title: Construction and Validation of a Women's Autonomy Measurement Scale with Reference to Utilization of Maternal Health Care Services in Nepal.
abstract: BACKGROUND
  Women's autonomy is one of the predictors of maternal health care service utilization. This study aimed to construct and validate a scale for measuring women's autonomy with relevance to developing countries.
  
  
  METHODS
  We conducted a study for construction and validation of a scale in Rupandehi and further validated in Kapilvastu districts of Nepal. Initially, we administered a 24-item preliminary scale and finalized a 23-item scale using psychometric tests. After defining the construct of women's autonomy, we pooled 194 items and selected 24 items to develop a preliminary scale. The scale development process followed different steps i.e. definition of construct, generation of items pool, pretesting, analysis of psychometric test and further validation.
  
  
  RESULTS
  The new scale was strongly supported by Cronbach's Alpha value (0.84), test-retest Pearson correlation (0.87), average content validity ratio (0.8) and overall agreement- Kappa value of the items (0.83) whereas all values were found satisfactory. From factor analysis, we selected 23 items for the final scale which show good convergent and discriminant validity. From preliminary draft, we removed one item; the remaining 23 items were loaded in five factors. All five factors had single loading items by suppressing absolute coefficient value less than 0.45 and average coefficient was more than 0.60 of each factor. Similarly, the factors and loaded items had good convergent and discriminant validity which further showed strong measurement capacity of the scale.
  
  
  CONCLUSIONS
  The new scale is a reliable tool for assessing women's autonomy in developing countries. We recommend for further use and validation of the scale for ensuring the measurement capacity.
authors.affiliation: Department of Public Health, School of Health and Allied Sciences, Pokhara University, Kaski, Nepal. and Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
authors.forename: T R
authors.initials: TR
authors.lastname: Bhandari
authors.affiliation: Department of Obstetrics and Gynaecology, Kathmandu Model Hospital, Kathmandu, Nepal.
authors.forename: G
authors.initials: G
authors.lastname: Dangal
authors.affiliation: Department of Obstetrics and Gynaecology, Kathmandu Model Hospital, Kathmandu, Nepal.
authors.forename: P S
authors.initials: PS
authors.lastname: Sarma
authors.affiliation: Department of Biology, Faculty of Natural and Life Sciences, Djillali Liabes University, Sidi-bel-Abbes, Algeria.
authors.forename: V R
authors.initials: VR
authors.lastname: Kutty
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008427:Maternal Health Services / Q000592:standards / Q000706:statistics & numerical data; D008429:Maternal Welfare; D009390:Nepal; D026684:Personal Autonomy; D011247:Pregnancy; D011594:Psychometrics / Q000379:methods*; D015203:Reproducibility of Results; D014930:Women / Q000523:psychology*; D016387:Women's Health / Q000592:standards*; D014933:Women's Rights / Q000458:organization & administration
keywords: maternal health care; scale construction and validation; women's autonomy measurement.