Validity of a questionnaire measuring the world health organization concept of health system responsiveness with respect to perinatal services in the dutch obstetric care system

Abstract

BackgroundThe concept of responsiveness, introduced by the World Health Organization (WHO), addresses non-clinical aspects of health service quality that are relevant regardless of provider, country, health system or health condition. Responsiveness refers to “aspects related to the way individuals are treated and the environment in which they are treated” during health system interactions. This paper assesses the psychometric properties of a newly developed responsiveness questionnaire dedicated to evaluating maternal experiences of perinatal care services, called the Responsiveness in Perinatal and Obstetric Health Care Questionnaire (ReproQ), using the eight-domain WHO concept.MethodsThe ReproQ was developed between October 2009 and February 2010 by adapting the WHO Responsiveness Questionnaire items to the perinatal care context. The psychometric properties of feasibility, construct validity, and discriminative validity were empirically assessed in a sample of Dutch women two weeks post partum.ResultsA total of 171 women consented to participation. Feasibility: the interviews lasted between 20 and 40 minutes and the overall missing rate was 8%. Construct validity: mean Cronbach’s alphas for the antenatal, birth and postpartum phase were: 0.73 (range 0.57-0.82), 0.84 (range 0.66-0.92), and 0.87 (range 0.62-0.95) respectively. The item-own scale correlations within all phases were considerably higher than most of the item-other scale correlations. Within the antenatal care, birth care and post partum phases, the eight factors explained 69%, 69%, and 76% of variance respectively. Discriminative validity: overall responsiveness mean sum scores were higher for women whose children were not admitted. This confirmed the hypothesis that dissatisfaction with health outcomes is transferred to their judgement on responsiveness of the perinatal services.ConclusionsThe ReproQ interview-based questionnaire demonstrated satisfactory psychometric properties to describe the quality of perinatal care in the Netherlands, with the potential to discriminate between different levels of quality of care. In view of the relatively small sample, further testing and research is recommended.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-014-0622-1) contains supplementary material, which is available to authorized users.

Experiences of women who planned birth in a birth centre compared to alternative planned places of birth. Results of the Dutch Birth Centre Study

“…We, therefore, compared the characteristics of the respondents with those of all the women who received postpartum care from the included midwifery practices. It appeared that the respondents have characteristics (older, higher educated, more often of Dutch origin and having less interventions during birth) that are associated with a more optimal birth experience, which may have positively influenced the results (Raleigh et al, 2010;Liabsuetrakul et al, 2012;van der Kooy et al, 2014).…”

“…Responsiveness is defined as aspects of the way individuals are treated and the environment in which they are treated during health system interactions (Murray and Frenk, 2000;Valentine et al, 2003). The concept has been applied in the Dutch maternity care a few times before (van der Kooy et al, 2014;Scheerhagen et al, 2015).…”

Measuring Client Experiences in Maternity Care under Change: Development of a Questionnaire Based on the WHO Responsiveness Model

“…First we looked at the responsiveness items of the World Health Survey and Multicountry Survey model [ 6 ], adapting items with contextual information of maternity care. Second, we used items generated for a previously developed face-to-face interview [ 27 ]. Third, we explored published questionnaires on the same or related concepts concerning maternity care [ 22 – 24 ].…”

“…The Maternity Experiences Survey from Canada assumes additional explanatory support of an interviewer, and its length precludes routine application [ 26 ]. Prior to the ReproQ, we developed a structured face-to-face interview based on the WHO responsiveness concept to evaluate care in an integrated birth centre, which includes clinical postdelivery services [ 27 ]. Like the Maternity Experiences Survey this interview was too long for routine application, and results suggested that after a complicated delivery, bias could occur in the report of client experiences antenatally (“carry back” effect [ 28 ]).…”

The Dutch Birth Centre Study: study design of a programmatic evaluation of the effect of birth centre care in the Netherlands

“…Client-experiences will be assessed by using the postnatal part of the Repro-Q [ 14 ]. The Repro-Q consists of the following components: 1) characteristics of the process of care; 2) questions about the 8 domains of the concept of responsiveness of the World Health Organisation (WHO); 3) additional questions including experienced outcomes; 4) the valuation of the relative importance of the various domains; 5) the respondent’s socio-demographic characteristics [ 15 ].…”