# Development and validation of the person-centered postnatal care scale for low- and middle-income countries

## TL;DR

This paper introduces a new tool to measure respectful and responsive postnatal care in low- and middle-income countries, based on women's experiences.

## Contribution

The study develops and validates a comprehensive scale to assess person-centered postnatal care in low- and middle-income settings.

## Key findings

- A 38-item PCPNC scale was developed with strong internal consistency (Cronbach alpha of 0.93).
- The scale includes three domains: dignity and respect, communication and autonomy, and responsive and supportive care.
- PCPNC scores correlate with satisfaction and future intent to use the same health facility.

## Abstract

High-quality postnatal care (PNC), including Person-centered postnatal care (PCPNC), is essential to achieving optimal maternal and neonatal outcomes. PCPNC refers to postnatal care that is respectful of and responsive to postpartum women’s preferences, needs, and values. While interest in person-centered care across the reproductive health continuum has increased, there are no validated tools to comprehensively measure PCPNC. This study aims to develop and validate a tool to comprehensively measure PCPNC that is relevant to the experiences of women in low- and middle-income countries (LMICs).

The adaptation and validation process included a literature review to define, construct, and develop the scale items. This was followed by expert reviews with maternal health experts, health care providers, and women with past postnatal care experience to assess content validity. We then conducted cognitive interviews with postpartum women to ensure the questions were relevant, clear, and understandable. We iteratively revised the questions at each stage and surveyed 268 postpartum women (who gave birth within the last six months) in the Upper East Region of Ghana for initial analysis. We then analyzed the data, which informed additional edits to the questions. The final questions were administered in a survey to 1,394 women in Ghana and Kenya who had received postnatal care within 12 weeks postpartum. Psychometric analysis was used for item reduction and to assess construct and criterion validity and internal consistency reliability.

Following iterative factor analysis, we developed a 38-item PCPNC scale. The 38 items load onto one dominant factor, with three factors having eigenvalues greater than one and Cronbach alpha of 0.93. We grouped the items into three conceptual domains representing “dignity and respect,” “communication and autonomy,” and “responsive and supportive care” subscales, each of which has Cronbach alpha > 0.7. PCPNC scores are associated with satisfaction with PNC and intent to receive PNC in the same health facility in the future, suggesting good criterion validity.

The PCPNC scale is a valid and reliable tool to measure respectful and responsive PNC and will thus facilitate efforts to monitor and improve women and their baby’s experiences during PNC.