# Assessing fear of childbirth in Malaysia: development and psychometric testing of the Malaysian Fear of Birth questionnaire (MyFOB)

## TL;DR

This study developed and validated a questionnaire to assess fear of childbirth among Malaysian women, which can help identify those in need of support during pregnancy.

## Contribution

The paper introduces the first culturally tailored Malaysian Fear of Birth questionnaire (MyFOB) with validated psychometric properties.

## Key findings

- MyFOB consists of 20 items grouped into four factors: Labour & delivery, Pain, Maternal emotion, and Healthcare professionals.
- The questionnaire demonstrated good reliability (Cronbach α = 0.88) and a strong model fit in confirmatory factor analysis.
- The tool is suitable for routine antenatal care to identify women with high childbirth fear.

## Abstract

Fear of childbirth or tokophobia refers to the pathological fear of childbirth, which affects the daily life of pregnant women. Childbirth fear is multidimensional and differs across cultures. We aimed to develop and validate the first Malaysian Fear of Birth questionnaire (MyFOB) among the multiethnic Malaysian women.

The research was conducted in the antenatal clinic, Hospital Canselor Tuanku Muhriz, Kuala Lumpur. A mixed-methods, exploratory sequential approach was applied. Phase 1 involved a qualitative exploration of childbirth fear through one-to-one interviews, while phase 2 comprised questionnaire development based on the qualitative results, literature review and experts’ input. Psychometric properties of the questionnaire were assessed through exploratory factor analysis (EFA), face validation, and reliability testing. Subsequently, confirmatory factor analysis (CFA) was performed to determine the model fit of the final version of MyFOB. EFA and CFA were conducted on two separate cohorts.

Twelve qualitative interviews yielded five themes. Subsequently, one hundred thirty-seven items were generated and underwent content validation by five experts. The construct validity of the initial 43-item questionnaire was assessed through EFA. Phase 2 cohorts for EFA and CFA were 257 and 341, respectively. Principal component analysis resulted in MyFOB, which comprised 20 items accounting for 65.6% of the total variance. These items were grouped into four factors: 1) Labour & delivery, 2) Pain, 3) Maternal emotion, and 4) Healthcare professionals. The pilot study on sixty-one women revealed good reliability (Cronbach α =0.88) while confirmatory factor analysis demonstrated a good model fit.

The Malaysian Fear of Childbirth Questionnaire (MyFOB) is a reliable and valid tool that can be utilised in routine antenatal care to identify vulnerable women.