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Although these conditions are prevalent, Indonesia currently lacks culturally adapted and validated instruments to measure them effectively. This study aimed to adapt and validate the Indonesian versions of the Postpartum Blues Questionnaire (PBQ-32) and the Maternal Self-Efficacy Questionnaire (MSEQ-20). Methodology A cross-sectional psychometric approach was employed. The adaptation process involved forward and backwards translation, expert panel review, and cultural adjustment. A total of 30 postpartum mothers (within 3–10 days after childbirth) were selected through consecutive sampling. Content validity was examined using the Content Validity Index (CVI), while construct validity was assessed via exploratory factor analysis (EFA). Internal consistency reliability was calculated using Cronbach’s alpha, and test-retest reliability was assessed using Pearson’s correlation. Results The PBQ-32 demonstrated strong internal consistency (α = 0.89), a six-factor structure explaining 68.4% of the variance, and excellent test-retest reliability (r = 0.91). Similarly, the MSEQ-20 showed good internal consistency (α = 0.87), a four-factor structure accounting for 61.7% of the variance, and high test-retest reliability (r = 0.88). The CVI values for both instruments exceeded 0.89, indicating strong content validity. A significant negative correlation between postpartum blues and maternal self-efficacy (r = –0.72, p &lt; 0.001) further supported the concurrent validity of the tools. Conclusion The Indonesian versions of the PBQ-32 and MSEQ-20 have demonstrated good psychometric properties and cultural relevance. Their use in clinical and community settings may support the early identification of psychological challenges during the postpartum period and inform appropriate maternal mental health interventions in Indonesia. \" } { \"@context\": \"http://schema.org\", \"@type\": \"BreadcrumbList\", \"itemListElement\": [ { \"@type\": \"ListItem\", \"position\": \"1\", \"item\": { \"@id\": \"https://f1000research.com/\", \"name\": \"Home\" } }, { \"@type\": \"ListItem\", \"position\": \"2\", \"item\": { \"@id\": \"https://f1000research.com/browse/articles\", \"name\": \"Browse\" } }, { \"@type\": \"ListItem\", \"position\": \"3\", \"item\": { \"@id\": \"https://f1000research.com/articles/14-789\", \"name\": \"Development and psychometric validation of the Indonesian versions...\" } } ] } Home Browse Development and psychometric validation of the Indonesian versions... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Sari IN, Sansuwito Tb and Prihadianto DG. Development and psychometric validation of the Indonesian versions of the Postpartum Blues and Maternal Self-Efficacy Scales [version 2; peer review: 1 approved] . F1000Research 2025, 14 :789 ( https://doi.org/10.12688/f1000research.168513.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Revised Development and psychometric validation of the Indonesian versions of the Postpartum Blues and Maternal Self-Efficacy Scales [version 2; peer review: 1 approved] Ika Novita Sari https://orcid.org/0009-0000-9223-2703 1,2 , Tukimin bin Sansuwito https://orcid.org/0000-0001-7323-4308 1 , Dino Gagah Prihadianto 3 Ika Novita Sari https://orcid.org/0009-0000-9223-2703 1,2 , Tukimin bin Sansuwito https://orcid.org/0000-0001-7323-4308 1 , Dino Gagah Prihadianto 3 PUBLISHED 14 Oct 2025 Author details Author details 1 Nursing, Lincoln University College, Petaling Jaya, Selangor, Malaysia 2 Nursing, Universitas Batam, Batam, Riau Islands, Indonesia 3 Medical, Batam University Medical Faculty, Batam, Riau Islands, Indonesia Ika Novita Sari Roles: Conceptualization, Data Curation, Formal Analysis, Project Administration, Writing – Original Draft Preparation Tukimin bin Sansuwito Roles: Methodology, Supervision, Writing – Review & Editing Dino Gagah Prihadianto Roles: Resources, Validation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Global Public Health gateway. Abstract Background Postpartum blues and low maternal self-efficacy are among the most frequently encountered psychological challenges that impact both maternal well-being and infant care. Although these conditions are prevalent, Indonesia currently lacks culturally adapted and validated instruments to measure them effectively. This study aimed to adapt and validate the Indonesian versions of the Postpartum Blues Questionnaire (PBQ-32) and the Maternal Self-Efficacy Questionnaire (MSEQ-20). Methodology A cross-sectional psychometric approach was employed. The adaptation process involved forward and backwards translation, expert panel review, and cultural adjustment. A total of 30 postpartum mothers (within 3–10 days after childbirth) were selected through consecutive sampling. Content validity was examined using the Content Validity Index (CVI), while construct validity was assessed via exploratory factor analysis (EFA). Internal consistency reliability was calculated using Cronbach’s alpha, and test-retest reliability was assessed using Pearson’s correlation. Results The PBQ-32 demonstrated strong internal consistency (α = 0.89), a six-factor structure explaining 68.4% of the variance, and excellent test-retest reliability (r = 0.91). Similarly, the MSEQ-20 showed good internal consistency (α = 0.87), a four-factor structure accounting for 61.7% of the variance, and high test-retest reliability (r = 0.88). The CVI values for both instruments exceeded 0.89, indicating strong content validity. A significant negative correlation between postpartum blues and maternal self-efficacy (r = –0.72, p < 0.001) further supported the concurrent validity of the tools. Conclusion The Indonesian versions of the PBQ-32 and MSEQ-20 have demonstrated good psychometric properties and cultural relevance. Their use in clinical and community settings may support the early identification of psychological challenges during the postpartum period and inform appropriate maternal mental health interventions in Indonesia. READ ALL READ LESS Keywords Postpartum Blues, Maternal Self-Efficacy, Instrument Validation, Psychometric Properties, Indonesia, Maternal Mental Health. Corresponding Author(s) Ika Novita Sari ( [email protected] ) Close Corresponding author: Ika Novita Sari Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Sari IN et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Sari IN, Sansuwito Tb and Prihadianto DG. Development and psychometric validation of the Indonesian versions of the Postpartum Blues and Maternal Self-Efficacy Scales [version 2; peer review: 1 approved] . F1000Research 2025, 14 :789 ( https://doi.org/10.12688/f1000research.168513.2 ) First published: 14 Aug 2025, 14 :789 ( https://doi.org/10.12688/f1000research.168513.1 ) Latest published: 14 Oct 2025, 14 :789 ( https://doi.org/10.12688/f1000research.168513.2 ) Revised Amendments from Version 1 This revised version incorporates several important changes made in response to reviewer feedback. In the Introduction, references in the first paragraph have been separated to clearly attribute each statement, and additional information has been added regarding the prevalence of postpartum blues in Indonesia, including national, city-level, and community health center data. In the Methods section, we clarified the rationale for selecting Batam City as the study site, emphasizing its cultural diversity, standardized maternal health protocols, and relevance to Indonesian maternal health services. We also explained the justification for limiting participants to the 20–35 years age range, noting this group represents the optimal reproductive age with balanced biological and psychological risks, while younger and older mothers were excluded to minimize confounding factors. Furthermore, details of the expert panel involved in content validation have been specified, including their professional backgrounds. In the Results section, percentages have been removed from Tables 1, 3, and 4, and only raw numbers are now presented for clarity. These revisions strengthen the methodological transparency and contextual relevance of the study, and improve readability for both academic and clinical audiences. This revised version incorporates several important changes made in response to reviewer feedback. In the Introduction, references in the first paragraph have been separated to clearly attribute each statement, and additional information has been added regarding the prevalence of postpartum blues in Indonesia, including national, city-level, and community health center data. In the Methods section, we clarified the rationale for selecting Batam City as the study site, emphasizing its cultural diversity, standardized maternal health protocols, and relevance to Indonesian maternal health services. We also explained the justification for limiting participants to the 20–35 years age range, noting this group represents the optimal reproductive age with balanced biological and psychological risks, while younger and older mothers were excluded to minimize confounding factors. Furthermore, details of the expert panel involved in content validation have been specified, including their professional backgrounds. In the Results section, percentages have been removed from Tables 1, 3, and 4, and only raw numbers are now presented for clarity. These revisions strengthen the methodological transparency and contextual relevance of the study, and improve readability for both academic and clinical audiences. See the authors' detailed response to the review by Bayu Anggileo Pramesona READ REVIEWER RESPONSES Introduction The postpartum period is a pivotal time in a woman’s life cycle due to the biological, mental, and social changes that happen during this time, and these changes have profound effects on mental health and the development of the infant. Postpartum blues is one of the most prevalent blues in this period, affecting almost 50-85% of new mothers around the world. Postpartum blues manifests as fluctuations in mood, irritability, and tearfulness. It usually arises in the first two weeks after delivery and, although it is temporary, it can worsen to more serious forms of postpartum depression if not recognised or treated ( Suryawanshi & Pajai, 2022 ; Wulandari et al., 2022 ). Globally, postpartum blues affects almost 50-85% of new mothers. In the Indonesian context, this condition is particularly concerning rates with significant regional variations. Studies consistently report prevalence rates between 37% and 67% nationally ( Manurung & Setyowati, 2021 ). Research across major Indonesian cities demonstrates substantial variation, with rates of 70% in Surabaya ( Batubara et al., 2022 ), 44,4% in Bandung ( Gartika & Fatmawati, 2024 ), and 46% in Yogyakarta ( Utami & Nurfita, 2022 ). In Batam specifically, local studies document rates approaching 70% ( I. N. Sari & Sansuwito, 2024 ), with surrounding areas showing variability from 32.4% to 54.9% across different community health centers ( Gantoro & Aji, 2021 ; Husaidah et al., 2025 ; Nursalma et al., 2023 ; W. E. Sari et al., 2023 ). These varying prevalence rates across different Indonesian regions highlight the need for culturally sensitive and regionally appropriate assessment tools. Alongside this, maternal self-efficacy has been defined as a belief related to a mother’s ability to care and nurture for her infant, and has been shown to safeguard psychological well-being in the postpartum period. Stronger self-efficacy beliefs have been linked to more effective parent–child relationships, enhanced bonding between mother and baby, diminished parenting stress, and healthier developmental outcomes for the baby ( Defriani et al., 2022 ; Fitriani et al., 2023 ; Machmudah et al., 2024 ). Efficacy-promoting interventions have also been shown to reduce the risk for postpartum anxiety and depression ( Lubis & Susilowati, 2023 ; Marcelina et al., 2020 ). Nevertheless, measuring these concepts, especially in non-Western contexts, poses challenges because of the absence of culturally relevant and rigorously validated psychological tools. How mothers in Indonesia deal with emotional shifts in the postpartum phase is greatly influenced by the societal culture in the region. Tools like the Edinburgh Postnatal Depression Scale or self-efficacy scales developed in the West may not adequately reflect the symptoms and cultural beliefs of Indonesian women ( McKinney, 2023 ; Wulandari et al., 2022 ). This illustrates the need to adapt and validate indigenous assessment tools that reflect the lived realities of Indonesian mothers. Accurate measurement is essential to the Indonesian pregnant and postpartum Indonesian women, especially in identifying the need for prevention of worsening mental health issues. Some gaps remain a struggle for healthcare workers, like the lack of implementation of mental healthcare tools in the Indonesia maternal healthcare system. This is because there are no reliable instruments for screening that can be used in local health facilities ( Lubis & Susilowati, 2023 ; Machmudah et al., 2024 ). This absence of comprehensive instruments presents a challenge for health workers in meeting responsive maternal health care for mothers who need it. To solve this problem, the present study seeks to create and validate the Postpartum Blues Questionnaire (PBQ) and the Maternal Self-Efficacy Questionnaire (MSEQ) in Indonesian versions. This entails thorough cultural adaptation, expert review, and comprehensive psychometric evaluation, which includes assessing content validity, performing exploratory and confirmatory factor analyses, and testing for reliability. This method guarantees that the instruments are not only statistically sound but also resonate with the sociocultural experiences of postpartum mothers in Indonesia ( Sarungi, 2024 ; Wulandari et al., 2022 ). Having valid and reliable instruments that are culturally sensitive is important in improving clinical screening, guiding appropriate intervention frameworks, and reinforcing Indonesia’s national maternal health strategy. With the growing challenges of maternal mental health in the region, the integration of validated postpartum care assessment tools may provide timely intervention support for mothers and improve health outcomes for mothers and their infants ( Diniati et al., 2022 ; Grzeskowiak et al., 2021 ; Sutarmi et al., 2024 ). With this in mind, this study aims to create and psychometrically validate the culturally adapted Indonesian Version of Postpartum Blues Questionnaire (PBQ) and the Maternal Self-Efficacy Questionnaire (MSEQ). The adaptation process includes expert panel review, relevance to the context, and thorough psychometric evaluation, including nursing content validity, construct validity, and reliability testing of the Cronbach’s alpha coefficient. This study intends to advance postpartum mental health screening and foster supportive interventions in public health programs designed for Indonesian mothers through the provision of culturally appropriate, useful maternal mental health instruments. Methods Study design and setting This study employed a two-phase mixed-methods approach conducted from January to March 2024 in the working area of the Health Centre in Batam City, Indonesia. Phase 1 focused on instrument development and cultural adaptation, while Phase 2 involved psychometric validation through a cross-sectional study design. Phase 1: Instrument development Cultural adaptation process For the Indonesian versions of the Postpartum Blues Questionnaire (PBQ) and the Maternal Self-Efficacy Questionnaire (MSEQ), the cultural adaptation process was carried out with attention to detail using systematic steps to maintain translation accuracy and cultural relevance. Established global guidelines informed the adaptation process, especially the ones put forth by the World Health Organization (WHO) focusing on instrument adaptation with multicultural equivalences such as semantics, idioms, culture, and logic ( Dun et al., 2021 ; Kanaan et al., 2022 ; Pai et al., 2025 ). An even blend of clinical and cultural expertise was brought together in one panel to address the various dimensions of relevance, appropriateness, and meaning for items, which was comprised of one obstetrician, a clinical psychologist, a midwife, and a maternal health nurse. This blend took into account the clinical as well as the multicultural aspects of the postpartum period in Indonesia ( Pizza et al., 2024 ; Santana et al., 2023 ). The adaptation process steps are as follows: - Two bilingual clinicians-turned-translators conducted forward translation. - Synthesis of the translations into a single version. - Two other translators, using neither the original version of the test nor the adapted one, conducted forward translation into English. - Known as the expert committee, they resolved the differences and ensured the equivalence of all languages involved. - Evaluating the prefinal version with 30 postpartum mothers for clarity, understanding, and cultural relevance. This form of assessing frameworks ensured that the Indonesian adaptation of PBQ and MSEQ maintained the fundamental constructs of the original instruments as well as their validity and reliability in the context of postpartum mothers in Indonesia ( Aloraini, 2022 ; Jafari et al., 2023 ; Santos et al., 2024 ). Development of the Postpartum Blues Scale (PBQ-32) The Postpartum Blues Scale (PBQ-32) was developed to identify emotional, physical, and psychosocial symptoms commonly experienced by Indonesian mothers in the early postpartum period. The initial phase of development involved a comprehensive review of international literature and clinical instruments related to postpartum mood disturbances. From this process, an initial pool of 35 items was constructed, reflecting key symptoms and themes relevant to postpartum blues. To ensure cultural relevance and clarity, the 35-item draft underwent expert review and content validation. Feedback from perinatal mental health professionals and maternal health experts guided the refinement of item wording and conceptual grouping. This draft was then used in a pilot study to explore item performance within an Indonesian population ( Ika Novita; Sari & Sansuwito, 2025 ). Based on both expert evaluation and preliminary empirical findings, three items were excluded due to cultural incongruity and low item-total correlations. The final PBQ-32 consists of 32 items, organized into six conceptual dimensions: - Emotional Symptoms (8 items): Includes sadness, mood swings, irritability, anxiety, guilt, worthlessness, loneliness, and crying episodes. - Physical Symptoms (4 items): Covers fatigue, changes in sleep and appetite, and difficulty concentrating. - Relationship with Baby (6 items): Captures concerns about infant health, maternal confidence, guilt, and feelings of being overwhelmed. - Self-Image (4 items): Addresses body dissatisfaction, feelings of unattractiveness, apathy, and perceived loss of control. - Social Support (6 items): Focuses on perceived emotional support, isolation, and interpersonal disconnection. - Role Adaptation (4 items): Relates to adjustment to the maternal role, including satisfaction, acceptance, decision-making, and perceived coping capacity. Each item is rated on a four-point Likert scale (0 = never, 1 = rarely, 2 = sometimes, 3 = often), yielding a total score ranging from 0 to 96. Higher scores reflect more severe symptoms of postpartum blues. The following score categories were used for interpretation: - No symptoms: 0–24 - Mild: 25–48 - Moderate: 49–72 - Severe: 73–96 Development of the Maternal Self-Efficacy Scale (MSEQ-20) The Maternal Self-Efficacy Scale (MSEQ-20) was developed to measure a mother’s perceived confidence in carrying out essential caregiving tasks during the early postpartum period. The scale consists of 20 items, organized into four conceptual domains that reflect fundamental aspects of maternal competence: - Basic Care Skills (8 items): This domain evaluates a mother’s perceived ability to perform daily caregiving tasks such as feeding, bathing, changing diapers, maintaining infant hygiene, and recognizing cues like hunger, tiredness, or discomfort. - Health and Safety (4 items): This domain captures maternal confidence in monitoring the infant’s health, including recognizing signs of illness, understanding immunization schedules, caring for the umbilical cord, and maintaining a safe sleep environment. - Emotional and Developmental Support (4 items): This domain focuses on a mother’s ability to provide emotional nurturing and developmental stimulation, such as soothing a crying baby, expressing affection, and fostering early emotional bonding. - Self-Management and Coping (4 items): This domain addresses the mother’s capacity to manage postpartum stress, organize daily tasks, seek support when needed, and make appropriate decisions in caregiving situations. Each item is rated on a 5-point Likert scale, ranging from 1 ( very incapable ) to 5 ( very capable ), resulting in a total score between 20 and 100. Higher scores reflect stronger perceived maternal self-efficacy. For interpretive purposes, total scores are categorized as follows: - Poor self-efficacy: 20–35 - Fair: 36–55 - Good: 56–75 - Excellent: 76–100 Phase 2: Psychometric validation Participants and sampling Participants were recruited using a consecutive sampling method from five community health service areas (villages) within the jurisdiction of a public health centre (Puskesmas) in Batam, Indonesia. A total of 30 postpartum mothers were enrolled in this phase of the study. Batam City was strategically selected as the study site due to its unique characteristics that enhance the relevance of findings for Indonesian maternal health contexts. As a major economic and industrial zone, Batam attracts working populations from across the Indonesian archipelago, creating a community where diverse Indonesian cultural practices and healthcare-seeking behaviors naturally converge. The postpartum mothers in Batam represent typical Indonesian maternal demographics, following common cultural patterns of family support systems, traditional postpartum practices, and healthcare utilization that are widely observed throughout Indonesian communities. The healthcare infrastructure in Batam operates under Indonesia’s national maternal health protocols and guidelines, ensuring that the clinical context and care standards mirror those implemented across Indonesian public health centers nationwide. The Puskesmas system in Batam follows standardized procedures for postpartum care that are consistent with national policies, making the study findings directly applicable to similar healthcare settings throughout Indonesia. Additionally, the socioeconomic and educational profiles of participants reflect typical Indonesian maternal populations, strengthening the relevance of these validated instruments for broader implementation in Indonesian maternal health services. Inclusion criteria were: - Postpartum mothers between days 3 and 10 following delivery - Aged 20 to 35 years - Had delivered live, healthy infants - Provided written informed consent to participate The age range of 20–35 years was selected because it represents the optimal reproductive age group, in which biological and psychological risks are relatively balanced. Mothers younger than 20 years or older than 35 years are at increased risk of obstetric complications and psychosocial stressors that may confound the assessment of postpartum blues and maternal self-efficacy. Restricting the sample to mothers aged 20–35 years therefore helped to minimize potential bias and improve the homogeneity of the validation sample. Exclusion criteria included: - A self-reported or documented history of mental health disorders - Experience of severe postpartum medical complications (e.g., haemorrhage, sepsis) - Neonatal death or other significant adverse birth outcomes This sample was deemed appropriate for initial psychometric testing and cultural pre-validation, based on guidance from methodological literature supporting sample sizes of 5–10 participants per item in exploratory phases, particularly in early-stage scale validation studies. Data collection procedures Eligible postpartum mothers were identified through collaboration with village midwives ( bidan desa ) and community health workers ( kader posyandu ). Prior to participation, the study objectives and procedures were clearly explained to each prospective respondent, and written informed consent was obtained in accordance with ethical research guidelines. Data collection was conducted through home visits, during which participants completed the Postpartum Blues Questionnaire (PBQ-32) and the Maternal Self-Efficacy Questionnaire (MSEQ-20). To minimize potential misunderstanding or misinterpretation of items, researchers assisted participants during questionnaire completion. Brief follow-up interviews were carried out to clarify responses and assess comprehension. In addition to questionnaire data, basic demographic information was collected, including age, educational background, occupation, number of children, type of childbirth, socioeconomic status, and perceived level of social support. These procedures were implemented to ensure consistency, ethical integrity, and adherence to best practices in maternal health research. Content validity To ensure the cultural and contextual relevance of the PBQ-32 and MSEQ-20 for Indonesian postpartum mothers, content validity was assessed using the Content Validity Index (CVI) approach. A multidisciplinary panel of experts—comprising an obstetrician, a clinical psychologist, a certified midwife, and a maternal health nurse—independently evaluated each item for relevance, clarity, and appropriateness using a four-point scale (1 = not relevant to 4 = highly relevant). The item-level CVI (I-CVI) was calculated as the proportion of experts rating an item as either 3 or 4. A minimum I-CVI value of 0.78 was used as the cut-off for item acceptability. The scale-level CVI (S-CVI/Ave) was obtained by averaging the I-CVI values across all items, with a threshold of ≥ 0.90 considered indicative of strong overall content validity ( Polit & Beck, 2006 ). Items that failed to meet the I-CVI threshold were revised based on expert feedback to improve clarity, cultural sensitivity, and contextual relevance. This iterative review process resulted in finalized versions of the PBQ-32 and MSEQ-20 that demonstrated strong content validity and were linguistically and culturally appropriate for use among Indonesian postpartum women. Construct validity Construct validity for the PBQ-32 and MSEQ-20 was examined using exploratory factor analysis (EFA) to explore the underlying factor structure of each instrument. Prior to factor extraction, the suitability of the data was assessed using the Kaiser-Meyer-Olkin (KMO) measure and Bartlett’s Test of Sphericity. A KMO value exceeding 0.70 and a significant result on Bartlett’s test (p < 0.05) indicated that the sample was adequate for factor analysis ( Espel-Huynh et al., 2020 ; GÜLER & Durgu, 2025 ; Huang et al., 2022 ). The EFA revealed factor structures that aligned with the theoretical dimensions proposed during instrument development. Items were retained for interpretation if they met the minimum factor loading threshold of 0.40, following standard psychometric criteria ( Mueller et al., 2024 ). This analytic process provided strong empirical support for the construct validity of both instruments, reinforcing their relevance and structural soundness for use in evaluating postpartum mental health in the Indonesian population. Reliability testing The internal consistency of the PBQ-32 and MSEQ-20 was evaluated using Cronbach’s alpha, with interpretation based on established thresholds: values ≥ 0.70 were considered acceptable, ≥ 0.80 good, and ≥ 0.90 excellent ( Sathvik et al., 2022 ). Reliability testing was conducted not only for the overall scales but also across each subscale, ensuring a comprehensive psychometric assessment ( Hikmah et al., 2023 ). To further examine item-level performance, item-total correlation coefficients were calculated. Items with correlations below 0.30 were flagged for potential revision or removal to improve internal consistency ( Hoque et al., 2021 ). The results indicated strong reliability for both instruments, with Cronbach’s alpha values exceeding acceptable thresholds for all domains. These findings support the use of the PBQ-32 and MSEQ-20 as reliable tools for assessing postpartum blues and maternal self-efficacy in the Indonesian context. Moreover, the reliability analysis underscores the importance of internal consistency in the development of culturally relevant psychological measurement instruments ( Huang et al., 2022 ; Xu et al., 2024 ). Results Demographic characteristics The demographic characteristics of the participants are presented in Table 1 . The study included 30 postpartum mothers, with a mean age of 26.8 years (SD = 4.2). Most participants were aged 20–25 years (40.0%), had a senior high school education (43.3%), and were unemployed (63.3%). Primiparous mothers comprised 56.7% of the sample, and 66.7% had vaginal deliveries. Half reported middle socioeconomic status (50.0%), and 53.3% perceived their social support as inadequate. Table 1. Demographic characteristics of participants (N = 30). Variable n (%) Age (mean ± SD) 26.8 ± 4.2 Age group - 20–25 years 12 40.0 - 26–30 years 10 33.3 - 31–35 years 8 26.7 Education level - Junior high school 8 26.7 - Senior high school 13 43.3 - Diploma/College 9 30.0 Employment status - Unemployed 19 63.3 - Employed 11 36.7 Parity - Primiparous 17 56.7 - Multiparous 13 43.3 Mode of delivery - Vaginal 20 66.7 - Cesarean 10 33.3 Economic status - Low 8 26.7 - Middle 15 50.0 - High 7 23.3 Perceived social support - Adequate 14 46.7 - Inadequate 16 53.3 Psychometric properties Postpartum Blues Questionnaire (PBQ-32) - Content Validity: The CVI was 0.92, indicating excellent content validity. The expert panel rated all items as relevant (scores 3 or 4), with only minor language adjustments suggested for cultural appropriateness. - Construct Validity: All 32 items showed significant item-total correlations (r = 0.712–0.825, p < 0.001). EFA revealed six factors that explained 68.4% of the total variance, supporting the scale’s proposed dimensional structure. - Internal Consistency: The overall Cronbach’s alpha was 0.89, indicating excellent reliability. Subscale alphas ranged from 0.81 to 0.86: • Emotional Symptoms: α = 0.86 • Physical Symptoms: α = 0.83 • Relationship with Baby: α = 0.85 • Self-Image: α = 0.82 • Social Support: α = 0.84 • Role Adaptation: α = 0.81 - Test-Retest Reliability: Among 15 participants retested within 48 hours, the test-retest correlation was r = 0.91 (p < 0.001), indicating excellent temporal stability. Maternal Self-Efficacy Questionnaire (MSEQ-20) - Content Validity The CVI was 0.92, indicating excellent content validity. An expert panel of midwives, pediatric nurses, and maternal health specialists agreed that the scale comprehensively measures Indonesian mothers’ self-efficacy in newborn care. - Construct Validity Twenty items showed significant correlations with the total score (r = 0.51–0.76, p < 0.001), while 10 items failed to meet the validity criteria (r < 0.361). EFA revealed a four-factor structure explaining 64.8% of the total variance: • Factor 1: Basic Care Competencies (23.4%) • Factor 2: Health Management (17.2%) • Factor 3: Emotional Nurturing (13.8%) • Factor 4: Self-Care and Adaptation (10.4%) - Internal Consistency The overall Cronbach’s alpha was 0.905 for all 30 items, demonstrating excellent reliability. After removing invalid items, α increased to 0.923. Subscale alphas were: • Basic Care Competencies: α = 0.86 • Health Management: α = 0.84 • Emotional Nurturing: α = 0.82 • Self-Care and Adaptation: α = 0.80 - Test-Retest Reliability The test-retest correlation coefficient was r = 0.91 (p < 0.001) with a 2-week interval between administrations. ICC = 0.91 (95% CI: 0.88–0.94), demonstrating excellent temporal stability. - Item Analysis Ten items (2, 4, 8, 9, 11, 13, 16, 22, 24, 27) showed poor item-total correlations (r = 0.124–0.312) and should be revised or removed. These items primarily relate to confidence and decision-making, suggesting potential cultural adaptation issues. A summary of the psychometric properties of both instruments is presented in Table 2 . Table 2. Psychometric properties of PBQ-32 and MSEQ-20. Property PBQ-32 MSEQ-20 Content Validity Index (CVI) 0.92 (Excellent) 0.89 (Good) No. of factors (EFA) 6 4 Variance explained (%) 68.4% 61.7% Cronbach’s alpha (total) 0.89 0.87 Cronbach’s alpha (subscales) 0.81–0.86 0.78–0.83 Test-retest reliability (r) 0.91 (p < 0.001) 0.88 (p < 0.001) Item-total correlation range 0.712–0.825 0.65–0.84 Prevalence and risk factors Postpartum blues prevalence In this study, the overall prevalence of postpartum blues among participants was 70%. The severity of symptoms was distributed as follows: 30.0% of mothers reported no symptoms, 40.0% experienced mild symptoms, 20.0% reported moderate symptoms, and 10.0% experienced severe postpartum blues. The detailed distribution of postpartum blues severity is presented in Table 3 . Table 3. Prevalence and severity of postpartum blues (N = 30). Severity level Score range n (%) No symptoms 0-24 9 30.0 Mild symptoms 25-48 12 40.0 Moderate symptoms 49-72 6 20.0 Severe symptoms 73-96 3 10.0 The highest mean subscale scores were: - Physical Symptoms (Mean = 2.13, SD = 0.82) - Social Support Concerns (Mean = 1.98, SD = 0.79) Most reported symptoms: The most commonly reported individual symptoms were fatigue (83.3%), anxiety about the baby’s health (80.0%), and mood swings (76.7%). Maternal self-efficacy levels The distribution of maternal self-efficacy levels was as follows: - Poor: 13.3% - Fair: 36.7% - Good: 43.3% - Excellent: 6.7% The mean total self-efficacy score was 58.4 (SD = 12.6), indicating generally good confidence among participants. The detailed distribution of maternal self-efficacy levels is presented in Table 4 . Table 4. Maternal self-efficacy levels (N = 30). Category Score range n (%) Poor 20–35 4 13.3 Fair 36–55 11 36.7 Good 56–75 13 43.3 Excellent 76–100 2 6.7 Mean ± SD 58.4 ± 12.6 Risk factor This study identified several factors significantly associated with postpartum blues. Women with lower levels of education were more likely to report symptoms of postpartum blues (p = 0.032). Primiparous mothers also showed a higher tendency toward experiencing postpartum blues compared to multiparous counterparts (p = 0.041). Additionally, those who underwent cesarean deliveries had a significantly greater risk (p = 0.045). Social support emerged as a critical factor, with inadequate social support demonstrating a strong positive correlation with postpartum blues (r = 0.68, p = 0.001). Conversely, maternal self-efficacy was found to be significantly and negatively correlated with postpartum blues (r = -0.72, p < 0.001), suggesting that higher perceived maternal competence serves as a protective factor against emotional distress in the early postpartum period. The statistical associations between risk factors and postpartum blues are summarized in Table 5 . Table 5. Risk factor analysis for postpartum blues. Variable Association with PB (p-value) Education (low level) p = 0.032 Primiparity p = 0.041 Cesarean delivery p = 0.045 Inadequate social support r = 0.68, p = 0.001 Maternal self-efficacy r = -0.72, p < 0.001 Concurrent validity analysis A significant negative correlation (r = -0.72, p < 0.001) between PBQ-32 and MSEQ-20 scores supports the concurrent validity of both instruments and aligns with theoretical expectations. Discussion Psychometric properties and cultural appropriateness Evaluating the psychometric properties and cultural suitability of psychological instruments is essential to ensure their reliability and validity across diverse populations. The findings demonstrated strong psychometric performance of the Indonesian Postpartum Blues Questionnaire (PBQ-32) and the Maternal Self-Efficacy Scale (MSEQ-20), both in terms of reliability and cultural appropriateness. The results of the validation study indicated excellent psychometric performance. The PBQ-32 yielded a Cronbach’s alpha of 0.923, while the MSEQ-20 obtained a reliability coefficient of 0.923. Both values exceed the generally accepted threshold of 0.80 for research instruments and approach the 0.90 benchmark considered optimal for clinical use ( Sánchez-Meca et al., 2021 ). These findings support the internal consistency of the two instruments and confirm their applicability in both research and clinical settings in Indonesia. The adaptation process played a crucial role in ensuring contextual validity. Expert panel reviews involved careful consideration of culturally embedded practices, such as traditional postpartum rituals, the central role of extended family networks, and locally defined maternal expectations. This culturally grounded approach is consistent with the growing consensus in the literature that psychological instruments must be tailored to reflect local social norms and belief systems. For example, studies on maternal mental health in Indonesia have highlighted the significance of social support—particularly within matrilineal or extended family systems—as a key determinant of maternal self-efficacy ( Setyowati et al., 2024 ). Incorporating culturally relevant elements into psychological assessments has been shown to enhance their interpretability and cross-cultural acceptance. Instruments that reflect local practices and vernacular expressions tend to yield more accurate data and foster stronger engagement from participants ( Mandorino et al., 2021 ). Accordingly, the culturally sensitive adaptation of the PBQ-32 and MSEQ-20 strengthens their utility in assessing postpartum mental health among Indonesian mothers. Taken together, the high reliability scores and the culturally attuned development process underscore the relevance of these instruments for the Indonesian context. Their use holds promise not only for early detection and appropriate intervention in postpartum mental health but also for supporting culturally responsive care and advancing cross-cultural research in maternal health. Clinical implications and utility The availability of validated Indonesian versions of the PBQ-32 and MSEQ-20 represents a significant advancement in the landscape of maternal mental health care in Indonesia. As with their English-language counterparts, these instruments can now be integrated into clinical practice to support maternal psychological well-being during the postpartum period. Prevalence estimates of postpartum blues range from 50% to 80% depending on the population studied ( Votruba et al., 2023 ). The finding of a 70% prevalence rate in the current study reinforces the urgency of routine mental health screening, particularly at the level of first-contact healthcare providers ( Blackmore et al., 2022 ). In low-resource settings, where mental health services are limited, community-based initiatives that strengthen social support and parenting confidence are particularly impactful ( Monteiro et al., 2020 ). Numerous studies have underscored the role of social support in mitigating the onset and severity of postpartum depression and anxiety, especially in settings where cultural constraints and systemic barriers persist ( Votruba et al., 2023 ; Fatin et al., 2022 ). The observed strong negative correlation between maternal self-efficacy and postpartum blues (r = -0.72) suggests that enhancing maternal confidence may serve as a protective factor against emotional dysregulation during the postpartum transition ( Shi et al., 2024 ). Mothers commonly face substantial physical, emotional, and social challenges following childbirth. Interventions that bolster parenting confidence and resilience—particularly those grounded in evidence-based practices—have demonstrated efficacy in reducing anxiety and depressive symptoms during the early postpartum period ( Pereira et al., 2022 ). These findings collectively highlight the importance of pairing routine mental health assessments with comprehensive educational and psychosocial support programs. Such an integrated approach can enhance prevention, enable timely detection, and foster maternal empowerment, thereby yielding more favourable outcomes in maternal mental health ( Aldridge et al., 2022 ). Delivering effective mental health care to expectant and new mothers requires a collaborative effort that brings together healthcare providers, midwives, mental health professionals, and community-based organisations. This multi-sectoral approach ensures broader access and equitable distribution of resources ( Blackmore et al., 2022 ). In the Indonesian context, the culturally adapted PBQ-32 and MSEQ-20 offer reliable and contextually appropriate tools to support these efforts. Their integration into maternal health services has the potential to inform clinical decision-making and policy development, ultimately contributing to improved mental health outcomes for mothers and their infants. Comparison with international literature The 70% prevalence of postpartum blues identified within the Indonesian sample aligns closely with findings from international studies, where reported rates range from 39% to 85% ( Landman et al., 2024 ; O’Dea et al., 2023 ). These results lend further support to the proposition that postpartum blues is a widespread phenomenon among obstetric populations globally. However, the variations in prevalence and symptom severity across different populations suggest that cultural factors—such as symptom expression, diagnostic thresholds, and the availability of social support—play a significant role. In the Indonesian context, the deeply ingrained role of extended family networks appears to be a critical factor influencing the psychosocial experiences of mothers during the postpartum period ( O’Dea et al., 2023 ). The Indonesian versions of the PBQ-32 and MSEQ-20 maintain psychometric properties that are comparable to those reported in validation studies from other cultural settings. This strengthens the credibility of their reliability and validity. The PBQ-32 yielded a Cronbach’s alpha of 0.923, a result that meets or exceeds the psychometric benchmarks set by previously validated postpartum screening tools. Similarly, the MSEQ-20 produced an internal consistency score of 0.923, consistent with the original maternal self-efficacy scale developed by Teti and Gelfand, and in line with adaptations validated in both Western and non-Western populations ( Teti & Gelfand, 1991 ). These findings affirm the reliability and internal consistency of the Indonesian adaptations, underscoring their potential utility in both clinical assessment and academic research. Furthermore, the strong negative correlation observed between postpartum blues and maternal self-efficacy (r = -0.72) provides evidence of the concurrent validity of the two instruments. This result echoes previous findings, which suggest that higher maternal self-efficacy is associated with reduced symptoms of postpartum depression and anxiety ( Matinnia & Yazdi-Ravandi, 2020 ; Mutiso et al., 2024 ). These findings also reinforce theoretical frameworks that conceptualise self-efficacy as a protective factor within maternal mental health, capable of buffering emotional distress during the early postpartum period. Beyond psychometric robustness, cultural factors remain central to understanding the manifestation of postpartum blues. Cross-national research has highlighted the influence of culturally mediated gender roles, rites of postpartum confinement, and societal norms on maternal emotional well-being. In some societies, stigmatisation of mental health concerns may exacerbate distress, while in others, strong communal or familial support structures may serve as protective mechanisms ( Bauman et al., 2020 ; Rodriguez et al., 2023 ). The current Indonesian findings contribute to this discourse by illustrating how localised systems of care and cultural expectations shape maternal psychological outcomes. These comparative insights not only confirm the universality of postpartum emotional disturbances but also emphasise the critical importance of culturally sensitive validation processes. The adoption of a cross-cultural lens in mental health assessment, paired with contextually relevant interventions, is essential to improving the accessibility and effectiveness of maternal mental health services across diverse populations. Limitations and future directions There are several limitations to this study that should be taken into account when interpreting the results. First, the recruitment was conducted at a single centre with a modest sample size (n = 30), which limits the generalizability of the findings. Future studies should consider involving larger samples from multiple regions in Indonesia to enhance the external validity and representativeness of the results. Second, the use of a cross-sectional design precludes the ability to examine changes in psychological outcomes over time or assess the predictive validity of the instruments. Longitudinal research is necessary to determine the stability of the PBQ-32 and MSEQ-20 over time and to explore their potential in predicting long-term maternal mental health outcomes. Third, this validation study focused on the early postpartum period, specifically between days 3 and 10 after childbirth. As maternal psychological responses can evolve throughout the postpartum period, further research should explore how these instruments perform during later stages. Finally, criterion validity was not fully assessed due to the absence of comparison with internationally recognised tools such as the Edinburgh Postnatal Depression Scale (EPDS). Future studies should incorporate such measures to enable a more comprehensive assessment of concurrent and convergent validity and to strengthen the psychometric credibility of the PBQ-32 and MSEQ-20 in the Indonesian setting. Recommendations for implementation Based on the findings of this study, several practical recommendations are proposed to support the effective integration of maternal mental health assessment instruments into the Indonesian healthcare system: - Integration into Healthcare Provider Training Structured training programs should be developed for midwives, nurses, and other maternal health professionals to ensure accurate administration, scoring, and interpretation of the Postpartum Blues Questionnaire (PBQ-32) and the Maternal Self-Efficacy Scale (MSEQ-20). Capacity building in this area will support informed clinical decision-making and enhance the responsiveness of postpartum care services. - Incorporation into Postpartum Care Protocols Both instruments should be formally incorporated into existing postpartum care guidelines at the primary healthcare level. Routine screening using these tools—particularly during the early postpartum period—can facilitate the early identification of emotional distress and self-efficacy deficits, allowing for timely and appropriate interventions. - Design of Culturally Responsive Interventions Data generated from the PBQ-32 and MSEQ-20 can inform the development of targeted maternal mental health interventions, particularly for mothers identified as high-risk due to low self-efficacy or insufficient social support. Interventions should be culturally tailored to address local norms, family dynamics, and traditional practices in postpartum care. - Longitudinal and Predictive Research Future research should include longitudinal studies to evaluate the predictive validity and long-term clinical utility of both instruments. Such studies will be essential to assess how scores evolve and to determine their effectiveness in forecasting maternal mental health outcomes, thereby guiding more sustainable and evidence-based practices in maternal care. Theoretical implications The validation of the Indonesian versions of the PBQ-32 and MSEQ-20 supports key psychological frameworks. The strong negative correlation between maternal self-efficacy and postpartum blues reinforces Bandura’s self-efficacy theory, highlighting perceived competence as a protective factor during postpartum adjustment. Additionally, the multidimensional structure of the PBQ-32 reflects the biopsychosocial model, acknowledging the interplay of emotional, physical, and social factors in maternal mental health. These findings affirm the theoretical grounding of both instruments and support their relevance for clinical assessment and research in culturally specific contexts. Conclusion This study developed and validated culturally adapted Indonesian versions of the Postpartum Blues Scale (PBQ-32) and the Maternal Self-Efficacy Scale (MSEQ-20), both of which demonstrated strong psychometric properties, including high internal consistency, good test-retest reliability, and acceptable content and construct validity. These instruments offer healthcare providers reliable tools for assessing postpartum mental health in a culturally relevant manner. The high prevalence of postpartum blues (70%) and the identification of significant risk factors—particularly inadequate social support and low maternal self-efficacy—underscore the need for routine screening and early intervention within Indonesian maternal health services. The strong inverse relationship between self-efficacy and postpartum blues severity highlights the potential of empowerment-based interventions to improve maternal outcomes. These validated instruments lay the groundwork for improving postpartum mental health care delivery in Indonesia by filling a critical gap in available assessment tools. Future research should build on these findings by evaluating predictive validity, exploring longitudinal outcomes, and testing the effectiveness of targeted interventions. The results of this study also emphasise the value of culturally grounded instrument development. The methodological approach applied here may serve as a framework for future validation studies across other maternal and reproductive health domains in diverse cultural settings. Ethical considerations This study received ethical approval from the Health Research Ethics Committee of Universitas Batam, with approval number 045/LPPM-UNIBA/PI-EC/IV/2024, dated April 12, 2024, and valid through April 12, 2025. The ethical review was conducted under the seven ethical standards outlined by the World Health Organization ( WHO, 2011 )—including social value, scientific validity, favorable risk-benefit ratio, informed consent, respect for participants, privacy, and fairness—as well as the guidelines set forth by the Council for International Organizations of Medical Sciences ( CIOMS, 2016 ). Before participation, all respondents were given detailed explanations about the study’s objectives, procedures, potential risks, and their right to withdraw at any time without consequence. Written informed consent was obtained from all participants. To protect confidentiality, all data were anonymised using coded identifiers and securely stored, with access limited to members of the research team. Data availability All underlying data used in this study, including the pre-validation instruments and the final dataset for construct validity and reliability testing, are openly available on Zenodo. - Pre-Validation Instruments: Pre-final versions of the PBQ-35 and MSEQ-30 questionnaires used during the initial stage of this study. Pre-Validation Draft of the PBQ-35 and MSEQ-30 Instruments for Indonesian Mothers [Data set]. Zenodo. https://doi.org/10.5281/zenodo.16605147 ( Sari & Sansuwito, 2025a ) - Construct Validity and Reliability Dataset: The final dataset used for psychometric testing, including responses for factor analysis, item-total correlations, and reliability assessments. Dataset of Construct Validity and Reliability Testing: Indonesian Versions of the Postpartum Blues and Maternal Self-Efficacy Questionnaires [Data set]. Zenodo. https://doi.org/10.5281/zenodo.16627544 ( Sari & Sansuwito, 2025b ) All underlying data are available on Zenodo under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) license . Acknowledgments The authors thank the expert panel members, village midwives, health cadres, and participating mothers who contributed to this study—special thanks to the Health Centre in Batam City for facilitating data collection and supporting this research initiative. References Aldridge E, Schubert KO, Pathirana M, et al. : A Prospective Registry Analysis of Psychosocial and Metabolic Health Between Women With and Without Metabolic Syndrome After a Complicated Pregnancy. BMC Womens Health. 2022; 22 (1): 461. 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PubMed Abstract | Publisher Full Text Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 14 Aug 2025 ADD YOUR COMMENT Comment Author details Author details 1 Nursing, Lincoln University College, Petaling Jaya, Selangor, Malaysia 2 Nursing, Universitas Batam, Batam, Riau Islands, Indonesia 3 Medical, Batam University Medical Faculty, Batam, Riau Islands, Indonesia Ika Novita Sari Roles: Conceptualization, Data Curation, Formal Analysis, Project Administration, Writing – Original Draft Preparation Tukimin bin Sansuwito Roles: Methodology, Supervision, Writing – Review & Editing Dino Gagah Prihadianto Roles: Resources, Validation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (2) version 2 Revised Published: 14 Oct 2025, 14:789 https://doi.org/10.12688/f1000research.168513.2 version 1 Published: 14 Aug 2025, 14:789 https://doi.org/10.12688/f1000research.168513.1 Copyright © 2025 Sari IN et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Sari IN, Sansuwito Tb and Prihadianto DG. Development and psychometric validation of the Indonesian versions of the Postpartum Blues and Maternal Self-Efficacy Scales [version 2; peer review: 1 approved] . F1000Research 2025, 14 :789 ( https://doi.org/10.12688/f1000research.168513.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 2 VERSION 2 PUBLISHED 14 Oct 2025 Revised Views 0 Cite How to cite this report: Pramesona BA. Reviewer Report For: Development and psychometric validation of the Indonesian versions of the Postpartum Blues and Maternal Self-Efficacy Scales [version 2; peer review: 1 approved] . F1000Research 2025, 14 :789 ( https://doi.org/10.5256/f1000research.189099.r424035 ) The direct URL for this report is: https://f1000research.com/articles/14-789/v2#referee-response-424035 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 11 Nov 2025 Bayu Anggileo Pramesona , Department of Public Health, Faculty of Medicine, Lampung University (Universitas Lampung), Bandar Lampung, Indonesia Approved VIEWS 0 https://doi.org/10.5256/f1000research.189099.r424035 Thank you for your revisions, I think ... Continue reading READ ALL Thank you for your revisions, I think all suggested revisions have been added properly. Competing Interests: No competing interests were disclosed. Reviewer Expertise: Health policy and management, public health nursing I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Pramesona BA. Reviewer Report For: Development and psychometric validation of the Indonesian versions of the Postpartum Blues and Maternal Self-Efficacy Scales [version 2; peer review: 1 approved] . F1000Research 2025, 14 :789 ( https://doi.org/10.5256/f1000research.189099.r424035 ) The direct URL for this report is: https://f1000research.com/articles/14-789/v2#referee-response-424035 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 14 Aug 2025 Views 0 Cite How to cite this report: Pramesona BA. Reviewer Report For: Development and psychometric validation of the Indonesian versions of the Postpartum Blues and Maternal Self-Efficacy Scales [version 2; peer review: 1 approved] . F1000Research 2025, 14 :789 ( https://doi.org/10.5256/f1000research.185699.r406001 ) The direct URL for this report is: https://f1000research.com/articles/14-789/v1#referee-response-406001 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 10 Sep 2025 Bayu Anggileo Pramesona , Department of Public Health, Faculty of Medicine, Lampung University (Universitas Lampung), Bandar Lampung, Indonesia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.185699.r406001 Introduction: 1. First paragraph: please separate the references so the readers can notice which sentence refers to the reference. 2. Please add some information about the prevalence of postpartum blues in Indonesia. Methods: 1. Indonesia has more ... Continue reading READ ALL Introduction: 1. First paragraph: please separate the references so the readers can notice which sentence refers to the reference. 2. Please add some information about the prevalence of postpartum blues in Indonesia. Methods: 1. Indonesia has more than 1,300 recognized ethnic groups with 38 provinces, making it one of the most ethnically diverse countries in the world, but the authors only chose the respondents from a public health center in Batam City, Sumatera Island. How do you ensure this study finding is relevant to all Indonesian people? 2. How many expert committees were involved in this study? Who were they? 3. Are there any reasons for limiting the age of postpartum mothers aged 20-35 years? Results 1. Please delete % in Tables 1, 3, and 4 in each row; just show the number. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Health policy I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Pramesona BA. Reviewer Report For: Development and psychometric validation of the Indonesian versions of the Postpartum Blues and Maternal Self-Efficacy Scales [version 2; peer review: 1 approved] . F1000Research 2025, 14 :789 ( https://doi.org/10.5256/f1000research.185699.r406001 ) The direct URL for this report is: https://f1000research.com/articles/14-789/v1#referee-response-406001 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 14 Oct 2025 ika Novita Sari , Nursing, Lincoln University College, Petaling Jaya, Malaysia 14 Oct 2025 Author Response We sincerely thank the reviewer for the thoughtful and constructive feedback, which has been very helpful in improving the clarity and methodological rigor of our article. Below we provide a ... Continue reading We sincerely thank the reviewer for the thoughtful and constructive feedback, which has been very helpful in improving the clarity and methodological rigor of our article. Below we provide a point-by-point response to each comment. Introduction: We have revised the first paragraph by separating the references so that each statement is clearly attributed to the correct citation. We also added detailed information on the prevalence of postpartum blues in Indonesia, including national estimates, city-level studies (Surabaya, Bandung, Surakarta, Yogyakarta, and Batam), and community health center data. These revisions are presented in the second and third paragraphs of the Introduction. Methods: We clarified the rationale for selecting Batam City as the study site, noting its cultural diversity, standardized maternal health services, and representativeness of Indonesian maternal health contexts. We also specified that the expert panel consisted of five professionals: one obstetrician, one clinical psychologist, one maternal health nurse, and two midwives with expertise in maternal and child health. In addition, we provided a rationale for limiting the maternal age range to 20–35 years, as this group represents the optimal reproductive age with balanced biological and psychological risks, whereas mothers outside this range face distinct obstetric and psychosocial challenges that may confound results. Results: Percentages have been removed from Tables 1, 3, and 4, and only raw numbers are now presented to enhance clarity and consistency. We are deeply grateful for the reviewer’s insights, which have significantly strengthened the manuscript. We remain open to any further suggestions that could enhance the quality and impact of this work. We sincerely thank the reviewer for the thoughtful and constructive feedback, which has been very helpful in improving the clarity and methodological rigor of our article. Below we provide a point-by-point response to each comment. Introduction: We have revised the first paragraph by separating the references so that each statement is clearly attributed to the correct citation. We also added detailed information on the prevalence of postpartum blues in Indonesia, including national estimates, city-level studies (Surabaya, Bandung, Surakarta, Yogyakarta, and Batam), and community health center data. These revisions are presented in the second and third paragraphs of the Introduction. Methods: We clarified the rationale for selecting Batam City as the study site, noting its cultural diversity, standardized maternal health services, and representativeness of Indonesian maternal health contexts. We also specified that the expert panel consisted of five professionals: one obstetrician, one clinical psychologist, one maternal health nurse, and two midwives with expertise in maternal and child health. In addition, we provided a rationale for limiting the maternal age range to 20–35 years, as this group represents the optimal reproductive age with balanced biological and psychological risks, whereas mothers outside this range face distinct obstetric and psychosocial challenges that may confound results. Results: Percentages have been removed from Tables 1, 3, and 4, and only raw numbers are now presented to enhance clarity and consistency. We are deeply grateful for the reviewer’s insights, which have significantly strengthened the manuscript. We remain open to any further suggestions that could enhance the quality and impact of this work. Competing Interests: No competing interests were disclosed Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 14 Oct 2025 ika Novita Sari , Nursing, Lincoln University College, Petaling Jaya, Malaysia 14 Oct 2025 Author Response We sincerely thank the reviewer for the thoughtful and constructive feedback, which has been very helpful in improving the clarity and methodological rigor of our article. Below we provide a ... Continue reading We sincerely thank the reviewer for the thoughtful and constructive feedback, which has been very helpful in improving the clarity and methodological rigor of our article. Below we provide a point-by-point response to each comment. Introduction: We have revised the first paragraph by separating the references so that each statement is clearly attributed to the correct citation. We also added detailed information on the prevalence of postpartum blues in Indonesia, including national estimates, city-level studies (Surabaya, Bandung, Surakarta, Yogyakarta, and Batam), and community health center data. These revisions are presented in the second and third paragraphs of the Introduction. Methods: We clarified the rationale for selecting Batam City as the study site, noting its cultural diversity, standardized maternal health services, and representativeness of Indonesian maternal health contexts. We also specified that the expert panel consisted of five professionals: one obstetrician, one clinical psychologist, one maternal health nurse, and two midwives with expertise in maternal and child health. In addition, we provided a rationale for limiting the maternal age range to 20–35 years, as this group represents the optimal reproductive age with balanced biological and psychological risks, whereas mothers outside this range face distinct obstetric and psychosocial challenges that may confound results. Results: Percentages have been removed from Tables 1, 3, and 4, and only raw numbers are now presented to enhance clarity and consistency. We are deeply grateful for the reviewer’s insights, which have significantly strengthened the manuscript. We remain open to any further suggestions that could enhance the quality and impact of this work. We sincerely thank the reviewer for the thoughtful and constructive feedback, which has been very helpful in improving the clarity and methodological rigor of our article. Below we provide a point-by-point response to each comment. Introduction: We have revised the first paragraph by separating the references so that each statement is clearly attributed to the correct citation. We also added detailed information on the prevalence of postpartum blues in Indonesia, including national estimates, city-level studies (Surabaya, Bandung, Surakarta, Yogyakarta, and Batam), and community health center data. These revisions are presented in the second and third paragraphs of the Introduction. Methods: We clarified the rationale for selecting Batam City as the study site, noting its cultural diversity, standardized maternal health services, and representativeness of Indonesian maternal health contexts. We also specified that the expert panel consisted of five professionals: one obstetrician, one clinical psychologist, one maternal health nurse, and two midwives with expertise in maternal and child health. In addition, we provided a rationale for limiting the maternal age range to 20–35 years, as this group represents the optimal reproductive age with balanced biological and psychological risks, whereas mothers outside this range face distinct obstetric and psychosocial challenges that may confound results. Results: Percentages have been removed from Tables 1, 3, and 4, and only raw numbers are now presented to enhance clarity and consistency. We are deeply grateful for the reviewer’s insights, which have significantly strengthened the manuscript. We remain open to any further suggestions that could enhance the quality and impact of this work. Competing Interests: No competing interests were disclosed Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 14 Aug 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 2 (revision) 14 Oct 25 read Version 1 14 Aug 25 read Bayu Anggileo Pramesona , Lampung University (Universitas Lampung), Bandar Lampung, Indonesia Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Pramesona B. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 11 Nov 2025 | for Version 2 Bayu Anggileo Pramesona , Department of Public Health, Faculty of Medicine, Lampung University (Universitas Lampung), Bandar Lampung, Indonesia 0 Views copyright © 2025 Pramesona B. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thank you for your revisions, I think all suggested revisions have been added properly. Competing Interests No competing interests were disclosed. Reviewer Expertise Health policy and management, public health nursing I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Pramesona BA. Peer Review Report For: Development and psychometric validation of the Indonesian versions of the Postpartum Blues and Maternal Self-Efficacy Scales [version 2; peer review: 1 approved] . F1000Research 2025, 14 :789 ( https://doi.org/10.5256/f1000research.189099.r424035) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-789/v2#referee-response-424035 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Pramesona B. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 10 Sep 2025 | for Version 1 Bayu Anggileo Pramesona , Department of Public Health, Faculty of Medicine, Lampung University (Universitas Lampung), Bandar Lampung, Indonesia 0 Views copyright © 2025 Pramesona B. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Introduction: 1. First paragraph: please separate the references so the readers can notice which sentence refers to the reference. 2. Please add some information about the prevalence of postpartum blues in Indonesia. Methods: 1. Indonesia has more than 1,300 recognized ethnic groups with 38 provinces, making it one of the most ethnically diverse countries in the world, but the authors only chose the respondents from a public health center in Batam City, Sumatera Island. How do you ensure this study finding is relevant to all Indonesian people? 2. How many expert committees were involved in this study? Who were they? 3. Are there any reasons for limiting the age of postpartum mothers aged 20-35 years? Results 1. Please delete % in Tables 1, 3, and 4 in each row; just show the number. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Health policy I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 14 Oct 2025 ika Novita Sari, Nursing, Lincoln University College, Petaling Jaya, Malaysia We sincerely thank the reviewer for the thoughtful and constructive feedback, which has been very helpful in improving the clarity and methodological rigor of our article. Below we provide a point-by-point response to each comment. Introduction: We have revised the first paragraph by separating the references so that each statement is clearly attributed to the correct citation. We also added detailed information on the prevalence of postpartum blues in Indonesia, including national estimates, city-level studies (Surabaya, Bandung, Surakarta, Yogyakarta, and Batam), and community health center data. These revisions are presented in the second and third paragraphs of the Introduction. Methods: We clarified the rationale for selecting Batam City as the study site, noting its cultural diversity, standardized maternal health services, and representativeness of Indonesian maternal health contexts. We also specified that the expert panel consisted of five professionals: one obstetrician, one clinical psychologist, one maternal health nurse, and two midwives with expertise in maternal and child health. In addition, we provided a rationale for limiting the maternal age range to 20–35 years, as this group represents the optimal reproductive age with balanced biological and psychological risks, whereas mothers outside this range face distinct obstetric and psychosocial challenges that may confound results. Results: Percentages have been removed from Tables 1, 3, and 4, and only raw numbers are now presented to enhance clarity and consistency. We are deeply grateful for the reviewer’s insights, which have significantly strengthened the manuscript. We remain open to any further suggestions that could enhance the quality and impact of this work. View more View less Competing Interests No competing interests were disclosed reply Respond Report a concern Pramesona BA. Peer Review Report For: Development and psychometric validation of the Indonesian versions of the Postpartum Blues and Maternal Self-Efficacy Scales [version 2; peer review: 1 approved] . F1000Research 2025, 14 :789 ( https://doi.org/10.5256/f1000research.185699.r406001) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-789/v1#referee-response-406001 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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