Questionnaire based on WHO standards to measure health workers’ views on quality of care at the time of childbirth in the WHO European region: development and validation of mixed methods in six countries

BMJ open. 2022 Apr 8;12(4):e056753. doi: 10.1136/bmjopen-2021-056753.


OBJECTIVES: To develop and validate an online questionnaire based on WHO standards to measure the quality of maternal and newborn care (QMNC) at the time of childbirth from the perspective of health workers.

DESIGN: Mixed methods study.

SETTING: Six countries in the WHO European Region.

PARTICIPANTS AND METHODS: The questionnaire is based on lessons learned from previous studies and was developed in three sequential phases: (1) WHO quality measures were prioritized and content, construct and face validity were assessed through a Delphi involving a multidisciplinary committee of experts from 11 countries in the WHO European Region; (2) the translation/back-translation of the English version was carried out in accordance with the guidelines of the Professional Society for Health Economics and Outcomes Research; (3) internal consistency, intra-rater reliability, and acceptability were assessed with 600 health workers in six countries.

RESULTS: The questionnaire included 40 items based on WHO standards quality measures, equally divided into four domains: care delivery, experience of care, availability of human and physical resources, organizational changes due to COVID-19; and it is organized into six sections. It has been translated/retranslated into 12 languages: Bosnian, Croatian, French, German, Italian, Norwegian, Portuguese, Romanian, Russian, Slovenian, Spanish and Swedish. Cronbach’s alpha values ​​were ≥0.70 for each section of the questionnaire where questions were assumed to be interrelated, indicating good internal consistency. Cohen K or Gwet AC1 values ​​were ≥ 0.60, suggesting good intra-rater reliability except for one question. Acceptability was good with only 1.70% of health workers asking for minimal changes in question wording.

CONCLUSIONS: The results suggest that the questionnaire has good content, construct, face validity, internal consistency, intra-rater reliability and acceptability in six countries of the WHO European Region. Future studies could further explore the use of the questionnaire in other countries and how to translate the evidence generated by this tool into policies to improve QMNC.


PMID:35396296 | DOI:10.1136/bmjopen-2021-056753

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