Measuring responsiveness and mistreatment in maternity care in sub-Saharan Africa: a questionnaire validation and development of a score

Abstract Introduction: Mistreatment and abuse are still experienced by women during hospital childbirth in many parts of the world, with sub-Saharan Africa being one of the places where it is most common. Interventions aiming to improve respectful maternity care must be able to assess the prevalence of responsiveness and mistreatment women experience. This is usually done with questionnaires, though these are not always validated. Scores to represent the level of responsiveness and mistreatment experienced have many uses and can be created from questionnaire results, though no score is consistently used in this field. A new questionnaire measuring responsiveness and mistreatment was developed for use in the ALERT (“Action leveraging evidence to reduce perinatal mortality and morbidity in sub-Saharan Africa”) study, as a questionnaire covering both of these concepts did not previously exist. This study aimed to validate this questionnaire and to create a scoring method. Methods: Psychometric analyses, including exploratory and confirmatory factor analysis, were performed on data collected from the ALERT project to identify and confirm underlying factors. Using these factors, simple summation and factor-weighted methods were used to create scores and their results compared. Results: Six factors were identified: “Communication & supportive care”, “Hospital environment”, “Respect & dignity”, “Social support”, “Privacy & confidentiality” and “No normalised abuse”. The results of the two scoring methods developed were similar. Conclusions: The responsiveness and mistreatment questionnaire has high validity in the ALERT study population for the six factors identified. The two scoring methods developed are useful for many aspects of the ALERT intervention, including to facilitate comparisons and measure progress towards improving respectful maternity care.