# Validation of the adapted pregnancy-related anxiety scale in Northern Ghana (PrAS-NG)

## TL;DR

This study validates a culturally adapted pregnancy-related anxiety scale for use in Northern Ghana, showing it is reliable and effective for screening anxiety during pregnancy.

## Contribution

The study introduces and validates a culturally adapted 22-item pregnancy-related anxiety scale (PrAS-NG22) for use in Northern Ghana.

## Key findings

- A 22-item, 9-factor version of the PrAS was developed and validated with a comparative fit index of 0.96.
- The PrAS-NG22 showed strong internal and test-retest reliability and full invariance across key demographic factors.
- The scale demonstrated convergent validity by correlating with anxiety and psychological distress during pregnancy.

## Abstract

Pregnancy-related anxiety refers to anxiety experienced throughout pregnancy, including concerns about labor, maternal and fetal wellbeing, healthcare access, and parental readiness. Pregnancy-related anxiety has significant adverse effects on maternal and neonatal outcomes, distinct from other mental health conditions during pregnancy. However, research in low- and middle-income countries, notably Ghana, remains limited, in part because of lack of culturally relevant, high-quality measures. This study aims to validate the adapted PrAS for use in Northern Ghana (PrAS-NG).

Using survey data from 586 pregnant women, we conducted a pre-registered assessment of the reliability and validity of the PrAS-NG. Reliability was evaluated using Cronbach's alpha and test-retest analyses. For internal validity, we conduct exploratory factor analysis and confirmatory factor analysis. Convergent and divergent validity were assessed through Pearson correlation analysis.

Following an exploratory factor analysis of the initial 52-item scale, a refined, 22-item, 9-factor version (PrAS-NG22) was developed. A confirmatory factor analysis validated the scale with a comparative fit index of 0.96. The scale demonstrated full invariance across age, gestational age, and parity. Internal (α=0.90) and test-retest reliability were strong (ICC=0.81). The PrAS-NG22 was related to anxiety and psychological distress during pregnancy, suggestive of convergent validity.

The results suggest the PrAS-NG22 is a valid, reliable, and culturally sensitive tool for pregnancy-related anxiety screening in Northern Ghana.