Measuring clients’ experiences with antenatal care before or after childbirth: it matters

Abstract

BackgroundWhen clients’ experiences with maternity care are measured for quality improvement, surveys are administered once, usually six weeks or more after childbirth. Most surveys conveniently cover pregnancy, childbirth and postnatal care all in one. However, the validity of measuring the experiences during pregnancy (antenatal experiences) after childbirth is unknown. We explored the relation between the measurement of antenatal experiences late in pregnancy but prior to childbirth (‘test’ or gold standard) and its retrospective measurement after childbirth (retrospective test). Additionally, we explored the role of modifying determinants that explained the gap between these two measurements.Methods and FindingsClient’s experiences were measured by the ReproQuestionnaire that consists of an antenatal and postnatal version, and covers the eight WHO Responsiveness domains. 462 clients responded to the antenatal and postnatal questionnaire, and additionally filled out the repeated survey on antenatal experiences after childbirth. First, we determined the association between the test and retrospective test using three scoring models: mean score, equal or above the median score and having a negative experience. The association was moderate for having any negative experience (absolute agreement = 68%), for the median (absolute agreement = 69%) and for the mean score (ICC = 0.59). Multiple linear and logistic regression analysis for all three scoring models revealed systematic modifiers. The gap between antenatal and postnatal measurement was (partly) associated with clients’ experiences during childbirth and postnatal care and by professional discontinuity during childbirth but unrelated to the perceived health outcome.ConclusionsThe antenatal experiences should be measured before and not after childbirth, as the association between the antenatal experiences measured before and after childbirth is moderate.

The discriminative power of the ReproQ: a client experience questionnaire in maternity care

“…These gaps appear modest in quantitative terms. More important, a study we conducted recently on the determinants of experience scores showed that maternal age and educational level have no significant impact on the level of experience scores (Scheerhagen et al, 2019). Reference data on client-reported health status are absent.…”

“…Psychometric analyses support the content and construct validity as well as the test-retest reliability of the questionnaire (Scheerhagen et al, 2015b; Scheerhagen et al, 2016). For the remainder of this paper, we will only present the results of the 2nd half of pregnancy, as the ratings of the 1st and 2nd half of the pregnancy are highly associated (ICC = 0.83) (Scheerhagen et al, 2018).…”

Effects of a Personal Health Record in Maternity Care: A Stepped-Wedge Trial

“…The second endpoint was the effect of the PHR on women’s perspectives of the quality of their care, measured using a simplified version of the validated ReproQ self-administered questionnaire. This instrument was developed to evaluate prenatal, natal, and postnatal care, and is based on the WHO Responsiveness model, which includes eight domains: dignity, autonomy, confidentiality, communication, prompt attention, social consideration, basic amenities, and choice and continuity [ 26 , 27 , 28 ]. Each domain consisted of several items, through which experiences were rated on a 4-point scale, with ‘1′ being the lowest score and ‘4’ being the highest.…”

Peer Review #3 of "The discriminative power of the ReproQ: a client experience questionnaire in maternity care (v0.1)"

“…Psychometric analyses support the content and construct validity as well as the testretest reliability of the questionnaire (Scheerhagen et al 2015b;Scheerhagen et al 2016). For the remainder of this paper, we will only present the results of the 2 nd half of pregnancy, as the ratings of the 1 st and 2 nd half of the pregnancy are highly associated (ICC=0.83) (Scheerhagen et al 2018).…”