop and test the psychometric properties of a shared decision-making tool: Childbirth Options, Information, and Person-Centered Explanation (CHOICEs).

Design

Multiphase instrument development study beginning with item development through a cross-sectional postpartum survey.

Setting

The cross-sectional postpartum survey was distributed online through convenience and snowball sampling methods.

Methods

We developed instrument items through an iterative process with key stakeholders. We evaluated reliability based on internal consistency and differential item functioning analysis. We evaluated validity on evidence of construct validity. We used criterion-related item mapping to evaluate whether the measure addressed the full spectrum of shared decision making related to maternity care.

Results

Surveys were completed by 1,171 participants. A Cronbach’s αcoefficient of .99 supported internal consistency reliability. Infit and outfit statistics that ranged from 0.92 to 1.55 supported item fit. Differential item functioning analysis showed that CHOICEs scores were invariant between different demographic groups. Significant positive correlations between scores on CHOICEs and the Mothers on Respect index (r = 0.75, p = .01) and the Mothers Autonomy in Decision-Making scale (r = 0.75, p = .01) supported criterion-related validity. Item mapping suggested more items were needed to capture the full spectrum of shared decision making.

Conclusion

We recommend using CHOICEs to evaluate shared decision making in maternity care for research and quality improvement projects.

Section snippetsMethods

We designed CHOICEs to measure shared decision making from the patient perspective during prenatal and intrapartum care. We hypothesized that reliability would be supported based on internal consistency with an αcoefficient of .70 or greater (Tennant & Conaghan, 2007) and no evidence of differential item functioning (DIF) among races. We further hypothesized that validity would be supported by evidence that the items fit the model or concept of shared decision making as per infit and outfit

Results

Participants initiated a total of 2,076 surveys; 317 did not meet the inclusion criteria. Those who did not meet the inclusion criteria had a community birth or out-of-hospital birth (n = 58), were younger than 18 years (n = 108), gave birth before August 1, 2019 (n = 124), or gave birth outside the United States (n = 27). In addition, potential participants (n = 588) initiated the survey but did not complete the CHOICEs measure, so they were excluded from the analysis. Finally, 1,171

Discussion

Our findings provide initial support for the reliability and validity of CHOICEs in this broad sample of predominantly women who gave birth in U.S. hospitals. Reliability was supported based on internal consistency of the items and the invariance demonstrated when compared across different groups of participants. Construct validity was supported based on infit and outfit statistics. Mapping, however, indicated that it might be useful to add items that are more difficult.

More difficult items

Conclusion

CHOICEs is a new person-centered measure for use in the postpartum period to quantify shared decision-making experiences during prenatal and intrapartum care in hospitals. Psychometric testing of CHOICEs provided preliminary evidence of reliability and validity. Additional items should be considered to comprehensively address shared decision making in maternity care. We recommend CHOICEs to evaluate shared decision making in maternity care for research and quality improvement projects. In the

Uncited reference

Declercq et al., 2018, Jou et al., 2015, Watkins, 2018.

Acknowledgment

The authors thank Ovia Health, LLC, for support with recruitment.

Conflict of Interest

The authors report no conflicts of interest or relevant financial relationships.

Funding

Rachel Blankstein Breman is supported through a KL2 grant from the University of Maryland, Institute for Clinical and Translational Research, grant no. 1UL1TR003098-01, and she received the Association of Women’s Health, Obstetric and Neonatal Nurses March of Dimes Margaret Comerford Freda “Saving Babies Together” Award, which partially funded this

Rachel Blankstein Breman, PhD, MPH, RN, is an assistant professor, Partnerships, Professional Education, and Practice, School of Nursing, University of Maryland, Baltimore, MD

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Rachel Blankstein Breman, PhD, MPH, RN, is an assistant professor, Partnerships, Professional Education, and Practice, School of Nursing, University of Maryland, Baltimore, MD

Barbara Resnick, PhD, CRNP, FAANP, FAAN, is a professor and Chair of Organizational Systems and Adult Health, School of Nursing, University of Maryland, Baltimore, MD

Yolanda Ogbolu, PhD, CRNP, FNAP, FAAN, is an associate professor and Chair of Partnerships, Professional Education, and Practice, School of Nursing, University of Maryland, Baltimore, MD

Sophia Dada, is a student nurse and research assistant, Partnerships, Professional Education, and Practice, School of Nursing, University of Maryland, Baltimore, MD

Lisa Kane Low, PhD, CNM, FACNM, FAAN, is a professor and the Associate Dean for Professional Graduate Studies, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI

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© 2022 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

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