Development of the Person-Centered Prenatal Care scale for People of Color.

Abstract

BACKGROUND\nGiven stark disparities in maternal mortality and adverse birth outcomes among Black, Indigenous, and other people of color, there is a need to better understand and measure how individuals from these communities experience their care during pregnancy.\n\n\nOBJECTIVES\nTo develop and validate a tool that can be used to measure person-centered prenatal care (PCPC) that reflects the experiences of people of color.\n\n\nSTUDY DESIGN\nWe followed standard procedures for scale development-integrated with community-based participatory approaches-to adapt a person-centered maternity care scale that was initially developed and validated for intrapartum care in low resource countries to reflect the needs and prenatal care experiences of people of color in the US. The adaptation process included expert reviews with a Community Advisory Board (CAB), consisting of community members, community-based health workers, and social service providers from San Francisco, Oakland, and Fresno, to assess content validity. We conducted cognitive interviews with potential respondents to assess clarity, appropriateness, and relevance of the questions, which were then refined and administered in an online survey to people in California who had given birth in the past year. Data from 293 respondents (84% of whom identified as Black) who received prenatal care were used in psychometric analysis to assess construct and criterion validity and reliability.\n\n\nRESULTS\nExploratory factor analysis yielded three factors with eigenvalues of greater than one, but with one dominant factor. A 34-item version of the PCPC scale was developed based on factor analyses and recommendations from the CAB. We also developed a 26-item version using stricter criteria for relevance, factor loadings, and uniqueness. Items grouped into three conceptual domains representing subscales for dignity and respect, communication and autonomy, and responsive and supportive care. The Cronbach alphas for the 34-item and the 26-item versions, and for the subscales, were >0.8. Scores based on the sum of responses for the two PCPC scale versions and all subscales were standardized to range from 0 to 100, where higher scores indicate more PCPC. These scores were correlated with global measures of prenatal care satisfaction suggesting good criterion validity.\n\n\nCONCLUSIONS\nWe present two versions of the PCPC scale: a 34-item and a 26-item version. Both versions have high validity and reliability in a sample made up predominantly of Black women. This scale will facilitate measurement to improve person-centered prenatal care for people of color and could contribute to reducing disparities in birth outcomes. The similarity with the original scale also suggests that the PCPC may be applicable across different contexts. Validation with more diverse samples in additional settings are however needed.