A questionnaire to measure women's experiences with pregnancy, birth and postnatal care: instrument development and assessment following a national survey in Norway

Background: The Norwegian authorities monitor the quality of public health-care services, including from the patients' perspective. The aim of this paper is to describe the development and psychometric properties of a pregnancy- and maternity-care patients' experiences questionnaire (PreMaPEQ). Methods: The PreMaPEQ and data collection procedures were developed based on a literature review, reference group activities, user interviews, cognitive interviews and a pilot test. The PreMaPEQ was then used in a national survey that included a retest distribution. The participants were identified from the hospital records where the birth took place. The invitation to take part was sent by mail and the questionnaire was distributed in electronic (i.e. via the Internet) and (subsequently) paper forms. The completed questionnaires were assessed using descriptive statistics, explorative factor analyses, psychometric measures and confirmatory factor analysis (CFA). Results: The PreMaPEQ response rate for the national sample was 56.6 % (N = 4904), and retest data were provided by 123 women. Statistics and theoretical considerations were used to construct 16 scales, covering the following 4 phases of the care: pregnancy control (4 scales), the delivery (3 scales), the postnatal hospital stay (5 scales) and the services in the public health clinic (4 scales). All scales had a Cronbach's a of >0.7, and all but three scales had an intraclass correlation coefficient for test-retest stability of >0.700. CFA revealed a satisfactory fit between the questionnaire data and the model, with a four-factor solution of the care experiences with pregnancy, birth and postnatal care. CFA provided support for the suggested structures, and demonstrated that the first-order factors are indicators of a second-order factor. Conclusion: The PreMaPEQ appears to be an acceptable, valid and reliable tool for collecting women's experiences of the whole course of maternity care in health systems that have features in common with the Norwegian health system.