title: Developing a Questionnaire for Iranian Women's Attitude on Medical Ethics in Vaginal Childbirth.
abstract: BACKGROUND
  Vaginal delivery is one of the challenging issues in medical ethics. It is important to use an appropriate instrument to assess medical ethics attitudes in normal delivery, but the lack of tool for this purpose is clear.
  
  
  OBJECTIVE
  The aim of this study was to develop and validate a questionnaire for the assessment of women's attitude on medical ethics application in normal vaginal delivery.
  
  
  METHODS
  This methodological study was carried out in Iran in 2013 - 2014. Medical ethics attitude in vaginal delivery questionnaire (MEAVDQ) was developed using the findings of a qualitative data obtained from a grounded theory research conducted on 20 women who had vaginal childbirth, in the first phase. Then, the validation criteria of this tool were tested by content and face validity in the second phase. Exploratory factor analysis was used for construct validity and reliability was also tested by Cronbach's alpha coefficient in the third phase of this study. SPSS version 13 was used in this study. The sample size for construct validity was 250 females who had normal vaginal childbirth.
  
  
  RESULTS
  In the first phase of this study (tool development), by the use of four obtained categories and nine subcategories from grounded theory and literature review, three parts (98-items) of this tool were obtained (A, B and J). Part A explained the first principle of medical ethics, part B pointed to the second and third principles of medical ethics, and part J explained the fourth principle of medical ethics. After evaluating and confirming its face and content validity, 75 items remained in the questionnaire. In construct validity, by the employment of exploratory factor analysis, in parts A, B and J, 3, 7 and 3 factors were formed, respectively; and 62.8%, 64% and 51% of the total variances were explained by the obtained factors in parts A, B and J, respectively. The names of these factors in the three parts were achieved by consideration of the loading factor and medical ethics principles. The subscales of MEAVDQ showed significant reliability. In parts A, B and J, Cronbach's alpha coefficients were 0.76, 0.72 and 0.68, respectively and for the total questionnaire, it was 0.72. The results of the test-retest were satisfactory for all the items (ICC = 0.60 - 0.95).
  
  
  CONCLUSIONS
  The present study showed that the 59-item MEAVDQ was a valid and reliable questionnaire for the assessment of women's attitudes toward medical ethics application in vaginal childbirth. This tool might assist specialists in making a judgment and plan appropriate for women in vaginal delivery management.
authors.affiliation: Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IR Iran.
authors.forename: Firoozeh
authors.initials: F
authors.lastname: Mirzaee Rabor
authors.affiliation: Department of Epidemiology, School of Health, Mashhad University of Medical Sciences, Mashhad, IR Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Taghipour
authors.affiliation: Department of Biostatistics and Epidemiology, Social Determinants of Health Research Center, Institute of Futures Studies in Health, School of Public Health, Kerman University of Medical Sciences, Kerman, IR Iran.
authors.forename: Moghaddameh
authors.initials: M
authors.lastname: Mirzaee
authors.affiliation: Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IR Iran.
authors.forename: Khadigeh
authors.initials: K
authors.lastname: Mirzaii Najmabadi
authors.affiliation: Department of Psychology, School of Letters, Shahid Bahoonar University of Kerman, Kerman, IR Iran.
authors.forename: Masoud
authors.initials: M
authors.lastname: Fazilat Pour
authors.affiliation: Department of Thoracic Surgery, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran.
authors.forename: Seyed Hosein
authors.initials: SH
authors.lastname: Fattahi Masoum
keywords: Medical Ethics; Natural Childbirth; Validation Studies, Attitude; Women
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