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. 2023 Nov 28;18(11):e0291591. doi: 10.1371/journal.pone.0291591

Cultural adaptation and psychometric evaluation of Childbirth Experience Questionnaire 2 in Karnataka state, India

Paridhi Jha 1, Vikas Kumar Jha 2, Bharati Sharma 3, Ajeya Jha 4, Kerstin Erlandsson 5, Malin Bogren 6,*
Editor: Pracheth Raghuveer7
PMCID: PMC10684018  PMID: 38015907

Abstract

Background

Women’s birthing experience is a sensitive indicator of the quality of childbirth care and can impact the physical and mental health of both women and their neonates. Negligible evidence exists on Indian women’s birth experiences and–to the best of authors’ knowledge–no questionnaire has been tested in India for measuring women’s birthing experiences. This study aimed to test the construct validity and reliability of the Kannada-translated Revised Childbirth Experience Questionnaire.

Methodology

A cross-sectional survey was carried out among postnatal women (n = 251, up to six months postpartum, with a live healthy neonate) who had given birth at a public or private health facility using the Kannada-translated CEQ2 in two districts of Karnataka. Data were collected at participants’ homes after seeking written informed consent. Model fit was determined by Confirmatory Factor Analyses.

Results

The 4-factor model of the CEQ2 showed good fit after deletion of one item (item 8, subcategory “participation”) with CMIN = 1.33; SRMR = 0.04; GFI = 0.92, CFI = 0.98, TLI = 0.99, RMSEA = 0.037 and p value 0.002). The Cronbach alpha values were acceptable for the four subscales (0.92, 0.93, 0.97, 0.91) as well as for the overall 21-item scale (0.84).

Conclusions

The Kannada-translated CEQ2 is a reliable tool to measure the childbirth experiences among Kannada-speaking women and can serve as a reliable ongoing evaluation of women’s birth experiences.

Introduction

Women’s experiences of childbirth care have been reported as a global public health issue [1]as they can cause an immediate and long-term impact on the lives, well-being and health of women and their neonates. A positive birth experience can be empowering and facilitate the transition to motherhood [2], whereas a negative birth experience can cause fear of birth [3, 4] and postpartum depression [5, 6], and it can diminish maternal-neonatal bonding [7] and stunt the growth and development of a neonate [8]. Poor quality of childbirth-related care is one of the most common reasons behind negative birth experience [9]. Examples of such experiences include malpractice or negligence, lack of respect from care providers, and poor hands-on care given to women during labour and birth [10]. These are critical reasons why women avoid coming to hospitals for childbirth [11, 12]. Therefore, women’s experiences need to be better understood, and gaps in respectful and supportive care need to be identified. A validated and reliable tool that can measure the women’s birth experiences becomes important in such circumstances.

Valid and reliable tools for measuring the women’s birth experiences

There are existing instruments measuring women’s childbirth experiences [1318] which can guide researchers to identify and adapt an appropriate instrument for use instead of developing a new one. After reviewing the seven questionnaires measuring women’s childbirth experiences, the Revised Childbirth Experience Questionnaire (CEQ2) developed by Dencker et al. (2020) was considered most suitable [18] given the widespread validation and use of the original CEQ in several low-, middle- and high-income countries [13, 1922]. In 2020, the authors of the original CEQ updated the questionnaire by adding new questions that explored the professional support and participation-related aspects of childbirth care in addition to the original dimensions of perceptions regarding own capacity and personal safety during childbirth. This 22-item questionnaire–CEQ2 –has been validated and culturally adapted in European and Asian countries [18, 23, 24]. The CEQ2 was selected for use in India due to its broadly framed questions that allowed for easy socio-cultural contextualisation of the tool.

Intrapartum care in India

The government of India has invested in improving maternal and child health care over the past decade, including infrastructural reforms of labour rooms [25], re-skilling of care providers in safe and sensitive care, and taking the historic decision to roll out India’s first midwifery service guidelines to introduce professional midwives as an independent cadre in the Indian healthcare system. However, there is a dearth of evidence reporting women’s birth experiences from India. While several qualitative studies have described Indian women’s experiences of giving birth/receiving childbirth care, no standardised childbirth experience measurement questionnaire has been tested and validated in India–to the best of the authors’ knowledge–to measure these experiences, nor does an Indian questionnaire exist that does so.

Testing a standardised questionnaire in India would contribute to measuring the overall birth experience of Indian women, which is an important step in identifying quality improvement areas and developing strategies for providing respectful, quality maternity care during labour and childbirth. As part of a larger project designed to implement midwife-led care in Karnataka state, India, this study aimed to test the construct validity and reliability of the Kannada-translated Revised Childbirth Experience Questionnaire (Kannada-translated CEQ2).

Methodology

The Revised Childbirth Experience Questionnaire (CEQ2) developed by Dencker et al. [26], with 22 items, 19 of them structured as a 4-point Likert scale (1 = Totally disagree, 4 = Totally agree), and three items on a Visual Analogue Scale (VAS), was selected for cultural adaptation and testing in Karnataka, India. The CEQ2 has eight negatively worded items that need reverse coding before analyses. The 22 items are clustered under four domains: 1) Own capacity (8 items), 2) Perceived safety (6 items), 3) Professional support (5 items) and 4) Participation (3 items). The questionnaire has good construct validity and has been tested in European and Asian countries with moderate to significant changes in its structure. To the best of the authors’ knowledge, the CEQ2 has not been translated and used in any state of India.

Contextualising the CEQ2 for use in Karnataka, India

The trans-cultural questionnaire process recommended by Wild et al. [27] was followed. The authors prepared themselves by discussing the CEQ2 with original authors and seeking their advice. A forward translation of the CEQ2 was carried out from English to Kannada by a translation expert in the field, and reconciliation of all other possible translations was carried out by the Indian authors. Another independent language expert back-translated the questionnaire, which was reviewed by all the authors and by the author of the original CEQ2. All suggestions were incorporated. The other available translations of the CEQ2 were reviewed online to check for different translations, however no changes were made in the Kannada-translated questionnaire as our translation seemed harmonised with other published CEQ2 versions. Cognitive debriefing was carried out using a “think-aloud” technique with seven postpartum women who had recently given birth in order to test for the Kannada-translated CEQ2’s understandability, interpretation and cultural relevance of the translation. As a result, the term “partner” was replaced with “birth companion/family member”, and the term “midwife” was replaced with “care provider during labour and birth”. The visual analogue scale was prepared using a pictorial representation to increase understanding of quantification among women, if required (1 dollar to 100 dollar image instead of 1–100 scale) for ensuring uniform understanding. The authors further reviewed the outcomes of cognitive debriefing activities to identify any further discrepancies, though none were observed. The proof-reading of this final prepared Kannada-translated CEQ2 was carried out by another translator to rule out any typological errors. It is noteworthy that all translators involved in this process were native Kannada speakers and were also fluent in reading and writing English.

The final version of the Kannada-translated CEQ2 consisted of 22 items from the original CEQ2, along with socio-demographic profiling-related questions, obstetric history-related questions, questions specific to the last birth, and questions about participants’ general health (Table 1). The Kannada-translated CEQ2 was pilot tested with 25 women who did not participate in the actual study.

Table 1. Socio-demographic, obstetric and general health profile of the participants.
n (%)
SOCIO-DEMOGRAPHIC PROFILE OF PARTICIPANTS
Age of the participants in completed years (mean, (SD)) 25.5 (4.97)
Educational status of the participants
Illiterate/home schooled 4/2 (2.4)
Up to 10 years of formal education 89 (35.5)
Up to 12 years of formal education 75 (29.8)
Graduation or higher 81 (32.3)
Work status of the participants
Homemaker 174 (69.3)
Salaried employee 62 (24.7)
Other (contractual/project based) 15 (6.0)
Reported annual income of the participants’ families
Up to 1 million Indian rupees 181 (72.1)
More than 1 million Indian rupees 70 (27.9)
Marital status of participants
Married 249 (99.2)
Widowed 8 (0.8)
OBSTETRIC PROFILE OF THE PARTICIPANTS
Participant groups based on parity
Primipara 125 (49.7)
Multipara 126 (50.3)
Mode of childbirth
Vaginal birth (with/without requiring perineal suturing) 162 (64.8)
Caesarean birth (planned/emergency) 85 (33.8)
Assisted (vacuum/forceps) 3 (1.2)
Self-reported duration of labour by the participants
Did not experience labour 19 (7.7)
Up to two hours of labour pain 39 (15.7)
>2–5 hours of labour pain 50 (20.2)
>5–10 hours of labour pain 91 (36.7)
>10 hours of labour pain 49 (19.7)
As reported by the participants, the birth facility belonged to
Private sector 115 (46.0)
Public sector 136 (54.0)
As reported by the participants, the birth facility was
A private specialty hospital 61 (24.4)
A private nursing home/family-run small hospital 54 (21.6)
A government medical college hospital 38 (14.6)
A government district hospital 98 (39.4)
GENERAL HEALTH PROFILE OF THE PARTICIPANTS
Self-perception of general health
Good 196 (78.1)
Quite Good 45 (17.9)
Somewhat poor 8 (3.2)
Poor 2 (0.8)
Reported being treated for anxiety in past 6 (2.4)
Reported being treated for depression in past 5 (2.0)

Design, participants and data collection. A cross-sectional survey was carried out from June 2022 to September 2022 to collect data. Postpartum women who had given birth in the six-month period before data collection (vaginally, assisted, or by Caesarean section) to at least one live newborn were invited to participate. Eight native Kannada-speaking research assistants, who were rigorously trained in processes of information sharing, consent taking and data collection using face-to-face interviews, collected the data. A face-to-face interview method was chosen to ensure that illiterate women–if any–had an equal opportunity to participate. To minimise response bias, all research assistants were provided with the operational definition of each key term used in 22 items of the CEQ2. They were instructed to contact the authors in case a participant’s query needed information beyond the operational definitions.

Study site and sample size

Women were recruited for home-based interviews from the communities around large public and private health facilities (500 or more monthly childbirths) in two districts of Karnataka. A sample size of 220 participants (10 times the number of items in the CEQ2) was determined following the principles of psychometric evaluation [28], and 251 women were approached based on an expected 25% refusal to participate.

Statistics and data analyses

Baseline descriptive statistics (frequencies and percentage; mean and SD when required) were calculated to describe the participants who responded to the Kannada-translated CEQ2. Mean and SD of each item on the Kannada-translated CEQ2 was calculated. An exploratory Principal Component Analysis (PCA) and Confirmatory Factor Analysis (CFA) were carried out to understand the factor structure, validity, known-group validity and reliability of this questionnaire.

Principal component analysis. IBM SPSS 25 was used to perform PCA. A significance level of p = 0.05 was considered throughout the study. Kaiser-Meyer-Olkin (KMO) test of sample adequacy and Bartlett’s Test of Sphericity were performed, followed by PCA using direct oblimin rotation; extracting the factors based on eigenvalues ≥1, coefficients having <0.40 factor loadings were suppressed.

Confirmatory factor analysis

IBM SPSS AMOS 26 software was used to conduct CFA. Model fit statistics were used to assess the factor structure suggested in EFA: minimum discrepancy divided by degrees of freedom (CMIN/DF), chi squared, the Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), standardised root mean square residual (SRMR), and root mean square error of approximation (RMSEA), where CMIN/DF< 5, CFI and TLI values closer to 0.95, the SRMR values closer to 0.08 and RMSEA values <0.08 demonstrate a good fit [28].

Internal construct validity

Item-factor, factor scale and item-scale correlations were calculated to determine the internal construct validity of the Kannada-translated CEQ2. Coefficients <0.2 would require deletion of that item from the scale [28].

Internal consistency

Cronbach’s alpha coefficient (α) was calculated to determine the internal consistency. For this purpose, α would be calculated for items as clustered under all factors identified and for the total scale, where α ≥ 0.70 to 0.90 would demonstrate good internal consistency [28].

Known group validity

The ability of the Kannada-translated CEQ2 to differentiate between different groups was carried out using the known-group validity check. Women’s parity, mode of birth and the duration of labour were selected as these variables were used with original CEQ2 testing [26]. In addition, presence of a birth companion during labour was also included as a variable for known-group testing, in line with CEQ2 testing reported by Lok et al. [23]. Cohen’s d effect sizes were calculated and considered trivial (<0.2), small (≥0.2–0.5), moderate (≥0.5 and ≤0.8) and large (>0.8) [28].

Ethical clearance and participants’ consent

This study was approved by the Ethical Review Board of the Foundation for Research in Health Systems (FRHS) (Referral No. 2022/MWC/01). All participating women received verbal and written information on the study and duly gave their written informed consent before responding to the CEQ2. The questionnaire was administered at a time convenient for the women and their families, minimising disruption to their daily routines. Women RAs were recruited to ensure socio-cultural acceptance of the research team by the community.

Findings

A total of 251 women participated in the study. All invited women accepted participation. After responses were checked for completeness (none missing), all completed forms were used in the analysis. The median postnatal period in which women responded was 2.9 months (SD 1.6). All participants were married, and a majority of the participants were homemakers (69.3%). About half of the participants were primiparous (49.7%), and 54% participants had given birth in public health facilities. About 9% of participants had experienced at least one miscarriage (ranging from 1–5 miscarriages), and 5.2% had lost an under-5-year-old child. Table 1 presents the socio-demographic, obstetric and general health profile of the participants.

Principal component analyses

The Kannada-translated CEQ2 passed the KMO test of sample adequacy (value 0.875) and was factorable as demonstrated by a significant Bartlett’s test of sphericity (χ2 = 4869.2, p = <0.001). The PCA revealed a four-factor solution which was similar to the one proposed by Dencker et al. (2020) in their original testing [26]. However, the “Perceived safety” (items 3,16,17,18,19,22) factor explained the maximum amount of variance instead of the “Own capacity” factor (items 1,2,4,5,6,7,20,21), which was the first factor in the original CEQ2. The “Professional support” (Items 10,12,13,14,15) and “Participation” (Items 8,9,11) were the third and fourth extracted factors respectively in this study. Together, the four factors explained 75.6% of the variance. The construct validity showed that item 8 had poor correlation with the overall scale score (<0.2), and therefore the item was deleted from the scale. Table 2 presents the overview of PCA findings for the Kannada-translated CEQ2.

Table 2. Overview of principal component analyses for Kannada-translated CEQ2.
Factor/subscales Item analyses (correlations) Construct Validity Cronbach’s alpha (α) Range of Mean Scores (SD) of items
Item-total correlation range Item-subscale correlation range Subscale-total correlation range eigenvalue Variance explained (%) Item loading range
1 Perceived Safety (6 items) 0.42–0.48 0.82–0.94 0.53 6.4 29.1 0.75–0.91 0.92 2.10 (0.58)- 2.19 (0.70)
2 Own Capacity (8 items) 0.55–0.75 0.69–0.89 0.81 5.3 24.2 0.67–0.90 0.93 1.82 (0.88)-2.00 (0.98)
3 Professional Support (5 items) 0.82–0.93 0.82–0.93 0.46 2.7 12.3 0.78–0.93 0.97 2.27 (0.56–2.30 (0.57)
4 Participation* (2 items) 0.22*-0.28 0.91–0.93 0.24 2.2 10.1 0.90–0.93 0.91 2.57 (0.74)- 2.73 (0.67)
Total scale Range 0.22–0.93 Range 0.69–0.93 Range 0.24–0.81 75.7% - 0.84 2.14 (0.39)

*item 8 was deleted due to poor item-total score correlation (<0.2)

The Confirmatory Factor Analysis was carried out using the maximum likelihood modelling with the aim of justifying the compliance between the identified exploratory factors. Using the four factors with all 22 items generated a statistical model with poor fit. Therefore, the 4-factor model was re-run after removing item 8 from factor 4, “Participation”, which generated a 4-factor model with an acceptable fit. Table 3 presents CFA findings from the original questionnaire, and from the 4-factor model– 22 items and 21 items respectively–as identified in this study, whereas Table 4 presents the differences in subscale scores and overall average score on 21-items Kannada-CEQ2 by the participants divided based on their socio-demographic and work-related characteristics.

Table 3. Confirmatory factor analyses findings for two models of Kannada-translated CEQ2 as compared to original CEQ2 model.
CMIN/DF GFI AGFI Chi squared value of model fit Degrees of freedom P value CFI TLI SRMR RMSEA
Model by the original authors 2.79 0.940 - 2348.143 203 <0.001 0.94 0.93 - 0.054
4-factor model (22 items): this study 3.061 0.825 0.783 624.375 204 <0.001 0.912 0.901 0.043 0.091
4-factor model (21 items): this study * 1.334 0.915 0.891 240.191 180 0.002 0.984 0.986 0.042 0.037

*retained model with good fit

Table 4. Differences in subscale scores and overall score of Kannada-translated CEQ2 by different groups.
n Perceived safety (mean, SD) Own capacity (mean, SD) Professional support (mean, SD) Participation (mean, SD) Mean Kannada-translated CEQ2 score (mean, SD)
Primipara 125 2.10 (0.60) 1.71 (0.72) 2.23 (0.51) 2.68 (0.64) 2.04 (0.35)
Multipara 126 2.23 (0.51) 2.10 (0.79) 2.34 (0.51) 2.62 (0.59) 2.24 (0.39)
Unadjusted p value 0.03 <0.001 0.07 0.65 <0.001
Gave birth vaginally (spontaneous/assisted) 166 2.21 (0.53) 1.97 (0.78) 2.27 (0.47) 2.64 (0.57) 2.17 (0.38)
Gave birth through Caesarean Section (planned/emergency) 85 2.08 (0.61) 1.77 (0.75) 2.32 (0.56) 2.68 (0.71) 2.07 (0.39)
Unadjusted p value 0.31 0.04 0.69 0.39 0.07
Total duration of labour < 12 hours 200 2.17 (0.52) 1.92 (0.77) 2.32 (0.53) 2.66 (0.62) 2.16 (0.39)
Total duration of labour12 hours 51 2.16 (0.52) 1.86 (0.83) 2.17 (0.38) 2.60 (0.64) 2.08 (0.38)
Unadjusted p value 0.59 0.46 0.07 0.64 0.23
Birth companion for as long she wanted 46 2.03 (0.59) 2.18 (0.81) 2.22 (0.43) 2.65 (0.60) 2.19 (0.36)
Birth companion not allowed 205 2.19 (0.56) 1.84 (0.75) 2.31 (0.53) 2.65 (0.63) 2.13 (0.39)
Unadjusted p value 0.102 0.004 0.46 0.30 0.16

Discussion

This study aimed to culturally adapt and evaluate the psychometric properties of the Kannada-translated CEQ2; to the best of our knowledge, this is the first study to do so. Based on exploratory and confirmatory factor analyses findings in this study, the 21-item Kannada-translated CEQ2 was found to be a reliable and valid questionnaire for use within Kannada-speaking populations. The Kannada-translated questionnaire had good Cronbach alpha scores for all subscales and overall scales (≥ 0.84).

The Kannada-translated CEQ2 had the same factor structure as reported for the original CEQ2 [26]. This was in line with the findings from other studies [18, 24] but contrasted with the study done in Hong Kong [23], where nine items had to be removed from the original 22 items. This may be because the respondents from our study were literate, professional women (although many were currently not working and identified as homemakers) who could relate to all items of the CEQ2, as evidenced by the face validation exercise. It is noteworthy that the fourth factor in the Kannada-translated CEQ2, “Participation”, had lower subscale—total scale correlations during construct validity testing when compared to the other three factors, which could be a reflection on how Indian women prioritise their own involvement in birthing care planning and implementation as compared to “giving up control”. Some qualitative studies from India have suggested that the women voluntarily gave up control because they trusted the expertise of the care providers in keeping both the neonate and mother safe [2931]. However, there is a need to further explore this aspect through other studies, especially because the Government of India has committed to promoting women-centred, respectful maternity care in the country, and promoting the women’s participation is critical in realising this vision [32].

Results from this study showed that, for the most part, there were no differences in women’s scores across known groups (primi/multipara; vaginal/CS births; presence/absence of birth companions; and less than/more than 12 hours of labour pains) except for the differences having logical explanations. For example, multiparous women were more likely to have positive experiences of “perceived safety” (p value 0.03) and “Own capacity” (p value <0.001) compared to primiparous women, interpreted in light of the fact that their previous birth experiences had readied them for what to expect. This was in line with other studies using the CEQ or CEQ2 [21, 23, 26]. Women who gave birth vaginally scored higher on “Own capacity” (p value 0.04) compared to women who had birthed through Caesarean Section; this was in line with other studies validating the CEQ or CEQ2 [21, 23, 26]. Women who had a birth companion with them for as long as they wished scored higher on “Own capacity” (p value 0.004). It could be that the birth companion’s emotional support boosted the women’s confidence during birth, a phenomenon reported in some recent studies from India [33, 34].

Our study–despite being at a community level and towards the end of the acute phase of COVID-19 –had a 100% response rate. This could be because postnatal women in India may not have the opportunity to talk openly about their birth experiences, due to the cultural beliefs that disclosing details of birth and babies brings evil eyes [35], which leaves a critical unmet need, known to impact women’s transition into motherhood as well as their mental health [3638].

Being a short questionnaire using self-assessment, this questionnaire is an easy, time- and cost-saving tool to administer for measuring the quality of childbirth-related care from the women’s perspective. Additionally, this tool provides a unique opportunity to measure women’s childbirth experiences that are known to be a sensitive indicator of quality of childbirth care and can serve as a valid instrument to record women’s birth experiences and comparisons across midwife-led care units and care received in traditional labour rooms.

Strengths and limitations

To the best of the authors’ knowledge, this study is the first of its kind validating the CEQ2 for use in India among Kannada-speaking women. The study adopted a rigorous methodology to improve data quality. Data were collected with an adequate number of participants by experienced researchers who were further trained for implementing this study. The data quality was closely monitored by the researchers. Research teams carried printouts of the definitions of key terms used in each item of the CEQ2 and used those to answer any queries during data collection to mitigate bias during data collection. However, participants’ responses remain subjective and may have intrinsic response bias, which is an inherent constraint to all surveys seeking human response. The CEQ2 has been validated for Kannada-speaking women and should be re-validated before use in other regions of India. While the CEQ2 is a multidimensional tool validated to capture the multifaceted nature of birth experiences, there may be some aspects of birth experience that could be beyond quantification and may not have been captured.

Conclusion

The Kannada-translated CEQ2 validated through this study has good internal consistency and construct validity and can be used for ongoing measurement of Kannada-speaking women’s birth experiences and for providing the evidence to further improve quality of childbirth care in India.

Acknowledgments

We are thankful to the women and their families who consented to participate in this study.

Data Availability

The minimal dataset cannot be uploaded to any server accessible from outside India as per the Indian Council for Medical Research Ethical Guidelines as the data contain sensitive patient information. However, data can be accessible upon reasonable request. Request can be sent to: Chairperson, Ethical Review Board, Foundation for Research in Health Systems Indian Society for Health Administrators Building, Door Number 3009, II-A Main, 17th Cross, Banashankari II Stage, K. R. Road, Bengaluru-560070. India Landline (between 10 am- 6 pm IST on working days) +91 80 2657 7978 Email ID: admin@frhsindia.org.

Funding Statement

This study was conducted with financial assistance from Aastrika(AastarUrmika Health Systems Pvt. Ltd.) https://www.aastrika.org/ The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

References

  • 1.World Health Organization. Intrapartum care for a positive childbirth experience [Internet]. 2018. 212 p. http://apps.who.int/iris/bitstream/10665/260178/1/9789241550215-eng.pdf?ua=1%0Ahttp://www.who.int/reproductivehealth/publications/intrapartum-care-guidelines/en/ [PubMed]
  • 2.Slootjes H, Mckinstry C, Kenny A. Maternal role transition: Why new mothers need occupational therapists. Aust Occup Ther J. 2016;63(2):130–3. doi: 10.1111/1440-1630.12225 [DOI] [PubMed] [Google Scholar]
  • 3.Olza I, Uvnas-Moberg K, Ekström-Bergström A, Leahy-Warren P, Karlsdottir SI, Nieuwenhuijze M, et al. Birth as a neuro-psycho-social event: An integrative model of maternal experiences and their relation to neurohormonal events during childbirth. PLoS One. 2020;15(7 July):1–15. doi: 10.1371/journal.pone.0230992 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Nilsson C. The delivery room: Is it a safe place? A hermeneutic analysis of women’s negative birth experiences. Sex Reprod Healthc [Internet]. 2014;5(4):199–204. Available from: 10.1016/j.srhc.2014.09.010 [DOI] [PubMed] [Google Scholar]
  • 5.Dencker A, Nilsson C, Begley C, Jangsten E, Mollberg M, Patel H, et al. Causes and outcomes in studies of fear of childbirth: A systematic review. Women and Birth [Internet]. 2019;32(2):99–111. Available from: doi: 10.1016/j.wombi.2018.07.004 [DOI] [PubMed] [Google Scholar]
  • 6.Agius A, Xuereb RB, Carrick-Sen D, Sultana R, Rankin J. The co-existence of depression, anxiety and post-traumatic stress symptoms in the postpartum period: A systematic review. Midwifery [Internet]. 2016;36:70–9. Available from: http://www.sciencedirect.com/science/article/pii/S0266613816000516 [DOI] [PubMed] [Google Scholar]
  • 7.Field T. Postnatal anxiety prevalence, predictors and effects on development: A narrative review. Infant Behav Dev. 2018;51(March):24–32. doi: 10.1016/j.infbeh.2018.02.005 [DOI] [PubMed] [Google Scholar]
  • 8.Patel V, DeSouza N, Rodrigues M. Postnatal depression and infant growth and development in low income countries: A cohort study from Goa, India. Arch Dis Child [Internet]. 2003;88(1):34–7. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1719257&tool=pmcentrez&rendertype=abstract [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Bishaw KA, Temesgen H, Amha H, Desta M, Bazezew Y, Ayenew T, et al. A systematic review and meta-analysis of women’s satisfaction with skilled delivery care and the associated factors in Ethiopia. SAGE Open Med. 2022;10(February):205031212110682. doi: 10.1177/20503121211068249 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Reproductive Health Library. WHO recommendation on companionship during labour and childbirth [Internet]. 2018. https://extranet.who.int/rhl/topics/preconception-pregnancy-childbirth-and-postpartum-care/care-during-childbirth/who-recommendation-respectful-maternity-care-during-labour-and-childbirth
  • 11.Kane S, Rial M, Kok M, Matere A, Dieleman M, Broerse JEW. Too afraid to go: Fears of dignity violations as reasons for non-use of maternal health services in South Sudan. Reprod Health. 2018;15(1):1–11. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Devasenapathy N, George MS, Ghosh Jerath S, Singh A, Negandhi H, Alagh G, et al. Why women choose to give birth at home: A situational analysis from urban slums of Delhi. BMJ Open [Internet]. 2014;4(5):e004401. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4039791&tool=pmcentrez&rendertype=abstract [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Dencker A, Taft C, Bergqvist L, Lilja H, Berg M. Childbirth experience questionnaire (CEQ): Development and evaluation of a multidimensional instrument. BMC Pregnancy Childbirth [Internet]. 2010. Jan [cited 2014 Jun 15];10(1):81. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3008689&tool=pmcentrez&rendertype=abstract, Available from: http://www.biomedcentral.com/1471-2393/10/81 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Steegers EA, Bonsel GJ, Vujkovic M, Birnie E, Denktaş S, Valentine NB, et al. Validity of a questionnaire measuring the World Health Organization concept of health system responsiveness with respect to perinatal services in the Dutch obstetric care system. BMC Health Serv Res. 2014;14(1). doi: 10.1186/s12913-014-0622-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Sjetne IS, Iversen HH, Kjøllesdal JG. A questionnaire to measure women’s experiences with pregnancy, birth and postnatal care: Instrument development and assessment following a national survey in Norway. BMC Pregnancy Childbirth [Internet]. 2015;15(1):1–11. Available from: doi: 10.1186/s12884-015-0611-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Truijens SEM, Wijnen HA, Pommer AM, Oei SG, Pop VJM. Development of the Childbirth Perception Scale (CPS): Perception of delivery and the first postpartum week. Arch Women’s Ment Health. 2014;17(5):411–21. doi: 10.1007/s00737-014-0420-0 [DOI] [PubMed] [Google Scholar]
  • 17.Wijma K, Wijma B, Zar M. Psychometric aspects of the W-DEQ; A new questionnaire for the measurement of fear of childbirth. J Psychosom Obstet Gynaecol. 1998;19(2):84–97. doi: 10.3109/01674829809048501 [DOI] [PubMed] [Google Scholar]
  • 18.Walker KF, Dencker A, Thornton JG. Childbirth experience questionnaire 2: Validating its use in the United Kingdom. Eur J Obstet Gynecol Reprod Biol X [Internet]. 2020;5:100097. Available from: doi: 10.1016/j.eurox.2019.100097 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Zhu X, Wang Y, Zhou H, Qiu L, Pang R. Adaptation of the Childbirth Experience Questionnaire (CEQ) in China: A multisite cross-sectional study. PLoS One. 2019;14(4):1–16. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Patabendige M, Palihawadana TS, Herath RP, Wijesinghe PS. Childbirth Experience Questionnaire (CEQ) in the Sri Lankan setting: Translation, cultural adaptation and validation into the Sinhala language. BMC Res Notes [Internet]. 2020;13(1):1–6. Available from: doi: 10.1186/s13104-020-05380-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Kalok A, Nordin N, Sharip S, Rahman RA, Shah SA, Mahdy ZA, et al. Psychometric evaluation of the Malay version of the Childbirth Experience Questionnaire (CEQ-My). Int J Environ Res Public Health. 2022;19(13). doi: 10.3390/ijerph19137644 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Abbaspoor Z, Moghaddam-Banaem L, Ronaghi S, Dencker A. Translation and cultural adaptation of the Childbirth Experience Questionnaire (CEQ) in Iran. Iran J Nurs Midwifery Res. 2019;24(4):296–300. doi: 10.4103/ijnmr.IJNMR_103_18 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Lok KYW, Fan HSL, Ko RWT, Kwok JYY, Wong JYH, Fong DYT, et al. Validating the use of the revised childbirth experience questionnaire in Hong Kong. BMC Pregnancy Childbirth [Internet]. 2022;22(1):1–10. Available from: doi: 10.1186/s12884-022-04456-x [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Peters LL, van der Pijl MSG, Vedam S, Barkema WS, van Lohuizen MT, Jansen DEMC, et al. Assessing Dutch women’s experiences of labour and birth: Adaptations and psychometric evaluations of the measures Mothers on Autonomy in Decision Making Scale, Mothers on Respect Index, and Childbirth Experience Questionnaire 2.0. BMC Pregnancy Childbirth [Internet]. 2022;22(1):1–25. Available from: doi: 10.1186/s12884-022-04445-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25.National Health Mission. LAQSHYA: Labour Room Quality Improvement Initiative [Internet]. New Delhi; 2017. http://nhsrcindia.org/sites/default/files/LaQshya-LabourRoomQualityImprovementInitiativeGuideline.pdf
  • 26.Dencker A, Bergqvist L, Berg M, Greenbrook JTV, Nilsson C, Lundgren I. Measuring women’s experiences of decision-making and aspects of midwifery support: A confirmatory factor analysis of the revised Childbirth Experience Questionnaire. BMC Pregnancy Childbirth. 2020;20(1):1–8. doi: 10.1186/s12884-020-02869-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Wild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A, et al. Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: Report of the ISPOR Task Force for Translation and Cultural Adaptation. Value Heal. 2005;8(2):94–104. doi: 10.1111/j.1524-4733.2005.04054.x [DOI] [PubMed] [Google Scholar]
  • 28.Netemeyer RG, Bearden WO, Sharma SC. Scaling procedures: Issues and applications. New Delhi: SAGE Publications, Inc; 2003. 224 p. [Google Scholar]
  • 29.Jha P, Larsson M, Christensson K, Svanberg AS. Satisfaction with childbirth services provided in public health facilities: Results from a cross-sectional survey among postnatal women from Chhattisgarh, India. Glob Health Action [Internet]. 2017;10(1):1–12. Available from: 10.1080/16549716.2017.1386932 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Jha P, Christensson K, Svanberg AS, Larsson M, Sharma B, Johansson E. Cashless childbirth, but at a cost: A grounded theory study on quality of intrapartum care in public health facilities in India. Midwifery [Internet]. 2016;39:78–86. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0266613816300407 [DOI] [PubMed] [Google Scholar]
  • 31.Srivastava A, Avan BI, Rajbangshi P, Bhattacharyya S. Determinants of women’s satisfaction with maternal health care: A review of literature from developing countries. BMC Pregnancy Childbirth [Internet]. 2015;15(1):1–12. Available from: http://www.biomedcentral.com/1471-2393/15/97 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.GoI M of H and FW. Guidelines on midwifery services in India [Internet]. Government of India. New Delhi; 2018. http://nhm.gov.in/images/pdf/programmes/maternal-health/guidelines/Guidelines_on_Midwifery_Services_in_India.pdf
  • 33.Gadappa SN, Deshpande SS. A quasi-experimental study to compare the effect of respectful maternity care using intrapartum birth companion of her choice on maternal and newborn outcome in tertiary care centre. J Obstet Gynecol India [Internet]. 2021;71(s2):84–9. Available from: doi: 10.1007/s13224-021-01587-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34.Singh S, Goel R, Gogoi A, Caleb-Varkey L, Manoranjini M, Ravi T, et al. Presence of birth companion—a deterrent to disrespectful behaviours towards women during delivery: An exploratory mixed-method study in 18 public hospitals of India. Health Policy Plan [Internet]. 2021. Dec 1;36(10):1552–61. Available from: doi: 10.1093/heapol/czab098 [DOI] [PubMed] [Google Scholar]
  • 35.Khan SS, Tawale NK, Patel A, Dibley MJ, Alam A. “My husband is my family.” The culture of pregnancy disclosure and its implications on early pregnancy registration in a child nutrition intervention in rural Maharashtra, India. Midwifery [Internet]. 2021;103(September):103141. Available from: doi: 10.1016/j.midw.2021.103141 [DOI] [PubMed] [Google Scholar]
  • 36.Mercer RT. Becoming a mother versus maternal role attainment. J Nurs Scholarsh. 2004;36(3):226–32. doi: 10.1111/j.1547-5069.2004.04042.x [DOI] [PubMed] [Google Scholar]
  • 37.Bertucci V, Boffo M, Mannarini S, Serena A, Saccardi C, Cosmi E, et al. Assessing the perception of the childbirth experience in Italian women: A contribution to the adaptation of the childbirth perception questionnaire. Midwifery [Internet]. 2012;28(2):265–74. Available from: 10.1016/j.midw.2011.02.009 [DOI] [PubMed] [Google Scholar]
  • 38.Karkee R, Lee AH, Pokharel PK. Women’s perception of quality of maternity services: A longitudinal survey in Nepal. BMC Pregnancy Childbirth [Internet]. 2014;14:45. Available from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=medl&NEWS=N&AN=24456544 [DOI] [PMC free article] [PubMed] [Google Scholar]

Decision Letter 0

Pracheth Raghuveer

4 Sep 2023

Cultural adaptation and psychometric evaluation of Childbirth Experience Questionnaire 2 in Karnataka state, India

PONE-D-23-04234

Dear Dr. Borgen,

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Acceptance letter

Pracheth Raghuveer

5 Oct 2023

PONE-D-23-04234

Cultural adaptation and psychometric evaluation of Childbirth Experience Questionnaire 2 in Karnataka state, India

Dear Dr. Bogren:

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    Data Availability Statement

    The minimal dataset cannot be uploaded to any server accessible from outside India as per the Indian Council for Medical Research Ethical Guidelines as the data contain sensitive patient information. However, data can be accessible upon reasonable request. Request can be sent to: Chairperson, Ethical Review Board, Foundation for Research in Health Systems Indian Society for Health Administrators Building, Door Number 3009, II-A Main, 17th Cross, Banashankari II Stage, K. R. Road, Bengaluru-560070. India Landline (between 10 am- 6 pm IST on working days) +91 80 2657 7978 Email ID: admin@frhsindia.org.


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