title: Measuring client experiences in maternity care under change: development of a questionnaire based on the WHO Responsiveness model.
abstract: BACKGROUND
  Maternity care is an integrated care process, which consists of different services, involves different professionals and covers different time windows. To measure performance of maternity care based on clients' experiences, we developed and validated a questionnaire.
  
  
  RESULTS
  We used the 8-domain WHO Responsiveness model, and previous materials to develop a self-report questionnaire. A dual study design was used for development and validation. Content validity of the ReproQ-version-0 was determined through structured interviews with 11 pregnant women (≥28 weeks), 10 women who recently had given birth (≤12 weeks), and 19 maternity care professionals. Structured interviews established the domain relevance to the women; all items were separately commented on. All Responsiveness domains were judged relevant, with Dignity and Communication ranking highest. Main missing topic was the assigned expertise of the health professional. After first adaptation, construct validity of the ReproQ-version-1 was determined through a web-based survey. Respondents were approached by maternity care organizations with different levels of integration of services of midwives and obstetricians. We sent questionnaires to 605 third trimester pregnant women (response 65%), and 810 women 6 weeks after delivery (response 55%). Construct validity was based on: response patterns; exploratory factor analysis; association of the overall score with a Visual Analogue Scale (VAS), known group comparisons. Median overall ReproQ score was 3.70 (range 1-4) showing good responsiveness. The exploratory factor analysis supported the assumed domain structure and suggested several adaptations. Correlation of the VAS rating and overall ReproQ score (antepartum, postpartum) supported validity (r = 0.56; 0.59, p<0.001 Spearman's correlation coefficient). Pre-stated group comparisons confirmed the expected difference following a good vs. adverse birth outcome. Fully integrated organizations performed slightly better (median = 3.78) than less integrated organizations (median = 3.63; p<0.001). Participation rate of women with a low educational level and/or a non-western origin was low.
  
  
  CONCLUSIONS
  The ReproQ appears suitable for assessing quality of maternity care from the clients' perspective. Recruitment of disadvantaged groups requires additional non-digital approaches.
authors: Erasmus Medical Centre, Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, The Netherlands.
authors: Marisja
authors: M
authors: Scheerhagen
authors: University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Department of Health Technology Assessment, Utrecht, The Netherlands.
authors: Henk F
authors: HF
authors: van Stel
authors: Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors: Erwin
authors: E
authors: Birnie
authors: University Medical Center Utrecht, Division Women and Baby, Department of Obstetrics, Utrecht, The Netherlands.
authors: Arie
authors: A
authors: Franx
authors: Erasmus Medical Centre, Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, The Netherlands.
authors: Gouke J
authors: GJ
authors: Bonsel
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D015233:Models, Statistical; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011247:Pregnancy; D015397:Program Evaluation / Q000379:methods* / Q000706:statistics & numerical data; D011594:Psychometrics; D057566:Self Report; D011795:Surveys and Questionnaires; D014944:World Health Organization; D055815:Young Adult