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Abstract: Objective: To develop an instrument to the assess quality of care during pregnancy and delivery as perceived by women who recently gave birth. Study design: Prospective design from focus group interviews to validation of the questionnaire. The focus groups consisted of seven care providers, ten pregnant women and six women who recently gave birth. With the results of the focus group interviews, a draft questionnaire of 52 items was composed and its psychometric properties were tested in a first cohort of 300 women who recently gave birth (sample I) by means of exploratory factor analysis (EFA) and reliability analysis. The final version was further explored by confirmatory factor analyses (CFA) in another sample of 289 women (sample II) with similar characteristics as sample I. Results: EFA in sample I suggested an 18-item scale with two components concerning the quality of care during pregnancy: ‘personal treatment’ (11 items, Cronbach's alpha (α)=0.87) and ‘educational information’ (7 items, α =0.90); the ‘delivery’ scale showed a single domain (7 items, α =0.88). CFA in sample II confirmed both factor structures with an adequate model fit. Overall, satisfaction with care was highest among women who only received midwife-led care, while women who were referred to an obstetrician during pregnancy reported less satisfaction. Conclusions: The 25-item PCQ, primarily based on the experiences and perceptions of pregnant women and women who recently gave birth, showed adequate psychometric properties evaluating the quality of care during pregnancy and delivery. This user-friendly instrument might be a valuable instrument for future research to further evaluate the quality of care to pregnant women. [Copyright &y& Elsevier]

Abstract: Objective: COPD-guidelines recommend regular evaluation of both the degree of airway obstruction and health-status to provide adequate treatment. Numerous health-status questionnaires have been developed of which the ‘Clinical-COPD-Questionnaire’ and the ‘COPD-Assessment-Test’ are best known; although highly recommended, both have several limitations regarding structure, content, and/or methodological qualities. In the present study a new COPD-specific instrument was developed to measure impairment: the ‘Patient-centred-COPD-Questionnaire’ (PCQ). Methods: Six focus groups with COPD patients and (lung) health care providers from primary, secondary and tertiary (rehabilitation) care were formed to discuss aspects of COPD most relevant to patients' daily lives. Eighty candidate items were derived for explorative factor analyses (EFA) to test their psychometric properties (study I, n=541). These resulted in an 18-item scale that was further explored by confirmatory factor analyses (CFA) and construct and concurrent validity assessment (study II, n=412). Results: EFA in study I suggested a reliable three component solution (‘shortness of breath’, ‘acceptance of COPD’ and ‘confidence in care’). In study II this model was confirmed with CFA, and significant and clinically relevant correlations were found between the PCQ subscales, and other COPD specific and general health questionnaires. Furthermore, multivariate analyses of covariance revealed that more severely ill patients reported more impairment. Conclusions: The PCQ is a questionnaire with three dimensions to assess the impact of COPD on daily life that is easy to complete. For the first time, a dimension referring to ‘confidence in care’ is included in a tool that assesses COPD-related impairment. [Copyright &y& Elsevier]