BMJ Open (Apr 2022)
WHO Standards-based questionnaire to measure health workers’ perspective on the quality of care around the time of childbirth in the WHO European region: development and mixed-methods validation in six countries
- Marzia Lazzerini,
- Benedetta Covi,
- Emanuelle Pessa Valente,
- Carina Rodrigues,
- Emma Sacks,
- Verena Sengpiel,
- Helen Elden,
- Ilaria Mariani,
- Ornella Lincetto,
- Dace Rezeberga,
- Mehreen Zaigham,
- Karolina Linden,
- Moise Muzigaba,
- Ekaterina Yarotskaya,
- Sandra Morano,
- Ioana Nanu,
- Micaela Iuliana Nanu,
- Eline Skirnisdottir Vik,
- Sigrun Kongslien,
- Ingvild Nedberg,
- Raquel Costa,
- Heloísa Dias,
- Daniela Drandić,
- Magdalena Kurbanović,
- Amira Ćerimagic,
- Rozée Virginie,
- Elise deLa Rochebrochard,
- Kristina Löfgren,
- Céline Miani,
- Stephanie Batram-Zantvoort,
- Lisa Wandschneider,
- Giuseppa Verardi,
- Beatrice Zanin,
- Ilana Chertok,
- Rada Artzi-Medvedik,
- Elizabete Pumpure,
- Agnija Vaska,
- Dārta Jakovicka,
- Paula Rudzīte,
- Elīna Ērmane,
- Katrīna Paula Vilcāne,
- Maryse Arendt,
- Barbara Tasch,
- Barbara Baranowska,
- Urszula Tataj-Puzyna,
- Maria Węgrzynowska,
- Catarina Barata,
- Teresa Santos,
- Jelena Radetić,
- Jovana Ružičić,
- Zalka Drglin,
- Barbara Mihevc Ponikvar,
- Anja Bohinec,
- Serena Brigidi,
- Lara Martín Castañeda,
- Ana Canales Viver,
- Claire De Labrusse,
- Alessia Abderhalden,
- Anouck Pfund,
- Harriet Thorn,
- Marina Otelea
Affiliations
- Marzia Lazzerini
- Maternal Adolescent Reproductive and Child Health Care Centre, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Public Health, London, UK
- Benedetta Covi
- 1 WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
- Emanuelle Pessa Valente
- 1 WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
- Carina Rodrigues
- 11 EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal
- Emma Sacks
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
- Verena Sengpiel
- Helen Elden
- 6 Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Ilaria Mariani
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS `Burlo Garofolo`, Trieste, Italy
- Ornella Lincetto
- 18 Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
- Dace Rezeberga
- Mehreen Zaigham
- 8 Department of Obstetrics and Gynecology - Institution of Clinical Sciences Lund, Lund University, Lund and Skåne University Hospital, Malmö, Sweden
- Karolina Linden
- 6 Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Moise Muzigaba
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
- Ekaterina Yarotskaya
- Sandra Morano
- 2 Medical School and Midwifery School, Genoa University, Genoa, Italy
- Ioana Nanu
- 5 National Institute for Mother and Child Health Alessandrescu - Rusescu, Bucharest, Romania
- Micaela Iuliana Nanu
- 5 National Institute for Mother and Child Health Alessandrescu - Rusescu, Bucharest, Romania
- Eline Skirnisdottir Vik
- 9 Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Sigrun Kongslien
- 10 Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Ingvild Nedberg
- 10 Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Raquel Costa
- 6 EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal
- Heloísa Dias
- 14 Regional Health Administration of the Algarve, IP (ARS - Algarve), Albufeira, Portugal
- Daniela Drandić
- 15 Roda – Parents in Action, Zagreb, Croatia
- Magdalena Kurbanović
- 16 Faculty of Health Studies, University of Rijeka, Rijeka, Croatia
- Amira Ćerimagic
- Rozée Virginie
- Elise deLa Rochebrochard
- Kristina Löfgren
- Céline Miani
- Department of Social Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
- Stephanie Batram-Zantvoort
- Lisa Wandschneider
- Giuseppa Verardi
- Beatrice Zanin
- Ilana Chertok
- Rada Artzi-Medvedik
- Elizabete Pumpure
- Agnija Vaska
- Dārta Jakovicka
- Paula Rudzīte
- Elīna Ērmane
- Katrīna Paula Vilcāne
- Maryse Arendt
- Barbara Tasch
- Barbara Baranowska
- Urszula Tataj-Puzyna
- Maria Węgrzynowska
- Catarina Barata
- Teresa Santos
- Jelena Radetić
- Jovana Ružičić
- Zalka Drglin
- Barbara Mihevc Ponikvar
- Anja Bohinec
- Serena Brigidi
- Lara Martín Castañeda
- Ana Canales Viver
- Claire De Labrusse
- Alessia Abderhalden
- Anouck Pfund
- Harriet Thorn
- Marina Otelea
- 3 University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- DOI
- https://doi.org/10.1136/bmjopen-2021-056753
- Journal volume & issue
-
Vol. 12,
no. 4
Abstract
Objectives Develop and validate a WHO Standards-based online questionnaire to measure the quality of maternal and newborn care (QMNC) around the time of childbirth from the health workers’ perspective.Design Mixed-methods study.Setting Six countries of the WHO European Region.Participants and methods The questionnaire is based on lessons learnt in previous studies, and was developed in three sequential phases: (1) WHO Quality Measures were prioritised and content, construct and face validity were assessed through a Delphi involving a multidisciplinary board of experts from 11 countries of the WHO European Region; (2) translation/back translation of the English version was conducted following The Professional Society for Health Economics and Outcomes Research guidelines; (3) internal consistency, intrarater reliability and acceptability were assessed among 600 health workers in six countries.Results The questionnaire included 40 items based on WHO Standards Quality Measures, equally divided into four domains: provision of care, experience of care, availability of human and physical resources, organisational changes due to COVID-19; and its organised in six sections. It was translated/back translated in 12 languages: Bosnian, Croatian, French, German, Italian, Norwegian, Portuguese, Romanian, Russian, Slovenian, Spanish and Swedish. The Cronbach’s alpha values were ≥0.70 for each questionnaire section where questions were hypothesised to be interrelated, indicating good internal consistence. Cohen K or Gwet’s AC1 values were ≥0.60, suggesting good intrarater reliability, except for one question. Acceptability was good with only 1.70% of health workers requesting minimal changes in question wording.Conclusions Findings suggest that the questionnaire has good content, construct, face validity, internal consistency, intrarater reliability and acceptability in six countries of the WHO European Region. Future studies may further explore the questionnaire’s use in other countries, and how to translate evidence generated by this tool into policies to improve the QMNC.Trail registration number NCT04847336
