title: Quality of prenatal care questionnaire: psychometric testing in an Australia population.
abstract: 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.
authors.affiliation: School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada. wendy.sword@uottawa.ca.
authors.forename: Wendy
authors.initials: W
authors.lastname: Sword
authors.affiliation: College of Nursing and Departments of Community Health Sciences and Obstetrics, Gynecology and Reproductive Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada. maureen.heaman@umanitoba.ca.
authors.forename: Maureen
authors.initials: M
authors.lastname: Heaman
authors.affiliation: School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, VIC, 3800, Australia. maryanne.biro@monash.edu.
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Biro
authors.affiliation: Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia. caroline.homer@uts.edu.au.
authors.forename: Caroline
authors.initials: C
authors.lastname: Homer
authors.affiliation: Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute and General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, 3052, Australia. jane.yelland@mcri.edu.au.
authors.forename: Jane
authors.initials: J
authors.lastname: Yelland
authors.affiliation: School of Nursing and Department of Clinical Epidemiology & Biostatics, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. daneshn@mcmaster.ca.
authors.forename: Noori
authors.initials: N
authors.lastname: Akhtar-Danesh
authors.affiliation: Gilbrea Centre for Studies in Aging, Faculty of Social Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4M4, Canada. bradfor@mcmaster.ca.
authors.forename: Amanda
authors.initials: A
authors.lastname: Bradford-Janke
mesh_terms: D000328:Adult; D002170:Canada; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D007802:Language; D017060:Patient Satisfaction; D011247:Pregnancy; D011295:Prenatal Care / Q000523:psychology* / Q000592:standards; D011594:Psychometrics; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires / Q000592:standards*; D014739:Victoria