Test Validity of The Pregnancy-related Anxiety Scale (PrAS) for Pregnant Women in Indonesia: A Pilot Study

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The Pregnancy-related Anxiety Scale (PrAS) is a common tool for assess pregnancy anxiety. However, not yet validated in Indonesia. This study aimed to evaluate the psychometric properties of the PrAS in Indonesia. Methods A cross-sectional study was conducted among 92 pregnant women at the Public Health Center in Indonesia. The content validity index (CVI) and content validity ratio (CVR) measured the relevancy of each item with the content (pregnancy anxiety) and items interrater-reliability. The construct validity Confirmatory Factor Analysis (CFA) was applied to test the construct validity of the Pregnancy-Related Anxiety Scale (PrAS). Results The mean age of pregnant women who participated was 29.12 years (SD = 4.85) with their pregnancy age mean 28 weeks. The content validity using CVI shows that 29 of 32 items are valued 1.00, the same score produced on the CVR. Indicating only 3 items need to be reviewed or revised. Regarding the construct validity, the final model of the PrAS was 7 dimensions which initially formed 8 dimensions. Although the Chi-square (χ2) index was not a good fit (df = 370, p-value = 0.0001) this multidimensional model fits the data supported by the index of Root Mean Square Error of Approximation (RMSEA) estimate was 0.058. Followed by the Comparative Fit Index (CFI) and the Tucker-Lewis Index (TLI) were 0.978 and 0.976 respectively, meaning that the goodness of fit indices were obtained. This pilot study results in a valid instrument of the Pregnancy-Related Anxiety Scale (PrAS). Conclusions The Indonesian version of the PrAS is a valid tool for screening and assessing Indonesian women's pregnancy-related anxiety. confirmatory factor analysis fear of childbirth Indonesia pregnancy Wijma delivery expectancy questionnaire Background Anxiety is become a common disorder during pregnancy [1]. The prevalence of anxiety varies across countries and cultures; it has been reported around 22. 9% of women identified the anxiety symptoms and a diagnosis of an anxiety disorder was found in 15.2% in Canada [2]. Other studies found that anxiety during pregnancy is between 4.6% and 40.8% [1,3]. Anxiety during pregnancy can be problematic and cause a negative impact for the mother and their fetal well-being [4]. This condition increases the risk of developing preeclampsia, obstetric complications, and bonding problems [5]. Anxiety itself develops into the postpartum period and raises postpartum depression [6,7,8]. For the newborn, anxiety from their mother has impact on lower gestational age, birth weight, and poor cognitive development, among others [9]. Early detection of anxiety during pregnancy is important due to the negative impact on women. It’s need a validated and reliable instrument to measure this condition [10]. In Indonesia, studies related to anxiety during pregnancy reported that 20.2% of subjects had mild to moderate to severe anxiety levels [11]. In another study the 53.3% of respondents who felt anxious. Anxiety was most common among pregnant women with high education levels, gestational age < 19 weeks, and working pregnant women [12]. Anxiety during pregnancy is still under assessment in delivery services and it’s affected women and fetal wellbeing. Therefore, prompt instrument, such as the PrAS in the Indonesian context is necessary. The cultural differences, from Indonesian factor will give different structure of the PrAS from those in different countries. This pilot study aimed to evaluate the psychometric properties of the PrAS in Indonesia. The objectives of the study are to: (a) to validate how well the items cover all relevant part of the content (content validity) using CVI and CVR; (b) to test the construct validation of PrAS in Indonesia whether the eight-factor structure of the original PrAS scale fits the Indonesian sample using the Confirmatory Factor Analysis (CFA).The results of this study also aim to provide future recommendations for the development of PrAS. Methods Study Design A descriptive, pilot study of pregnant women (N = 92) with single pregnancy was conducted at Public Health Center in Indonesia (majority in Jakarta) during November 2023. The study was approved by the institutional review board of Faculty of Nursing Universitas Indonesia and written informed consent obtained from each mother after the study purpose was explained. Sample and recruitment Pregnant women with single tone pregnancy receiving antenatal care in antenatal clinic were screened and recruited by the investigators. The study located at Public Health Center in Indonesia as a research site due to the number of antenatal visit consideration. Study participants A convenience sampling method was used in this study. The inclusion criteria were the mother with a singleton pregnancy, spoke and understand Bahasa. The exclusion criteria are the mother who had an obstetric complication including preeclampsia or hemorrhage or had a mental illness history. As the PrAS has 32 items, a sample of 92 was gathered. Procedure Translation and Back Translation of the PrAS Cross-cultural research instrument validation is essential due to the diversity of the global population [13]. To ensure the quality of the instrument, the researcher arranged for translation from English into Indonesian using the following steps. (1) Selecting Well-Qualified Translators For this study, the original instrument was translated from English into Bahasa Indonesia and translated back into English. To produce a high-quality translation, it is important to choose well-qualified translators [13]. The translators for this study were fully bilingual and were sufficiently educated to be familiar with the concepts. The first translator is an expert in the field of English education and studied about anxiety. She forwardly translated the PrAS from English into Bahasa Indonesian. Then the second translator is a faculty member of Nursing Department. She did translation the new Indonesian version of the PrAS back into English. (2) Translating the Instrument The researchers adopted the Brislin method in translating the questionnaire. According to Brislin (1970), the most common and highly recommended procedure for translating is translation and back-translation. Steps for translating an instrument are translating from the source to the target language, blindly translating back from the translated version to the source language, and comparing the two versions in the original language [14] a. Translating from the source to the target language The first translator translated the original English version into the target language, Bahasa Indonesian. Bahasa Indonesian is the official language in Indonesia. b. Blindly translating back from the target to the source Back-translation is translating from the newly translated version back into the original source language without looking at the original [14]. The second translator back-translated from the first translator’s Indonesian version into English. The forward-translator and backward-translator did not discuss translation with each other during this stage to avoid the back-translator being influenced by exposure to the original English version of the questionnaire. c. Comparing the two versions in the original language The equivalence of the source and target language versions of the instrument must then be evaluated. If the two English versions of the questionnaire are identical, the translated version of the questionnaire (in this case, the Indonesian version) may be considered as equivalent to the original one [14]. Therefore, the researcher conducted a panel discussion to compare if the original English version to the back-translated version were alike, as well as the final version in the Indonesian language. During this process, there were several distinct opinions between the two translators and the researcher considered terms and sentence structure of the original and translated versions of Indonesian and English. Differences were found in items 3, 4, and 5. First, on item 3, the forward translator used the word “very” in Indonesian translation. Whereas, in the original English version, there is no “very” term on item 3. Therefore, the researcher agreed to remove the word “very” in both Indonesian and back-translated versions. Then, on item 4: the back-translator wrote the word “stiff” rather than “restrain” as written in the original English version. It because the forward translator also translated “restrain” as “stiff” in Indonesian. Due to the two English version of item 4 was unidentical, the researcher agreed to revise the Indonesian version in order to make it alike. Lastly, on item 5, the back translator put “aggrieved” rather than the original, “harmed.” The definition of “harmed” is “physically injured”, which is different with “aggrieved”. After a discussion, we decided to change the translated version into a term that is more identical with “harmed” which seemed more suitable. In the end, the researcher and the translators reached agreement on all items. The process of translation and back translation of Pregnancy-related Anxiety Scale is described in Fig. 1 . Content Validity Index of the PrAS To test for validity, the researcher invited six experts to evaluate the questionnaire. These six experts include: 2 maternity nurses, 3 lecturers of maternity nursing, and 1 obgyn doctor. The minimal number of content validity experts should be three [15,16]. The content validity index (CVI) in this study that was rated by six experts ranged from 0.83 to 1 and had average of 0.984. The scale’s content validity (S-CVI) average for an instrument should be at least 0.90. In addition, according to Polit and colleagues, an item-level content validity (I-CVI) that is more than 0.50 is acceptable. Specifically, they noted that for six experts, an item with an I-CVI 0.67 is “fair,” while 0.86 and 1.00 are “excellent,” according to the kappa evaluation criteria [16]. These results indicate that the PrAS is valid and reliable for use in Indonesia. Measure A pilot test of 92 pregnant women was conducted to confirm the wording and adequacy of the final version. Data were collected using Google Forms, and it approximately took 30 minutes to complete. For women who were unable to read the investigator read out the questionnaire in Bahasa and assisted in filling it out. Psychometric analysis the conducted using content validity (CVI and CVR) and construct validity using confirmatory factor analysis (CFA). Pregnancy Anxiety The Pregnancy-related Anxiety Scale (PrAS) was developed by Robyn Brunton and colleagues to measure anxiety that is related to women’s feelings during pregnancy. The instrument comprises 32 items and uses a four-point Likert scale from 1 to 4 (1 = not at all, 2 = occasionally, 3 = quite often, and 4 = very often), with the highest and lowest answers describing the opposite extremes of a pregnant woman’s anxiety [17,18]. The 32-item questionnaire is divided into eight main subscales: 1) items 1 to 6 are about childbirth concerns; 2) items 7 to 11 describe a pregnant woman’s body image concerns; 3) items 12 to 14 correspond to the attitudes towards childbirth; 4) questions 15 to 20 are about a pregnant woman’s worry about self; 5) questions 21 to 23 indicate a woman’s concerns to the baby; and 6) questions 24 to 26 identify a woman’s acceptance of pregnancy; 7) items 27 to 29 are about a woman’s avoidance of vaginal delivery; and 8) items 30 to 32 identify about a woman’s attitudes towards medical staff [18]. The total possible score on the PrAS is 128, with the cut-off point is 75.50 which indicates a pregnant woman has having high level of anxiety. The PrAS has internal consistency reliability of α = .92 for the full-scale, and α = .84–.95 for each subscale, which is excellent and appropriate for a research instrument [18]. Demographic variables Demographic data including age, employment status, educational level (background), pregnancy age, and pregnancy sequence were assessed using a structured questionnaire. Statistical analysis Data analysis was conducted using the Statistical Package for the Social Sciences (SPSS) version 26 (IBM, 2019) and MPlus version 8.0 (Muthén & Muthén, 2017). Descriptive statistics including frequency, mean, and standard deviation (SD) were generalized to summarize participants’ characteristics. In the development phase of the Pregnancy-Related Anxiety Scale (PrAS), each item (32-item) of the instrument was evaluated and rated by 6 panelists (subject matter experts). The content validity was conducted to measure the relevancy of Construct Validation of the PrAS was assessed using confirmatory factor analysis (CFA). The CFA was undertaken to determine the multidimensional fit of the original PrAS. The weighted least squares mean and variance adjusted ( WMLSV) estimator achieves robust results that do not assume normally distributed variables and provides the best option for modeling categorical or ordered data [19]. Also, the Bayesian estimator is used as the fit index model. Bayesian approaches for estimating multilevel latent variable models can be beneficial in small samples [20]. Goodness-of-fit indices were used to confirm the model fit, namely, a Chi-square test (χ2) and its p-value (≥ 0.05 = acceptable fit; ≥0.10 = good fit), which is sensitive to large sample size. Therefore, there are in this study other indices included root mean square error of approximation (RMSEA: ≤0.08 = acceptable fit; ≤0.05 = good fit), comparative fit index (CFI: ≥0.85 = acceptable fit; ≥0.95 = good fit), and Tucker-Lewis index (TLI: ≥0.80 = acceptable fit; ≥0.95 = good fit) were considered in this study. At least three adequacy indices with values within the acceptable ranges were considered in analyzing the goodness of fit of data. Result Characteristic of participants In total, 92 pregnant women have participated in this study. The majority of women were older ≥ 25 years (87.61%) with the mean of participants being 29.12 (SD = 4.75) and the pregnancy age 28 weeks. The participants were employed (36.96%) and had a secondary education (55.43%) (See Table 1 ). Most of the women experienced their first pregnancy and second pregnancy (69.57%). Table 1 Descriptive Statistics Variables Frequency Percentage (%) Employment Status Not Employed 57 61.96% Employed 34 36.96% Education Level Primary Level 2 2.17% Secondary Level 51 55.43% Tertiary Level 37 40.22% Pregnancy Sequence First Pregnancy 34 36.96% Second Pregnancy 30 32.61% Third Pregnancy 19 20.65% Fourth Pregnancy 8 8.70% Content Validity Content Validity Ratio (CVR) Each item of PrAS is counted by the formula CVR=(N e - N/2)/(N/2), in which the N e is the number of panelists indicating "essential" and N is the total number of panelists (in this study evaluated by 6 panelists). From 32 items, only 3 items (30, 31, 32) in the woman’s attitudes towards medical staff dimension show the value of CVR 0.83, while others are 1.00. The closer to 1.0 the CVR is, the more essential the object is measured to be. Contrariwise, the closer to -1.0 the CVR is, the more non-essential it is [21]. Content Validity Index (CVI) The content validity index (CVI) is related to the number of experts. Reflecting this study where there are 6 or fewer experts, the I-CVI must be 1.00—that is, all experts must agree that the item is content valid [16]. From 32 items, only 3 items (30, 31, 32) in the woman’s attitudes towards medical staff dimension show the value of CVI 0.67, while others are 1.00. It shows that the three items need to be revised before entering the data collection phase. Confirmatory Factor Analysis (CFA) The CFA was conducted to test the eight dimensions of the original Pregnancy-Related Anxiety Scale (PrAS). Specifically, the 32-item was tested as multidimensional (8 dimensions), in the first attempt the model was an acceptable fit (RMSEA = 0.064), but it was potential to be modified regarding achieving the good fit model. The CFA confirmed that the entire scale of the PrAS is a good fit (RMSEA = 0.058). The Comparative Fit Index (CFI) and Tucker-Lewis Index (TLI) were fit the model with the result of 0.978 and 0.976 respectively. The fit model of PrAS shows in the diagram below (Diagram 1). The final model eliminated one of the dimensions, named woman’s acceptance of pregnancy (item 24, item 25, and item 26) with the loading of -0.038 in measuring PrAS. After the model fit was tested, the next step was to identify each dimension factor loading (λ) or coefficient which indicates the contribution of the items to the construct being measured (pregnancy-related anxiety). Initially, the 32-item measure yielded 10 items due to the eliminated dimension, resulting in 29 final items divided in 7 dimensions. Table 2 below shows the information of the standardized dimensions and its significance. Table 2 Standardized Model Results of PrAS Dimension Coefficient (λ) Standard Error (S.E) T-Value P-Value Sig. Childbirth (gb) 0.782 0.046 17.054 0.000 * Pregnant woman’s body image (bi) 0.792 0.046 17.172 0.000 * Attitudes towards childbirth (ac) 0.351 0.088 4.008 0.000 * Worry about self (sf) 0.955 0.031 30.468 0.000 * Concerns to the baby (bb) 0.823 0.039 20.929 0.000 * Woman’s avoidance of vaginal delivery (an) 0.308 0.104 2.972 0.000 * Woman’s attitudes towards medical staff (ms) 0.622 0.068 9.206 0.000 * Note : p -value < 0.05 (Significant) Discussion Referring to the RMSEA (root mean square error of approximation), a good model fit is produced, along with the CFI and TLI indices. The construct validity of PrAS in 7 dimensions model was accepted. Although, the eliminated dimension (woman’s acceptance of pregnancy) needs to be reviewed and adjusted with the local context. Besides that, this pilot study also only refers to one region in Indonesia (Jakarta), for future studies, it would be better if the sample was representative from each region in Indonesia. Conclusion The Indonesian version of PrAS 7 dimensions is a valid tool for screening and assessing pregnancy-related anxiety among Indonesian women in this pilot study. The expansion of representative samples (pregnant mothers) in Indonesia needs to be considered to apply this instrument on a national scale. Abbreviations CFA Confirmatory Factor Analysis PrAS Pregnancy-related Anxiety Scale. Declarations Acknowledgments The pregnant women who participated in this study made this study successful . Authors’ Contribution WK designed the study and drafted the original manuscript. CWT read and revised the manuscript. NL conducted the data gathering and prepared the data. NFS designed the study drafting the original manuscript. YLA translated and revised the manuscript. FF directed the statistical analysis and revised the manuscript. The author(s) read and approved the final manuscript. Authors’ Information WK is a lecturer at the Faculty of Nursing, Universitas Indonesia. CWT is a professor and director at The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong. NL is a student in the maternity nursing magister program at the Faculty of Nursing Universitas Indonesia. NFS is a nursing lecturer at the Faculty of Medicine Universitas Negeri Malang. YLA is a lecturer at the Midwifery Department, Jakarta I Health Polytechnic of Health Ministry. FF is a research assistant in psychometrics at the Australian Council for Educational Research Indonesia. Funding This study was supported by The PUTI Grant from Universitas Indonesia (NKB-342/UN2.RST/HKP.05.00/2023). Availability of data and materials The datasets during this study are available from the corresponding author upon request. Ethics approval and consent to participants The study was approved by the institutional review board of the Faculty of Nursing Universitas Indonesia (No: KET-185/UN2.F12.D1.2.1/PPM.00.02/2023) and written informed consent was obtained from each mother after the study purpose was explained. Consent for publication Not applicable Competing interest The authors have no conflicts of interest to declare. References Falah-Hassani, K., Shiri, R., & Dennis, C. The prevalence of antenatal and postnatal co-morbid anxiety and depression: A meta-analysis. Psychological Medicine.2017;47(12), 2041-2053. https://doi.org/10.1017/S0033291717000617. Dennis, C., Falah-Hassani, K., & Shiri, R. Prevalence of antenatal and postnatal anxiety: Systematic review and meta-analysis. The British Journal of Psychiatry.2017;210(5), 315-323. https://doi.org https://doi.org//10.1192/bjp.bp.116.187179. Doraiswamy S., Jithesh A., Chaabane S., Abraham A., Chaabna K., Cheema S. 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Cite Share Download PDF Status: Published Journal Publication published 30 Sep, 2025 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted Editorial decision: Revision requested 06 Feb, 2025 Reviews received at journal 29 Jan, 2025 Reviews received at journal 27 Jan, 2025 Reviewers agreed at journal 20 Jan, 2025 Reviewers agreed at journal 19 Jan, 2025 Reviewers agreed at journal 19 Jan, 2025 Reviewers agreed at journal 10 Aug, 2024 Reviewers agreed at journal 03 Aug, 2024 Reviews received at journal 24 Jul, 2024 Reviewers agreed at journal 20 Jul, 2024 Reviewers agreed at journal 17 Jul, 2024 Reviewers invited by journal 15 Jul, 2024 Editor invited by journal 08 May, 2024 Editor assigned by journal 08 May, 2024 Submission checks completed at journal 01 May, 2024 First submitted to journal 23 Apr, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4314074","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":297493901,"identity":"d188ac6b-45f1-400c-8c50-d5da2d6dc5ae","order_by":0,"name":"Wiwit Kurniawati","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAs0lEQVRIiWNgGAWjYDACZgaGAwwMCXIgBhBIMDYQpeUAQ4IxCVpAAKglEaaSsBaD4zyGhz8wpKVvOM7A+OEHg4UsYS2HeQyADsvJ3XCYgVmyh0HCmKAWs8O8G4BaKkBaGKSBfkkkWku6AdCW36RoyUkAamEjzhb7w/wfDpwxSDOceZixzbLHgAi/SPYfS/5QUZEsz3f+8OEbPyrqCIcYBBiACFCMGBCnfhSMglEwCkYBAQAAMfM76swZBh0AAAAASUVORK5CYII=","orcid":"","institution":"Universitas Indonesia","correspondingAuthor":true,"prefix":"","firstName":"Wiwit","middleName":"","lastName":"Kurniawati","suffix":""},{"id":297493902,"identity":"7c40186b-7213-4a27-a9ae-4a69a9d1c781","order_by":1,"name":"Chien Wai Tong","email":"","orcid":"","institution":"Chinese University of Hong Kong","correspondingAuthor":false,"prefix":"","firstName":"Chien","middleName":"Wai","lastName":"Tong","suffix":""},{"id":297493904,"identity":"85b3892a-dd45-47b8-8aee-c971860dd647","order_by":2,"name":"Nurlela Lantu","email":"","orcid":"","institution":"Universitas Indonesia","correspondingAuthor":false,"prefix":"","firstName":"Nurlela","middleName":"","lastName":"Lantu","suffix":""},{"id":297493906,"identity":"7e62bdaa-1ab7-4a79-ba58-2c08cfa47474","order_by":3,"name":"Neni Fidya Santi","email":"","orcid":"","institution":"Universitas Negeri Malang","correspondingAuthor":false,"prefix":"","firstName":"Neni","middleName":"Fidya","lastName":"Santi","suffix":""},{"id":297493908,"identity":"db7a9d05-a3ce-4e17-b2fb-3be6e55b0b83","order_by":4,"name":"Yunita Laila Astuti","email":"","orcid":"","institution":"Jakarta I Health Polythecnic of Health Ministry","correspondingAuthor":false,"prefix":"","firstName":"Yunita","middleName":"Laila","lastName":"Astuti","suffix":""},{"id":297493912,"identity":"7fd9b141-c75c-4b3b-985c-855a8e9f5d03","order_by":5,"name":"Fayna Faradiena","email":"","orcid":"","institution":"Australian Council for Educational Research Indonesia","correspondingAuthor":false,"prefix":"","firstName":"Fayna","middleName":"","lastName":"Faradiena","suffix":""},{"id":297493916,"identity":"08e5e379-e76e-4011-b4d2-b805cdd97e5f","order_by":6,"name":"Arie Kusumaningrum","email":"","orcid":"","institution":"Universitas Sriwijaya","correspondingAuthor":false,"prefix":"","firstName":"Arie","middleName":"","lastName":"Kusumaningrum","suffix":""}],"badges":[],"createdAt":"2024-04-23 19:33:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4314074/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4314074/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12884-025-08036-7","type":"published","date":"2025-09-30T15:58:01+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":92883808,"identity":"b2f4a934-9626-47ea-9442-74f43e6c3283","added_by":"auto","created_at":"2025-10-06 16:10:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":708497,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4314074/v1/04bb73ec-5483-4e6b-9131-150d580dba56.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Test Validity of The Pregnancy-related Anxiety Scale (PrAS) for Pregnant Women in Indonesia: A Pilot Study","fulltext":[{"header":"Background","content":"\u003cp\u003eAnxiety is become a common disorder during pregnancy [1]. The prevalence of anxiety varies across countries and cultures; it has been reported around 22. 9% of women identified the anxiety symptoms and a diagnosis of an anxiety disorder was found in 15.2% in Canada [2]. Other studies found that anxiety during pregnancy is between 4.6% and 40.8% [1,3].\u003c/p\u003e \u003cp\u003eAnxiety during pregnancy can be problematic and cause a negative impact for the mother and their fetal well-being [4]. This condition increases the risk of developing preeclampsia, obstetric complications, and bonding problems [5]. Anxiety itself develops into the postpartum period and raises postpartum depression [6,7,8]. For the newborn, anxiety from their mother has impact on lower gestational age, birth weight, and poor cognitive development, among others [9].\u003c/p\u003e \u003cp\u003eEarly detection of anxiety during pregnancy is important due to the negative impact on women. It\u0026rsquo;s need a validated and reliable instrument to measure this condition [10]. In Indonesia, studies related to anxiety during pregnancy reported that 20.2% of subjects had mild to moderate to severe anxiety levels [11]. In another study the 53.3% of respondents who felt anxious. Anxiety was most common among pregnant women with high education levels, gestational age\u0026thinsp;\u0026lt;\u0026thinsp;19 weeks, and working pregnant women [12]. Anxiety during pregnancy is still under assessment in delivery services and it\u0026rsquo;s affected women and fetal wellbeing. Therefore, prompt instrument, such as the PrAS in the Indonesian context is necessary. The cultural differences, from Indonesian factor will give different structure of the PrAS from those in different countries.\u003c/p\u003e \u003cp\u003eThis pilot study aimed to evaluate the psychometric properties of the PrAS in Indonesia. The objectives of the study are to: (a) to validate how well the items cover all relevant part of the content (content validity) using CVI and CVR; (b) to test the construct validation of PrAS in Indonesia whether the eight-factor structure of the original PrAS scale fits the Indonesian sample using the Confirmatory Factor Analysis (CFA).The results of this study also aim to provide future recommendations for the development of PrAS.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eA descriptive, pilot study of pregnant women (N\u0026thinsp;=\u0026thinsp;92) with single pregnancy was conducted at Public Health Center in Indonesia (majority in Jakarta) during November 2023. The study was approved by the institutional review board of Faculty of Nursing Universitas Indonesia and written informed consent obtained from each mother after the study purpose was explained.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSample and recruitment\u003c/h2\u003e \u003cp\u003ePregnant women with single tone pregnancy receiving antenatal care in antenatal clinic were screened and recruited by the investigators. The study located at Public Health Center in Indonesia as a research site due to the number of antenatal visit consideration.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStudy participants\u003c/h2\u003e \u003cp\u003eA convenience sampling method was used in this study. The inclusion criteria were the mother with a singleton pregnancy, spoke and understand Bahasa. The exclusion criteria are the mother who had an obstetric complication including preeclampsia or hemorrhage or had a mental illness history. As the PrAS has 32 items, a sample of 92 was gathered.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eProcedure\u003c/h2\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003eTranslation and Back Translation of the PrAS\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eCross-cultural research instrument validation is essential due to the diversity of the global population [13]. To ensure the quality of the instrument, the researcher arranged for translation from English into Indonesian using the following steps.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e(1) Selecting Well-Qualified Translators\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eFor this study, the original instrument was translated from English into Bahasa Indonesia and translated back into English. To produce a high-quality translation, it is important to choose well-qualified translators [13]. The translators for this study were fully bilingual and were sufficiently educated to be familiar with the concepts. The first translator is an expert in the field of English education and studied about anxiety. She forwardly translated the PrAS from English into Bahasa Indonesian. Then the second translator is a faculty member of Nursing Department. She did translation the new Indonesian version of the PrAS back into English.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e(2) Translating the Instrument\u003c/h2\u003e \u003cp\u003eThe researchers adopted the Brislin method in translating the questionnaire. According to Brislin (1970), the most common and highly recommended procedure for translating is translation and back-translation. Steps for translating an instrument are translating from the source to the target language, blindly translating back from the translated version to the source language, and comparing the two versions in the original language [14]\u003c/p\u003e \u003cp\u003ea. Translating from the source to the target language\u003c/p\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe first translator translated the original English version into the target language, Bahasa Indonesian. Bahasa Indonesian is the official language in Indonesia.\u003c/p\u003e \u003c/div\u003e\u003cp\u003eb. Blindly translating back from the target to the source\u003c/p\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eBack-translation is translating from the newly translated version back into the original source language without looking at the original [14]. The second translator back-translated from the first translator\u0026rsquo;s Indonesian version into English. The forward-translator and backward-translator did not discuss translation with each other during this stage to avoid the back-translator being influenced by exposure to the original English version of the questionnaire.\u003c/p\u003e \u003c/div\u003e\u003cp\u003ec. Comparing the two versions in the original language\u003c/p\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe equivalence of the source and target language versions of the instrument must then be evaluated. If the two English versions of the questionnaire are identical, the translated version of the questionnaire (in this case, the Indonesian version) may be considered as equivalent to the original one [14]. Therefore, the researcher conducted a panel discussion to compare if the original English version to the back-translated version were alike, as well as the final version in the Indonesian language.\u003c/p\u003e \u003cp\u003eDuring this process, there were several distinct opinions between the two translators and the researcher considered terms and sentence structure of the original and translated versions of Indonesian and English. Differences were found in items 3, 4, and 5. First, on item 3, the forward translator used the word \u0026ldquo;very\u0026rdquo; in Indonesian translation. Whereas, in the original English version, there is no \u0026ldquo;very\u0026rdquo; term on item 3. Therefore, the researcher agreed to remove the word \u0026ldquo;very\u0026rdquo; in both Indonesian and back-translated versions.\u003c/p\u003e \u003cp\u003eThen, on item 4: the back-translator wrote the word \u0026ldquo;stiff\u0026rdquo; rather than \u0026ldquo;restrain\u0026rdquo; as written in the original English version. It because the forward translator also translated \u0026ldquo;restrain\u0026rdquo; as \u0026ldquo;stiff\u0026rdquo; in Indonesian. Due to the two English version of item 4 was unidentical, the researcher agreed to revise the Indonesian version in order to make it alike.\u003c/p\u003e \u003cp\u003eLastly, on item 5, the back translator put \u0026ldquo;aggrieved\u0026rdquo; rather than the original, \u0026ldquo;harmed.\u0026rdquo; The definition of \u0026ldquo;harmed\u0026rdquo; is \u0026ldquo;physically injured\u0026rdquo;, which is different with \u0026ldquo;aggrieved\u0026rdquo;. After a discussion, we decided to change the translated version into a term that is more identical with \u0026ldquo;harmed\u0026rdquo; which seemed more suitable. In the end, the researcher and the translators reached agreement on all items.\u003c/p\u003e \u003cp\u003eThe process of translation and back translation of Pregnancy-related Anxiety Scale is described in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e\u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eContent Validity Index of the PrAS\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eTo test for validity, the researcher invited six experts to evaluate the questionnaire. These six experts include: 2 maternity nurses, 3 lecturers of maternity nursing, and 1 obgyn doctor. The minimal number of content validity experts should be three [15,16]. The content validity index (CVI) in this study that was rated by six experts ranged from 0.83 to 1 and had average of 0.984. The scale\u0026rsquo;s content validity (S-CVI) average for an instrument should be at least 0.90. In addition, according to Polit and colleagues, an item-level content validity (I-CVI) that is more than 0.50 is acceptable. Specifically, they noted that for six experts, an item with an I-CVI 0.67 is \u0026ldquo;fair,\u0026rdquo; while 0.86 and 1.00 are \u0026ldquo;excellent,\u0026rdquo; according to the kappa evaluation criteria [16]. These results indicate that the PrAS is valid and reliable for use in Indonesia.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eMeasure\u003c/h2\u003e \u003cp\u003eA pilot test of 92 pregnant women was conducted to confirm the wording and adequacy of the final version. Data were collected using Google Forms, and it approximately took 30 minutes to complete. For women who were unable to read the investigator read out the questionnaire in Bahasa and assisted in filling it out. Psychometric analysis the conducted using content validity (CVI and CVR) and construct validity using confirmatory factor analysis (CFA).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003ePregnancy Anxiety\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe Pregnancy-related Anxiety Scale (PrAS) was developed by Robyn Brunton and colleagues to measure anxiety that is related to women\u0026rsquo;s feelings during pregnancy. The instrument comprises 32 items and uses a four-point Likert scale from 1 to 4 (1\u0026thinsp;=\u0026thinsp;not at all, 2\u0026thinsp;=\u0026thinsp;occasionally, 3\u0026thinsp;=\u0026thinsp;quite often, and 4\u0026thinsp;=\u0026thinsp;very often), with the highest and lowest answers describing the opposite extremes of a pregnant woman\u0026rsquo;s anxiety [17,18].\u003c/p\u003e \u003cp\u003eThe 32-item questionnaire is divided into eight main subscales: 1) items 1 to 6 are about childbirth concerns; 2) items 7 to 11 describe a pregnant woman\u0026rsquo;s body image concerns; 3) items 12 to 14 correspond to the attitudes towards childbirth; 4) questions 15 to 20 are about a pregnant woman\u0026rsquo;s worry about self; 5) questions 21 to 23 indicate a woman\u0026rsquo;s concerns to the baby; and 6) questions 24 to 26 identify a woman\u0026rsquo;s acceptance of pregnancy; 7) items 27 to 29 are about a woman\u0026rsquo;s avoidance of vaginal delivery; and 8) items 30 to 32 identify about a woman\u0026rsquo;s attitudes towards medical staff [18].\u003c/p\u003e \u003cp\u003eThe total possible score on the PrAS is 128, with the cut-off point is 75.50 which indicates a pregnant woman has having high level of anxiety. The PrAS has internal consistency reliability of α\u0026thinsp;=\u0026thinsp;.92 for the full-scale, and α\u0026thinsp;=\u0026thinsp;.84\u0026ndash;.95 for each subscale, which is excellent and appropriate for a research instrument [18].\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eDemographic variables\u003c/h2\u003e \u003cp\u003eDemographic data including age, employment status, educational level (background), pregnancy age, and pregnancy sequence were assessed using a structured questionnaire.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData analysis was conducted using the Statistical Package for the Social Sciences (SPSS) version 26 (IBM, 2019) and MPlus version 8.0 (Muth\u0026eacute;n \u0026amp; Muth\u0026eacute;n, 2017). Descriptive statistics including frequency, mean, and standard deviation (SD) were generalized to summarize participants\u0026rsquo; characteristics. In the development phase of the Pregnancy-Related Anxiety Scale (PrAS), each item (32-item) of the instrument was evaluated and rated by 6 panelists (subject matter experts). The content validity was conducted to measure the relevancy of Construct Validation of the PrAS was assessed using confirmatory factor analysis (CFA). The CFA was undertaken to determine the multidimensional fit of the original PrAS.\u003c/p\u003e \u003cp\u003eThe weighted least squares mean and variance adjusted \u003cem\u003e(\u003c/em\u003eWMLSV) estimator achieves robust results that do not assume normally distributed variables and provides the best option for modeling categorical or ordered data [19]. Also, the Bayesian estimator is used as the fit index model. Bayesian approaches for \u003cem\u003eestimating multilevel latent variable models can be beneficial in small samples\u003c/em\u003e [20].\u003c/p\u003e \u003cp\u003eGoodness-of-fit indices were used to confirm the model fit, namely, a Chi-square test (χ2) and its p-value (\u0026ge;\u0026thinsp;0.05\u0026thinsp;=\u0026thinsp;acceptable fit; \u0026ge;0.10\u0026thinsp;=\u0026thinsp;good fit), which is sensitive to large sample size. Therefore, there are in this study other indices included root mean square error of approximation (RMSEA: \u0026le;0.08\u0026thinsp;=\u0026thinsp;acceptable fit; \u0026le;0.05\u0026thinsp;=\u0026thinsp;good fit), comparative fit index (CFI: \u0026ge;0.85\u0026thinsp;=\u0026thinsp;acceptable fit; \u0026ge;0.95\u0026thinsp;=\u0026thinsp;good fit), and Tucker-Lewis index (TLI: \u0026ge;0.80\u0026thinsp;=\u0026thinsp;acceptable fit; \u0026ge;0.95\u0026thinsp;=\u0026thinsp;good fit) were considered in this study. At least three adequacy indices with values within the acceptable ranges were considered in analyzing the goodness of fit of data.\u003c/p\u003e \u003c/div\u003e "},{"header":"Result","content":"\u003cdiv id=\"Sec15\" type=\"Results\" class=\"Section2\"\u003e\u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003eCharacteristic of participants\u003c/h2\u003e \u003cp\u003eIn total, 92 pregnant women have participated in this study. The majority of women were older\u0026thinsp;\u0026ge;\u0026thinsp;25 years (87.61%) with the mean of participants being 29.12 (SD\u0026thinsp;=\u0026thinsp;4.75) and the pregnancy age 28 weeks. The participants were employed (36.96%) and had a secondary education (55.43%) (See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Most of the women experienced their first pregnancy and second pregnancy (69.57%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive Statistics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eEmployment Status\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot Employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.96%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.96%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eEducation Level\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.17%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.43%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.22%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePregnancy Sequence\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst Pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.96%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecond Pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.61%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThird Pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.65%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFourth Pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.70%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eContent Validity\u003c/h2\u003e \u003cdiv id=\"Sec18\" class=\"Section3\"\u003e \u003ch2\u003eContent Validity Ratio (CVR)\u003c/h2\u003e \u003cp\u003eEach item of PrAS is counted by the formula CVR=(N\u003csub\u003ee\u003c/sub\u003e - N/2)/(N/2), in which the N\u003csub\u003ee\u003c/sub\u003e is the number of panelists indicating \"essential\" and N is the total number of panelists (in this study evaluated by 6 panelists). From 32 items, only 3 items (30, 31, 32) in the woman\u0026rsquo;s attitudes towards medical staff dimension show the value of CVR 0.83, while others are 1.00. The closer to 1.0 the CVR is, the more essential the object is measured to be. Contrariwise, the closer to -1.0 the CVR is, the more non-essential it is [21].\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eContent Validity Index (CVI)\u003c/h2\u003e \u003cp\u003eThe content validity index (CVI) is related to the number of experts. Reflecting this study where there are 6 or fewer experts, the I-CVI must be 1.00\u0026mdash;that is, all experts must agree that the item is content valid [16]. From 32 items, only 3 items (30, 31, 32) in the woman\u0026rsquo;s attitudes towards medical staff dimension show the value of CVI 0.67, while others are 1.00. It shows that the three items need to be revised before entering the data collection phase.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eConfirmatory Factor Analysis (CFA)\u003c/h2\u003e \u003cp\u003eThe CFA was conducted to test the eight dimensions of the original Pregnancy-Related Anxiety Scale (PrAS). Specifically, the 32-item was tested as multidimensional (8 dimensions), in the first attempt the model was an acceptable fit (RMSEA\u0026thinsp;=\u0026thinsp;0.064), but it was potential to be modified regarding achieving the good fit model. The CFA confirmed that the entire scale of the PrAS is a good fit (RMSEA\u0026thinsp;=\u0026thinsp;0.058). The Comparative Fit Index (CFI) and Tucker-Lewis Index (TLI) were fit the model with the result of 0.978 and 0.976 respectively. The fit model of PrAS shows in the diagram below (Diagram 1).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003cp\u003eThe final model eliminated one of the dimensions, named woman\u0026rsquo;s acceptance of pregnancy (item 24, item 25, and item 26) with the loading of -0.038 in measuring PrAS. After the model fit was tested, the next step was to identify each dimension factor loading (λ) or coefficient which indicates the contribution of the items to the construct being measured (pregnancy-related anxiety). Initially, the 32-item measure yielded 10 items due to the eliminated dimension, resulting in 29 final items divided in 7 dimensions. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e below shows the information of the standardized dimensions and its significance.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStandardized Model Results of PrAS\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDimension\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCoefficient (λ)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStandard Error (S.E)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eT-Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChildbirth (gb)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.782\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePregnant woman\u0026rsquo;s body image\u003c/p\u003e \u003cp\u003e(bi)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.792\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttitudes towards childbirth (ac)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorry about self (sf)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.955\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.468\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConcerns to the baby (bb)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.823\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.929\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWoman\u0026rsquo;s avoidance of vaginal delivery (an)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.308\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.972\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWoman\u0026rsquo;s attitudes towards medical staff (ms)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.622\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.068\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003eNote\u003c/em\u003e: \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 (Significant)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eReferring to the RMSEA (root mean square error of approximation), a good model fit is produced, along with the CFI and TLI indices. The construct validity of PrAS in 7 dimensions model was accepted. Although, the eliminated dimension (woman\u0026rsquo;s acceptance of pregnancy) needs to be reviewed and adjusted with the local context. Besides that, this pilot study also only refers to one region in Indonesia (Jakarta), for future studies, it would be better if the sample was representative from each region in Indonesia.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe Indonesian version of PrAS 7 dimensions is a valid tool for screening and assessing pregnancy-related anxiety among Indonesian women in this pilot study. The expansion of representative samples (pregnant mothers) in Indonesia needs to be considered to apply this instrument on a national scale.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCFA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfirmatory Factor Analysis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePrAS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePregnancy-related Anxiety Scale.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe pregnant women who participated in this study made this study successful\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWK designed the study and drafted the original manuscript. \u0026nbsp;CWT read and revised the manuscript. NL conducted the data gathering and prepared the data. NFS designed the study drafting the original manuscript. YLA translated and revised the manuscript. FF directed the statistical analysis and revised the manuscript. The author(s) read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWK is a lecturer at the Faculty of Nursing, Universitas Indonesia. CWT is a professor and director at The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong. NL is a student in the maternity nursing magister program at the Faculty of Nursing Universitas Indonesia. NFS is a nursing lecturer at the Faculty of Medicine Universitas Negeri Malang. YLA is a lecturer at the Midwifery Department, Jakarta I Health Polytechnic of Health Ministry. FF is a research assistant in psychometrics at the Australian Council for Educational Research Indonesia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by The PUTI Grant from Universitas Indonesia (NKB-342/UN2.RST/HKP.05.00/2023).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets during this study are available from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the institutional review board of the Faculty of Nursing Universitas Indonesia (No: KET-185/UN2.F12.D1.2.1/PPM.00.02/2023) and written informed consent was obtained from each mother after the study purpose was explained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflicts of interest to declare.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eFalah-Hassani, K., Shiri, R., \u0026amp; Dennis, C. The prevalence of antenatal and postnatal co-morbid anxiety and depression: A meta-analysis. Psychological Medicine.2017;47(12), 2041-2053. https://doi.org/10.1017/S0033291717000617. \u003c/li\u003e\n\u003cli\u003eDennis, C., Falah-Hassani, K., \u0026amp; Shiri, R. Prevalence of antenatal and postnatal anxiety: Systematic review and meta-analysis. The British Journal of Psychiatry.2017;210(5), 315-323. https://doi.org https://doi.org//10.1192/bjp.bp.116.187179. \u003c/li\u003e\n\u003cli\u003eDoraiswamy S., Jithesh A., Chaabane S., Abraham A., Chaabna K., Cheema S. Perinatal mental illness in the middle east and North Africa Region-A systematic overvie\u003cem\u003ew. \u003cem\u003eInternational Journal of Environmental Research and Public Health\u003c/em\u003e.\u003c/em\u003e2020;17(15), 1\u0026ndash;20. https://doi.org/10.3390/ijerph17155487.\u003c/li\u003e\n\u003cli\u003eAraji, S., Griffin, A., Dixon, L., Spencer, S.K., Peavie, C., Wallace, K. An Overview of Maternal Anxiety During Pregnancy and the Post-Partum Period. J Ment Health Clin Psycho.2020; 4(4): 47-56. https://doi.org/10.29245/2578-2959/2020/4.1221.\u003c/li\u003e\n\u003cli\u003eAlipour, Z., Lamyian, M., \u0026amp; Hajizadeh, E. Anxiety and fear of childbirth as predictors of postnatal depression in nulliparous women. Women and birth : journal of the Australian College of Midwives. 2012;25(3), e37\u0026ndash;e43. https://doi.org/10.1016/j.wombi.2011.09.002\u003c/li\u003e\n\u003cli\u003eFarr\u0026eacute;-Sender, B., Torres, A., Gelabert, E., Andr\u0026eacute;s, S., Roca, A., Lasheras. G.,\u0026hellip;Garcia-Esteve, L. Mother\u0026ndash;infant bonding in the postpartum period: assessment of the impact of pre-delivery factors in a clinical sample. Arch Womens Ment Health. 2018; 21, 287\u0026ndash;297.https://doi.org/10.1007/s00737-017-0785-y.\u003c/li\u003e\n\u003cli\u003eField, T. Prenatal anxiety effects: A review. \u003cem\u003eInfant Behavior and Development\u003c/em\u003eVolume 49, November 2017, Pages 120-128. https://doi.org/10.1016/j.infbeh.2017.08.008\u003c/li\u003e\n\u003cli\u003eM\u0026iacute;guez, M.C. Fern\u0026aacute;ndez, V. \u0026amp; Pereira, B. Depresi\u0026oacute;n postparto y factores asociados en mujeres con embarazos de riesgo [Postpartum depression and associated risk factors among women with risk pregnancies]. Behav. Psychol.2017;25, 47\u0026ndash;64.\u003c/li\u003e\n\u003cli\u003eDing, X., Wu, Y., Xu, S., Zhu, R., Jia, X., Zhang, S. Tao, F. Maternal anxiety during pregnancy and adverse birth outcomes: A systematic review and meta-analysis of prospective cohort studies. Journal of Affective Disorders.2014; Volume 159, 20 April 2014, Pages 103-110 https://doi.org/10.1016/j.jad.2014.02.027.\u003c/li\u003e\n\u003cli\u003eVal, A. \u0026amp; M\u0026iacute;guez, M.C. Prevalence of Antenatal Anxiety in European Women: A Literature Review. Int. J. Environ. Res. Public Health. 2023; 20, 1098. https:// doi.org/10.3390/ijerph20021098. \u003c/li\u003e\n\u003cli\u003eMargawati, A., Syauqy, A., Utami, A., Hananingtyas, A., \u0026amp; Zaimatussoleha, C.. Anxiety among Pregnant Women in Rural-Urban Area Indonesia during the COVID-19 Pandemic in Semarang, Indonesia. Open Access Macedonian Journal of Medical Sciences.2022;10(E), 1830\u0026ndash;1837. https://doi.org/10.3889/oamjms.2022.10937.\u003c/li\u003e\n\u003cli\u003eNurrizka, R. H., Nurdiantami, Y., \u0026amp; Makkiyah, F. A. Psychological outcomes of the COVID-19 pandemic among pregnant women in Indonesia: a cross-sectional study. Osong public health and research perspectives. 2021; 12(2), 80\u0026ndash;87. https://doi.org/10.24171/j.phrp.2021.12.2.05.\u003c/li\u003e\n\u003cli\u003eSousa, V. D., \u0026amp; Rojjanasrirat, W. Translation, adaptation and validation of instruments or scales for use in cross‐cultural health care research: a clear and user‐friendly guideline. Journal of Evaluation in Clinical Practice.2011;17(2), 268\u0026ndash;274.\u003c/li\u003e\n\u003cli\u003eBrislin, R. W. Back-translation for cross-cultural research. Journal of Cross-Cultural Psychology. 1970;1(3), 185\u0026ndash;216.\u003c/li\u003e\n\u003cli\u003eLynn, M. R. Determination and quantification of content validity. Nursing Research. 1986;35(6), 382\u0026ndash;385.\u003c/li\u003e\n\u003cli\u003ePolit, D. F., Beck, C. T., \u0026amp; Owen, S. V. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Research in Nursing \u0026amp; Health.2007; 30(4), 459\u0026ndash;467. https://doi.org/10.1002/nur.20199. \u003c/li\u003e\n\u003cli\u003eBrunton, R. J., Dryer, R., Saliba, A., \u0026amp; Kohlhoff, J. The initial development of the Pregnancy-related Anxiety Scale. Women and Birth. 2018;32(1), e118\u0026ndash;e130. https://doi.org/10.1016/j.wombi.2018.05.004.\u003c/li\u003e\n\u003cli\u003eBrunton, R., Gosper, K., \u0026amp; Dryer, R. Psychometric evaluation of the pregnancy-related anxiety scale: Acceptance of pregnancy, avoidance, and worry about self subscales. Journal of Affective Disorders. 2021; 278, 341-349. https://doi.org/10.1016/j.jad.2020.09.064. \u003c/li\u003e\n\u003cli\u003eBrown, T. (2006). \u003cem\u003eConfirmatory factor analysis for applied research.\u003c/em\u003e New York: Guildford; 2006.\u003c/li\u003e\n\u003cli\u003eZitzmann, S., Helm, C., \u0026amp; Hecht, M. Prior specification for more stable bayesian estimation of multilevel latent variable models in small samples: A Comparative Investigation of two different approaches. Frontiers in Psychology.2021;11. https://doi.org/10.3389/fpsyg.2020.611267. \u003c/li\u003e\n\u003cli\u003eAnuar, A., \u0026amp; Sadek, D. M. Validity Test of Lean Healthcare using Lawshe\u0026apos;s Method. International Journal of Supply Chain Management, 2018; 7(6).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Diagrams","content":"\u003cp\u003eDiagram 1 is available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"confirmatory factor analysis, fear of childbirth, Indonesia, pregnancy, Wijma delivery expectancy questionnaire","lastPublishedDoi":"10.21203/rs.3.rs-4314074/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4314074/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAnxiety is become a common disorder during pregnancy. The Pregnancy-related Anxiety Scale (PrAS) is a common tool for assess pregnancy anxiety. However, not yet validated in Indonesia. This study aimed to evaluate the psychometric properties of the PrAS in Indonesia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional study was conducted among 92 pregnant women at the Public Health Center in Indonesia. The content validity index (CVI) and content validity ratio (CVR) measured the relevancy of each item with the content (pregnancy anxiety) and items interrater-reliability. The construct validity Confirmatory Factor Analysis (CFA) was applied to test the construct validity of the Pregnancy-Related Anxiety Scale (PrAS).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean age of pregnant women who participated was 29.12 years (SD\u0026thinsp;=\u0026thinsp;4.85) with their pregnancy age mean 28 weeks. The content validity using CVI shows that 29 of 32 items are valued 1.00, the same score produced on the CVR. Indicating only 3 items need to be reviewed or revised. Regarding the construct validity, the final model of the PrAS was 7 dimensions which initially formed 8 dimensions. Although the Chi-square (χ2) index was not a good fit (df\u0026thinsp;=\u0026thinsp;370, p-value\u0026thinsp;=\u0026thinsp;0.0001) this multidimensional model fits the data supported by the index of Root Mean Square Error of Approximation (RMSEA) estimate was 0.058. Followed by the Comparative Fit Index (CFI) and the Tucker-Lewis Index (TLI) were 0.978 and 0.976 respectively, meaning that the goodness of fit indices were obtained. This pilot study results in a valid instrument of the Pregnancy-Related Anxiety Scale (PrAS).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe Indonesian version of the PrAS is a valid tool for screening and assessing Indonesian women's pregnancy-related anxiety.\u003c/p\u003e","manuscriptTitle":"Test Validity of The Pregnancy-related Anxiety Scale (PrAS) for Pregnant Women in Indonesia: A Pilot Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-07 07:57:42","doi":"10.21203/rs.3.rs-4314074/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-02-06T06:08:15+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-29T19:09:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-27T09:47:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"101661752129952849338678860728884140784","date":"2025-01-20T07:26:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"101935291098310486771948841291741510154","date":"2025-01-19T21:55:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"54949340967326666428835332513685587312","date":"2025-01-19T08:19:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"139471817461155492240738458052354331281","date":"2024-08-10T08:01:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"112963060738154131273291169909871480994","date":"2024-08-04T01:07:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-25T01:04:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"117315897157165961294415386682425713774","date":"2024-07-20T10:48:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"104669995929479992835120744151308017944","date":"2024-07-18T01:05:29+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-15T10:27:35+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-05-08T13:20:13+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-08T13:04:12+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-01T06:49:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2024-04-23T19:31:59+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e22aebe4-4e44-47ad-9dc8-16aa24b1a2a9","owner":[],"postedDate":"May 7th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-06T16:03:59+00:00","versionOfRecord":{"articleIdentity":"rs-4314074","link":"https://doi.org/10.1186/s12884-025-08036-7","journal":{"identity":"bmc-pregnancy-and-childbirth","isVorOnly":false,"title":"BMC Pregnancy and Childbirth"},"publishedOn":"2025-09-30 15:58:01","publishedOnDateReadable":"September 30th, 2025"},"versionCreatedAt":"2024-05-07 07:57:42","video":"","vorDoi":"10.1186/s12884-025-08036-7","vorDoiUrl":"https://doi.org/10.1186/s12884-025-08036-7","workflowStages":[]},"version":"v1","identity":"rs-4314074","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4314074","identity":"rs-4314074","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}