Development of a Questionnaire to Measure Attitude Toward Birth Method Selection

Lida Moghaddam Banaem, Fazlollah Ahmadi, Anoshirvan Kazemnejad, Zahra Abbaspoor


Background: The rate of mothers undergoing cesarean section in the absence of medical indication  is increasing in the world. Women attitude have an essential role in the request or selecting a birth mode. This study aimed to develop a scale for measuring attitude toward birth method selection.
Materials and Methods: The study was conducted in two qualitative and quantitative parts. Data collection was conducted from June to December 2012 in Ahvaz, Iran. In the qualitative part of the study, 21 interviews were conducted with pregnant or parturient women and key informants. Consequently, content and face validity were performed to provide a pre‑final version of the questionnaire. Then, in the quantitative part of the study, validity, exploratory factor analysis, and
reliability were performed to assess the psychometric properties of the scale.

Results: A 130‑item questionnaire was developed through the qualitative phase. It was reduced to an 82‑item questionnaire after content and face validity. Exploratory factor analysis loaded a 68‑item with an 8‑factor solution (“beliefs and attitudes,” “sexual and physical attitudes,” “fear of childbirth,” “preference of convenience, health, and supporting,” “socio‑ cultural norms,” “confidence to the birth practitioner,” “personal and practical choice,” and “sources of motivations,” which jointly accounted for 42.97% of the observed variance. Cronbach’s alpha coefficient showed excellent internal consistency (á = 0.87), and test–retest of the scale with 2‑week intervals indicated an appropriate stability for the scale (0.89).

Conclusions: The findings showed that the designed questionnaire was a valid and reliable instrument for indicating the pregnant womens’ attitudes to their birth method selection. Also, ATBMS is an easy use questionnaire and contains the most significant factors persuading women to choose vaginal delivery or cesarean section.


Birth method; cesarean section; Iranian women; selection; questionnaire

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