Women’s report of mistreatment during facility-based childbirth: validity and reliability of community survey measures

Abstract

BackgroundAccountability for mistreatment during facility-based childbirth requires valid tools to measure and compare birth experiences. We analyse the WHO ‘How women are treated during facility-based childbirth’ community survey to test whether items mapping the typology of mistreatment function as scales and to create brief item sets to capture mistreatment by domain.MethodsThe cross-sectional community survey was conducted at up to 8 weeks post partum among women giving birth at hospitals in Ghana, Guinea, Myanmar and Nigeria. The survey contained items assessing physical abuse, verbal abuse, stigma, failure to meet professional standards, poor rapport with healthcare workers, and health system conditions and constraints. For all domains except stigma, we applied item-response theory to assess item fit and correlation within domain. We tested shortened sets of survey items for sensitivity in detecting mistreatment by domain. Where items show concordance and scale reliability ≥0.60, we assessed convergent validity with dissatisfaction with care and agreement of scale scores between brief and full versions.Results2672 women answered over 70 items on mistreatment during childbirth. Reliability exceeded 0.60 in all countries for items on poor rapport with healthcare workers and in three countries for items on failure to meet professional standards; brief scales generally showed high agreement with longer versions and correlation with dissatisfaction. Brief item sets were ≥85% sensitive in detecting mistreatment in each country, over 90% for domains of physical abuse and health system conditions and constraints.ConclusionBrief scales to measure two domains of mistreatment are largely comparable with longer versions and can be informative for these four distinct settings. Brief item sets efficiently captured prevalence of mistreatment in the five domains analysed; stigma items can be used and adapted in full. Item sets are suitable for confirmation by context and implementation to increase accountability and inform efforts to eliminate mistreatment during childbirth.

Comparing observed occurrence of mistreatment during childbirth with women’s self-report: a validation study in Ghana, Guinea and Nigeria

“…While measuring mistreatment using either a community survey or labour observation depends on resources available, we also note that any research or monitoring related to women’s experiences of care should allow women to report on what matters most to them. Shortened and full versions of the tools used in our analyses can inform key areas of focus, while cognisant of certain types of mistreatment that may be feasible to rule out but difficult to detect with observation and might need to be explored further using two methods 32 33. Furthermore, the measurement approaches need to be interpreted in the context of tool implementation for effective action on improving quality of care.…”

“…Our analysis has both strengths and limitations. This study builds on the strengths of the WHO ‘How women are treated during facility-based childbirth’ study, which developed tools specifically to capture mistreatment that have been validated in four countries 32 33. The robust approach to the analysis allowed us to consider individual-level and population-level accuracy of labour observations relative to the community survey.…”

Dignity and respect in maternity care

“…The Berger and Leslie papers used the full versions of the validated WHO tools for observation and community survey and developed shorter versions for easy use. Berger tested a set of three concise measures of mistreatment for facilities that ‘can be adapted and used in future research and quality improvement initiatives to quantify the burden, frequency and overlap of multiple types of mistreatment in a standardised way that can be compared across studies, settings and time periods’ 15 16. These papers advance our understanding of measurement issues of mistreatment and provide new knowledge of methodologies and scales that can be used and adapted by programmes in many countries.…”

Development of measures for assessing mistreatment of women during facility-based childbirth based on labour observations

“…9 Our measures may include items that could be readily observed but 'matter' less to women's personal experience of care, removing items that may be important to a women's birth experience such as blaming women for poor outcomes. Triangulating labour observation measures with measures based on women's reports of mistreatment, like those developed in an analysis of the WHO community survey data 89 , aligns multiple perspectives to enhance our understanding of rigorously measuring this complex phenomenon. Other methodological limitations using the study dataset and tools have been previously described.…”