The development and psychometric validation of the Postpartum Posttraumatic Growth Inventory (PP-PTGI)

The development and psychometric validation of the Postpartum Posttraumatic Growth Inventory (PP-PTGI) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The development and psychometric validation of the Postpartum Posttraumatic Growth Inventory (PP-PTGI) Wen Mingjun, Cheng Zhuoting, Li Jinhui, Liu Wenjing, Bi Lele, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7309721/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: The Posttraumatic Growth Inventory (PTGI) is widely used across various trauma-affected populations. However, no version specifically targets the maternal population, limiting its ability to fully capture the unique characteristics of posttraumatic growth (PTG) in this group. To address this gap, the present study aimed to develop the Postpartum Posttraumatic Growth Inventory (PP-PTGI) and evaluate its psychometric properties, guided by PTG theory. Methods: A total of 3 separate studies contributed to the development of the PP-PTGI scale between July 2023 and May 2024. In study 1, a preliminary item pool was developed on the basis of PTG theoretical framework, and a Delphi expert letter consultation (N=17) was conducted to modify and improve the items, and a preliminary PP-PTGI scale with 33 items was obtained. Study 2 involved item analysis and exploratory factor analysis (N=211) to screen the items. In Study 3, confirmatory factor analysis, criterion-related validity, and reliability analysis (N=202) were performed to assess the reliability and validity of the final scale. Results: The PP-PTGI comprises 26 items across six dimensions. The scale demonstrated good reliability, with a total Cronbach’s α of 0.901 and subscale α values ranging from 0.832 to 0.883, indicating high internal consistency. It also showed good content validity, structural validity, and criterion-related validity, supporting its applicability in assessing posttraumatic growth among women with birth-related trauma. Conclusions: The PP-PTGI is a reliable and valid tool for measuring posttraumatic growth in postpartum women. Its use can support healthcare professionals in better understanding the psychological recovery of women following birth trauma, and in delivering more targeted and effective care to promote their posttraumatic growth. Posttraumatic growth Instrument development Parturition psychometric Figures Figure 1 Figure 2 Introduction While childbirth is commonly regarded as a positive and life-sustaining event, research indicates that over a third of women experience traumatic events during delivery[1], which can lead to psychological issues such as postpartum depression and post-traumatic stress disorder (PTSD)[2, 3]. These conditions not only adversely affect the physical and mental health of the mother but also have implications for the health of the newborn and the mother-child attachment relationship[4]. Furthermore, they can influence women's future reproductive choices[5] and the long-term social development of their children[6]. Although postpartum trauma can exert short- and long-term negative effects on women, an increasing amount of evidence suggests that, amidst ongoing challenges, women may also undergo positive psychological transformations and make constructive behavioral adjustments in their lives. This phenomenon is known as post-traumatic growth (PTG)[7]. PTG refers to the positive psychological changes and personal development that occur after an individual faces a significant crisis, manifesting as emotional recovery, a reassessment of life’s meaning, enhanced relationships with others, and increased self-efficacy[8]. Consequently, focusing on and promoting the level of post-traumatic growth in women not only aids in improving their mental health but also provides them with hope and strength, enabling them to adapt more effectively to the role of motherhood and to foster personal and family harmony. Existing PTG measurement tools, such as the Posttraumatic Growth Inventory (PTGI)[9], Thriving Scale (TS)[10], and the Stress-Related Growth Scale (SRGS)[11], play a crucial role in assessing PTG. Among these, the PTGI[9], developed by Tedeschi et al., is the most widely utilized PTG assessment tool, applicable to various trauma populations. However, there is currently no scale specifically designed to address the unique experiences and needs of the maternal population. A literature review revealed that most scales utilized in quantitative studies on postpartum PTG are universal instruments[12, 13], which fail to adequately consider the physiological and psychological changes that mothers experience during childbirth.Postpartum traumatic experiences differ significantly from other types of trauma[14]. In traditional social contexts, pregnancy and childbirth are often perceived as "positive" events, whereas other traumas, such as bereavement[15] and serious illness[16], are typically regarded as negative. This distinction results in unique experiences for women who undergo traumatic births, setting them apart from other types of traumatic events in several key ways. For instance, the infant, as an integral part of the traumatic experience, may serve as a constant reminder of the trauma, a phenomenon rarely observed in other trauma contexts. And IONIO et al.[17] have noted that the most significant transformation for women following pregnancy and childbirth is the change in identity. This transformation is particularly complex and multidimensional for those who have experienced childbirth trauma, as it encompasses aspects that are not typically encountered by other trauma populations. The PTGI report highlights that variations in language, socio-cultural and religious backgrounds, and participant characteristics significantly influence the factor structure of the scale[18]. Within the maternal trauma group, the spiritual dimension has been a particularly contentious issue. For instance, the Japanese version of the PTGI (PTGI-J) for postpartum women considered the cultural and religious differences between Japan and the United States, resulting in the removal of two items from the spiritual dimension of the original PTGI. Consequently, the final PTGI-J consists of 17 items and three factors[19]. And research by Taubman-Ben-Ari et al.[20] explored the positive changes experienced by mothers after childbirth through open-ended questions and grounded theory content analysis. Their findings indicated that these changes predominantly aligned with the four dimensions of the PTGI, yet the dimensions related to spirituality and religious beliefs were notably absent. Similarly, Aftyka et al.[21] demonstrated that mothers facing the uncertainty and sense of loss of control associated with the treatment of premature infants might adopt religious coping strategies to manage psychological trauma. However, these strategies primarily focus on praying for the safety of their children, rather than on the enhancing or growing their of religious beliefs. In response to these controversies, Tedeschi et al. introduced the expanded version of the Post-Traumatic Growth Scale (PTGI-X) in 2017[22], acknowledging that the two items in the spiritual domain of the original PTGI did not fully capture the broader changes individuals experience in the realm of spiritual existence. As a result, additional items were incorporated into PTGI-X to assess the spiritual domain, reflecting diverse perspectives on spiritual-existential experiences across different cultures. However, it is important to note that this scale is not specifically tailored to the maternal population. Japanese scholar Suzuki applied PTGI-X to women who underwent cesarean sections to validate its effectiveness and subsequently revised it to create the PTGI-X-J-PWV, which demonstrated good internal consistency reliability (Cronbach's α = 0.94)[19]. Nonetheless, since the PTGI-X-J-PWV was validated exclusively among cesarean section patients, it cannot fully capture the commonalities experienced by the broader maternal trauma population. Furthermore, numerous qualitative studies on PTG have identified changes in motherhood, identity, and responsibility within maternal trauma groups[7, 23, 24]that are not adequately represented in the PTGI scale. Given the importance of accurately assessing and understanding the postpartum growth process, this study aims to develop and validate a Postpartum Posttraumatic Growth Inventory (PP-PTGI) specifically for women who have experienced postpartum trauma. This tool will assist in evaluating and supporting the psychological recovery process within this specific population. The development of the PP-PTGI will enable obstetric healthcare professionals to identify the distinct psychological needs of mothers, facilitating a more accurate assessment of their needs and growth processes. Ultimately, this will allow for the provision of targeted psychological support and interventions to promote the mental health and well-being of mothers following the trauma of childbirth. Methods This study is divided into three stages, of which study 1 aims to initially develop the PP-PTGI. Study 2 aims to screen projects through project analysis and exploratory factor analysis (EFA). Study 3 was designed to evaluate the validity and reliability of the final scale by confirmatory factor analysis (CFA) and reliability analysis. This research protocol was approved by the Ethics Committee of Hubei University of Medicine (Reference No.2023-RE-008). Informed consent ensures written authorization from participants preceding data acquisition, analysis, and dissemination. The technology roadmap for the three phases is shown in Figure 1.The full English version of the scale is provided in Supplementary File 1. Study 1: instrument development Literature review and qualitative interview We conducted a comprehensive literature and concept search in both academic and grey literature from May to July 2023 to identify core elements related to postpartum PTG. Our search included databases such as PubMed, the Cochrane Library, Web of Science, Embase, and SinoMed, utilizing keywords including "childbirth," "maternity," "postnatal," "post-traumatic growth," "psychological growth," "birth trauma," and "factors/effects." Additionally, we gathered relevant information from policy documents and guidelines pertaining to postnatal health on an international scale. Using the aggregated meta-integration method from the JBI Evidence-Based Health Care Center[25], we pooled qualitative literature pertinent to maternal PTG. The research team screened literature that met the inclusion criteria from the aforementioned databases, including CNKI, cqVIP, Wanfang, and SinoMed. Following this, we performed data extraction and quality evaluation. Each piece of literature was re-read, analyzed, and interpreted to distill its meaning, leading to the formation of new categories that were subsequently summarized into integrated results. We then developed an interview outline informed by the literature review and PTG theory. Employing an objective sampling method, we screened eligible Chinese women through the electronic information system of the obstetrics department from July 2023 to October 2023. After obtaining informed consent from participants, we conducted semi-structured in-depth interviews, which were recorded and transcribed for timely analysis. Data collection continued until saturation was achieved. Directed content analysis was employed, guided by the five dimensions of PTG theory[26, 27], while also allowing for the emergence of new themes from the data. This approach facilitated a focus on research questions and the validation, refinement, and extension of existing theories in diverse contexts[28, 29]. All interviews were transcribed verbatim, with multiple coders utilizing NVivo 12.0 to independently code and categorize the interview texts. The research team then convened to discuss and compare the encoded results until consensus was reached. Finally, we constructed a preliminary draft inventory based on the post-traumatic growth model proposed by Tedeschi[26, 27], informed by literature analysis, systematic reviews, qualitative interviews, and group discussions. The items in the draft inventory were measured using a five-point Likert scale, ranging from "strongly disagree" (1) to "strongly agree" (5). A higher score indicates a greater level of postpartum PTG. Delphi expert consensus In accordance with the principles of representativeness and authority[30], we selected 17 experts from relevant fields to evaluate the importance and relevance of the proposed items. The selection criteria were as follows: (1) a minimum of a bachelor's degree and at least an intermediate professional title; (2) a minimum of five years of experience in obstetrics, nursing research, or related fields; and (3) demonstrated enthusiasm and willingness to participate in this study. Expert consultation questionnaires were distributed via email or WeChat. The expert consultation questionnaire consisted of several components: (1) Expert Letter : This section included informed consent and an explanation of the purpose of the correspondence; (2) Expert Basic Information Questionnaire : This section collected demographic data, including gender, title, educational background, career focus, work unit, and years of experience. It also included a familiarity questionnaire (Ca) and a judgment basis questionnaire (CS)[31] to assess the experts' familiarity with the study content and their evaluation criteria, thereby ensuring the credibility of their input; (3) Expert Evaluation Table : Grounded in the PTG conceptual framework, this scoring table evaluated each index based on importance, scientific rigor, feasibility, and logical classification. A column for "Modification Suggestions" allowed experts to provide feedback on potential changes. Experts were invited to assess the relevance and importance of the project pool, with the option to suggest modifications, additions, or deletions as deemed appropriate. The importance evaluation employed a five-point scale, with scores ranging from 1 to 5, indicating low to high importance, respectively[32]. We modified and improved the items based on the feedback from the experts, resulting in the formation of the second round of the consultation questionnaire. Expert correspondence ceased once the opinions of the experts converged. Pilot survey Prior to the formal study, 30 women from the postpartum rehabilitation department of the hospital, who met the selection criteria, were recruited to pilot the scale. Participants provided preliminary evaluations of the scale's readability and comprehensibility. All participants indicated that the content of the scale items was clear and easy to understand, and no modifications were made to the content or format of the scale based on the pre-survey results. Study 2: confirmation of the PP-PTGI Inclusion and exclusion criteria According to the Kendall sample estimation method, the sample size for exploratory factor analysis (EFA) should be at least 5 to 10 times the number of scale items, with an additional 10% added to account for potential invalid responses[33]. In this study, 220 questionnaires were distributed, meeting the required sample size standards. The inclusion criteria for participants were as follows: (1) age ≥ 18 years; (2) Chinese women who have successfully given birth within the past year; (3) individuals who consider their childbirth experience to be traumatic, as assessed by the City Birth Trauma Scale[34]; (4) those who reported experiencing some form of personal growth following the birth trauma; (5) individuals with normal communication, comprehension, and expression skills; and (6) participants who understood the purpose and content of the interview and voluntarily agreed to participate in the survey. Exclusion criteria included: (1) self-reported or referred cases of depression, anxiety, or other mental disorders prior to pregnancy; (2) individuals who had received care from a psychiatric team before joining the study; and (3) cases of stillbirth, neonatal deformity, or serious illness. Procedure A convenience sampling method was employed to select eligible women receiving treatment at a Grade III general hospital in Shiyan City, Hubei Province, from October 2023 to January 2024 for field investigation. Investigators provided uniform guidelines to explain the purpose, significance, and implementation process of the study to the participants. After obtaining informed consent, participants signed the consent form, and the questionnaire was distributed immediately. A standardized approach was used to address any questions participants had while completing the questionnaire. Participants filled out questionnaires anonymously, provided demographic information and completed the PP-PTGI questionnaire developed for this study. Once the questionnaires were filled out, investigators promptly collected them and conducted on-the-spot checks. If any questionnaires were found to be incomplete, investigators requested that participants provide the necessary information immediately to ensure the integrity of the data collected. Measures of analysis of item Item analysis was conducted using several methods, including frequency distribution, discrete trend analysis, correlation coefficient analysis, critical ratio analysis, and Cronbach's α coefficient analysis, to screen items for the scale. Items that did not meet at least two of the five screening criteria were excluded from further consideration. (1) Frequency Distribution Method: This method assesses the central tendency of item responses. For items rated on a five-point scale, those with a response rate of less than 10% for ratings of 3 or higher were removed[35]. (2) Discrete Trend Method: This method evaluates item sensitivity by examining the standard deviation or coefficient of variation of item scores. Items with low standard deviations indicate less sensitivity to differences among target, thereby reducing their discriminative ability. It is generally accepted that items should have a standard deviation of at least 0.75, indicating a wide distribution of scores and good sensitivity[36]. (3) Correlation Coefficient Method: The Pearson Correlation Coefficient (PCC) was utilized to calculate the correlation between each item’s scores and the scores of their respective domains. A larger absolute value of the correlation coefficient, along with statistical significance, indicates better representativeness of the item. The correlation coefficient (r) ranges from -1 to 1; a positive r value indicates a positive correlation, while a negative r value indicates a negative correlation. The closer the absolute value of r is to 1, the stronger the correlation between the variables. According to the theoretical structure of this study, if the correlation between an item’s score and the score of its corresponding domain is greater than 0.40 and statistically significant (P < 0.05), it suggests a high correlation, and the item should be retained; otherwise, it should be discarded[37]. (4) Critical Ratio Method: This method assesses the differentiation and discrimination of key test items. For items to be considered reasonable, there should be a statistically significant mean difference in scores between high and low groups, indicating good distinguishing ability. Specifically, the total scores for each item were sorted to identify the upper and lower 27% quantiles. Individuals with scores above the upper 27% quantile were classified into the high group, while those below the lower 27% quantile were classified into the low group. An independent samples t-test was conducted to compare the scores of each item between the two groups. Items that did not yield significant t-test results (P > 0.05) or had a t-statistic below the critical value of 3 were excluded[38]. (5) Cronbach's α Coefficient Method: This method evaluates items from the perspective of internal consistency. By calculating the Cronbach's α coefficient for all aspects and comparing the coefficient changes after the removal of an item, we can assess the degree of correlation between items, indicating internal consistency. If the coefficient significantly increases after the removal of an item, it suggests that the item negatively impacts the internal consistency of its domain, warranting its exclusion; otherwise, the item is retained[39]. Exploratory factor analysis (EFA) After filtering the entries, the remaining items were subjected to Kaiser-Meyer-Olkin (KMO) [40] and Bartlett's sphericity tests[41] to assess the suitability of the sample data for EFA. The KMO statistic ranges from 0 to 1 and reflects the strength of correlations among the variables. A KMO value approaching 1 indicates a strong correlation among the variables, suggesting that the original variables are suitable for factor analysis. Specifically, a KMO value greater than 0.8 is generally considered very suitable for conducting factor analysis. The Bartlett test assesses the correlations among variables within the correlation matrix to determine whether each variable is independent. If the variables are independent, common factors cannot be extracted for factor analysis. A significant result, indicated by a P-value of less than 0.05 in the Bartlett sphericity test, confirms the appropriateness of the data for factor analysis. When both the KMO and Bartlett's sphericity tests meet the established criteria, EFA is performed for each dimension of the scale using principal component analysis and maximum variance orthogonal rotation to evaluate structural validity. Common factors with eigenvalues greater than 1 are extracted through principal component analysis. Entries with factor loadings less than 0.4, as well as those with two or more common factor loadings exceeding 0.4, are excluded following maximum variance orthogonal rotation[42]. This rigorous approach ensures the reliability and validity of the identified factors within the scale. Study 3: Reliability and validity test of the psychometric characteristics Inclusion and exclusion criteria The inclusion and exclusion criteria for this study were consistent with those established in Study 2. For confirmatory factor analysis, a minimum sample size of 200 cases is recommended[43], and the sample size for this study meets this standard. The research was conducted from January to March 2024. Procedure The design, setup, research procedures, and measures of this study were consistent with those of Study 2. Participants were required to complete demographic information, the PP-PTGI developed for this study, and the Chinese version of the PTGI to assess calibration validity. Given that this tool is intended to measure maternal PTG, a test-retest procedure was employed to evaluate its stability. To achieve this, a group of mothers (N = 30) completed two assessments within a 2-hour interval. This brief time frame was chosen to minimize the potential impact of confounding factors, such as changes resulting from postpartum health lectures or parenting experiences, as well as the effects of spontaneous growth. Participants were not informed about the specific arrangements of the test-retest process prior to testing to reduce the likelihood of memory bias. The conditions for both measurement sessions were kept consistent. Investigators received standardized training before data collection and distributed the questionnaires only after obtaining informed consent Reliability test Reliability is a crucial indicator for evaluating the consistency and stability of a scale. In this study, we employed several reliability indices, including Cronbach’s α coefficient, split-half reliability, and test-retest reliability. (1) Cronbach's α coefficient Cronbach’s α coefficient is utilized to assess the internal consistency of a scale, with values ranging from 0 to 1. A higher coefficient indicates greater reliability of the scale. It is generally accepted that for a scale to demonstrate reliable internal consistency, the overall Cronbach’s α coefficient should exceed 0.7, while the coefficient for each dimension should be greater than 0.5. (2) Split-Half Reliability Split-half reliability evaluates the internal reliability of a scale by dividing it into two parts, either through odd-even or front-back splitting. The correlation (r) between the two halves is then calculated. A higher correlation indicates better reliability and stronger internal consistency of the scale. (3) Test-Retest Reliability Test-retest reliability, also referred to as the stability coefficient, is typically assessed by administering the same scale to the same subjects at different time points and calculating the correlation coefficient between the two measurements. A correlation coefficient above 0.7 is considered to meet statistical requirements[44]. This form of reliability necessitates that the psychological characteristics being measured remain relatively stable over time, while also accounting for potential interference from unconscious practice or memory effects on the results. Validity test Validity refers to the effectiveness of measurement results, reflecting the degree of closeness between the outcomes obtained using a scale and the intended measurement target. It is typically assessed through three primary aspects: content validity, construct validity, and criterion-related validity. (1) Content validity is evaluated using the Item-level Content Validity Index (I-CVI) and the Scale-level Content Validity Index (S-CVI), which indicate the degree of alignment between the actual measurement content and the expected content. The I-CVI is calculated by dividing the number of experts who rate an item as 3 or 4 by the total number of experts, while the S-CVI is the average of all I-CVIs. It is recommended to retain items with an I-CVI of 0.78 or above and an S-CVI of 0.90 or above[45, 46]. (2) Construct Validity: The construct validity of the scale is examined through CFA, where each item of the scale is treated as an indicator. The analysis assesses the latent factors among all indicators and the loadings of each item on these factors. A higher degree of alignment between the latent factors extracted from the factor analysis and the domains identified during the scale design indicates better construct validity. Generally, the following criteria are considered indicative of good construct validity: ① factor loadings > 0.50 with P 0.80; ④ Root Mean Square Error of Approximation (RMSEA) 0.80; ⑥ Incremental Fit Index (IFI) > 0.80; ⑦ Comparative Fit Index (CFI) > 0.90; and ⑧ Tucker-Lewis Index (TLI) > 0.80. (3) Criterion-Related Validity: Criterion-related validity is assessed by correlating the ratings of the scale with a Calibration standard. The Chinese version of the PTGI scale has been widely utilized in PTG research within China and demonstrates good reliability and validity, making it a suitable criterion for evaluating the correlation of scores on the scale developed in this study. The consistency between measurement results and the criterion is typically tested using correlation analysis. A high correlation between the two measurement results indicates that the compared measurement tool possesses high criterion-related validity. Results Literature and interview analysis results Finally, based on literature analysis, systematic reviews, qualitative interviews, and group discussions, we came up with a draft of 38 projects. The project in the draft is based on the five dimensions of the PTG model and adds a category on the role of mothers to cover the factors associated with maternal perception, acceptance and positive evaluation of motherhood, which is not related to the five dimensions of the PTG theoretical model and not only reflects the unique aspects of maternal personal growth. It also reflects the interwoven influence of social and cultural background in posttraumatic growth. The draft list consists of six subcategories: (1) Personal strength: Evaluate the improvement of maternal skills after coping with challenges; (2) interpersonal relationships: evaluate the level of family and social relationship support after childbirth; (3)Attitude towards daily life: Covers reflection and the search for meaning in everyday Life; (4) Comprehension of Life's Essence: Evaluates the understanding of life, self and the Role of the world; (5) mothers: Focuses on the perception, acceptance and positive evaluation of motherhood; (6) Future development: covers the planning and outlook of future life. Delphi expert consultation results Given that this tool should be applicable for psychological assessment purposes across all populations of postpartum women, the experts involved represented fields including nursing research, obstetric nursing, obstetric medicine, nursing management, and psychological care. In both rounds of the Delphi survey, 17 questionnaires were distributed and 17 valid responses were received, yielding a 100% effective response rate, which indicates a high level of expert engagement. The judgment coefficient (Ca) of the experts in this study was 0.89, the familiarity coefficient (Cs) was 0.91, and the authority coefficient (Cr), calculated as (Ca + Cs) / 2, was 0.9, suggesting strong reliability of the survey results. Following the second round of the Delphi survey via letters, the Kendall's coefficient was 0.201, with a significance level of P < 0.001, indicating a consensus among experts on the indicators. During the first round, the research team revised one dimension, added three items, deleted seven items, and modified the phrasing of 15 items. In the second round of expert feedback, the phrasing of nine items was adjusted, one indicator was removed, and no additional indicators were added. After two rounds of surveys, a consensus was reached among the experts. Ultimately, an initial version of the Postpartum Post-Traumatic Growth Scale was developed, comprising six dimensions and 33 items. The scale was developed, analyzed, and collected entirely in Chinese and has been translated into English for the purpose of this paper. Item analysis results A total of 220 questionnaires were distributed, with 211 effectively collected, yielding an effective recovery rate of 95.91%. The demographic characteristics of the participants in Studies 2 and 3 are presented in Table 1. The collected data were analyzed, yielding the following results: (1) Frequency Distribution Method: Items B13, B14, C18, D23, E27, and E29 exhibited a response rate of less than 10% across three or more rating levels, necessitating their removal. (2) Discrete Trend Method: The standard deviations for items B13, B14, C18, D21, D23, D24, E25, E27, E29, F30, and F33 were below 0.75, warranting their exclusion. (3) Correlation Coefficient Method: All items demonstrated a correlation coefficient greater than 0.4 with the total score, indicating strong representativeness. (4) Critical Ratio Method: All CR values exceeded 3.00, with P < 0.05, confirming the significance of the items. (5) Cronbach's α Coefficient Method: The overall Cronbach's α coefficient for the scale was 0.938. Deletion of any single item did not result in a significant increase in the coefficient. In summary, six items (B13, B14, C18, D23, E27, and E29) met two deletion criteria simultaneously. Consequently, these items were removed, resulting in a final scale comprising 27 items, as detailed in Table 2. Table 1 Demographic characteristics of the sample. Variables Study 2 Study 3 n=211 N=202 Age (years) ≤24 19(9.00) 11(5.45) 25-29 64(30.33) 50(24.75) 30-34 97(45.97) 91(45.05) ≥35 31(14.70) 50(24.75) Week of delivery ＜37 21(9.95) 24(11.88) 37-41 ＋ 6 185(87.68) 173(85.64) ≥42 5(2.37) 5(2.48) Education Primary and below 1(0.47) 1(5.00) Secondary school 22(10.43) 33(16.34) High school 22(10.43) 29(14.36) Diploma 68(32.23) 61(30.2) Bachelor 87(41.23) 69(34.16) Postgraduate 11(5.21) 9(4.46) Residence area City 180(85.31) 157(77.72) town 22(10.43) 29(14.36) Country 9(4.27) 16(7.92) Previous miscarriage Yes 74(35.07) 83(41.09) No 137(64.93) 119(58.91) Maternal parity Primiparous 140(66.35) 117(57.92) Pluriparous 71(33.65) 85(42.08) Mode of conception Naturally 199(94.31) 184(91.09) Assisted reproductive technology 12(5.69) 18(8.91) Delivery Vaginal 87(41.23) 76(37.62) Caesarean 124(58.77) 126(62.38) Monthly per capita household income（RMB） ≤3000 26(12.32) 23(11.39) 3001-5000 80(37.91) 86(42.57) 5001-10000 79(37.44) 65(32.18) ≥10001 26(12.32) 28(13.86) Insurance status Yes 166(79.67) 161(79.70) No 45(21.33) 41(20.30) Table 2 Item analysis for women (N=211) Item number Frequency distribution method Discrete trend method Item-total correlation Item discrimination Scale’s Cronbach α coefficient when an item excluded Item exclusion or retention A1 ＜3 0.912 0.500 7.875*** 0.937 retained A2 ＜3 0.863 0.484 6.714*** 0.937 retained A3 ＜3 0.882 0.509 7.687*** 0.937 retained A4 ＜3 0.845 0.623 10.593*** 0.935 retained A5 ＜3 0.793 0.594 10.339*** 0.936 retained A6 ＜3 0.854 0.524 7.431*** 0.937 retained B7 ＜3 0.799 0.613 9.515*** 0.935 retained B8 ＜3 0.799 0.416 5.361*** 0.938 retained B9 ＜3 0.823 0.642 9.685*** 0.935 retained B10 ＜3 0.937 0.569 7.529*** 0.936 retained B11 ＜3 0.934 0.646 9.867*** 0.935 retained B12 ＜3 0.853 0.638 10.073*** 0.935 retained B13 ≥3 0.682 0.600 7.664*** 0.936 excluded B14 ≥3 0.692 0.593 8.421*** 0.936 excluded C15 ＜3 0.775 0.528 7.425*** 0.936 retained C16 ＜3 0.772 0.412 6.108*** 0.938 retained C17 ＜3 0.781 0.448 6.516*** 0.937 retained C18 ≥3 0.748 0.421 4.747*** 0.937 excluded C19 ＜3 0.786 0.557 7.621*** 0.936 retained C20 ＜3 0.791 0.565 8.678*** 0.936 retained D21 ＜3 0.791 0.608 9.334*** 0.936 retained D22 ＜3 0.808 0.649 9.611*** 0.935 retained D23 ≥3 0.604 0.584 8.355*** 0.936 excluded D24 ＜3 0.743 0.678 11.461*** 0.935 retained E25 ＜3 0.733 0.669 10.737*** 0.935 retained E26 ＜3 0.815 0.739 13.966*** 0.934 retained E27 ≥3 0.555 0.599 10.742*** 0.936 excluded E28 ＜3 0.777 0.669 11.211*** 0.935 retained E29 ≥3 0.604 0.612 9.63*** 0.936 excluded F30 ＜3 0.731 0.686 11.079*** 0.935 retained F31 ＜3 0.835 0.513 6.785*** 0.937 retained F32 ＜3 0.757 0.640 9.499*** 0.935 retained F33 ＜3 0.727 0.710 10.593*** 0.935 retained Exploratory factor analysis results The initial EFA yielded a KMO value of 0.899, and the Bartlett's test of sphericity produced a value of 3518.579, which reached statistical significance (P < 0.05). Therefore, the data in this study are suitable for factor analysis. In the subsequent EFA, item A6 was excluded due to a factor loading of less than 0.4. Ultimately, after applying principal component analysis with maximum orthogonal rotation, 26 items met the criteria for factor analysis, with all factor loadings exceeding 0.4. Six factors with eigenvalues greater than 1 were extracted, accounting for a cumulative variance contribution rate of 70.986% (see Table 3). (1) The first factor, comprising items q1 to q5, reflects the personal strength and resilience demonstrated by mothers in coping with the challenges following childbirth, and is labeled "Personal Strength." (2) The second factor, consisting of items q6 to q11, pertains to the interactions and dynamics between postpartum women and their family, friends, and social connections, and is designated as "Interpersonal Relationships." (3) The third factor, including items q12 to q16, represents the new perspective on life that mothers gain after experiencing childbirth trauma, as well as a reassessment of life's meaning, labeled "Attitude Towards Daily Life." (4) The fourth factor, comprising items q17 to q19, reflects the mothers' deep understanding of Life, self and world and sense of spiritual belief after childbirth, and is labeled "Comprehension of Life's Essence." (5) The fifth factor, including items q20 to q22, relates to women's understanding of their roles and responsibilities following the attainment of motherhood, and is designated as "Role of Mothers." (6) The sixth factor, comprising items q23 to q26, pertains to women's career pathways and interests developed in balancing family and professional life, labeled "Future Development." Table 3 Exploratory factor analysis of the PP-PTGI (N=211) items Factor loadings Factor 1 Factor 2 Factor 3 Factor 4 Factor 5 Factor 6 A1（q1） 0.388 -0.124 0.645 0.079 -0.077 0.305 A2（q2） 0.103 0.035 0.808 0.085 0.094 0.059 A3（q3） 0.145 0.156 0.804 0.133 0.057 -0.072 A4（q4） 0.277 0.164 0.735 0.228 -0.004 0.127 A5（q5） 0.204 0.142 0.65 0.112 0.236 0.08 B7（q6） 0.679 0.114 0.074 0.159 0.125 0.312 B8（q7） 0.627 -0.067 0.039 0.15 0.202 -0.038 B9（q8） 0.766 0.166 0.338 0.066 0.071 0.023 B10（q9） 0.661 0.267 0.259 0.075 0.054 -0.098 B11（q10） 0.788 0.132 0.161 0.075 0.15 0.208 B12（q11） 0.702 -0.003 0.383 0.139 0.024 0.276 C15（q12） 0.319 0.064 0.173 0.616 -0.074 0.213 C16（q13） -0.037 0.047 0.202 0.697 -0.083 0.32 C17（q14） 0.16 0.041 0.118 0.832 0.04 -0.098 C19（q15） 0.144 0.11 -0.003 0.699 0.388 0.12 C20（q16） 0.094 0.191 0.188 0.648 0.367 -0.068 D21（q17） 0.172 0.185 0.086 0.104 0.838 0.162 D22（q18） 0.157 0.361 0.058 0.029 0.744 0.321 D24（q19） 0.154 0.311 0.14 0.17 0.772 0.195 E25（q20） 0.189 0.342 0.086 0.137 0.279 0.696 E26（q21） 0.223 0.329 0.162 0.173 0.371 0.659 E28（q22） 0.124 0.384 0.115 0.094 0.277 0.749 F30（q23） 0.214 0.723 0.158 0.015 0.315 0.226 F31（q24） -0.023 0.814 0.046 -0.006 0.17 0.222 F32（q25） 0.083 0.881 0.140 0.21 0.111 0.070 F33（q26） 0.196 0.783 0.068 0.161 0.259 0.230 Confirmatory factor analysis results A total of 220 questionnaires were distributed, with 202 effectively collected, yielding an effective recovery rate of 91.82%. Table 1 presents the characteristics of the participants (Study 3, N = 202). Reliability results The Cronbach's alpha coefficient of each dimension ranges from 0.832 to 0.883, and the total Cronbach's alpha is 0.901. The half-partition reliability of each dimension ranges from 0.837 to 0.873. The total half-reliability was 0.760. The retest reliability of each dimension ranges from 0.711 to 0.808. The total retest reliability is 0.887. Table 4 shows the reliability of the final scale. Table 4 Reliability coefficients for the PP-PTGI (N=202) Scale/Dimensions No. of items Cronbach’s α Split-half reliability test-retest reliability Personal strength 5 0.832 0.847 0.794 Relationships with others 6 0.862 0.841 0.789 Appreciation of life 5 0.841 0.853 0.808 Spiritual/existential beliefs 3 0.883 0.866 0.781 Role of mothers 3 0.852 0.873 0.746 New possibilities 4 0.844 0.837 0.711 total 26 0.901 0.760 0.887 Validity results Content validity: The I-CVI of all items ranges from 0.866 to 1.000; S-CVI is 0.977. Structural validity: CFA model fitting indices were as follows: χ2=549.474, df=284, χ2 / df=1.935, GFI=0.820, NFI=0.815, TLI=0.885, CFI=0.900, IFI=0.901, RMSEA=0.068. Factor loadings were distributed as follows: Factor 1 ranged from 0.636 to 0.698; Factor 2 from 0.650 to 0.790; Factor 3 from 0.662 to 0.879; Factor 4 from 0.801 to 0.886; Factor 5 from 0.732 to 0.859; and Factor 6 from 0.698 to 0.820. All factor loadings were statistically significant (P < 0.001). Figure 2 shows the standardized factor load for CFA. Standard Correlation Validity: Correlation analysis revealed that the correlation coefficient between the total score of this scale and the total score of the PTGI was 0.673. Additionally, the correlation coefficients between the scores of the six dimensions and the total score of the PTGI ranged from 0.354 to 0.504, all of which were statistically significant, indicating good criterion validity. Discussion The aim of this study was to develop and validate the PP-PTGI. PTG has emerged as a critical determinant of maternal psychological recovery; however, there is currently no scale specifically designed to measure PTG in postpartum women. A multidimensional and targeted assessment of PTG in this population can identify growth challenges and lay the groundwork for subsequent psychological interventions and support. Our findings indicate that the developed PP-PTGI scale is a reliable and effective tool, encompassing various aspects such as personal strength, interpersonal relationships, attitude towards daily life, comprehension of life's essence, role of mothers, and future development. The scale comprehensively reflects the growth process of postpartum women following trauma and can scientifically and specifically identify PTG issues across multiple dimensions. In this study, we utilized PTG theory as the theoretical framework[26]. Through a combination of literature review, systematic evaluation, qualitative interviews, and group discussions, we ultimately formulated a draft comprising 38 items for further evaluation. We selected 17 academic or clinical experts from six provinces in China, representing fields such as nursing research, obstetric nursing, obstetric medicine, nursing management, and psychological nursing. These experts possess extensive professional knowledge and strong research capabilities. Based on the Delphi expert consultation, we initially developed a postpartum PTG scale for mothers that includes six dimensions and 33 items. Prior to the evaluation of the scale, the content and format remained unchanged during the pilot survey. Item analysis is a crucial step in scale development, aimed at enhancing the differentiation of the questionnaire while ensuring it is concise and scientifically rigorous. We employed frequency distribution method, discrete trend method, correlation coefficient method, critical ratio method, Cronbach' s α coefficient method to assess the items, which resulted in the recommendation to delete six items. Following KMO and Bartlett's sphericity tests, EFA was conducted, revealing that the factor loading of one item did not meet the required standard, leading to its removal. Ultimately, the remaining items underwent CFA to evaluate their reliability and validity. The reliability analysis results indicated that the total Cronbach's α was 0.9011, the total split-half reliability was 0.760, and the total test-retest reliability was 0.887, with all dimensions exhibiting reliability values above 0.7. This demonstrates that the scale possesses good internal consistency and temporal stability. Validity analysis results showed that the content validity index of the scale exceeded the recommended threshold[32], indicating a strong correlation between the items and the construct being measured, effectively reflecting relevant aspects of postpartum PTG. Structural validity results indicated that the goodness-of-fit indices from the CFA met published recommended values[47], with standardized factor loadings for each dimension exceeding 0.6, signifying a good fit between the data and the model. Additionally, the Chinese version of the PTGI scale was utilized as a reference for criterion-related validity, yielding a correlation coefficient of 0.746 between the total scores of the two scales, which suggests that the PP-PTGI demonstrates good criterion-related validity. In summary, the postpartum post-traumatic growth scale developed in this study exhibits strong reliability and validity, effectively capturing the level of post-traumatic growth among postpartum women. The PP-PTGI scale comprises four dimensions—“Personal Strength,” “Interpersonal Relationships,” “Attitude Towards Living,” and “Future Development”—which align with the fundamental dimensions of the PTGI. This consistency supports research findings that indicate psychological growth in individuals following other significant stressful life events[48, 49]. Specifically, it suggests that after experiencing stress and trauma, postpartum women can uncover their potential, recognize the importance of interpersonal relationships, cherish daily life more deeply, and develop clearer plans for the future. The dimension of “Comprehension of Life's Essence” reflects the profound understanding of the source and meaning of life that mothers attain following childbirth trauma. This dimension diverges from the original PTGI scale, which focused on religious beliefs and spiritual changes, and is more akin to the new entries introduced in PTGI-X, thereby broadening the understanding of spiritual and existential growth[22]. Building upon the context of maternal experiences, we have made appropriate modifications to this dimension, emphasizing how mothers interpret the essence of life in the face of childbirth trauma and how they re-evaluate and rediscover the value and meaning of life. Additionally, the “Maternal Role Identity” dimension of the PP-PTGI scale captures the unique psychological growth that mothers experience after childbirth and the challenges it brings, which is a growth that is unique to women's motherhood and cannot be experienced by other trauma types[14]. This dimension encompasses various psychological changes that mothers undergo while adapting to their new roles, including the adjustment to motherhood, the identification with their maternal role, and the assumption of family responsibilities[50]. Research has shown that due to differences in cultural backgrounds, study populations, and stressors, the dimensions and contents of post-stress growth can exhibit unique characteristics[18, 22]. This highlights the significance of developing this scale. In summary, the PP-PTGI scale developed in this study provides a comprehensive reflection of the growth process experienced by postpartum women after trauma, encompassing multiple dimensions. This scale demonstrates strong reliability and validity, offering researchers and healthcare providers a scientific and reliable tool to assess the level of growth in postpartum women following trauma. It also provides precise theoretical guidance for healthcare providers in developing personalized psychological support and interventions. Through the quantitative assessment provided by the scale, mothers can recognize their resilience and coping abilities, which aids in their understanding and acceptance of personal changes, ultimately promoting psychological recovery and overall well-being. Limitations and strengths This study has several limitations. First, the data collection phase included participants solely from one prefecture-level city in Hubei Province, and no multi-center, large-sample testing was conducted. This limitation may restrict the generalizability of the findings. Second, due to cultural differences between China and other countries, topics such as religious beliefs were not incorporated into the scale's development. This omission may affect the universality of the compiled scale among women in different cultural contexts, necessitating further cross-cultural validation. Additionally, in this study, the screening process for determining whether mothers experienced birth trauma relied on criteria from the City Birth Trauma Scale, owing to the absence of a well-established birth trauma scale. This reliance may introduce certain inaccuracies in the screening results, highlighting the need for refinement and verification in future research. Despite these limitations, this study presents notable advantages. The development of the PP-PTGI scale is grounded in the PTG theoretical framework and is supported by a comprehensive approach that includes literature review, expert consultation, and empirical research, ensuring the scale's scientific rigor and effectiveness. Furthermore, the scale encompasses multiple dimensions, allowing for a comprehensive assessment of post-traumatic growth in postpartum women. During the sample collection process, various types of birth trauma were included, enhancing the generalizability and applicability of our findings. Conclusion Based on the theory of PTG, the PP-PTGI was developed to reflect the physical and psychological characteristics of women who have experienced traumatic labor. The results indicate that the PP-PTGI comprises six dimensions and 26 items, utilizing a five-point Likert scale for scoring. Each item is rated from 1 to 5, corresponding to "strongly disagree" to "strongly agree," with higher scores indicating a greater level of postpartum post-traumatic growth among mothers. The scale demonstrates robust psychometric properties across two reliability indicators (internal consistency and test-retest reliability) and three validity indicators (content validity, structural validity, and criterion-related validity). Consequently, the use of this scale can assist obstetrical healthcare professionals in assessing the level of PTG following childbirth trauma, thereby facilitating the implementation of relevant care measures and guidance. Declarations Acknowledgements We would like to express our sincere gratitude to all the postpartum women who participated in this study and generously shared their experiences. We also thank the expert panel members who contributed to the Delphi process and provided valuable insights for item development. Authors’ contributions Wen Mingjun and Cheng Zhuoting contributed equally to this work. They conceptualized and designed the study, conducted data collection and analysis, and drafted the manuscript. Zhang Taotao and Nie Xiaofei jointly supervised the research, provided critical revisions, and approved the final version. Li Jinhui, Liu Wenjing, Cheng Yan, Xu Caijie, Bi Lele, and Liu Xinyang contributed to data collection and preliminary analysis. All authors have read and approved the final manuscript. Funding This research was supported by the Youth Project of Philosophy and Social Sciences Research Program of Hubei Provincial Education Department (No. 23Q175), the Science Research Foundation of Department of Education of Hubei Province (No. B2024106), and the Hubei Provincial Natural Science Foundation of China (No. 2025AFB537). The funders had no role in study design, data collection and analysis, manuscript preparation, or decision to publish. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Ethics approval and consent to participate The study was approved by the Ethics Committee of Hubei University of Medicine (Approval No: 2023-RE-008). Written informed consent was obtained from all participants prior to participation. All methods were carried out in accordance with relevant guidelines and regulations. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Author details 1. School of Nursing, Hubei University of Medicine, Shiyan, Hubei, China 2. School of Nursing, Suizhou Vocational and Technical College, Suizhou, Hubei, China References Gregory E, Robyn M. The psychosocial experience of traumatic birth in couples: an interpretative phenomenological study. Journal of reproductive and infant psychology, 2023. Lawrence CG, Breau G, Yang L, Hellerstein OS, Hippman C, Kennedy AL, et al. Effectiveness of a web-enabled psychoeducational resource for postpartum depression and anxiety among women in British Columbia. Arch Womens Ment Health, 2024. Chen Y, Dai J, Wang Y, Guo L, Huang Q. Postpartum post-traumatic stress disorder symptoms in high-risk pregnancies: Associated resilience and social support. J Psychosom Res, 2023, 165: 111098. D’Souza S, Waldie KE, Peterson ER, Underwood L, Morton SMB. Antenatal and Postnatal Determinants of Behavioural Difficulties in Early Childhood: Evidence from Growing Up in New Zealand. Child Psychiatry Hum Dev, 2019, 50: 45–60. Beck CT, Watson S. Subsequent Childbirth After a Previous Traumatic Birth. Nursing Research, 2010, 59: 241–9. Dekel S, Thiel F, Dishy G, Ashenfarb AL. Is childbirth-induced PTSD associated with low maternal attachment? Arch Womens Ment Health, 2019, 22: 119–22. Ketley R, Darwin Z, Masterson C, McGowan L. Women’s experience of post-traumatic growth following a traumatic birth: an interpretive phenomenological analysis. Journal of Reproductive and Infant Psychology, 2022, 42: 126–37. Tedeschi RG. Trauma and Transformation: Growing in the Aftermath of Suffering. Sage Publications, 1995. Tedeschi RG, Calhoun LG. The Posttraumatic Growth Inventory: measuring the positive legacy of trauma. J Trauma Stress, 1996, 9: 455–71. Abraido-Lanza AF, Guier C, Colón RM. Psychological Thriving Among Latinas With Chronic Illness. Journal of social issues, 1998, 54: 405–24. Park CL, Cohen LH, Murch RL. Assessment and prediction of stress-related growth. J Pers, 1996, 64: 71–105. Nishi D, Usuda K. Psychological growth after childbirth: an exploratory prospective study. J Psychosom Obstet Gynaecol, 2017, 38: 87–93. Babu MS, Chan SJ, Ein-Dor T, Dekel S. Traumatic childbirth during COVID-19 triggers maternal psychological growth and in turn better mother-infant bonding. J Affect Disord, 2022, 313: 163–6. Horesh D, Garthus-Niegel S, Horsch A. Childbirth-related PTSD: is it a unique post-traumatic disorder? J Reprod Infant Psychol, 2021, 39: 221–4. Elyoseph Z, Levi-Belz Y, Shimoni Y, Levkovich I. Exploring Post-Traumatic Growth Among Young Adults Coping With Parental Loss: The Role of Resilience and of Willingness to Seek Psychological Help. Omega (Westport), 2024: 302228241254559. Wang Y, Wang S, Tong L, Zhuang J, Xu Y, Wu Y, et al. Relationships between body image, dyadic coping and post-traumatic growth in breast cancer patients: a cross-sectional study. Front Psychol, 2024, 15: 1368429. Ionio C, Smorti M, Mascheroni E, Ongaro G, Cattaneo E, Gemignani A, et al. What is the role played by pregnancy in the construction of a woman’s identity and her association with her child-to-be? J Reprod Infant Psychol, 2021, 39: 250–62. Weiss T, Berger R, editors. Posttraumatic growth and culturally competent practice: lessons learned from around the globe. Hoboken, N.J: John Wiley & Sons, 2010. Suzuki A, Iriyama S, Obayashi Y. Validity and reliability of the Posttraumatic Growth Inventory among Japanese women with cesarean section. Nagoya J Med Sci. Taubman-Ben-Ari O, Findler L, Sharon N. Personal growth in mothers: examination of the suitability of the posttraumatic growth inventory as a measurement tool. Women & health, 2011, 51. Aftyka A, Rozalska I, Milanowska J. Is post-traumatic growth possible in the parents of former patients of neonatal intensive care units? Ann Agric Environ Med, 2020, 27: 106–12. Tedeschi RG, Cann A, Taku K, Senol‐Durak E, Calhoun LG. The Posttraumatic Growth Inventory: A Revision Integrating Existential and Spiritual Change. Journal of Traumatic Stress, 2017, 30: 11–8. Waugh A, Kiemle G, Slade P. Understanding mothers’ experiences of positive changes after neonatal death. Eur J Psychotraumatol, 2018, 9: 1528124. Attard R, Iles J, Bristow F, Satherley R-M. An interpretative phenomenological analysis of the experience of couples’ recovery from the psychological symptoms of trauma following traumatic childbirth. BMC Pregnancy Childbirth, 2022, 22: 798. C L, Z M, K P. Qualitative research synthesis: methodological guidance for systematic reviewers utilizing meta-aggregation. International journal of evidence-based healthcare, 2015, 13. Dursun P, Söylemez İ. Posttraumatic Growth: A Comprehensive Evaluation of the Recently Revised Model. Turk Psikiyatri Derg, 2020, 31: 57–68. Tedeschi RG, Calhoun LG. Posttraumatic Growth: Conceptual Foundations and Empirical Evidence. Psychological Inquiry, 2004, 15: 1–18. Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res, 2005, 15: 1277–88. Assarroudi A, Heshmati Nabavi F, Armat MR, Ebadi A, Vaismoradi M. Directed qualitative content analysis: the description and elaboration of its underpinning methods and data analysis process. J Res Nurs, 2018, 23: 42–55. Belsky J. Child maltreatment: an ecological integration. Am Psychol, 1980, 35: 320–35. Zhou X, Wu J, Liu Y, Yan Y, Zhou G, Li M. Developing a Multi-Dimensional Health Index System for a General Occupational Population in the Light of Health Ecology Theory: A Delphi Study. Risk Manag Healthc Policy, 2024, 17: 1523–32. Shi J, Mo X, Sun Z. Content validity index in scale development. J Cent South Univ(Med Sci), 2012, 37: 152–5. Marsh HW, Hau KT, Balla JR, Grayson D. Is More Ever Too Much? The Number of Indicators per Factor in Confirmatory Factor Analysis. Multivariate Behav Res, 1998, 33: 181–220. Nie X-F, Cheng L, Huang F, Zhang T-T, Yao Y-D, Tan J, et al. Construct validity and psychometric properties of the Chinese version of the City Birth Trauma Scale. J Obstet Gynaecol Res, 2022, 48: 2946–55. Streiner DL. Figuring out factors: the use and misuse of factor analysis. Can J Psychiatry, 1994, 39: 135–40. Yuan J. Development and Application of Preschooler’s Caregivers’ Feeding Behavior Scale. Air Force Medical University, 2019. Carey RG, Seibert JH. A patient survey system to measure quality improvement: questionnaire reliability and validity. Med Care, 1993, 31: 834–45. Zhang L. Development and preliminary application of self-management evaluation scale for patients with aortic dissection after surgery. Fujian Medical University, 2021. Du C, Zhao Y, Ren J, Chen Y. Study advancement on commonly used tatistics methods in item selection of TCM syndrome scale. Journal of Shanxi University of Chinese Medicine, 2015: 67–70. Tian F, Peng Z, Mi Y, Gui S, Liu M, Zhang T, et al. Development and validation of a rating scale for barriers to and facilitators of nurses’ participation intentions in “Internet + Nursing Service.” BMC Nurs, 2024, 23: 559. Jayawardena CK, Groenier M, Nawarathna LS. Relationship of adaptive expertise of health professions educators with age, experience, academic rank, and their work performance during an altered academic environment. BMC Med Educ, 2024, 24: 862. Gu R, Sun T, Pan Y, Wang J, Li Q, Zhang Y, et al. Development and validation of gestational diabetes mellitus health literacy scale. Patient Educ Couns, 2024, 127: 108365. Shultz KS, Whitney DJ, Zickar MJ. Measurement Theory in Action： Case Studies and Exercises. Routledge, 2020. Leechanavanicpan P, Phucharoenrak P, Phansuea P, Trachootham D. Coconut Milk Consumption and Breast Cancer Risk in Thai Women: A Case-Control Study. Nutr Cancer, 2024: 1–11. Liu Y, Zhang L, Xu K, Ding Y, Li F, Zhang T. Cross-cultural adaptation and validation of the short nutritional literacy scale for young adults (18-35years) and analysis of the influencing factors. BMC Public Health, 2024, 24: 2158. Li S, Fan J, Liu Y, Yu M, Jiang Y. Development and psychometric properties of a perceived social support scale for nurses returning to work after childbirth. BMC Nurs, 2024, 23: 547. Wolf MG, McNeish D. dynamic : An R Package for Deriving Dynamic Fit Index Cutoffs for Factor Analysis. Multivariate Behav Res, 2023, 58: 189–94. Ma M, Shi Z, Chen Y, Ma X. Recovery journey of people with a lived experience of schizophrenia: a qualitative study of experiences. BMC Psychiatry, 2023, 23: 468. Glad KA, Jensen TK, Holt T, Ormhaug SM. Exploring self-perceived growth in a clinical sample of severely traumatized youth. Child Abuse Negl, 2013, 37: 331–42. Wen M, Wang R, Cheng L, Nie X, Peng Z, Chen G, et al. Meta-synthesis of Qualitative Studies on Postpartum Posttraumatic Growth Experiences. Mil Nurs, 2024, 41: 94-97,102. Additional Declarations No competing interests reported. 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08:17:58","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":15832,"visible":true,"origin":"","legend":"","description":"","filename":"PostpartumPosttraumaticGrowthInventory.docx","url":"https://assets-eu.researchsquare.com/files/rs-7309721/v1/54bdc76f110fbc44e450930d.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The development and psychometric validation of the Postpartum Posttraumatic Growth Inventory (PP-PTGI)","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWhile childbirth is commonly regarded as a positive and life-sustaining event, research indicates that over a third of women experience traumatic events during delivery[1], which can lead to psychological issues such as postpartum depression and post-traumatic stress disorder (PTSD)[2, 3]. These conditions not only adversely affect the physical and mental health of the mother but also have implications for the health of the newborn and the mother-child attachment relationship[4]. Furthermore, they can influence women\u0026apos;s future reproductive choices[5] and the long-term social development of their children[6]. Although postpartum trauma can exert short- and long-term negative effects on women, an increasing amount of evidence suggests that, amidst ongoing challenges, women may also undergo positive psychological transformations and make constructive behavioral adjustments in their lives. This phenomenon is known as post-traumatic growth (PTG)[7]. PTG refers to the positive psychological changes and personal development that occur after an individual faces a significant crisis, manifesting as emotional recovery, a reassessment of life\u0026rsquo;s meaning, enhanced relationships with others, and increased self-efficacy[8]. Consequently, focusing on and promoting the level of post-traumatic growth in women not only aids in improving their mental health but also provides them with hope and strength, enabling them to adapt more effectively to the role of motherhood and to foster personal and family harmony.\u003c/p\u003e\n\u003cp\u003eExisting PTG measurement tools, such as the Posttraumatic Growth Inventory (PTGI)[9], Thriving Scale (TS)[10], and the Stress-Related Growth Scale (SRGS)[11], play a crucial role in assessing PTG. Among these, the PTGI[9], developed by Tedeschi et al., is the most widely utilized PTG assessment tool, applicable to various trauma populations. However, there is currently no scale specifically designed to address the unique experiences and needs of the maternal population. A literature review revealed that most scales utilized in quantitative studies on postpartum PTG are universal instruments[12, 13], which fail to adequately consider the physiological and psychological changes that mothers experience during childbirth.Postpartum traumatic experiences differ significantly from other types of trauma[14]. In traditional social contexts, pregnancy and childbirth are often perceived as \u0026quot;positive\u0026quot; events, whereas other traumas, such as bereavement[15] and serious illness[16], are typically regarded as negative. This distinction results in unique experiences for women who undergo traumatic births, setting them apart from other types of traumatic events in several key ways. For instance, the infant, as an integral part of the traumatic experience, may serve as a constant reminder of the trauma, a phenomenon rarely observed in other trauma contexts. And IONIO et al.[17] have noted that the most significant transformation for women following pregnancy and childbirth is the change in identity. This transformation is particularly complex and multidimensional for those who have experienced childbirth trauma, as it encompasses aspects that are not typically encountered by other trauma populations.\u003c/p\u003e\n\u003cp\u003eThe PTGI report highlights that variations in language, socio-cultural and religious backgrounds, and participant characteristics significantly influence the factor structure of the scale[18]. Within the maternal trauma group, the spiritual dimension has been a particularly contentious issue. For instance, the Japanese version of the PTGI (PTGI-J) for postpartum women considered the cultural and religious differences between Japan and the United States, resulting in the removal of two items from the spiritual dimension of the original PTGI. Consequently, the final PTGI-J consists of 17 items and three factors[19]. And research by Taubman-Ben-Ari et al.[20] explored the positive changes experienced by mothers after childbirth through open-ended questions and grounded theory content analysis. Their findings indicated that these changes predominantly aligned with the four dimensions of the PTGI, yet the dimensions related to spirituality and religious beliefs were notably absent. Similarly, Aftyka et al.[21] demonstrated that mothers facing the uncertainty and sense of loss of control associated with the treatment of premature infants might adopt religious coping strategies to manage psychological trauma. However, these strategies primarily focus on praying for the safety of their children, rather than on the enhancing or growing their of religious beliefs.\u003c/p\u003e\n\u003cp\u003eIn response to these controversies, Tedeschi et al. introduced the expanded version of the Post-Traumatic Growth Scale (PTGI-X) in 2017[22], acknowledging that the two items in the spiritual domain of the original PTGI did not fully capture the broader changes individuals experience in the realm of spiritual existence. As a result, additional items were incorporated into PTGI-X to assess the spiritual domain, reflecting diverse perspectives on spiritual-existential experiences across different cultures. However, it is important to note that this scale is not specifically tailored to the maternal population. Japanese scholar Suzuki applied PTGI-X to women who underwent cesarean sections to validate its effectiveness and subsequently revised it to create the PTGI-X-J-PWV, which demonstrated good internal consistency reliability (Cronbach\u0026apos;s \u0026alpha; = 0.94)[19]. Nonetheless, since the PTGI-X-J-PWV was validated exclusively among cesarean section patients, it cannot fully capture the commonalities experienced by the broader maternal trauma population. Furthermore, numerous qualitative studies on PTG have identified changes in motherhood, identity, and responsibility within maternal trauma groups[7, 23, 24]that are not adequately represented in the PTGI scale.\u003c/p\u003e\n\u003cp\u003eGiven the importance of accurately assessing and understanding the postpartum growth process, this study aims to develop and validate a Postpartum Posttraumatic Growth Inventory (PP-PTGI) specifically for women who have experienced postpartum trauma. This tool will assist in evaluating and supporting the psychological recovery process within this specific population. The development of the PP-PTGI will enable obstetric healthcare professionals to identify the distinct psychological needs of mothers, facilitating a more accurate assessment of their needs and growth processes. Ultimately, this will allow for the provision of targeted psychological support and interventions to promote the mental health and well-being of mothers following the trauma of childbirth.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study is divided into three stages, of which study 1 aims to initially develop the PP-PTGI. Study 2 aims to screen projects through project analysis and exploratory factor analysis (EFA). Study 3 was designed to evaluate the validity and reliability of the final scale by confirmatory factor analysis (CFA) and reliability analysis. This research protocol was approved by the Ethics Committee of Hubei University of Medicine (Reference No.2023-RE-008). Informed consent ensures written authorization from participants preceding data acquisition, analysis, and dissemination. The technology roadmap for the three phases is shown in Figure 1.The full English version of the scale is provided in Supplementary File 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy 1: instrument development\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLiterature review and qualitative interview\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe conducted a comprehensive literature and concept search in both academic and grey literature from May to July 2023 to identify core elements related to postpartum PTG. Our search included databases such as PubMed, the Cochrane Library, Web of Science, Embase, and SinoMed, utilizing keywords including \u0026quot;childbirth,\u0026quot; \u0026quot;maternity,\u0026quot; \u0026quot;postnatal,\u0026quot; \u0026quot;post-traumatic growth,\u0026quot; \u0026quot;psychological growth,\u0026quot; \u0026quot;birth trauma,\u0026quot; and \u0026quot;factors/effects.\u0026quot; Additionally, we gathered relevant information from policy documents and guidelines pertaining to postnatal health on an international scale.\u003c/p\u003e\n\u003cp\u003eUsing the aggregated meta-integration method from the JBI Evidence-Based Health Care Center[25], we pooled qualitative literature pertinent to maternal PTG. The research team screened literature that met the inclusion criteria from the aforementioned databases, including CNKI, cqVIP, Wanfang, and SinoMed. Following this, we performed data extraction and quality evaluation. Each piece of literature was re-read, analyzed, and interpreted to distill its meaning, leading to the formation of new categories that were subsequently summarized into integrated results.\u003c/p\u003e\n\u003cp\u003eWe then developed an interview outline informed by the literature review and PTG theory. Employing an objective sampling method, we screened eligible Chinese women through the electronic information system of the obstetrics department from July 2023 to October 2023. After obtaining informed consent from participants, we conducted semi-structured in-depth interviews, which were recorded and transcribed for timely analysis. Data collection continued until saturation was achieved. Directed content analysis was employed, guided by the five dimensions of PTG theory[26, 27], while also allowing for the emergence of new themes from the data. This approach facilitated a focus on research questions and the validation, refinement, and extension of existing theories in diverse contexts[28, 29]. All interviews were transcribed verbatim, with multiple coders utilizing NVivo 12.0 to independently code and categorize the interview texts. The research team then convened to discuss and compare the encoded results until consensus was reached.\u003c/p\u003e\n\u003cp\u003eFinally, we constructed a preliminary draft inventory based on the post-traumatic growth model proposed by Tedeschi[26, 27], informed by literature analysis, systematic reviews, qualitative interviews, and group discussions. The items in the draft inventory were measured using a five-point Likert scale, ranging from \u0026quot;strongly disagree\u0026quot; (1) to \u0026quot;strongly agree\u0026quot; (5). A higher score indicates a greater level of postpartum PTG.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDelphi expert consensus\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn accordance with the principles of representativeness and authority[30], we selected 17 experts from relevant fields to evaluate the importance and relevance of the proposed items. The selection criteria were as follows: (1) a minimum of a bachelor\u0026apos;s degree and at least an intermediate professional title; (2) a minimum of five years of experience in obstetrics, nursing research, or related fields; and (3) demonstrated enthusiasm and willingness to participate in this study. Expert consultation questionnaires were distributed via email or WeChat.\u003c/p\u003e\n\u003cp\u003eThe expert consultation questionnaire consisted of several components: (1) \u003cstrong\u003eExpert Letter\u003c/strong\u003e: This section included informed consent and an explanation of the purpose of the correspondence; (2) \u003cstrong\u003eExpert Basic Information Questionnaire\u003c/strong\u003e: This section collected demographic data, including gender, title, educational background, career focus, work unit, and years of experience. It also included a familiarity questionnaire (Ca) and a judgment basis questionnaire (CS)[31] to assess the experts\u0026apos; familiarity with the study content and their evaluation criteria, thereby ensuring the credibility of their input; (3) \u003cstrong\u003eExpert Evaluation Table\u003c/strong\u003e: Grounded in the PTG conceptual framework, this scoring table evaluated each index based on importance, scientific rigor, feasibility, and logical classification. A column for \u0026quot;Modification Suggestions\u0026quot; allowed experts to provide feedback on potential changes. Experts were invited to assess the relevance and importance of the project pool, with the option to suggest modifications, additions, or deletions as deemed appropriate. The importance evaluation employed a five-point scale, with scores ranging from 1 to 5, indicating low to high importance, respectively[32].\u0026nbsp;We modified and improved the items based on the feedback from the experts, resulting in the formation of the second round of the consultation questionnaire. Expert correspondence ceased once the opinions of the experts converged.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePilot survey\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrior to the formal study, 30 women from the postpartum rehabilitation department of the hospital, who met the selection criteria, were recruited to pilot the scale. Participants provided preliminary evaluations of the scale\u0026apos;s readability and comprehensibility. All participants indicated that the content of the scale items was clear and easy to understand, and no modifications were made to the content or format of the scale based on the pre-survey results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy 2: confirmation of the PP-PTGI\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion and exclusion criteria\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to the Kendall sample estimation method, the sample size for exploratory factor analysis (EFA) should be at least 5 to 10 times the number of scale items, with an additional 10% added to account for potential invalid responses[33]. In this study, 220 questionnaires were distributed, meeting the required sample size standards.\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria for participants were as follows: (1) age \u0026ge; 18 years; (2) Chinese women who have successfully given birth within the past year; (3) individuals who consider their childbirth experience to be traumatic, as assessed by the City Birth Trauma Scale[34]; (4) those who reported experiencing some form of personal growth following the birth trauma; (5) individuals with normal communication, comprehension, and expression skills; and (6) participants who understood the purpose and content of the interview and voluntarily agreed to participate in the survey.\u003c/p\u003e\n\u003cp\u003eExclusion criteria included: (1) self-reported or referred cases of depression, anxiety, or other mental disorders prior to pregnancy; (2) individuals who had received care from a psychiatric team before joining the study; and (3) cases of stillbirth, neonatal deformity, or serious illness.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProcedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA convenience sampling method was employed to select eligible women receiving treatment at a Grade III general hospital in Shiyan City, Hubei Province, from October 2023 to January 2024 for field investigation. Investigators provided uniform guidelines to explain the purpose, significance, and implementation process of the study to the participants. After obtaining informed consent, participants signed the consent form, and the questionnaire was distributed immediately. A standardized approach was used to address any questions participants had while completing the questionnaire. Participants filled out questionnaires anonymously, provided demographic information and completed the PP-PTGI questionnaire developed for this study. Once the questionnaires were filled out, investigators promptly collected them and conducted on-the-spot checks. If any questionnaires were found to be incomplete, investigators requested that participants provide the necessary information immediately to ensure the integrity of the data collected.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasures of analysis of item\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eItem analysis was conducted using several methods, including frequency distribution, discrete trend analysis, correlation coefficient analysis, critical ratio analysis, and Cronbach\u0026apos;s \u0026alpha; coefficient analysis, to screen items for the scale. Items that did not meet at least two of the five screening criteria were excluded from further consideration.\u003c/p\u003e\n\u003cp\u003e(1) Frequency Distribution Method: This method assesses the central tendency of item responses. For items rated on a five-point scale, those with a response rate of less than 10% for ratings of 3 or higher were removed[35].\u003c/p\u003e\n\u003cp\u003e(2) Discrete Trend Method: This method evaluates item sensitivity by examining the standard deviation or coefficient of variation of item scores. Items with low standard deviations indicate less sensitivity to differences among target, thereby reducing their discriminative ability. It is generally accepted that items should have a standard deviation of at least 0.75, indicating a wide distribution of scores and good sensitivity[36].\u003c/p\u003e\n\u003cp\u003e(3) Correlation Coefficient Method: The Pearson Correlation Coefficient (PCC) was utilized to calculate the correlation between each item\u0026rsquo;s scores and the scores of their respective domains. A larger absolute value of the correlation coefficient, along with statistical significance, indicates better representativeness of the item. The correlation coefficient (r) ranges from -1 to 1; a positive r value indicates a positive correlation, while a negative r value indicates a negative correlation. The closer the absolute value of r is to 1, the stronger the correlation between the variables. According to the theoretical structure of this study, if the correlation between an item\u0026rsquo;s score and the score of its corresponding domain is greater than 0.40 and statistically significant (P \u0026lt; 0.05), it suggests a high correlation, and the item should be retained; otherwise, it should be discarded[37].\u003c/p\u003e\n\u003cp\u003e(4) Critical Ratio Method: This method assesses the differentiation and discrimination of key test items. For items to be considered reasonable, there should be a statistically significant mean difference in scores between high and low groups, indicating good distinguishing ability. Specifically, the total scores for each item were sorted to identify the upper and lower 27% quantiles. Individuals with scores above the upper 27% quantile were classified into the high group, while those below the lower 27% quantile were classified into the low group. An independent samples t-test was conducted to compare the scores of each item between the two groups. Items that did not yield significant t-test results (P \u0026gt; 0.05) or had a t-statistic below the critical value of 3 were excluded[38].\u003c/p\u003e\n\u003cp\u003e(5) Cronbach\u0026apos;s \u0026alpha; Coefficient Method: This method evaluates items from the perspective of internal consistency. By calculating the Cronbach\u0026apos;s \u0026alpha; coefficient for all aspects and comparing the coefficient changes after the removal of an item, we can assess the degree of correlation between items, indicating internal consistency. If the coefficient significantly increases after the removal of an item, it suggests that the item negatively impacts the internal consistency of its domain, warranting its exclusion; otherwise, the item is retained[39].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExploratory factor analysis (EFA)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter filtering the entries, the remaining items were subjected to Kaiser-Meyer-Olkin (KMO) [40] and Bartlett\u0026apos;s sphericity tests[41] to assess the suitability of the sample data for EFA. The KMO statistic ranges from 0 to 1 and reflects the strength of correlations among the variables. A KMO value approaching 1 indicates a strong correlation among the variables, suggesting that the original variables are suitable for factor analysis. Specifically, a KMO value greater than 0.8 is generally considered very suitable for conducting factor analysis.\u0026nbsp;The Bartlett test assesses the correlations among variables within the correlation matrix to determine whether each variable is independent. If the variables are independent, common factors cannot be extracted for factor analysis. A significant result, indicated by a P-value of less than 0.05 in the Bartlett sphericity test, confirms the appropriateness of the data for factor analysis.\u003c/p\u003e\n\u003cp\u003eWhen both the KMO and Bartlett\u0026apos;s sphericity tests meet the established criteria, EFA is performed for each dimension of the scale using principal component analysis and maximum variance orthogonal rotation to evaluate structural validity. Common factors with eigenvalues greater than 1 are extracted through principal component analysis. Entries with factor loadings less than 0.4, as well as those with two or more common factor loadings exceeding 0.4, are excluded following maximum variance orthogonal rotation[42]. This rigorous approach ensures the reliability and validity of the identified factors within the scale.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy 3: Reliability and validity test of the psychometric characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion and exclusion criteria\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe inclusion and exclusion criteria for this study were consistent with those established in Study 2. For confirmatory factor analysis, a minimum sample size of 200 cases is recommended[43], and the sample size for this study meets this standard. The research was conducted from January to March 2024.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProcedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe design, setup, research procedures, and measures of this study were consistent with those of Study 2. Participants were required to complete demographic information, the PP-PTGI developed for this study, and the Chinese version of the PTGI to assess calibration validity. Given that this tool is intended to measure maternal PTG, a test-retest procedure was employed to evaluate its stability.\u003c/p\u003e\n\u003cp\u003eTo achieve this, a group of mothers (N = 30) completed two assessments within a 2-hour interval. This brief time frame was chosen to minimize the potential impact of confounding factors, such as changes resulting from postpartum health lectures or parenting experiences, as well as the effects of spontaneous growth. Participants were not informed about the specific arrangements of the test-retest process prior to testing to reduce the likelihood of memory bias. The conditions for both measurement sessions were kept consistent. Investigators received standardized training before data collection and distributed the questionnaires only after obtaining informed consent\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReliability test\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eReliability is a crucial indicator for evaluating the consistency and stability of a scale. In this study, we employed several reliability indices, including Cronbach\u0026rsquo;s \u0026alpha; coefficient, split-half reliability, and test-retest reliability.\u003c/p\u003e\n\u003cp\u003e(1) Cronbach\u0026apos;s \u0026alpha; coefficient\u003c/p\u003e\n\u003cp\u003eCronbach\u0026rsquo;s \u0026alpha; coefficient is utilized to assess the internal consistency of a scale, with values ranging from 0 to 1. A higher coefficient indicates greater reliability of the scale. It is generally accepted that for a scale to demonstrate reliable internal consistency, the overall Cronbach\u0026rsquo;s \u0026alpha; coefficient should exceed 0.7, while the coefficient for each dimension should be greater than 0.5.\u003c/p\u003e\n\u003cp\u003e(2) Split-Half Reliability\u003c/p\u003e\n\u003cp\u003eSplit-half reliability evaluates the internal reliability of a scale by dividing it into two parts, either through odd-even or front-back splitting. The correlation (r) between the two halves is then calculated. A higher correlation indicates better reliability and stronger internal consistency of the scale.\u003c/p\u003e\n\u003cp\u003e(3) Test-Retest Reliability\u003c/p\u003e\n\u003cp\u003eTest-retest reliability, also referred to as the stability coefficient, is typically assessed by administering the same scale to the same subjects at different time points and calculating the correlation coefficient between the two measurements. A correlation coefficient above 0.7 is considered to meet statistical requirements[44]. This form of reliability necessitates that the psychological characteristics being measured remain relatively stable over time, while also accounting for potential interference from unconscious practice or memory effects on the results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eValidity test\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eValidity refers to the effectiveness of measurement results, reflecting the degree of closeness between the outcomes obtained using a scale and the intended measurement target. It is typically assessed through three primary aspects: content validity, construct validity, and criterion-related validity.\u003c/p\u003e\n\u003cp\u003e(1) Content validity is evaluated using the Item-level Content Validity Index (I-CVI) and the Scale-level Content Validity Index (S-CVI), which indicate the degree of alignment between the actual measurement content and the expected content. The I-CVI is calculated by dividing the number of experts who rate an item as 3 or 4 by the total number of experts, while the S-CVI is the average of all I-CVIs. It is recommended to retain items with an I-CVI of 0.78 or above and an S-CVI of 0.90 or above[45, 46].\u003c/p\u003e\n\u003cp\u003e(2) Construct Validity: The construct validity of the scale is examined through CFA, where each item of the scale is treated as an indicator. The analysis assesses the latent factors among all indicators and the loadings of each item on these factors. A higher degree of alignment between the latent factors extracted from the factor analysis and the domains identified during the scale design indicates better construct validity. Generally, the following criteria are considered indicative of good construct validity: ① factor loadings \u0026gt; 0.50 with P \u0026lt; 0.05; ② chi-square goodness-of-fit test (\u0026chi;\u0026sup2;/df) between 1 and 3; ③ Goodness-of-Fit Index (GFI) \u0026gt; 0.80; ④ Root Mean Square Error of Approximation (RMSEA) \u0026lt; 0.08; ⑤ Normed Fit Index (NFI) \u0026gt; 0.80; ⑥ Incremental Fit Index (IFI) \u0026gt; 0.80; ⑦ Comparative Fit Index (CFI) \u0026gt; 0.90; and ⑧ Tucker-Lewis Index (TLI) \u0026gt; 0.80.\u003c/p\u003e\n\u003cp\u003e(3) Criterion-Related Validity: Criterion-related validity is assessed by correlating the ratings of the scale with a Calibration standard. The Chinese version of the PTGI scale has been widely utilized in PTG research within China and demonstrates good reliability and validity, making it a suitable criterion for evaluating the correlation of scores on the scale developed in this study. The consistency between measurement results and the criterion is typically tested using correlation analysis. A high correlation between the two measurement results indicates that the compared measurement tool possesses high criterion-related validity.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eLiterature and interview analysis results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFinally, based on literature analysis, systematic reviews, qualitative interviews, and group discussions, we came up with a draft of 38 projects. The project in the draft is based on the five dimensions of the PTG model and adds a category on the role of mothers to cover the factors associated with maternal perception, acceptance and positive evaluation of motherhood, which is not related to the five dimensions of the PTG theoretical model and not only reflects the unique aspects of maternal personal growth. It also reflects the interwoven influence of social and cultural background in posttraumatic growth. The draft list consists of six subcategories: (1) Personal strength: Evaluate the improvement of maternal skills after coping with challenges; (2) interpersonal relationships: evaluate the level of family and social relationship support after childbirth; (3)Attitude towards daily life: Covers reflection and the search for meaning in everyday Life; (4) Comprehension of Life\u0026apos;s Essence: Evaluates the understanding of life, self and the Role of the world; (5) mothers: Focuses on the perception, acceptance and positive evaluation of motherhood; (6) Future development: covers the planning and outlook of future life.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDelphi expert consultation results\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGiven that this tool should be applicable for psychological assessment purposes across all populations of postpartum women, the experts involved represented fields including nursing research, obstetric nursing, obstetric medicine, nursing management, and psychological care. In both rounds of the Delphi survey, 17 questionnaires were distributed and 17 valid responses were received, yielding a 100% effective response rate, which indicates a high level of expert engagement.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe judgment coefficient (Ca) of the experts in this study was 0.89, the familiarity coefficient (Cs) was 0.91, and the authority coefficient (Cr), calculated as (Ca + Cs) / 2, was 0.9, suggesting strong reliability of the survey results. Following the second round of the Delphi survey via letters, the Kendall\u0026apos;s coefficient was 0.201, with a significance level of P \u0026lt; 0.001, indicating a consensus among experts on the indicators. During the first round, the research team revised one dimension, added three items, deleted seven items, and modified the phrasing of 15 items. In the second round of expert feedback, the phrasing of nine items was adjusted, one indicator was removed, and no additional indicators were added. After two rounds of surveys, a consensus was reached among the experts. Ultimately, an initial version of the Postpartum Post-Traumatic Growth Scale was developed, comprising six dimensions and 33 items. The scale was developed, analyzed, and collected entirely in Chinese and has been translated into English for the purpose of this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eItem analysis results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 220 questionnaires were distributed, with 211 effectively collected, yielding an effective recovery rate of 95.91%. The demographic characteristics of the participants in Studies 2 and 3 are presented in Table 1. The collected data were analyzed, yielding the following results:\u003c/p\u003e\n\u003cp\u003e(1) Frequency Distribution Method: Items B13, B14, C18, D23, E27, and E29 exhibited a response rate of less than 10% across three or more rating levels, necessitating their removal.\u003c/p\u003e\n\u003cp\u003e(2) Discrete Trend Method: The standard deviations for items B13, B14, C18, D21, D23, D24, E25, E27, E29, F30, and F33 were below 0.75, warranting their exclusion.\u003c/p\u003e\n\u003cp\u003e(3) Correlation Coefficient Method: All items demonstrated a correlation coefficient greater than 0.4 with the total score, indicating strong representativeness.\u003c/p\u003e\n\u003cp\u003e(4) Critical Ratio Method: All CR values exceeded 3.00, with P \u0026lt; 0.05, confirming the significance of the items.\u003c/p\u003e\n\u003cp\u003e(5) Cronbach\u0026apos;s \u0026alpha; Coefficient Method: The overall Cronbach\u0026apos;s \u0026alpha; coefficient for the scale was 0.938. Deletion of any single item did not result in a significant increase in the coefficient.\u003c/p\u003e\n\u003cp\u003eIn summary, six items (B13, B14, C18, D23, E27, and E29) met two deletion criteria simultaneously. Consequently, these items were removed, resulting in a final scale comprising 27 items, as detailed in Table 2.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"469\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 469px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003eDemographic characteristics of the sample.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 224px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy 2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy 3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en=211\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN=202\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003e\u0026le;24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e19(9.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e11(5.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003e25-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e64(30.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e50(24.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003e30-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e97(45.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e91(45.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003e\u0026ge;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e31(14.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e50(24.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eWeek of delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003e＜37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e21(9.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e24(11.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003e37-41\u003csup\u003e＋\u003c/sup\u003e\u003csup\u003e6\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e185(87.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e173(85.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003e\u0026ge;42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e5(2.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e5(2.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003ePrimary and below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1(0.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1(5.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eSecondary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e22(10.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e33(16.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e22(10.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e29(14.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eDiploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e68(32.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e61(30.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eBachelor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e87(41.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e69(34.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003ePostgraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e11(5.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e9(4.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eResidence area\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eCity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e180(85.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e157(77.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003etown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e22(10.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e29(14.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eCountry\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e9(4.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e16(7.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003ePrevious miscarriage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e74(35.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e83(41.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e137(64.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e119(58.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eMaternal parity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003ePrimiparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e140(66.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e117(57.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003ePluriparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e71(33.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e85(42.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eMode of conception\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eNaturally\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e199(94.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e184(91.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eAssisted reproductive technology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e12(5.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e18(8.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eDelivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eVaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e87(41.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e76(37.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eCaesarean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e124(58.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e126(62.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eMonthly per capita household income（RMB）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003e\u0026le;3000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e26(12.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e23(11.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003e3001-5000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e80(37.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e86(42.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003e5001-10000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e79(37.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e65(32.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003e\u0026ge;10001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e26(12.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e28(13.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eInsurance status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e166(79.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e161(79.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e45(21.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e41(20.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"844\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 844px;\"\u003e\n \u003cp\u003eTable 2 Item analysis for women (N=211)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eItem number\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFrequency distribution method\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDiscrete trend method\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eItem-total correlation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eItem discrimination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eScale\u0026rsquo;s Cronbach \u0026alpha; coefficient when an item excluded\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eItem exclusion or retention\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eA1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.912\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.500\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.875***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.937\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eretained\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eA2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.863\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.484\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.714***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.937\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eretained\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eA3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.882\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.687***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.937\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eretained\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eA4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.845\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.623\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.593***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.935\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eretained\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eA5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.793\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.594\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.339***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.936\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eretained\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eA6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.854\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.524\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.431***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.937\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eretained\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eB7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.799\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.613\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.515***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.935\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eretained\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eB8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.799\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.416\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.361***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.938\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eretained\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eB9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.823\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.642\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.685***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.935\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eretained\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eB10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.937\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.569\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.529***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.936\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eretained\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eB11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.934\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.646\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.867***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.935\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eretained\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eB12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.853\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.638\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.073***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.935\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eretained\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eB13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge;3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.682\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.600\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.664***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.936\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eexcluded\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eB14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge;3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.692\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.593\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.421***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.936\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eexcluded\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eC15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.775\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.528\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.425***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.936\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eretained\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eC16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.772\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.412\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.108***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.938\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eretained\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eC17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.781\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.448\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.516***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.937\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eretained\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eC18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge;3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.748\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.421\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.747***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.937\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eexcluded\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eC19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.786\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.557\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.621***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.936\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eretained\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eC20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.791\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.565\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.678***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.936\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eretained\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eD21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.791\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.608\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.334***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.936\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eretained\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eD22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.808\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.649\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.611***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.935\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eretained\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eD23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge;3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.604\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.584\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.355***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.936\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eexcluded\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eD24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.743\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.678\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.461***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.935\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eretained\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eE25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.733\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.669\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.737***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.935\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eretained\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eE26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.815\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.739\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13.966***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.934\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eretained\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eE27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge;3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.555\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.599\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.742***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.936\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eexcluded\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eE28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.777\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.669\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.211***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.935\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eretained\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eE29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge;3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.604\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.612\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.63***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.936\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eexcluded\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eF30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.731\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.686\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.079***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.935\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eretained\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eF31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.835\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.513\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.785***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.937\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eretained\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eF32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.757\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.640\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.499***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.935\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eretained\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eF33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.727\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.710\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.593***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.935\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eretained\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExploratory factor analysis results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe initial EFA yielded a KMO value of 0.899, and the Bartlett\u0026apos;s test of sphericity produced a value of 3518.579, which reached statistical significance (P \u0026lt; 0.05). Therefore, the data in this study are suitable for factor analysis. In the subsequent EFA, item A6 was excluded due to a factor loading of less than 0.4. Ultimately, after applying principal component analysis with maximum orthogonal rotation, 26 items met the criteria for factor analysis, with all factor loadings exceeding 0.4. Six factors with eigenvalues greater than 1 were extracted, accounting for a cumulative variance contribution rate of 70.986% (see Table 3).\u003c/p\u003e\n\u003cp\u003e(1) The first factor, comprising items q1 to q5, reflects the personal strength and resilience demonstrated by mothers in coping with the challenges following childbirth, and is labeled \u0026quot;Personal Strength.\u0026quot;\u003c/p\u003e\n\u003cp\u003e(2) The second factor, consisting of items q6 to q11, pertains to the interactions and dynamics between postpartum women and their family, friends, and social connections, and is designated as \u0026quot;Interpersonal Relationships.\u0026quot;\u003c/p\u003e\n\u003cp\u003e(3) The third factor, including items q12 to q16, represents the new perspective on life that mothers gain after experiencing childbirth trauma, as well as a reassessment of life\u0026apos;s meaning, labeled \u0026quot;Attitude Towards Daily Life.\u0026quot;\u003c/p\u003e\n\u003cp\u003e(4) The fourth factor, comprising items q17 to q19, reflects the mothers\u0026apos; deep understanding of Life, self and world and sense of spiritual belief after childbirth, and is labeled \u0026quot;Comprehension of Life\u0026apos;s Essence.\u0026quot;\u003c/p\u003e\n\u003cp\u003e(5) The fifth factor, including items q20 to q22, relates to women\u0026apos;s understanding of their roles and responsibilities following the attainment of motherhood, and is designated as \u0026quot;Role of Mothers.\u0026quot;\u003c/p\u003e\n\u003cp\u003e(6) The sixth factor, comprising items q23 to q26, pertains to women\u0026apos;s career pathways and interests developed in balancing family and professional life, labeled \u0026quot;Future Development.\u0026quot;\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"646\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 646px;\"\u003e\n \u003cp\u003eTable 3 Exploratory factor analysis of the PP-PTGI (N=211)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eitems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\"\u003e\n \u003cp\u003eFactor loadings\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFactor 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFactor 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFactor 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFactor 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFactor 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFactor 6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eA1（q1）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.388\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.645\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.079\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.305\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eA2（q2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.808\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.094\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eA3（q3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.804\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.072\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eA4（q4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.277\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.735\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.127\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eA5（q5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.65\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eB7（q6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.679\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.312\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eB8（q7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.627\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eB9（q8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.766\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.338\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eB10（q9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.661\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.267\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.259\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eB11（q10）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.788\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.208\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eB12（q11）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.702\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.383\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.276\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eC15（q12）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.319\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.616\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.213\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eC16（q13）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.697\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eC17（q14）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.832\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eC19（q15）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.699\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.388\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eC20（q16）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.094\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.648\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.367\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eD21（q17）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.838\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.162\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eD22（q18）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.361\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.744\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.321\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eD24（q19）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.311\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.772\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.195\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eE25（q20）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.342\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.279\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.696\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eE26（q21）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.223\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.329\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.371\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.659\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eE28（q22）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.384\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.094\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.277\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.749\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eF30（q23）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.723\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.315\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.226\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eF31（q24）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.814\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.222\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eF32（q25）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.881\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.140\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.070\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eF33（q26）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e0.783\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.259\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.230\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eConfirmatory factor analysis results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 220 questionnaires were distributed, with 202 effectively collected, yielding an effective recovery rate of 91.82%. Table 1 presents the characteristics of the participants (Study 3, N = 202).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReliability results\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Cronbach\u0026apos;s alpha coefficient of each dimension ranges from 0.832 to 0.883, and the total Cronbach\u0026apos;s alpha is 0.901. The half-partition reliability of each dimension ranges from 0.837 to 0.873. The total half-reliability was 0.760. The retest reliability of each dimension ranges from 0.711 to 0.808. The total retest reliability is 0.887. Table 4 shows the reliability of the final scale.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"687\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 687px;\"\u003e\n \u003cp\u003eTable 4 Reliability coefficients for the PP-PTGI (N=202)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eScale/Dimensions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo. of items\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCronbach\u0026rsquo;s \u0026alpha;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSplit-half reliability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003etest-retest reliability\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePersonal strength\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.832\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.847\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.794\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eRelationships with others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.862\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.841\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.789\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAppreciation of life\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.841\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.853\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.808\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSpiritual/existential beliefs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.883\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.866\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.781\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eRole of mothers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.852\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.873\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.746\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNew possibilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.844\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.837\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.711\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003etotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.901\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.760\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.887\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eValidity results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eContent validity: The I-CVI of all items ranges from 0.866 to 1.000; S-CVI is 0.977.\u003c/p\u003e\n\u003cp\u003eStructural validity: CFA model fitting indices were as follows: \u0026chi;2=549.474, df=284, \u0026chi;2 / df=1.935, GFI=0.820, NFI=0.815, TLI=0.885, CFI=0.900, IFI=0.901, RMSEA=0.068.\u0026nbsp;Factor loadings were distributed as follows: Factor 1 ranged from 0.636 to 0.698; Factor 2 from 0.650 to 0.790; Factor 3 from 0.662 to 0.879; Factor 4 from 0.801 to 0.886; Factor 5 from 0.732 to 0.859; and Factor 6 from 0.698 to 0.820. \u0026nbsp;All factor loadings were statistically significant (P \u0026lt; 0.001). Figure 2 shows the standardized factor load for CFA.\u003c/p\u003e\n\u003cp\u003eStandard Correlation Validity: Correlation analysis revealed that the correlation coefficient between the total score of this scale and the total score of the PTGI was 0.673. Additionally, the correlation coefficients between the scores of the six dimensions and the total score of the PTGI ranged from 0.354 to 0.504, all of which were statistically significant, indicating good criterion validity.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe aim of this study was to develop and validate the PP-PTGI. PTG has emerged as a critical determinant of maternal psychological recovery; however, there is currently no scale specifically designed to measure PTG in postpartum women. A multidimensional and targeted assessment of PTG in this population can identify growth challenges and lay the groundwork for subsequent psychological interventions and support. Our findings indicate that the developed PP-PTGI scale is a reliable and effective tool, encompassing various aspects such as personal strength, interpersonal relationships, attitude towards daily life, comprehension of life\u0026apos;s essence, role of mothers, and future development. The scale comprehensively reflects the growth process of postpartum women following trauma and can scientifically and specifically identify PTG issues across multiple dimensions.\u003c/p\u003e\n\u003cp\u003eIn this study, we utilized PTG theory as the theoretical framework[26]. Through a combination of literature review, systematic evaluation, qualitative interviews, and group discussions, we ultimately formulated a draft comprising 38 items for further evaluation. We selected 17 academic or clinical experts from six provinces in China, representing fields such as nursing research, obstetric nursing, obstetric medicine, nursing management, and psychological nursing. These experts possess extensive professional knowledge and strong research capabilities. Based on the Delphi expert consultation, we initially developed a postpartum PTG scale for mothers that includes six dimensions and 33 items. Prior to the evaluation of the scale, the content and format remained unchanged during the pilot survey. Item analysis is a crucial step in scale development, aimed at enhancing the differentiation of the questionnaire while ensuring it is concise and scientifically rigorous. We employed frequency distribution method, discrete trend method, correlation coefficient method, critical ratio method, Cronbach\u0026apos; s \u0026alpha; coefficient method to assess the items, which resulted in the recommendation to delete six items. Following KMO and Bartlett\u0026apos;s sphericity tests, EFA was conducted, revealing that the factor loading of one item did not meet the required standard, leading to its removal.\u003c/p\u003e\n\u003cp\u003eUltimately, the remaining items underwent CFA to evaluate their reliability and validity. The reliability analysis results indicated that the total Cronbach\u0026apos;s \u0026alpha; was 0.9011, the total split-half reliability was 0.760, and the total test-retest reliability was 0.887, with all dimensions exhibiting reliability values above 0.7. This demonstrates that the scale possesses good internal consistency and temporal stability. Validity analysis results showed that the content validity index of the scale exceeded the recommended threshold[32], indicating a strong correlation between the items and the construct being measured, effectively reflecting relevant aspects of postpartum PTG. Structural validity results indicated that the goodness-of-fit indices from the CFA met published recommended values[47], with standardized factor loadings for each dimension exceeding 0.6, signifying a good fit between the data and the model. Additionally, the Chinese version of the PTGI scale was utilized as a reference for criterion-related validity, yielding a correlation coefficient of 0.746 between the total scores of the two scales, which suggests that the PP-PTGI demonstrates good criterion-related validity. In summary, the postpartum post-traumatic growth scale developed in this study exhibits strong reliability and validity, effectively capturing the level of post-traumatic growth among postpartum women.\u003c/p\u003e\n\u003cp\u003eThe PP-PTGI scale comprises four dimensions\u0026mdash;\u0026ldquo;Personal Strength,\u0026rdquo; \u0026ldquo;Interpersonal Relationships,\u0026rdquo; \u0026ldquo;Attitude Towards Living,\u0026rdquo; and \u0026ldquo;Future Development\u0026rdquo;\u0026mdash;which align with the fundamental dimensions of the PTGI. This consistency supports research findings that indicate psychological growth in individuals following other significant stressful life events[48, 49]. Specifically, it suggests that after experiencing stress and trauma, postpartum women can uncover their potential, recognize the importance of interpersonal relationships, cherish daily life more deeply, and develop clearer plans for the future.\u003c/p\u003e\n\u003cp\u003eThe dimension of \u0026ldquo;Comprehension of Life\u0026apos;s Essence\u0026rdquo; reflects the profound understanding of the source and meaning of life that mothers attain following childbirth trauma. This dimension diverges from the original PTGI scale, which focused on religious beliefs and spiritual changes, and is more akin to the new entries introduced in PTGI-X, thereby broadening the understanding of spiritual and existential growth[22]. Building upon the context of maternal experiences, we have made appropriate modifications to this dimension, emphasizing how mothers interpret the essence of life in the face of childbirth trauma and how they re-evaluate and rediscover the value and meaning of life.\u003c/p\u003e\n\u003cp\u003eAdditionally, the \u0026ldquo;Maternal Role Identity\u0026rdquo; dimension of the PP-PTGI scale captures the unique psychological growth that mothers experience after childbirth and the challenges it brings, which is a growth that is unique to women\u0026apos;s motherhood and cannot be experienced by other trauma types[14]. This dimension encompasses various psychological changes that mothers undergo while adapting to their new roles, including the adjustment to motherhood, the identification with their maternal role, and the assumption of family responsibilities[50]. Research has shown that due to differences in cultural backgrounds, study populations, and stressors, the dimensions and contents of post-stress growth can exhibit unique characteristics[18, 22]. This highlights the significance of developing this scale.\u003c/p\u003e\n\u003cp\u003eIn summary, the PP-PTGI scale developed in this study provides a comprehensive reflection of the growth process experienced by postpartum women after trauma, encompassing multiple dimensions. This scale demonstrates strong reliability and validity, offering researchers and healthcare providers a scientific and reliable tool to assess the level of growth in postpartum women following trauma. It also provides precise theoretical guidance for healthcare providers in developing personalized psychological support and interventions. Through the quantitative assessment provided by the scale, mothers can recognize their resilience and coping abilities, which aids in their understanding and acceptance of personal changes, ultimately promoting psychological recovery and overall well-being.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations and strengths\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has several limitations. First, the data collection phase included participants solely from one prefecture-level city in Hubei Province, and no multi-center, large-sample testing was conducted. This limitation may restrict the generalizability of the findings. Second, due to cultural differences between China and other countries, topics such as religious beliefs were not incorporated into the scale\u0026apos;s development. This omission may affect the universality of the compiled scale among women in different cultural contexts, necessitating further cross-cultural validation. Additionally, in this study, the screening process for determining whether mothers experienced birth trauma relied on criteria from the City Birth Trauma Scale, owing to the absence of a well-established birth trauma scale. This reliance may introduce certain inaccuracies in the screening results, highlighting the need for refinement and verification in future research. Despite these limitations, this study presents notable advantages. The development of the PP-PTGI scale is grounded in the PTG theoretical framework and is supported by a comprehensive approach that includes literature review, expert consultation, and empirical research, ensuring the scale\u0026apos;s scientific rigor and effectiveness. Furthermore, the scale encompasses multiple dimensions, allowing for a comprehensive assessment of post-traumatic growth in postpartum women. During the sample collection process, various types of birth trauma were included, enhancing the generalizability and applicability of our findings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBased on the theory of PTG, the PP-PTGI was developed to reflect the physical and psychological characteristics of women who have experienced traumatic labor. The results indicate that the PP-PTGI comprises six dimensions and 26 items, utilizing a five-point Likert scale for scoring. Each item is rated from 1 to 5, corresponding to \u0026quot;strongly disagree\u0026quot; to \u0026quot;strongly agree,\u0026quot; with higher scores indicating a greater level of postpartum post-traumatic growth among mothers. The scale demonstrates robust psychometric properties across two reliability indicators (internal consistency and test-retest reliability) and three validity indicators (content validity, structural validity, and criterion-related validity). Consequently, the use of this scale can assist obstetrical healthcare professionals in assessing the level of PTG following childbirth trauma, thereby facilitating the implementation of relevant care measures and guidance.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eWe would like to express our sincere gratitude to all the postpartum women who participated in this study and generously shared their experiences. We also thank the expert panel members who contributed to the Delphi process and provided valuable insights for item development.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contributions\u003c/p\u003e\n\u003cp\u003eWen Mingjun and Cheng Zhuoting contributed equally to this work. They conceptualized and designed the study, conducted data collection and analysis, and drafted the manuscript. Zhang Taotao and Nie Xiaofei jointly supervised the research, provided critical revisions, and approved the final version. Li Jinhui, Liu Wenjing, Cheng Yan, Xu Caijie, Bi Lele, and Liu Xinyang contributed to data collection and preliminary analysis. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis research was supported by the Youth Project of Philosophy and Social Sciences Research Program of Hubei Provincial Education Department (No. 23Q175), the Science Research Foundation of Department of Education of Hubei Province (No. B2024106), and the Hubei Provincial Natural Science Foundation of China (No. 2025AFB537). The funders had no role in study design, data collection and analysis, manuscript preparation, or decision to publish.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Ethics Committee of Hubei University of Medicine (Approval No: 2023-RE-008). Written informed consent was obtained from all participants prior to participation. All methods were carried out in accordance with relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eAuthor details\u003c/p\u003e\n\u003cp\u003e1. School of Nursing, Hubei University of Medicine, Shiyan, Hubei, China\u003c/p\u003e\n\u003cp\u003e2. School of Nursing, Suizhou Vocational and Technical College, Suizhou, Hubei, China\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eGregory E, Robyn M. The psychosocial experience of traumatic birth in couples: an interpretative phenomenological study. Journal of reproductive and infant psychology, 2023.\u003c/li\u003e\n \u003cli\u003eLawrence CG, Breau G, Yang L, Hellerstein OS, Hippman C, Kennedy AL, et al. Effectiveness of a web-enabled psychoeducational resource for postpartum depression and anxiety among women in British Columbia. Arch Womens Ment Health, 2024.\u003c/li\u003e\n \u003cli\u003eChen Y, Dai J, Wang Y, Guo L, Huang Q. Postpartum post-traumatic stress disorder symptoms in high-risk pregnancies: Associated resilience and social support. J Psychosom Res, 2023, 165: 111098.\u003c/li\u003e\n \u003cli\u003eD\u0026rsquo;Souza S, Waldie KE, Peterson ER, Underwood L, Morton SMB. Antenatal and Postnatal Determinants of Behavioural Difficulties in Early Childhood: Evidence from Growing Up in New Zealand. Child Psychiatry Hum Dev, 2019, 50: 45\u0026ndash;60.\u003c/li\u003e\n \u003cli\u003eBeck CT, Watson S. Subsequent Childbirth After a Previous Traumatic Birth. Nursing Research, 2010, 59: 241\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eDekel S, Thiel F, Dishy G, Ashenfarb AL. Is childbirth-induced PTSD associated with low maternal attachment? Arch Womens Ment Health, 2019, 22: 119\u0026ndash;22.\u003c/li\u003e\n \u003cli\u003eKetley R, Darwin Z, Masterson C, McGowan L. Women\u0026rsquo;s experience of post-traumatic growth following a traumatic birth: an interpretive phenomenological analysis. Journal of Reproductive and Infant Psychology, 2022, 42: 126\u0026ndash;37.\u003c/li\u003e\n \u003cli\u003eTedeschi RG. Trauma and Transformation: Growing in the Aftermath of Suffering. Sage Publications, 1995.\u003c/li\u003e\n \u003cli\u003eTedeschi RG, Calhoun LG. The Posttraumatic Growth Inventory: measuring the positive legacy of trauma. J Trauma Stress, 1996, 9: 455\u0026ndash;71.\u003c/li\u003e\n \u003cli\u003eAbraido-Lanza AF, Guier C, Col\u0026oacute;n RM. Psychological Thriving Among Latinas With Chronic Illness. Journal of social issues, 1998, 54: 405\u0026ndash;24.\u003c/li\u003e\n \u003cli\u003ePark CL, Cohen LH, Murch RL. Assessment and prediction of stress-related growth. J Pers, 1996, 64: 71\u0026ndash;105.\u003c/li\u003e\n \u003cli\u003eNishi D, Usuda K. Psychological growth after childbirth: an exploratory prospective study. J Psychosom Obstet Gynaecol, 2017, 38: 87\u0026ndash;93.\u003c/li\u003e\n \u003cli\u003eBabu MS, Chan SJ, Ein-Dor T, Dekel S. Traumatic childbirth during COVID-19 triggers maternal psychological growth and in turn better mother-infant bonding. J Affect Disord, 2022, 313: 163\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003eHoresh D, Garthus-Niegel S, Horsch A. Childbirth-related PTSD: is it a unique post-traumatic disorder? J Reprod Infant Psychol, 2021, 39: 221\u0026ndash;4.\u003c/li\u003e\n \u003cli\u003eElyoseph Z, Levi-Belz Y, Shimoni Y, Levkovich I. Exploring Post-Traumatic Growth Among Young Adults Coping With Parental Loss: The Role of Resilience and of Willingness to Seek Psychological Help. Omega (Westport), 2024: 302228241254559.\u003c/li\u003e\n \u003cli\u003eWang Y, Wang S, Tong L, Zhuang J, Xu Y, Wu Y, et al. Relationships between body image, dyadic coping and post-traumatic growth in breast cancer patients: a cross-sectional study. Front Psychol, 2024, 15: 1368429.\u003c/li\u003e\n \u003cli\u003eIonio C, Smorti M, Mascheroni E, Ongaro G, Cattaneo E, Gemignani A, et al. What is the role played by pregnancy in the construction of a woman\u0026rsquo;s identity and her association with her child-to-be? J Reprod Infant Psychol, 2021, 39: 250\u0026ndash;62.\u003c/li\u003e\n \u003cli\u003eWeiss T, Berger R, editors. Posttraumatic growth and culturally competent practice: lessons learned from around the globe. Hoboken, N.J: John Wiley \u0026amp; Sons, 2010.\u003c/li\u003e\n \u003cli\u003eSuzuki A, Iriyama S, Obayashi Y. Validity and reliability of the Posttraumatic Growth Inventory among Japanese women with cesarean section. Nagoya J Med Sci.\u003c/li\u003e\n \u003cli\u003eTaubman-Ben-Ari O, Findler L, Sharon N. Personal growth in mothers: examination of the suitability of the posttraumatic growth inventory as a measurement tool. Women \u0026amp; health, 2011, 51.\u003c/li\u003e\n \u003cli\u003eAftyka A, Rozalska I, Milanowska J. Is post-traumatic growth possible in the parents of former patients of neonatal intensive care units? Ann Agric Environ Med, 2020, 27: 106\u0026ndash;12.\u003c/li\u003e\n \u003cli\u003eTedeschi RG, Cann A, Taku K, Senol‐Durak E, Calhoun LG. The Posttraumatic Growth Inventory: A Revision Integrating Existential and Spiritual Change. Journal of Traumatic Stress, 2017, 30: 11\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eWaugh A, Kiemle G, Slade P. Understanding mothers\u0026rsquo;\u0026nbsp;experiences of positive changes after neonatal death. Eur J Psychotraumatol, 2018, 9: 1528124.\u003c/li\u003e\n \u003cli\u003eAttard R, Iles J, Bristow F, Satherley R-M. An interpretative phenomenological analysis of the experience of couples\u0026rsquo;\u0026nbsp;recovery from the psychological symptoms of trauma following traumatic childbirth. BMC Pregnancy Childbirth, 2022, 22: 798.\u003c/li\u003e\n \u003cli\u003eC L, Z M, K P. Qualitative research synthesis: methodological guidance for systematic reviewers utilizing meta-aggregation. International journal of evidence-based healthcare, 2015, 13.\u003c/li\u003e\n \u003cli\u003eDursun P, S\u0026ouml;ylemez\u0026nbsp;İ. Posttraumatic Growth: A Comprehensive Evaluation of the Recently Revised Model. Turk Psikiyatri Derg, 2020, 31: 57\u0026ndash;68.\u003c/li\u003e\n \u003cli\u003eTedeschi RG, Calhoun LG. Posttraumatic Growth: Conceptual Foundations and Empirical Evidence. Psychological Inquiry, 2004, 15: 1\u0026ndash;18.\u003c/li\u003e\n \u003cli\u003eHsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res, 2005, 15: 1277\u0026ndash;88.\u003c/li\u003e\n \u003cli\u003eAssarroudi A, Heshmati Nabavi F, Armat MR, Ebadi A, Vaismoradi M. Directed qualitative content analysis: the description and elaboration of its underpinning methods and data analysis process. J Res Nurs, 2018, 23: 42\u0026ndash;55.\u003c/li\u003e\n \u003cli\u003eBelsky J. Child maltreatment: an ecological integration. Am Psychol, 1980, 35: 320\u0026ndash;35.\u003c/li\u003e\n \u003cli\u003eZhou X, Wu J, Liu Y, Yan Y, Zhou G, Li M. Developing a Multi-Dimensional Health Index System for a General Occupational Population in the Light of Health Ecology Theory: A Delphi Study. Risk Manag Healthc Policy, 2024, 17: 1523\u0026ndash;32.\u003c/li\u003e\n \u003cli\u003eShi J, Mo X, Sun Z. Content validity index in scale development. J Cent South Univ(Med Sci), 2012, 37: 152\u0026ndash;5.\u003c/li\u003e\n \u003cli\u003eMarsh HW, Hau KT, Balla JR, Grayson D. Is More Ever Too Much? The Number of Indicators per Factor in Confirmatory Factor Analysis. Multivariate Behav Res, 1998, 33: 181\u0026ndash;220.\u003c/li\u003e\n \u003cli\u003eNie X-F, Cheng L, Huang F, Zhang T-T, Yao Y-D, Tan J, et al. Construct validity and psychometric properties of the Chinese version of the City Birth Trauma Scale. J Obstet Gynaecol Res, 2022, 48: 2946\u0026ndash;55.\u003c/li\u003e\n \u003cli\u003eStreiner DL. Figuring out factors: the use and misuse of factor analysis. Can J Psychiatry, 1994, 39: 135\u0026ndash;40.\u003c/li\u003e\n \u003cli\u003eYuan J. Development and Application of Preschooler\u0026rsquo;s Caregivers\u0026rsquo;\u0026nbsp;Feeding Behavior Scale. Air Force Medical University, 2019.\u003c/li\u003e\n \u003cli\u003eCarey RG, Seibert JH. A patient survey system to measure quality improvement: questionnaire reliability and validity. Med Care, 1993, 31: 834\u0026ndash;45.\u003c/li\u003e\n \u003cli\u003eZhang L. Development and preliminary application of self-management evaluation scale for patients with aortic dissection after surgery. Fujian Medical University, 2021.\u003c/li\u003e\n \u003cli\u003eDu C, Zhao Y, Ren J, Chen Y. Study advancement on commonly used tatistics methods in item selection of TCM syndrome scale. Journal of Shanxi University of Chinese Medicine, 2015: 67\u0026ndash;70.\u003c/li\u003e\n \u003cli\u003eTian F, Peng Z, Mi Y, Gui S, Liu M, Zhang T, et al. Development and validation of a rating scale for barriers to and facilitators of nurses\u0026rsquo;\u0026nbsp;participation intentions in\u0026nbsp;\u0026ldquo;Internet\u0026thinsp;+\u0026thinsp;Nursing Service.\u0026rdquo;\u0026nbsp;BMC Nurs, 2024, 23: 559.\u003c/li\u003e\n \u003cli\u003eJayawardena CK, Groenier M, Nawarathna LS. Relationship of adaptive expertise of health professions educators with age, experience, academic rank, and their work performance during an altered academic environment. BMC Med Educ, 2024, 24: 862.\u003c/li\u003e\n \u003cli\u003eGu R, Sun T, Pan Y, Wang J, Li Q, Zhang Y, et al. Development and validation of gestational diabetes mellitus health literacy scale. Patient Educ Couns, 2024, 127: 108365.\u003c/li\u003e\n \u003cli\u003eShultz KS, Whitney DJ, Zickar MJ. Measurement Theory in Action：\u0026nbsp;Case Studies and Exercises. Routledge, 2020.\u003c/li\u003e\n \u003cli\u003eLeechanavanicpan P, Phucharoenrak P, Phansuea P, Trachootham D. Coconut Milk Consumption and Breast Cancer Risk in Thai Women: A Case-Control Study. Nutr Cancer, 2024: 1\u0026ndash;11.\u003c/li\u003e\n \u003cli\u003eLiu Y, Zhang L, Xu K, Ding Y, Li F, Zhang T. Cross-cultural adaptation and validation of the short nutritional literacy scale for young adults (18-35years) and analysis of the influencing factors. BMC Public Health, 2024, 24: 2158.\u003c/li\u003e\n \u003cli\u003eLi S, Fan J, Liu Y, Yu M, Jiang Y. Development and psychometric properties of a perceived social support scale for nurses returning to work after childbirth. BMC Nurs, 2024, 23: 547.\u003c/li\u003e\n \u003cli\u003eWolf MG, McNeish D. dynamic : An R Package for Deriving Dynamic Fit Index Cutoffs for Factor Analysis. Multivariate Behav Res, 2023, 58: 189\u0026ndash;94.\u003c/li\u003e\n \u003cli\u003eMa M, Shi Z, Chen Y, Ma X. Recovery journey of people with a lived experience of schizophrenia: a qualitative study of experiences. BMC Psychiatry, 2023, 23: 468.\u003c/li\u003e\n \u003cli\u003eGlad KA, Jensen TK, Holt T, Ormhaug SM. Exploring self-perceived growth in a clinical sample of severely traumatized youth. Child Abuse Negl, 2013, 37: 331\u0026ndash;42.\u003c/li\u003e\n \u003cli\u003eWen M, Wang R, Cheng L, Nie X, Peng Z, Chen G, et al. Meta-synthesis of Qualitative Studies on Postpartum Posttraumatic Growth Experiences. Mil Nurs, 2024, 41: 94-97,102.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Posttraumatic growth, Instrument development, Parturition, psychometric","lastPublishedDoi":"10.21203/rs.3.rs-7309721/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7309721/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThe Posttraumatic Growth Inventory (PTGI) is widely used across various trauma-affected populations. However, no version specifically targets the maternal population, limiting its ability to fully capture the unique characteristics of posttraumatic growth (PTG) in this group. To address this gap, the present study aimed to develop the Postpartum Posttraumatic Growth Inventory (PP-PTGI) and evaluate its psychometric properties, guided by PTG theory.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA total of 3 separate studies contributed to the development of the PP-PTGI scale between July 2023 and May 2024. In study 1, a preliminary item pool was developed on the basis of PTG theoretical framework, and a Delphi expert letter consultation (N=17) was conducted to modify and improve the items, and a preliminary PP-PTGI scale with 33 items was obtained. Study 2 involved item analysis and exploratory factor analysis (N=211) to screen the items. In Study 3, confirmatory factor analysis, criterion-related validity, and reliability analysis (N=202) were performed to assess the reliability and validity of the final scale.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe PP-PTGI comprises 26 items across six dimensions. The scale demonstrated good reliability, with a total Cronbach’s α of 0.901 and subscale α values ranging from 0.832 to 0.883, indicating high internal consistency. It also showed good content validity, structural validity, and criterion-related validity, supporting its applicability in assessing posttraumatic growth among women with birth-related trauma.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe PP-PTGI is a reliable and valid tool for measuring posttraumatic growth in postpartum women. Its use can support healthcare professionals in better understanding the psychological recovery of women following birth trauma, and in delivering more targeted and effective care to promote their posttraumatic growth.\u003c/p\u003e","manuscriptTitle":"The development and psychometric validation of the Postpartum Posttraumatic Growth Inventory (PP-PTGI)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-10 08:17:53","doi":"10.21203/rs.3.rs-7309721/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3afefee0-18be-46e0-ad94-f96171915bdd","owner":[],"postedDate":"September 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-25T08:55:44+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-10 08:17:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7309721","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7309721","identity":"rs-7309721","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}