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Background and Purpose: To assess the psychometrics of the French language Quality of Prenatal Care Questionnaire (QPCQ). Methods: Data from 302 women were used in a confirmatory factor analysis and in assessment of construct validity through hypothesis testing and internal consistency reliability using Cronbach's alpha. Results: The 6 factors (subscales) were verified and confirmed. Hypothesis testing further supported construct validity. The overall QPCQ had acceptable internal consistency reliability (Cronbach's alpha = .97) as did 5 subscales (Cronbach's alpha = .70-.92); the Sufficient Time subscale had poorer reliability (Cronbach's alpha = .61). Conclusions: The French language QPCQ is a valid and reliable self-report measure of prenatal care quality. It can be used in research and in quality improvement work to strengthen prenatal care services.Keywords: prenatal care; quality of health care; questionnaires; psychometrics; translation; FrenchPrenatal care is a widely used health service in Canada. The Canadian Maternity Experiences Survey found that all women surveyed had at least one prenatal care visit, with an average number of 13 visits (Public Health Agency of Canada, 2009). Prenatal care encompasses "the detection, treatment, or prevention of adverse maternal, fetal, and infant outcomes as well as interventions to address psychosocial stress, detrimental health behaviors such as substance abuse, and adverse socioeconomic conditions" (Alexander & Kotelchuck, 2001, p. 316). However, the evidence for the efficacy and effectiveness of prenatal care has not been firmly established (Alexander & Kotelchuck, 2001; Moos, 2006). Research traditionally has focused on the association between adequacy of prenatal care, determined by the timing of initiation of care and number of visits, and pregnancy outcomes (Heaman, Newburn-Cook, Green, Elliott, & Helewa, 2008). As suggested by Alexander and Kotelchuck (2001), more attention needs to be given to attributes of the health care system and the prenatal care provider, and how these attributes influence the outcomes of prenatal care.These attributes reflect the structure and process of care elements of Donabedian's (1966, 1988) quality of care model; the health care system determines the structure of care whereas prenatal care providers enact clinical and interpersonal care processes. Several studies have highlighted the potential importance of the quality of prenatal care encounters. The content of prenatal care often is considered a quality indicator and there is evidence that health promotion advice (Wilkinson & McIntyre, 2012), attention to risk factors (Public Health Agency of Canada, 2010), and adherence to prenatal care guidelines (Handler, Rankin, Rosenberg, & Sinha, 2012) can improve outcomes. Also, group prenatal care, which was designed to improve quality of care and perinatal outcomes by attending to recommended prenatal care content (Massey, Rising, & Ickovics, 2006), has been found to contribute to higher levels of prenatal knowledge, readiness for labor and birth, and satisfaction with care when compared to traditional prenatal care (Homer et al., 2012). Whereas quality of prenatal care might be equally or more important than quantity of care (Sword et al., 2012), research to examine relationships between care quality and various outcomes has been hindered by the lack of a comprehensive, theoretically grounded measure of the quality of prenatal care (Heaman et al., 2014).In response to this scientific gap, the 46-item Quality of Prenatal Care Questionnaire (QPCQ) was developed and tested with samples of English-speaking women recruited from five major urban centers across Canada (Heaman et al., 2014). As reported by Heaman et al. (2014), the development of the instrument was guided by Donabedian's (1966, 1988) model of quality care. Instrument development was further informed by the work of Campbell, Roland, and Buetow (2000), who defined key components of Donabedian's structure and process categories (Heaman et al. …

Background The quality of antenatal care is recognized as critical to the effectiveness of care in optimizing maternal and child health outcomes. However, research has been hindered by the lack of a theoretically-grounded and psychometrically sound instrument to assess the quality of antenatal care. In response to this need, the 46-item Quality of Prenatal Care Questionnaire (QPCQ) was developed and tested in a Canadian context. The objective of this study was to validate the QPCQ and to establish its internal consistency reliability in an Australian population. Methods Study participants were recruited from two public maternity services in two Australian states: Monash Health, Victoria and Wollongong Hospital, New South Wales. Women were eligible to participate if they had given birth to a single live infant, were 18 years or older, had at least three antenatal visits during the pregnancy, and could speak, read and write English. Study questionnaires were completed in hospital. A confirmatory factor analysis (CFA) was conducted. Construct validity, including convergent validity, was further assessed against existing questionnaires: the Patient Expectations and Satisfaction with Prenatal Care (PESPC) and the Prenatal Interpersonal Processes of Care (PIPC). Internal consistency reliability of the QPCQ and each of its six subscales was assessed using Cronbach’s alpha. Results Two hundred and ninety-nine women participated in the study. CFA verified and confirmed the six factors (subscales) of the QPCQ. A hypothesis-testing approach and an assessment of convergent validity further supported construct validity of the instrument. The QPCQ had acceptable internal consistency reliability (Cronbach’s alpha = 0.97), as did each of the six factors (Cronbach’s alpha = 0.74 to 0.95). Conclusions The QPCQ is a valid and reliable self-report measure of antenatal care quality. This instrument fills a scientific gap and can be used in research to examine relationships between the quality of antenatal care and outcomes of interest, and to examine variations in antenatal care quality. It also will be useful in quality assurance and improvement initiatives.

Background Utilization indices exist to measure quantity of prenatal care, but currently there is no published instrument to assess quality of prenatal care. The purpose of this study was to develop and test a new instrument, the Quality of Prenatal Care Questionnaire (QPCQ). Methods Data for this instrument development study were collected in five Canadian cities. Items for the QPCQ were generated through interviews with 40 pregnant women and 40 health care providers and a review of prenatal care guidelines, followed by assessment of content validity and rating of importance of items. The preliminary 100-item QPCQ was administered to 422 postpartum women to conduct item reduction using exploratory factor analysis. The final 46-item version of the QPCQ was then administered to another 422 postpartum women to establish its construct validity, and internal consistency and test-retest reliability. Results Exploratory factor analysis reduced the QPCQ to 46 items, factored into 6 subscales, which subsequently were validated by confirmatory factor analysis. Construct validity was also demonstrated using a hypothesis testing approach; there was a significant positive association between women’s ratings of the quality of prenatal care and their satisfaction with care (r = 0.81). Convergent validity was demonstrated by a significant positive correlation (r = 0.63) between the “Support and Respect” subscale of the QPCQ and the “Respectfulness/Emotional Support” subscale of the Prenatal Interpersonal Processes of Care instrument. The overall QPCQ had acceptable internal consistency reliability (Cronbach’s alpha = 0.96), as did each of the subscales. The test-retest reliability result (Intra-class correlation coefficient = 0.88) indicated stability of the instrument on repeat administration approximately one week later. Temporal stability testing confirmed that women’s ratings of their quality of prenatal care did not change as a result of giving birth or between the early postpartum period and 4 to 6 weeks postpartum. Conclusion The QPCQ is a valid and reliable instrument that will be useful in future research as an outcome measure to compare quality of care across geographic regions, populations, and service delivery models, and to assess the relationship between quality of care and maternal and infant health outcomes.

A sample of 16 male and 30 female undergraduates completed the Greer and Francis Scale of Rejection of Christianity. The data support the internal consistency reliability and construct validity of the scale for this sample.