Development of the person-centered prenatal care scale for people of color

Abstract

BACKGROUND: Given the stark disparities in maternal mortality and adverse birth outcomes among Black, indigenous, and other people of color, there is a need to better understand and measure how individuals from these communities experience their care during pregnancy. OBJECTIVE: This study aimed to develop and validate a tool that can be used to measure person-centered prenatal care that reflects the experiences of people of color. STUDY DESIGN: We followed standard procedures for scale development-integrated with community-based participatory approachesto adapt a person-centered maternity care scale that was initially developed and validated for intrapartum care in low-resource countries to reflect the needs and prenatal care experiences of people of color in the United States. The adaptation process included expert reviews with a Community Advisory Board, consisting of community members, community-based health workers, and social service providers from San Francisco, Oakland, and Fresno, to assess content validity. We conducted cognitive interviews with potential respondents to assess the clarity, appropriateness, and relevance of the questions, which were then refined and administered in an online survey to people in California who had given birth in the past year. Data from 293 respondents (84% of whom identified as Black) who received prenatal care were used in psychometric analysis to assess construct and criterion validity and reliability. RESULTS: Exploratory factor analysis yielded 3 factors with eigenvalues of >1, but with 1 dominant factor. A 34-item version of the person-centered prenatal care scale was developed based on factor analyses and recommendations from the Community Advisory Board. We also developed a 26-item version using stricter criteria for relevance, factor loadings, and uniqueness. Items were grouped into 3 conceptual domains representing subscales for "dignity and respect," "communication and autonomy," and "responsive and supportive care." The Cronbach alphas for the 34-item and the 26item versions and for the subscales were >0.8. Scores based on the sum of responses for the 2 person-centered prenatal care scale versions and all subscales were standardized to range from 0 to 100, where higher scores indicate more person-centered prenatal care. These scores were correlated with global measures of prenatal care satisfaction suggesting good criterion validity. CONCLUSION: We present 2 versions of the person-centered prenatal care scale: a 34-item and a 26-item version. Both versions have high validity and reliability in a sample made up predominantly of Black women. This scale will facilitate measurement to improve person-centered prenatal care for people of color and could contribute to reducing disparities in birth outcomes. The similarity with the original scale also suggests that the person-centered prenatal care may be applicable across different contexts. However, validation with more diverse samples in additional settings is needed.

Factors associated with person‐centered care during pregnancy and birth for Black women and birthing people in California

“…A few questions have a "not applicable" option. Both scales have been shown to have high validity and reliability, 15,16 with Cronbach's alphas of 0.94 and 0.95 for the PCPC and PCMC-US scales, respectively. Scores on both scales are generated by adding responses to the individual items after reverse coding negatively worded items and recoding not applicable options to the upper middle category such that all item responses range from 0 to 3; higher numbers indicate the desired behaviors.…”

“…There are several available measures to capture aspects of respectful, or person‐centered, reproductive health care, which is defined as “health care that is respectful of and responsive to individual [people] and their families' preferences, needs and values, and [ensures] that their values guide all clinical decisions.” 14 The Person‐Centered Prenatal Care (PCPC) scale and the Person‐Centered Maternity Care (PCMC‐US) scale were recently validated as measures to cumulatively assess the major domains of person‐centered care during prenatal care and birth, including communication and autonomy, dignity and respect, and supportive care 15,16 . These scales were designed specifically to capture the disparate experiences among people of color to help elucidate determinants and consequences of poor care quality and to measure the effectiveness of interventions to improve person‐centered care and reduce inequities in birth outcomes.…”

“…14 The Person-Centered Prenatal Care (PCPC) scale and the Person-Centered Maternity Care (PCMC-US) scale were recently validated as measures to cumulatively assess the major domains of person-centered care during prenatal care and birth, including communication and autonomy, dignity and respect, and supportive care. 15,16 These scales were designed specifically to capture the disparate experiences among people of color to help elucidate determinants and consequences of poor care quality and to measure the effectiveness of interventions to improve person-centered care and reduce inequities in birth outcomes. The purpose of this paper is to examine the factors associated with experiences of person-centered care among Black birthing people in California using the PCPC and PCMC-US scales.…”

Birth includes us: Development of a community‐led survey to capture experiences of pregnancy care among LGBTQ2S+ families

“…Respectful maternity (perinatal) care, defined as care that maintains dignity, privacy, confidentiality, and prioritizes freedom from harm and mistreatment, informed choice, and continuous support during pregnancy and childbirth, 11 has been a focus within the global health literature as a mitigator of maternal mortality and morbidity disparities. 12 Several studies have developed measures to quantify respectful or person-centered care, [13][14][15][16][17] with many finding that experiences of disrespect, lack of autonomy and decision-making power, and mistreatment occur most frequently among racially marginalized communities. 14,15,18 Experiences of stigma and discrimination have been documented for LGBTQ2S+ families seeking perinatal care in qualitative research, 3,4,5,19 but larger scale measurement of respectful perinatal care have been largely absent for this population.…”

Agency in Contraceptive Decision-Making in Patient Care: a Psychometric Measure

“…6,[8][9][10]40,41 While there has been a long-standing need to prevent coercion and to support patients' agency, there has also been a notable scientific gap in the conceptualization and measurement of these constructs. Reproductive autonomy encompasses a range of fertility decisions, and recently, measures have been developed to capture autonomy in decision-making in maternity care 42,43 that can help to move the field forward to improve maternal health in key dimensions. In contraceptive care, the IQFP/PCCC scales measure quality of care, covering domains of interpersonal connection, decision support, and adequate information, and have helped to raise the standards and expectations for person-centered care.…”