Translation and psychometric evaluation of the Persian version of the “Quality of Woman-Centered Midwifery Care Scale” in labor and childbirth

Translation and psychometric evaluation of the Persian version of the “Quality of Woman-Centered Midwifery Care Scale” in labor and childbirth | 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 Translation and psychometric evaluation of the Persian version of the “Quality of Woman-Centered Midwifery Care Scale” in labor and childbirth Mahnaz Azari, Dr. mozhjgan javadnoori, Dr.Saeed ghanbari, Dr.Nahid Javadifar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4756255/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 role of service recipients in defining service quality can be considered an important competitive criterion. Therefore, health care providers are trying to use quality assessment tools that emphasize client-centered. This study aimed to translate and psychometrically evaluate the “quality of woman-centered midwifery care” (QWC_MC) in labor and childbirth for use in Iran. methods This cross-sectional study was conducted in two parts: translation and psychometric evaluation. The process of translating the QWC_MC questionnaire to Persian followed the model proposed by Wild et al. Face validity was investigated using a qualitative method with the participation of 20 mothers. The content validity was evaluated by 10 experts using the content validity ratio and content validity index. The construct validity was investigated with exploratory and confirmatory factor analysis by completing the questionnaire with 350 mothers who were admitted to the postpartum ward of hospitals (Imam Khomeini, Taleghani and Sina) affiliated with the University of Medical Sciences Ahvaz; these mothers were selected by convenience sampling. Reliability and repeatability were assessed using Cronbach’s α and the ICC. SPSS. V26 and STATA. V14 was used for the data analysis. Results The QWC-MC scale has 33 questions, and the translation and psychometric properties of its Persian version were confirmed. EFA identified four factors that accounted for 58.20% of the total variance. The structural validity of the extracted factors was confirmed through confirmatory factor analysis. The reliability and repeatability using Cronbach’s α and the ICC for the entire questionnaire were 0.88 and 0.99, respectively. Conclusions The findings show that the Persian version of the QWC-MC has good to acceptable validity and reliability. Therefore, it can be used as an effective tool to measure and evaluate the quality of woman-centered midwifery care during labor and childbirth in Iran. Woman-centered Psychometric evaluation Questionnaire Figures Figure 1 Figure 2 Background advancing maternal and neonatal health remained one of the unfinished agendas of the Millennium Development Goals and a high-priority section of the Sustainable Development Goals (1). According to the definition of the World Health Organization (WHO), the concept of maternal health indicates "mother’s health during pregnancy, childbirth and postpartum"(2). Approximately 830 women pass away each day from preventable causes related to pregnancy and childbirth. The majority of these can be prevented by offering necessary and high-quality care. A lack of person-centered care (PCC) in less developed areas may lead to delays in care and avoidable maternal deaths (3). Therefore, within the framework of the goal of sustainable development 3(4), a focus on providing high-quality care during labor is essential to reduce adverse maternal and neonatal outcomes (5). A person-centered approach in both developed and less developed regions holds promise for improving the quality of maternity care (6). Thus, PCC is now considered an essential motivation of policy and practice to obtain high-quality health care. The role of service recipients in defining service quality can be considered an important competitive criterion (6). For this reason, health care providers are trying to use quality assessment tools that meaningfully emphasize client-centered tools (7). Quality indicators or evaluations in clinical midwifery are usually used to evaluate the results, but they do not adequately reflect the complexity of midwifery care processes and mainly focus on measuring women's satisfaction with midwifery care. Additionally, they differ in structural definition and psychometric properties (8). To measure the quality of women-centered midwifery care inside and outside the hospital, a standard and valid tool to evaluate the quality of care processes according to the combination of theoretical approaches containing the most important features of woman-centered midwifery care is needed (8). The tool for measuring the quality of women-centered obstetric care includes important dimensions of women-centered care from the perspective of women and can be useful for evaluating women's views on women-centered care. This tool was first used by Schulz and Wirtz (2021) in Germany to measure the quality of woman-centered midwifery care (QWC-MC) processes with 33 questions in four subscales: Shared Decision Making (SDM-Q-9), Empathy Midwife (EM-Q-11), Internal Team Cooperation (TC-Q-5) and Professional Competence (PC-Q-8) (8). This tool exists in the German language, and our comprehensive search showed that the present instrument has not been psychometrically evaluated in other languages. Examining the psychometric characteristics and cultural adaptation of the scales helps researchers ensure that the scales used in different societies have measured the same concepts of interest and acceptable psychometric standards and therefore increase the power of interpretation of research findings (9). The lack of appropriate tools to measure the quality of woman-centered midwifery care from the perspective of women in Iran, and as a result, not using it, is a challenge in the field of woman-centered maternity care quality. This issue prompted the researchers to take measures for the translation and psychometrics of the midwifery Care Quality Scale for Women. The simplicity, brevity and consideration of the important aspects of woman-centered care in this instrument were among the reasons for choosing it for psychometric purposes. The translation and validation of the Persian QWC-MC in this research aim to facilitate a more accurate assessment of the quality of woman-centered midwifery care during labor and delivery from the perspective of women in Iran, which can serve as a basis for further research and interventions to improve the quality of woman-centered midwifery care. Methods Study design The present research is a cross-sectional study that was conducted with the aim of translating and psychometrically evaluating the Persian version of the “quality of woman-centered midwifery care” labor and childbirth from January to May 2024 in Ahvaz, Southwest Iran. Demographic questionnaire Demographic characteristics included age, education, job, income, place of residence, parity and ethnicity of the mothers. These demographic variables were considered important factors for obtaining a comprehensive understanding of sample characteristics and their potential impact on research results. QWC_MC Scale translation The QWC_MC Scale was translated following the model proposed by Wild et al (10). Permission for use and translation was obtained from the original developers through email correspondence. This approach included the following steps: translation, reverse translation, expert review, pilot study, correction and summary. The above steps were also followed in the present study. Two translators, proficient in German and Persian, translated the scale into Persian. Their translations were compared and modified to make a final version. Two additional translators, fluent in both the Persian and German languages, back-translated the Persian translation into German. Then, the original tool designer accredited the translated version. The facial validity, content validity, construct validity, internal consistency and scale stability of the translated scale were subsequently validated. Ethical consideration The research proposal was approved by the Ethics Committee of Ahvaz Jundishapur University of Medical Sciences (Ethics code: IR.AJUMS.REC.1402.506). After obtaining permission from the main designer of the tool and informed written consent from the participant’s study, the objectives of the research and the confidentiality of the information were shared with the participants. Sample size According to researchers, the minimum sample size required is 100-250 people (11); however, some studies determine the size according to the number of items; in this way, they choose 10-20 people for each item or, to determine construct validity, 3 to 10 people are needed for each item in the instrument (11-12). Therefore, considering 10 samples for each item, a sample size of 350 people was calculated. Participants The participants included all women who underwent vaginal delivery and who were admitted to the postpartum ward of hospitals (Imam Khomeini, Taleghani and Sina) affiliated with the University of Medical Sciences Ahvaz/Iran and who were selected by the available sampling method. A sample of 350 women completed the Persian version of the QWC-MC Scale for psychometric evaluation. The participants were selected based on the eligibility criteria of the study by means of convenience and purposeful sampling. The inclusion criteria were as follows: age > 18 years, singleton, gestational age > 37 weeks, vaginal delivery, literacy in reading-writing and willingness to participate in the study. The exclusion criteria were high-risk pregnancy (any medical or obstetric problems such as diabetes, high blood pressure, or intrauterine fetal death), hospitalization of the infant and incomplete questionnaires. Introduction of the QWC-MC Tool The QWC-MC scale was first developed by Schulz and Wirtz (2021) in Germany to measure the QWC-MC during prenatal care. The scale comprises 33 items categorized into 4 subscales: SDM-Q-9-M with a six-point Likert scale (0 = completely disagree all, 1 = Disagree, 2 = Somewhat disagree, 3 = Somewhat agree, 4 = Agree, 5 = completely agree); E-Q-11-M with a five-point Likert scale and reverse-coded (1 = Fully applies, 2 = Mostly applies, 3 = Occasionally applies, 4 = Hardly applies, 5 = Not apply at all); and TC-Q-5 and PC-Q-8-M with a six-point Likert scale (1 = Not apply at all, 2 = Mostly not apply, 3 = Somewhat not apply, 4 = Somewhat applies, 5 = Mostly applies, 6 = fully applies). The questionnaire scores are in the range of 24–178. Higher scores indicate better QWC-MC. The original scale showed good fit and reliability, with omega coefficients ranging from 0.84 to 0.92 for components and ≥ 0.86 for the overall scale (Table 1 ) ( 8 ). Table 1 Subscales and scores for the QWC-MC questionnaire Subscales items Score range Shared Decision-Making 9 0–45 Empathy Midwife 11 11–55 Internal Team cooperation 5 5–30 Professional competence 8 8–48 TOTAL 33 24–178 Table 1- shows that the midwifery care questionnaire is centered on women with 4 scales and scores in the range of 24 to 178. Descriptive statistics Data analysis was performed using SPSS version 26 and STATA version 14 software. Descriptive statistics, including frequencies and percentages, were used to report the characteristics of the participants, and the Kolmogorov‒Smirnov test was used to assess the normality of the distribution of the data. Cronbach's alpha coefficient was used for the internal consistency of all questionnaires and subscales. The mean and standard deviation were used to analyze quantitative variables, and the frequency and percentage were used for qualitative variables. Validity Face validity The scale was retranslated into Persian to 20 mothers to evaluate face validity using a qualitative method, and the items were evaluated in terms of difficulty level, appropriateness level and word ambiguity. The quantitative face validity was determined using the item impact method. At this stage, a number of people from the target group are asked to evaluate each item in terms of importance and give each item a score of 1 to 5 according to the importance level. For this purpose, a five-point Likert scale was used for each scale item: 5 = completely important, 4 = important, 3 = moderately important, 2 = slightly important and not 1 = important at all. In the impact score method, an impact score is obtained by multiplying the frequency of an item (Impact Score = Frequency (%) * Importance). An impact score above 1.5 means that the item was fit for subsequent analyses and will be retained( 13 ). Content validity To measure the validity of the content using a qualitative method, 10 university professors (specialists in midwifery and with a background in research in the field of instrument psychometrics from Iran's top universities) were asked to check the scale in terms of the appropriate time for completion, the correctness of the language, the appropriateness of the words and their correction points in writing. After carefully reading their comments, appropriate corrections were made by the research team. Finally, the writing of some items was changed and modified. To evaluate the validity of the quantitative content, two indices, the content validity ratio (CVR) and the content validity index (CVI), were used. A checklist with two sections was designed for each specialist. The first part of the checklist is designed to calculate CVI, and the second section is designed for CVR. The first section of the checklist evaluates the lucidity, simplicity and relation of the items based on a 4-point Likert scale. The second section evaluates the necessity of each item based on a 3-point Likert scale (3 = It is necessary, 2 = it is useful, but it is not necessary, 1 = it is not necessary). The minimum acceptable scores for the CVI and CVR were considered to be higher than 0.79 and 0.62, respectively( 14 ) . Construct validity The construct validity is measured using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) ( 1 ). EFA was conducted on a sample of 350 mothers. The suitability of the data for EFA was assessed using the Kaiser–Meyer–Olkin (KMO) measure and Bartlett’s test of sphericity. A KMO correlation above 0.60–0.70 is considered adequate for analyzing the EFA output( 15 ). CFA was conducted using STATA version 14 software. Model fit was assessed using several indices, including the no normed fit index (NNFI or TLI), comparative fit index (CFI), chi-square to degrees of freedom ratio, standardized root mean squared residual (SRMR), coefficients of determination (CD), and root mean square error of approximation (RMSEA). These indices are often used to appraise the fit of the CFA model ( 16 ). Principal component analysis was used to extract factors, and the eigenvalue method and scree plot were used to determine the number of factors. Varimax rotation was used to determine which variables belonged to which factor and to make the factors interpretable—confirmatory factor analysis. Reliability In this study, the internal consistency and consistency reliability methods were used to evaluate the reliability of the questionnaire. To determine the reliability and internal consistency of the instrument, the Cronbach’s α coefficient and the time stability or repeatability of the method (test-retest) were checked. The internal consistency of the scale was calculated using the Cronbach’s α coefficient for the whole questionnaire and then for each subscale. The considered scale will have adequate reliability when the Cronbach’s α coefficient is greater than or equal to 0.7 be( 17 ). with the test-retest method to determine the repeatability. The time interval between the two tests is suggested to be two weeks to one month ( 18 ). For this purpose, the researcher administered the questionnaire to 30 mothers in the postpartum ward in two shifts at an interval of 4 weeks. In the first stage, the questionnaire was completed 24 hours after delivery in the postpartum ward, and in the second stage, it was completed 28 days after delivery when the patients visited health centers with prior coordination or phone calls. This number of mothers was included in the sample. The Spearman-Brown correlation test was used to compare the results of two tests. The correlation between the scores obtained from the two tests was determined with the correlation coefficient (ICC) test, which is the most acceptable test for determining the stability of the test. When this index is between 0.7 and 0.8, the level of stability is favorable ( 19 ). Results Demographic characteristics A total of 350 mothers completed the questionnaire. The demographic data of the mothers revealed that 40.9% were between 26–35 years old, 52.0% had elementary-secondary literacy, 96.3% were homemakers, 77.7% were multiple parous, 51.1% were rural, and 69.71% had mothers of Arabian ethnicity (Table 2 ). Table 2 Demographic characteristics of the participants(n = 350) Variable Categories N (%) Age 19–25 38.3 26–35 40.9 36–45 20.9 Education Elementary -Secondary school 70.3 High school diploma 23.1 College education 6.6 Income Low 44.6 Moderate 50.3 High 5.1 Job Homemaker 96.3 Employed 3.7 Parity prim parous 22.3 Multi parous 77.7 Mother's Ethnicity Arab 69.71 Persian 14.2 Bakhtaran’s 9.4 Lori 6.69 Turkish 0 Place of Residence urban 48.9 rural 51.1 Table 2- shows that the mothers revealed that 40.9% were between 26 - 35 years old, 52.0% had elementary-secondary literacy, 96.3% were homemakers, 77.7% were multiple parous, 51.1% were rural, and 69.71% had mothers of Arabian ethnicity. Face validity After checking the opinions of the mothers, due to the problems in understanding the concept, modifications were made to question 1 of the SDM and question 6 of the PC for a better comprehension of the concept, and the questionnaire was given to the same mothers anew. the score of impact in all questions was ≥ 1.5. All questions were retained for further analysis. Content validity The CVI for all the items was 1, and the CVR ranged from 1-0.83. Accordingly, none of the questions were deleted. Overall, the content validity of the scale was confirmed (Table 4 , 5 , 6 ). Table 3- Eigenvalues, Percentage of variance of the Persian version (n = 350) Factor Eigenvalues Percentage of variance Cumulative variance percentage 1 10.417 31.568 31.568 2 4.456 13.504 45.072 3 2.375 7.197 52.269 4 1.958 5.932 58.2.1 The above table shows that the highest Eigenvalues and variance are related to the first factor (SDM subscale). Table 4- Impact score, CVR, CVI and factor loading of the SDM subscale Persian version (n = 350) Item Item impact score Content validity Extracted factors Item content CVR CVI 1 2 3 4 Shared Decision-Making 1-The midwife told me explicitly that I had to decide for myself. 3.62 1 1 .751 .285 -.030 .163 2-I had a desirable participation in the decision-making process. 3.44 0.83 1 .755 .272 -.035 .121 3-Information was provided about various options and alternatives. 2.92 1 1 .793 .232 -.072 .116 4-The pros and cons of the options were explained to me in detail. 3.88 1 1 .819 .190 -.054 .129 5-The midwife helped me understand all the information. 3.34 1 1 .804 .176 -.022 .139 6-The midwife asked me which option I preferred. 2.57 1 1 .786 .125 .068 .118 7-The midwife and I thoroughly explored the various options. 3.35 1 1 .764 .145 .036 .131 8-The midwife and I chose the final option. 2.58 1 1 .778 .123 -.009 .108 9-The midwife and I agreed on future care processes. 2.94 1 1 .774 .129 -.025 .182 Table 4: Impact score, CVR, CVI and the factor loading of the subscale SDM shows that all questions have high face validity, content and factor load. Therefore, SDM is very important for mothers in labor and delivery Table 5: Impact score, CVR, CVI and factor loading of the EM subscale Persian version (n = 350) Item Item impact score Content validity Extracted factors Item content CVR CVI 1 2 3 4 Empathy Midwife 1-Did the midwife behave in such a way that you feel comfortable with her? 2.69 1 1 .183 .657 .173 .132 2-Did the midwife let you tell your story? 2.59 1 1 .172 .682 .161 .051 3-Did the midwife actually (actively) listen to you? 3.40 1 1 .218 .746 .141 .114 4-The midwife cared about you as an important person . 3.68 1 1 .155 .757 .104 .081 5-The midwife really understood you. 3.15 1 1 .169 .785 .091 .071 6-The midwife was caring and compassionate with you . 3.75 1 1 .181 .721 .053 .145 7-The midwife treated you with a positive attitude . 2.62 1 1 .200 .681 .066 .121 8-The midwife explained everything to you clearly . 3.34 1 1 .146 .422 -.039 .140 9-The midwife created the necessary and sufficient preparation for birth and parenthood in you. 3.56 1 1 .127 .614 .131 .275 10-The midwife has worked with you to develop a plan for continued motherhood . 1.85 1 1 .113 .533 .040 .323 11-Did the midwife give you enough time? 2.56 1 1 .221 .474 .072 .293 Table 5: Impact score, CVR, CVI and the factor loading of the subscale EM shows that all questions have high face validity, content and factor load. Therefore, EM is very important for mothers in labor and delivery. Table 6 Impact score, CVR, CVI and factor loading of the TM and PC subscale Persian version (n = 350) Item Item impact score Content validity Extracted factors Item content CVR CVI 1 2 3 4 Team cooperation 1-The midwife and the gynecologist worked together. 1.87 1 1 .035 .122 .823 .123 2-The consultation between the midwife and my doctor worked well. 1.91 1 1 − .035 .128 .876 .138 3-The information and actions of my midwife and my doctor were well coordinated. 3.13 1 1 − .075 .163 .896 .065 4-Communication between my midwife and my doctor was good. 3.44 1 1 − .043 .086 .869 .093 5-My midwife and my doctor treated each other with respect. 2.29 1 1 .007 .142 .784 .012 Professional competence 1-The midwife involved the people who mattered to me (husband, sister, etc.) in my care. 3.44 0.83 1 .504 .186 .018 .103 2-The midwife took complete care of my health. 2.69 1 1 .360 .324 .052 .451 3-The midwife worked well with other professions (such as primary care, physicians). 1.59 0.83 1 .286 .273 .146 .585 4-The midwife has reliably addressed the issue of whether and when other professions should be involved (for example, early intervention, physicians). 1.40 1 1 .137 .093 .206 .770 5-The midwife was an expert in her field. 3.28 1 1 .070 .115 .222 .812 6-The midwife had up-to-date knowledge of midwifery. 1.69 1 1 .102 .175 .090 .749 7-The midwife did her best to prepare me physically for birth and parenthood. 3.64 1 1 .202 .257 − .045 .506 8-The midwife did her best to psychologically prepared me for birth and parenthood. 2.12 1 1 .224 .192 − .163 .419 Table 6: Impact score, CVR, CVI and the factor loading of the subscale TC and PC shows that all questions have high face validity, content and factor load. Therefore, TC is especially important for mothers in labor and delivery. Construct validity (EFA, CFA ( For EFA with a sample size of N = 350, the Kaiser–Meyer–Olkin (KMO) value was 0.882, which indicates sufficient sample adequacy. Bartlett's sphericity test was significant (χ2 = 8138.062, df = 528, p 1 were identified, which explained 58.20% of the total variance in the quality scale of the QWC-MC (Fig. 1 , Table 3 ). The four-factorial structure of all-item subscales SDM ≥ 0.751, EM ≥ 0.422, TC ≥ 0.784, and PC ≥ 0.419 were confirmed to be above 0.4. In addition to the 1-item subscale of PC {PC1- The midwife involved the people who mattered to me (husband, sister, etc.) in my care}, which was transferred to the subscale of SDM (Table 4 , 5 , 6 ). The above table shows that the highest Eigenvalues and variance are related to the first factor (SDM subscale). Based on the scree plot, the results of the factor analysis (4-factor structure) were justified. Varimax rotation was used to determine which variables belonged to which factor and to make the factors interpretable (Fig. 2 ). The flow diagram of the four-factor model of the Persian QWC-MC version shows that the minimum and maximum item-scale correlation coefficients are 0.31 and 0.92, respectively. For all the item-scale correlation coefficients in the factor analysis, P˂ 0.000 was significant, which means that all the items were significantly correlated with their factors, and Rotation converged in 5 iterations. The fit indices for the four-factor structure of the Scale QWC-MC, including the TLI, CFI, SRMR, CD, RMSEA and χ2/df (p < 0.000), demonstrated good to acceptable fits in the present study. Therefore, according to the fit indices, the obtained model shows an acceptable fit, which confirms the four-factor structure of the Persian version of the scale (Table 7 ). Table 7 Model fit indices of CFA for the Persian version Index TLI CFI SRMR CD RMSEA χ2/ df (p value) value 0.735 0.755 0.085 1 0.107 8138.062/528 p < 0.000 TLI: Tucker‒Lewis index, CFI: comparative fit index, df: degree of freedom, SRMR: standardized root mean squared residual, CD: coefficients of determination, RMSEA: root mean square error of approximation The above table shows that according to the fit indices (TLI, CFI, SRMR, χ2/df, p value) the obtained model has an acceptable fit and confirms the four-factor structure of the Persian version of the scale. The above table shows that according to the fit indices (TLI, CFI, SRMR, χ2/df and p value) the obtained model has an acceptable fit and confirms the four-factor structure of the Persian version of the scale. Reliability In this study, the Cronbach’s α coefficient for the translated scale was between 0.79 and 0.91, and for participation in the SDM subscale, it was 0.87; for EM, it was 0.91; for TM, it was 0.79; and for PC, it was 0.81. The value was found to be high and acceptable. The test-retest results were for the SDM subscale 1, EM = 0.98, TC = 0.99 and PC = 0.99; The reliability and repeatability using Cronbach’s α and the ICC for the entire questionnaire were 0.88 and 0.99, respectively therefore, the reliability of the temporal stability or repeatability of the questionnaire is acceptable and appropriate (Table 8 ). a Table 8 Cronbach’s α coefficient for the entire questionnaire and subscale the Persian version (n = 350) subscale items Cronbach’s α Test-retest Shared Decision-Making 10 0.87 1 Midwife empathy 11 0.91 0.98 Team cooperation 5 0.79 0.99 Professional competence 7 0.81 0.99 Table 8 : shows that the highest Cronbach's α score was obtained by the EM subscale and the highest test-retest by the SDM subscale. Discussion This study was conducted with the aim of investigating the psychometric properties and factor structure of the translated quality of the Woman-Centered Midwifery Care Scale among Iranian mothers. The findings show that the Persian version of the scale has good validity and reliability in the community of mothers. However, no previous research has specifically focused on the quality of Iranian woman-centered midwifery care. Furthermore, there is limited research on the psychometric properties of the scale in other countries and languages beyond the original German study. Woman-centered care includes supporting the woman's autonomy, respecting her values, and involving the woman in the care process(20). This relationship includes value-based care (21), self-management and customer-oriented care concepts (22). The government must ensure that women have access to quality maternal and newborn care, not only because it is a way to prevent maternal and newborn deaths but also because it is a basic human right that the government is obligated to support. The demographic characteristics of our study participants were consistent with the demographic characteristics of the participants in the original instrument development study. According to the original tool, 55.2% of mothers were aged 30-35 years, 96.5% were of German descent, 98.4% had a high school education or less, 77.6% were married, 85% had an average income, 76.6% had a low-risk pregnancy, 57.7% were prim parous women, and 73.6% had a vaginal delivery. The findings of the present research in determining face and content validity show that all scale items are relevant, clear and simple after minor changes are made. In addition, the obtained CVI values show that the Persian version of the questionnaire has very good content validity, which indicates its ability to effectively measure the QWC-MC. On the other hand, after conducting exploratory factor analysis and detailed examination of the results, a questionnaire with 33 items (without removing any item from the original questionnaire) and 4 identified factors was approved. Question one on the PC of exploratory factor analysis was placed in the SDM subgroup. In the original instrument, the subscale PC that measures professional competence showed insufficient data in the definition of the main one-dimensional model, and the residual correlation analysis has been shown to reflect the latent construct of professional competence as a quadratic factor(8) . Although the original tool was designed to evaluate the QWC-MC during prenatal care and the designer of the tool confirmed that this questionnaire can be used with changes to evaluate the quality of female-centered midwifery care for delivery and postpartum, this may be one of the possible reasons. Additionally, in our teaching hospitals, it is not possible to accompany (husband, sister, etc.) the mother's request for care during labor and delivery; for this reason, question 1 of the PC subscale moved to the SDM subscale, and this has been scientifically accepted. Ultimately, there were 10 SDM items and 7 professional qualification questions. In the present study, the fit indices for the four-factor structure of the QWC-MC scale demonstrated good to acceptable fits. According to our findings, in the study of Schulz, Wirtz (2021), the model showed good to acceptable model fit(8), so the results of this study with version The original matches. Additionally, the validity and reliability of the tool are consistent with those of its original version. In this study, a reliability coefficient of 0.88 was obtained for the entire tool. which shows the internal consistency with the original version of the instrument. In the original version of this tool, the Cronbach's α coefficients were ≥ 0.86 for all assessment scales(8). The stability and reliability results obtained from the two implementations of this tool four weeks apart in the study were desirable and satisfactory. This indicates the stability of the results over time and shows that if this tool is used at different times, it will provide the same results, which is consistent with the results of the original version of this tool. Our comprehensive search showed that the present instrument has not been psychometrically evaluated in other languages. Therefore, we have to compare this tool with other tools. In a number of recent studies, the PCMC questionnaire has been used to assess the quality of midwifery care for women. This scale includes 30 items that cover three sections: dignity and respect (6 items), communication and independence (9 items) and supportive care (15 items). For example, 0 (no, never), 1 (``yes, some times''), 2 (``yes, most of the time''), and 3 (``yes any time'') were reverse coded. Therefore, high numbers indicate good care. Therefore, the score of the scale varies from zero to 90(23-26) . According to the psychometric analysis of the PCMC tool by Naito et al. (2023), for Cambodian women, the content validity index for the entire 30-item tool, Kh-PCMC, was 0.96. However, twenty items performed better in the psychometric analysis of the data in Cambodia. The 20-item Kh-PCMC scale had a Cronbach's alpha of 0.86 for the whole instrument and 0.76-0.91 for the subscales, which indicates acceptable internal consistency (27) . This questionnaire is not specific to women-centered midwifery care; moreover, it does not examine the professional competence of providers separately. Khakbazan et al. (2022) focused on analyzing the concept of the quality of midwifery care (MCQ) through the design of a quality assessment tool and its psychometric analysis in maternity wards. The results of exploratory factor analysis confirmed a 39-item instrument with 4 factors that explained 49.61% of the variance of the variables of the whole instrument. The internal consistency of these four factors was 0.936 according to Cronbach's alpha, and the intracluster correlation coefficient was 0.945 according to the test-retest results. The MCQ tool assesses midwives' views on the quality of postpartum midwifery care(28). QWC-MC tool structures are the main components of the woman-centered midwifery care process and are used scales that are accepted internationally in the field of patient-centered care (8). With this tool, the conceptual basis and assessment of woman-centered midwifery care can be enhanced through assessments aligned with standards set in other clinical care settings. The instrument measuring the QWC-MC in labor and delivery had relatively good to acceptable validity and reliability among Iranian women and can be a good, valid and comprehensive measurement tool that highlights women's real experience with woman-centered care. Limitations: The present study, however, has weaknesses and limitations, such as the lack of generalizability of the results, due to place limitations. In the present study, the quality of woman-centered midwifery care was studied in selected hospitals of Jundishapur University, Ahvaz, and private and non-university hospitals were not considered. Therefore, it is suggested that in future studies, the psychometric characteristics of the mentioned questionnaire in private hospitals and postpartum care should also be assessed in a more comprehensive and national study. Conclusions The findings of the present study showed that the Persian version of the woman-centered midwifery care quality scale has acceptable validity and reliability among Iranian mothers. Additionally, the results of face and content validity evaluation indicate that this tool is attractive because it is suitable for evaluating the quality of midwifery care. Due to its desirable psychometric properties, ease of implementation and special evaluation ability, the use of this scale in labor and delivery is recommended. Additionally, the reliability of the Persian version of the scale showed that this questionnaire has good internal consistency. To further reinforce the validity of the Persian version of the scale, we proposed conducting more studies in clinical environments during pregnancy and after delivery. This helps to ensure the generalizability of the scale. Abbreviations MMR : : Maternal mortality rate, PCC : Person-Centered Care, WCC : woman-centered Care , PCMC : Person-Centered Maternity Care, Kh-PCMC : Khmer- Person Centered Maternity Care, QWC-MC : Quality of Woman-Centered Midwifery Care, MCQ : Midwifery Care Quality, EFA : Exploratory Factor Analysis, CFA : Confirmatory Factor Analysis, CFI: Comparative Fit Index, RMSEA: Root-mean-square Error of Approximation , SRMR : Standardized Root Mean Squared Residual , CD ; Coefficients of Determination, TLI : Tucker‒Lewis Index, CVI : Content Validity Index, CVR : Content Validity Ratio , ICC : Interclass Correlation Coefficient, χ2: Chi-square, D F: Degree of Freeness Declarations Acknowledgments: This article is a part of the doctoral thesis of midwifery at Jundishapur University of Ahvaz . We would like to thank and appreciate the research and technology vice-chancellor of the university as well as all the mothers who participated in this research. Author contributions MA: data collection, data analysis, interpretation and drafting of the article. NJ and MJ: critically revised of the article, SGH: data analysis; all the authors reviewed the manuscript. Funding The authors received no financial support for the research, authorship, and/or publication of this article. Availability of data and analyzed The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Ethics approval and consent to participate The research proposal was approved by the Ethics Committee of Ahvaz Jundishapur University of Medical Sciences (Ethics code: IR.AJUMS.REC.1402.506). Ethical considerations observed in this research include: permission to conduct the study, presentation of letter of introduction to hospital officials, announcement of study results if requested by the officials of the studied hospitals, and ensuring of confidentiality of information, the aims of the study were explained to the mothers and informed and written consent was obtained from them to participate in the study. All methods were performed in accordance with the relevant guidelines and regulations. Consent for publication Not applicable . Competing interests The authors declare that they have no competing interests References Hamal M, Dieleman M, De Brouwere V, de Cock Buning T. Social determinants of maternal health: a scoping review of factors influencing maternal mortality and maternal health service use in India. Public Health Reviews. 2020;41:1-24. Nelson P. Human rights and the 2030 development agenda. 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Identifying strategies to implement patient-centred care for women: qualitative interviews with women. Patient Education and Counseling. 2020;103(7):1422-7. Schulz AA, Wirtz MA. Assessment of the quality of woman-centred midwifery care from the mothers’ perspective: A structural analysis of cross-sectional survey data. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen. 2021;166:8-17. Heidari M, Akbarfahimi M, Salehi M, Nabavi SM. Survey validity of translation for Persian and cultural adaptation of Fatigue Impact Scale (FIS) questionnaire in multiple sclerosis patients in Iran. Modern Rehabilitation. 2012;6(3). Rybowiak V, Garst H, Frese M, Batinic B. Error orientation questionnaire (EOQ): Reliability, validity, and different language equivalence. Journal of Organizational Behavior: The International Journal of Industrial, Occupational and Organizational Psychology and Behavior. 1999;20(4):527-47. Arafat SY. Validation study can be a separate study design. Int J Med Sci Public Health. 2016;5(11):2421-2. Grove SK, Gray JR, Faan PR. Understanding Nursing Research: First South Asia Edition, E-Book: Building an Evidence-Based Practice: Elsevier India; 2019. Johnson E. Face Validity. In: Volkmar FR, editor. Encyclopedia of Autism Spectrum Disorders. Cham: Springer International Publishing; 2021. p. 1957-. Polit DF, Beck CT, Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Research in nursing & health. 2007;30(4):459-67. Taherdoost H, Sahibuddin S, Jalaliyoon N. Exploratory factor analysis; concepts and theory. Advances in applied and pure mathematics. 2022;27:375-82. Tinsley H, Brown S. Handbook of applied multivariate statistics and mathematical modeling: academic press. San Diego[Google Scholar]. 2000. Robinson MA. Using multi‐item psychometric scales for research and practice in human resource management. Human resource management. 2018;57(3):739-50. Reisy L, Ziaee S, Mohamad E. Designing a questionnaire for diagnosis of vaginismus and determining its validity and reliability. Journal of Mazandaran University of Medical Sciences. 2015;25(125):81-94. Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. Journal of chiropractic medicine. 2016;15(2):155-63. Berg M, Ólafsdóttir ÓA, Lundgren I. A midwifery model of woman-centred childbirth care–In Swedish and Icelandic settings. Sexual & Reproductive Healthcare. 2012;3(2):79-87. Hall J. Spirituality, compassion and maternity care. The roar behind the silence London: Pinter & Martin Ltd. 2015:94-7. Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J. Self-management approaches for people with chronic conditions: a review. Patient education and counseling. 2002;48(2):177-87. Getahun SA, Muluneh AA, Seneshaw WW, Workie SG, Kassa ZY. Person-centered care during childbirth and associated factors among mothers who gave birth at health facilities in Hawassa city administration Sidama Region, Southern Ethiopia. BMC Pregnancy and Childbirth. 2022;22(1):584. Alelign YA, Melesse MF, Beka E, Alemu AA, Ejigu Meskele N, Asres CG. Person-centered maternity care during childbirth and associated factors among mothers who gave birth at public health institutions of Debre Markos town, Northwest Ethiopia, 2022: A cross-sectional study. SAGE Open Medicine. 2024;12:20503121231225352. Tarekegne AA, Giru BW, Mekonnen B. Person-centered maternity care during childbirth and associated factors at selected public hospitals in Addis Ababa, Ethiopia, 2021: a cross-sectional study. Reproductive Health. 2022;19(1):199. Afulani PA, Phillips B, Aborigo RA, Moyer CA. Person-centred maternity care in low-income and middle-income countries: analysis of data from Kenya, Ghana, and India. The Lancet Global Health. 2019;7(1):e96-e109. Naito YT, Fukuzawa R, Ganchimeg T, Afulani PA, Aiga H, Kim R, et al. Validation of the person-centered maternity care scale at governmental health facilities in Cambodia. PloS one. 2023;18(7):e0288051. Khakbazan Z, Damghanian M, Zareiyan A, Abbaszadeh F. The concept of maternal care quality for women with low-risk pregnancy in the maternity ward: An integrative review. Nursing and Midwifery Studies. 2022;11(1):1-10. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4756255","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":338484469,"identity":"4d9d6b35-fff4-4f64-a228-45bca0ab8a07","order_by":0,"name":"Mahnaz Azari","email":"","orcid":"","institution":"Ahvaz Jundishapur University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mahnaz","middleName":"","lastName":"Azari","suffix":""},{"id":338484470,"identity":"148a3925-8051-4705-81ab-433f0c03a9e3","order_by":1,"name":"Dr. mozhjgan javadnoori","email":"","orcid":"","institution":"Ahvaz Jundishapur University of Medical Sciences","correspondingAuthor":false,"prefix":"Dr.","firstName":"mozhjgan","middleName":"","lastName":"javadnoori","suffix":""},{"id":338484471,"identity":"8698a599-5a43-43b0-bd61-0556eeb91068","order_by":2,"name":"Dr.Saeed ghanbari","email":"","orcid":"","institution":"Ahvaz Jundishapur University of Medical Sciences","correspondingAuthor":false,"prefix":"Dr.","firstName":"Saeed","middleName":"","lastName":"ghanbari","suffix":""},{"id":338484473,"identity":"77bc4889-3bdc-423c-838c-53e262603cf2","order_by":3,"name":"Dr.Nahid Javadifar","email":"data:image/png;base64,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","orcid":"","institution":"Ahvaz Jundishapur University of Medical Sciences","correspondingAuthor":true,"prefix":"Dr.","firstName":"Nahid","middleName":"","lastName":"Javadifar","suffix":""}],"badges":[],"createdAt":"2024-07-17 12:31:01","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4756255/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4756255/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":62301531,"identity":"9593f323-63a0-42e9-b0ce-b1e74f1e84e3","added_by":"auto","created_at":"2024-08-12 16:47:09","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":21496,"visible":true,"origin":"","legend":"\u003cp\u003eScree plot for the Persian version\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4756255/v1/5e89c6361efe4e00e4ee184e.png"},{"id":62301530,"identity":"3d0564f1-5bfa-4d46-ac48-b80efa270a39","added_by":"auto","created_at":"2024-08-12 16:47:09","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":623601,"visible":true,"origin":"","legend":"\u003cp\u003eResults of confirmatory factor analysis in standard mode the Persian version (n = 350)\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4756255/v1/e9cd874d007f9edaf36a94fa.png"},{"id":100590226,"identity":"cd1f7388-6350-4d13-90cb-a67c3bbd100d","added_by":"auto","created_at":"2026-01-19 12:48:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1809868,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4756255/v1/f77d879c-4eea-43ff-8c42-5ab664e5134f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Translation and psychometric evaluation of the Persian version of the “Quality of Woman-Centered Midwifery Care Scale” in labor and childbirth","fulltext":[{"header":"Background","content":"\u003cp\u003eadvancing maternal and neonatal health remained one of the unfinished agendas of the Millennium Development Goals and a high-priority section of the Sustainable Development Goals (1). According to the definition of the World Health Organization (WHO), the concept of maternal health indicates \u0026quot;mother\u0026rsquo;s health during pregnancy, childbirth and postpartum\u0026quot;(2). Approximately 830 women pass away each day from preventable causes related to pregnancy and childbirth. The majority of these can be prevented by offering necessary and high-quality care. A lack of person-centered care (PCC) in less developed areas may lead to delays in care and avoidable maternal deaths (3). Therefore, within the framework of the goal of sustainable development 3(4), a focus on providing high-quality care during labor is essential to reduce adverse maternal and neonatal outcomes (5). A person-centered approach in both developed and less developed regions holds promise for improving the quality of maternity care (6). Thus, PCC is now considered an essential motivation of policy and practice to obtain high-quality health care. The role of service recipients in defining service quality can be considered an important competitive criterion (6). For this reason, health care providers are trying to use quality assessment tools that meaningfully emphasize client-centered tools (7).\u003c/p\u003e\n\u003cp\u003eQuality indicators or evaluations in clinical midwifery are usually used to evaluate the results, but they do not adequately reflect the complexity of midwifery care processes and mainly focus on measuring women\u0026apos;s satisfaction with midwifery care. Additionally, they differ in structural definition and psychometric properties (8). To measure the quality of women-centered midwifery care inside and outside the hospital, a standard and valid tool to evaluate the quality of care processes according to the combination of theoretical approaches containing the most important features of woman-centered midwifery care is needed (8). The tool for measuring the quality of women-centered obstetric care includes important dimensions of women-centered care from the perspective of women and can be useful for evaluating women\u0026apos;s views on women-centered care. This tool was first used by Schulz and Wirtz (2021) in Germany to measure the quality of woman-centered midwifery care (QWC-MC) processes with 33 questions in four subscales: Shared Decision Making (SDM-Q-9), Empathy Midwife (EM-Q-11), Internal Team Cooperation (TC-Q-5) and Professional Competence (PC-Q-8) (8). This tool exists in the German language, and our comprehensive search showed that the present instrument has not been psychometrically evaluated in other languages. Examining the psychometric characteristics and cultural adaptation of the scales helps researchers ensure that the scales used in different societies have measured the same concepts of interest and acceptable psychometric standards and therefore increase the power of interpretation of research findings (9).\u003c/p\u003e\n\u003cp\u003eThe lack of appropriate tools to measure the quality of woman-centered midwifery care from the perspective of women in Iran, and as a result, not using it, is a challenge in the field of woman-centered maternity care quality. This issue prompted the researchers to take measures for the translation and psychometrics of the midwifery Care Quality Scale for Women. The simplicity, brevity and consideration of the important aspects of woman-centered care in this instrument were among the reasons for choosing it for psychometric purposes. The translation and validation of the Persian QWC-MC in this research aim to facilitate a more accurate assessment of the quality of woman-centered midwifery care during labor and delivery from the perspective of women in Iran, which can serve as a basis for further research and interventions to improve the quality of woman-centered midwifery care.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present research is a cross-sectional study that was conducted with the aim of translating and psychometrically evaluating the Persian version of the \u0026ldquo;quality of woman-centered midwifery care\u0026rdquo; labor and childbirth from January to May 2024 in Ahvaz, Southwest Iran.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDemographic questionnaire\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDemographic characteristics included age, education, job, income, place of residence, parity and ethnicity of the mothers. These demographic variables were considered important factors for obtaining a comprehensive understanding of sample characteristics and their potential impact on research results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQWC_MC Scale translation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe QWC_MC Scale was translated following the model proposed by Wild et al (10). Permission for use and translation was obtained from the original developers through email correspondence. This approach included the following steps: translation, reverse translation, expert review, pilot study, correction and summary. The above steps were also followed in the present study. Two translators, proficient in German and Persian, translated the scale into Persian. Their translations were compared and modified to make a final version. Two additional translators, fluent in both the Persian and German languages, back-translated the Persian translation into German. Then, the original tool designer accredited the translated version. The facial validity, content validity, construct validity, internal consistency and scale stability of the translated scale were subsequently validated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical consideration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research proposal was approved by the Ethics Committee of Ahvaz Jundishapur University of Medical Sciences (Ethics code: IR.AJUMS.REC.1402.506). After obtaining permission from the main designer of the tool and informed written consent from the participant\u0026rsquo;s study, the objectives of the research and the confidentiality of the information were shared with the participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to researchers, the minimum sample size required is 100-250 people (11); however, some studies determine the size according to the number of items; in this way, they choose 10-20 people for each item or, to determine construct validity, 3 to 10 people are needed for each item in the instrument\u0026nbsp;(11-12). Therefore, considering 10 samples for each item, a sample size of 350 people was calculated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eThe participants included all women who underwent vaginal delivery and who were admitted to the postpartum ward of hospitals (Imam Khomeini, Taleghani and Sina) affiliated with the University of Medical Sciences Ahvaz/Iran and who were selected by the available sampling method. A sample of 350 women completed the Persian version of the QWC-MC Scale for psychometric evaluation. The participants were selected based on the eligibility criteria of the study by means of convenience and purposeful sampling. The inclusion criteria were as follows: age \u0026gt; 18 years, singleton, gestational age \u0026gt; 37 weeks, vaginal delivery, literacy in reading-writing and willingness to participate in the study. The exclusion criteria were high-risk pregnancy (any medical or obstetric problems such as diabetes, high blood pressure, or intrauterine fetal death), hospitalization of the infant and incomplete questionnaires.\u003c/p\u003e\n\u003ch3\u003eIntroduction of the QWC-MC Tool\u003c/h3\u003e\n\u003cp\u003eThe QWC-MC scale was first developed by Schulz and Wirtz (2021) in Germany to measure the QWC-MC during prenatal care. The scale comprises 33 items categorized into 4 subscales: SDM-Q-9-M with a six-point Likert scale (0\u0026thinsp;=\u0026thinsp;completely disagree all, 1\u0026thinsp;=\u0026thinsp;Disagree, 2\u0026thinsp;=\u0026thinsp;Somewhat disagree, 3\u0026thinsp;=\u0026thinsp;Somewhat agree, 4\u0026thinsp;=\u0026thinsp;Agree, 5\u0026thinsp;=\u0026thinsp;completely agree); E-Q-11-M with a five-point Likert scale and reverse-coded (1\u0026thinsp;=\u0026thinsp;Fully applies, 2\u0026thinsp;=\u0026thinsp;Mostly applies, 3\u0026thinsp;=\u0026thinsp;Occasionally applies, 4\u0026thinsp;=\u0026thinsp;Hardly applies, 5\u0026thinsp;=\u0026thinsp;Not apply at all); and TC-Q-5 and PC-Q-8-M with a six-point Likert scale (1\u0026thinsp;=\u0026thinsp;Not apply at all, 2\u0026thinsp;=\u0026thinsp;Mostly not apply, 3\u0026thinsp;=\u0026thinsp;Somewhat not apply, 4\u0026thinsp;=\u0026thinsp;Somewhat applies, 5\u0026thinsp;=\u0026thinsp;Mostly applies, 6\u0026thinsp;=\u0026thinsp;fully applies). The questionnaire scores are in the range of 24\u0026ndash;178. Higher scores indicate better QWC-MC. The original scale showed good fit and reliability, with omega coefficients ranging from 0.84 to 0.92 for components and \u0026ge;\u0026thinsp;0.86 for the overall scale (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e) (\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e).\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSubscales and scores for the QWC-MC questionnaire\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSubscales\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eitems\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eScore range\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShared Decision-Making\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026ndash;45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmpathy Midwife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u0026ndash;55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInternal Team cooperation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u0026ndash;30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProfessional competence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u0026ndash;48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTOTAL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u0026ndash;178\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eTable 1- shows that the midwifery care questionnaire is centered on women with 4 scales and scores in the range of 24 to 178.\u003c/p\u003e\n\u003ch3\u003eDescriptive statistics\u003c/h3\u003e\n\u003cp\u003eData analysis was performed using SPSS version 26 and STATA version 14 software. Descriptive statistics, including frequencies and percentages, were used to report the characteristics of the participants, and the Kolmogorov‒Smirnov test was used to assess the normality of the distribution of the data. Cronbach\u0026apos;s alpha coefficient was used for the internal consistency of all questionnaires and subscales. The mean and standard deviation were used to analyze quantitative variables, and the frequency and percentage were used for qualitative variables.\u003c/p\u003e\n\u003ch3\u003eValidity\u003c/h3\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003eFace validity\u003c/h2\u003e\n \u003cp\u003eThe scale was retranslated into Persian to 20 mothers to evaluate face validity using a qualitative method, and the items were evaluated in terms of difficulty level, appropriateness level and word ambiguity. The quantitative face validity was determined using the item impact method. At this stage, a number of people from the target group are asked to evaluate each item in terms of importance and give each item a score of 1 to 5 according to the importance level. For this purpose, a five-point Likert scale was used for each scale item: 5\u0026thinsp;=\u0026thinsp;completely important, 4\u0026thinsp;=\u0026thinsp;important, 3\u0026thinsp;=\u0026thinsp;moderately important, 2\u0026thinsp;=\u0026thinsp;slightly important and not 1\u0026thinsp;=\u0026thinsp;important at all.\u003c/p\u003e\n \u003cp\u003eIn the impact score method, an impact score is obtained by multiplying the frequency of an item (Impact Score\u0026thinsp;=\u0026thinsp;Frequency (%) * Importance). An impact score above 1.5 means that the item was fit for subsequent analyses and will be retained(\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eContent validity\u003c/h2\u003e\n \u003cp\u003eTo measure the validity of the content using a qualitative method, 10 university professors (specialists in midwifery and with a background in research in the field of instrument psychometrics from Iran\u0026apos;s top universities) were asked to check the scale in terms of the appropriate time for completion, the correctness of the language, the appropriateness of the words and their correction points in writing. After carefully reading their comments, appropriate corrections were made by the research team. Finally, the writing of some items was changed and modified. To evaluate the validity of the quantitative content, two indices, the content validity ratio (CVR) and the content validity index (CVI), were used. A checklist with two sections was designed for each specialist. The first part of the checklist is designed to calculate CVI, and the second section is designed for CVR. The first section of the checklist evaluates the lucidity, simplicity and relation of the items based on a 4-point Likert scale. The second section evaluates the necessity of each item based on a 3-point Likert scale (3\u0026thinsp;=\u0026thinsp;It is necessary, 2\u0026thinsp;=\u0026thinsp;it is useful, but it is not necessary, 1\u0026thinsp;=\u0026thinsp;it is not necessary). The minimum acceptable scores for the CVI and CVR were considered to be higher than 0.79 and 0.62, respectively(\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e) .\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003eConstruct validity\u003c/h2\u003e\n \u003cp\u003eThe construct validity is measured using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e). EFA was conducted on a sample of 350 mothers. The suitability of the data for EFA was assessed using the Kaiser\u0026ndash;Meyer\u0026ndash;Olkin (KMO) measure and Bartlett\u0026rsquo;s test of sphericity. A KMO correlation above 0.60\u0026ndash;0.70 is considered adequate for analyzing the EFA output(\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e). CFA was conducted using STATA version 14 software. Model fit was assessed using several indices, including the no normed fit index (NNFI or TLI), comparative fit index (CFI), chi-square to degrees of freedom ratio, standardized root mean squared residual (SRMR), coefficients of determination (CD), and root mean square error of approximation (RMSEA). These indices are often used to appraise the fit of the CFA model (\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e). Principal component analysis was used to extract factors, and the eigenvalue method and scree plot were used to determine the number of factors. Varimax rotation was used to determine which variables belonged to which factor and to make the factors interpretable\u0026mdash;confirmatory factor analysis.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003eReliability\u003c/h2\u003e\n \u003cp\u003eIn this study, the internal consistency and consistency reliability methods were used to evaluate the reliability of the questionnaire. To determine the reliability and internal consistency of the instrument, the Cronbach\u0026rsquo;s \u0026alpha; coefficient and the time stability or repeatability of the method (test-retest) were checked. The internal consistency of the scale was calculated using the Cronbach\u0026rsquo;s \u0026alpha; coefficient for the whole questionnaire and then for each subscale. The considered scale will have adequate reliability when the Cronbach\u0026rsquo;s \u0026alpha; coefficient is greater than or equal to 0.7 be(\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e). with the test-retest method to determine the repeatability. The time interval between the two tests is suggested to be two weeks to one month (\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eFor this purpose, the researcher administered the questionnaire to 30 mothers in the postpartum ward in two shifts at an interval of 4 weeks. In the first stage, the questionnaire was completed 24 hours after delivery in the postpartum ward, and in the second stage, it was completed 28 days after delivery when the patients visited health centers with prior coordination or phone calls. This number of mothers was included in the sample. The Spearman-Brown correlation test was used to compare the results of two tests. The correlation between the scores obtained from the two tests was determined with the correlation coefficient (ICC) test, which is the most acceptable test for determining the stability of the test. When this index is between 0.7 and 0.8, the level of stability is favorable (\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\"\u003e\n \u003ch2\u003eDemographic characteristics\u003c/h2\u003e\n \u003cp\u003eA total of 350 mothers completed the questionnaire. The demographic data of the mothers revealed that 40.9% were between 26\u0026ndash;35 years old, 52.0% had elementary-secondary literacy, 96.3% were homemakers, 77.7% were multiple parous, 51.1% were rural, and 69.71% had mothers of Arabian ethnicity (Table \u003cspan\u003e2\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eDemographic characteristics of the participants(n\u0026thinsp;=\u0026thinsp;350)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategories\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u0026ndash;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u0026ndash;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36\u0026ndash;45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eElementary -Secondary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh school diploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCollege education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eIncome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eJob\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHomemaker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e96.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eParity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eprim parous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMulti parous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003eMother\u0026apos;s Ethnicity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eArab\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePersian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBakhtaran\u0026rsquo;s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLori\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTurkish\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ePlace of Residence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eurban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003erural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.1\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\u003eTable 2- shows that the mothers revealed that 40.9% were between 26 - 35 years old, 52.0% had elementary-secondary literacy, 96.3% were homemakers, 77.7% were multiple parous, 51.1% were rural, and 69.71% had mothers of Arabian ethnicity.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFace validity\u003c/strong\u003e After checking the opinions of the mothers, due to the problems in understanding the concept, modifications were made to question 1 of the SDM and question 6 of the PC for a better comprehension of the concept, and the questionnaire was given to the same mothers anew. the score of impact in all questions was \u0026ge;\u0026thinsp;1.5. All questions were retained for further analysis.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eContent validity\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThe CVI for all the items was 1, and the CVR ranged from 1-0.83. Accordingly, none of the questions were deleted. Overall, the content validity of the scale was confirmed (Table \u003cspan\u003e4\u003c/span\u003e,\u003cspan\u003e5\u003c/span\u003e,\u003cspan\u003e6\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eTable 3- \u0026nbsp;Eigenvalues, Percentage of variance of the Persian version (n = 350)\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.518987341772153%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFactor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.050632911392405%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEigenvalues\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.050632911392405%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage of variance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.379746835443036%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCumulative variance percentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.518987341772153%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.050632911392405%\" valign=\"top\"\u003e\n \u003cp\u003e10.417\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.050632911392405%\" valign=\"top\"\u003e\n \u003cp\u003e31.568\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.379746835443036%\" valign=\"top\"\u003e\n \u003cp\u003e31.568\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.518987341772153%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.050632911392405%\" valign=\"top\"\u003e\n \u003cp\u003e4.456\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.050632911392405%\" valign=\"top\"\u003e\n \u003cp\u003e13.504\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.379746835443036%\" valign=\"top\"\u003e\n \u003cp\u003e45.072\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.518987341772153%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.050632911392405%\" valign=\"top\"\u003e\n \u003cp\u003e2.375\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.050632911392405%\" valign=\"top\"\u003e\n \u003cp\u003e7.197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.379746835443036%\" valign=\"top\"\u003e\n \u003cp\u003e52.269\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.518987341772153%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.050632911392405%\" valign=\"top\"\u003e\n \u003cp\u003e1.958\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.050632911392405%\" valign=\"top\"\u003e\n \u003cp\u003e5.932\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.379746835443036%\" valign=\"top\"\u003e\n \u003cp\u003e58.2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003eThe above table shows that the highest Eigenvalues and variance are related to the first factor (SDM subscale).\n \u003c/div\u003e\n \u003cdiv\u003e\n \u003cdiv align=\"left\"\u003eTable 4- \u0026nbsp;Impact score, CVR, CVI and factor loading of the SDM subscale Persian version (n = 350)\u003c/div\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"684\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.75438596491228%\" valign=\"top\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.894736842105263%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eItem impact score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.157894736842104%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eContent validity \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.19298245614035%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eExtracted factors\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"56.19047619047619%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eItem content\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.619047619047619%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCVR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.666666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCVI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.619047619047619%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.666666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.619047619047619%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.619047619047619%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.75438596491228%\" valign=\"top\"\u003e\n \u003cp\u003eShared Decision-Making\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48.24561403508772%\" colspan=\"7\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.75438596491228%\" valign=\"top\"\u003e\n \u003cp\u003e1-The midwife told me explicitly that I had to decide for myself.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.894736842105263%\" valign=\"top\"\u003e\n \u003cp\u003e3.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.140350877192983%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.751\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.140350877192983%\" valign=\"top\"\u003e\n \u003cp\u003e.285\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e-.030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e.163\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.75438596491228%\" valign=\"top\"\u003e\n \u003cp\u003e2-I had a desirable participation in the decision-making process.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.894736842105263%\" valign=\"top\"\u003e\n \u003cp\u003e3.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.140350877192983%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.755\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.140350877192983%\" valign=\"top\"\u003e\n \u003cp\u003e.272\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e-.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e.121\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.75438596491228%\" valign=\"top\"\u003e\n \u003cp\u003e3-Information was provided about various options and alternatives.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.894736842105263%\" valign=\"top\"\u003e\n \u003cp\u003e2.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.140350877192983%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.793\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.140350877192983%\" valign=\"top\"\u003e\n \u003cp\u003e.232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e-.072\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e.116\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.75438596491228%\" valign=\"top\"\u003e\n \u003cp\u003e4-The pros and cons of the options were explained to me in detail.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.894736842105263%\" valign=\"top\"\u003e\n \u003cp\u003e3.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.140350877192983%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.819\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.140350877192983%\" valign=\"top\"\u003e\n \u003cp\u003e.190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e-.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e.129\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.75438596491228%\" valign=\"top\"\u003e\n \u003cp\u003e5-The midwife helped me understand all the information.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.894736842105263%\" valign=\"top\"\u003e\n \u003cp\u003e3.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.140350877192983%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.804\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.140350877192983%\" valign=\"top\"\u003e\n \u003cp\u003e.176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e-.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e.139\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.75438596491228%\" valign=\"top\"\u003e\n \u003cp\u003e6-The midwife asked me which option I preferred.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.894736842105263%\" valign=\"top\"\u003e\n \u003cp\u003e2.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.140350877192983%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.786\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.140350877192983%\" valign=\"top\"\u003e\n \u003cp\u003e.125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e.118\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.75438596491228%\" valign=\"top\"\u003e\n \u003cp\u003e7-The midwife and I thoroughly explored the various options.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.894736842105263%\" valign=\"top\"\u003e\n \u003cp\u003e3.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.140350877192983%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.764\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.140350877192983%\" valign=\"top\"\u003e\n \u003cp\u003e.145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e.131\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.75438596491228%\" valign=\"top\"\u003e\n \u003cp\u003e8-The midwife and I chose the final option.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.894736842105263%\" valign=\"top\"\u003e\n \u003cp\u003e2.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.140350877192983%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.778\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.140350877192983%\" valign=\"top\"\u003e\n \u003cp\u003e.123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e-.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e.108\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.75438596491228%\" valign=\"top\"\u003e\n \u003cp\u003e9-The midwife and I agreed on future care processes.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.894736842105263%\" valign=\"top\"\u003e\n \u003cp\u003e2.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.140350877192983%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.774\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.140350877192983%\" valign=\"top\"\u003e\n \u003cp\u003e.129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e-.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\" valign=\"top\"\u003e\n \u003cp\u003e.182\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003eTable 4: Impact score, CVR, CVI and the factor loading of the subscale SDM shows that all questions have high face validity, content and factor load. Therefore, SDM is very important for mothers in labor and delivery\u003cdiv align=\"left\"\u003eTable 5: \u0026nbsp;Impact score, CVR, CVI and factor loading of the EM subscale Persian version (n = 350)\u003c/div\u003e\u0026nbsp;\u0026nbsp;\n \u003c/div\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"690\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.91304347826087%\" valign=\"top\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.826086956521739%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eItem impact score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.304347826086957%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eContent validity \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.956521739130434%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eExtracted factors\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.490566037735846%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eItem content\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.60377358490566%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCVR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.660377358490566%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCVI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.547169811320755%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.60377358490566%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.547169811320755%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.547169811320755%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.91304347826087%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmpathy Midwife\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"46.08695652173913%\" colspan=\"7\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.91304347826087%\" valign=\"top\"\u003e\n \u003cp\u003e1-Did the midwife behave in such a way that you feel comfortable with her?\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.826086956521739%\" valign=\"top\"\u003e\n \u003cp\u003e2.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.086956521739131%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.217391304347826%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.086956521739131%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.657\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.132\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.91304347826087%\" valign=\"top\"\u003e\n \u003cp\u003e2-Did the midwife let you tell your story?\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.826086956521739%\" valign=\"top\"\u003e\n \u003cp\u003e2.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.086956521739131%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.217391304347826%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.086956521739131%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.682\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.051\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.91304347826087%\" valign=\"top\"\u003e\n \u003cp\u003e3-Did the midwife actually (actively) listen to you?\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.826086956521739%\" valign=\"top\"\u003e\n \u003cp\u003e3.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.086956521739131%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.217391304347826%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.086956521739131%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.746\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.114\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.91304347826087%\" valign=\"top\"\u003e\n \u003cp\u003e4-The midwife cared about you as an important person .\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.826086956521739%\" valign=\"top\"\u003e\n \u003cp\u003e3.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.086956521739131%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.217391304347826%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.086956521739131%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.757\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.081\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.91304347826087%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.826086956521739%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.086956521739131%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"5.217391304347826%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.086956521739131%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.91304347826087%\" valign=\"top\"\u003e\n \u003cp\u003e5-The midwife really understood you.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.826086956521739%\" valign=\"top\"\u003e\n \u003cp\u003e3.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.086956521739131%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.217391304347826%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.086956521739131%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.785\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.071\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.91304347826087%\" valign=\"top\"\u003e\n \u003cp\u003e6-The midwife was caring and compassionate with you .\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.826086956521739%\" valign=\"top\"\u003e\n \u003cp\u003e3.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.086956521739131%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.217391304347826%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.086956521739131%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.721\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.145\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.91304347826087%\" valign=\"top\"\u003e\n \u003cp\u003e7-The midwife treated you with a positive attitude .\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.826086956521739%\" valign=\"top\"\u003e\n \u003cp\u003e2.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.086956521739131%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.217391304347826%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.086956521739131%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.681\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.121\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.91304347826087%\" valign=\"top\"\u003e\n \u003cp\u003e8-The midwife explained everything to you clearly .\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.826086956521739%\" valign=\"top\"\u003e\n \u003cp\u003e3.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.086956521739131%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.217391304347826%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.086956521739131%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.422\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e-.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.140\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.91304347826087%\" valign=\"top\"\u003e\n \u003cp\u003e9-The midwife created the necessary and sufficient preparation for birth and parenthood in you.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.826086956521739%\" valign=\"top\"\u003e\n \u003cp\u003e3.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.086956521739131%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.217391304347826%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.086956521739131%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.614\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.275\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.91304347826087%\" valign=\"top\"\u003e\n \u003cp\u003e10-The midwife has worked with you to develop a plan for continued motherhood .\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.826086956521739%\" valign=\"top\"\u003e\n \u003cp\u003e1.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.086956521739131%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.217391304347826%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.086956521739131%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.533\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.323\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.91304347826087%\" valign=\"top\"\u003e\n \u003cp\u003e11-Did the midwife give you enough time?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.826086956521739%\" valign=\"top\"\u003e\n \u003cp\u003e2.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.086956521739131%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.217391304347826%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.221\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.086956521739131%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.474\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.072\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.956521739130435%\" valign=\"top\"\u003e\n \u003cp\u003e.293\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\u003eTable 5: Impact score, CVR, CVI and the factor loading of the subscale EM shows that all questions have high face validity, content and factor load. Therefore, EM is very important for mothers in labor and delivery.\u003c/p\u003e\n\u003cdiv id=\"Sec9\"\u003e\u003cbr\u003e\u003cbr\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 6\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eImpact score, CVR, CVI and factor loading of the TM and PC subscale Persian version (n\u0026thinsp;=\u0026thinsp;350)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eItem impact score\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eContent validity\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eExtracted factors\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eItem content\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCVR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCVI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTeam cooperation\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"7\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1-The midwife and the gynecologist worked together.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.823\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.123\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2-The consultation between the midwife and my doctor worked well.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.876\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.138\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3-The information and actions of my midwife and my doctor were well coordinated.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.896\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.065\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4-Communication between my midwife and my doctor was good.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.869\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.093\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5-My midwife and my doctor treated each other with respect.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.784\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfessional competence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1-The midwife involved the people who mattered to me (husband, sister, etc.) in my care.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.504\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.103\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2-The midwife took complete care of my health.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.360\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.324\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.451\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3-The midwife worked well with other professions (such as primary care, physicians).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.273\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.585\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4-The midwife has reliably addressed the issue of whether and when other professions should be involved (for example, early intervention, physicians).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.093\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.770\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5-The midwife was an expert in her field.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.070\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.812\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6-The midwife had up-to-date knowledge of midwifery.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.749\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7-The midwife did her best to prepare me physically for birth and parenthood.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.257\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.506\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8-The midwife did her best to psychologically prepared me for birth and parenthood.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.419\u003c/strong\u003e\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\u003eTable 6: Impact score, CVR, CVI and the factor loading of the subscale TC and PC shows that all questions have high face validity, content and factor load. Therefore, TC is especially important for mothers in labor and delivery.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\"\u003e\n \u003ch2\u003eConstruct validity (EFA, CFA (\u003c/h2\u003e\n \u003cp\u003eFor EFA with a sample size of N\u0026thinsp;=\u0026thinsp;350, the Kaiser\u0026ndash;Meyer\u0026ndash;Olkin (KMO) value was 0.882, which indicates sufficient sample adequacy. Bartlett\u0026apos;s sphericity test was significant (\u0026chi;2\u0026thinsp;=\u0026thinsp;8138.062, df\u0026thinsp;=\u0026thinsp;528, p\u0026thinsp;\u0026lt;\u0026thinsp;0.000), which indicates that the data are suitable for factor analysis. Four factors with eigenvalues\u0026thinsp;\u0026gt;\u0026thinsp;1 were identified, which explained 58.20% of the total variance in the quality scale of the QWC-MC (Fig. \u003cspan\u003e1\u003c/span\u003e, Table \u003cspan\u003e3\u003c/span\u003e). The four-factorial structure of all-item subscales SDM\u0026thinsp;\u0026ge;\u0026thinsp;0.751, EM\u0026thinsp;\u0026ge;\u0026thinsp;0.422, TC\u0026thinsp;\u0026ge;\u0026thinsp;0.784, and PC\u0026thinsp;\u0026ge;\u0026thinsp;0.419 were confirmed to be above 0.4. In addition to the 1-item subscale of PC {PC1- The midwife involved the people who mattered to me (husband, sister, etc.) in my care}, which was transferred to the subscale of SDM (Table \u003cspan\u003e4\u003c/span\u003e,\u003cspan\u003e5\u003c/span\u003e,\u003cspan\u003e6\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eThe above table shows that the highest Eigenvalues and variance are related to the first factor (SDM subscale).\u003c/p\u003e\n \u003cp\u003eBased on the scree plot, the results of the factor analysis (4-factor structure) were justified.\u003c/p\u003e\n \u003cp\u003eVarimax rotation was used to determine which variables belonged to which factor and to make the factors interpretable (Fig. \u003cspan\u003e2\u003c/span\u003e). The flow diagram of the four-factor model of the Persian QWC-MC version shows that the minimum and maximum item-scale correlation coefficients are 0.31 and 0.92, respectively. For all the item-scale correlation coefficients in the factor analysis, P˂ 0.000 was significant, which means that all the items were significantly correlated with their factors, and Rotation converged in 5 iterations.\u003c/p\u003e\n \u003cp\u003eThe fit indices for the four-factor structure of the Scale QWC-MC, including the TLI, CFI, SRMR, CD, RMSEA and \u0026chi;2/df (p\u0026thinsp;\u0026lt;\u0026thinsp;0.000), demonstrated good to acceptable fits in the present study. Therefore, according to the fit indices, the obtained model shows an acceptable fit, which confirms the four-factor structure of the Persian version of the scale (Table \u003cspan\u003e7\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab8\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 7\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eModel fit indices of CFA for the Persian version\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIndex\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTLI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCFI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSRMR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRMSEA\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026chi;2/ df\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e(p value)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003evalue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.735\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.755\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8138.062/528\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\"\u003eTLI: Tucker‒Lewis index, CFI: comparative fit index, df: degree of freedom, SRMR: standardized root mean squared residual, CD: coefficients of determination, RMSEA: root mean square error of approximation\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eThe above table shows that according to the fit indices (TLI, CFI, SRMR, \u0026chi;2/df, p value) the obtained model has an acceptable fit and confirms the four-factor structure of the Persian version of the scale.\u003c/p\u003e\n \u003cp\u003eThe above table shows that according to the fit indices (TLI, CFI, SRMR, \u0026chi;2/df and p value) the obtained model has an acceptable fit and confirms the four-factor structure of the Persian version of the scale.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\"\u003e\n \u003ch2\u003eReliability\u003c/h2\u003e\n \u003cp\u003eIn this study, the Cronbach\u0026rsquo;s \u0026alpha; coefficient for the translated scale was between 0.79 and 0.91, and for participation in the SDM subscale, it was 0.87; for EM, it was 0.91; for TM, it was 0.79; and for PC, it was 0.81. The value was found to be high and acceptable. The test-retest results were for the SDM subscale 1, EM\u0026thinsp;=\u0026thinsp;0.98, TC\u0026thinsp;=\u0026thinsp;0.99 and PC\u0026thinsp;=\u0026thinsp;0.99; The reliability and repeatability using Cronbach\u0026rsquo;s \u0026alpha; and the ICC for the entire questionnaire were 0.88 and 0.99, respectively therefore, the reliability of the temporal stability or repeatability of the questionnaire is acceptable and appropriate (Table \u003cspan\u003e8\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv\u003ea\u003ctable id=\"Tab9\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 8\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eCronbach\u0026rsquo;s \u0026alpha; coefficient for the entire questionnaire and subscale the Persian version (n\u0026thinsp;=\u0026thinsp;350)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003esubscale\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eitems\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCronbach\u0026rsquo;s \u0026alpha;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTest-retest\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShared Decision-Making\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMidwife empathy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTeam cooperation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProfessional competence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.99\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\u003eTable \u003cspan\u003e8\u003c/span\u003e: shows that the highest Cronbach\u0026apos;s \u0026alpha; score was obtained by the EM subscale and the highest test-retest by the SDM subscale.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study was conducted with the aim of investigating the psychometric properties and factor structure of the translated quality of the Woman-Centered Midwifery Care Scale among Iranian mothers. The findings show that the Persian version of the scale has good validity and reliability in the community of mothers. However, no previous research has specifically focused on the quality of Iranian woman-centered midwifery care. Furthermore, there is limited research on the psychometric properties of the scale in other countries and languages beyond the original German study. Woman-centered care includes supporting the woman\u0026apos;s autonomy, respecting her values, and involving the woman in the care process(20). This relationship includes value-based care\u0026nbsp;(21), self-management and customer-oriented care concepts\u0026nbsp;(22).\u0026nbsp;The government must ensure that women have access to quality maternal and newborn care, not only because it is a way to prevent maternal and newborn deaths but also because it is a basic human right that the government is obligated to support.\u003c/p\u003e\n\u003cp\u003eThe demographic characteristics of our study participants were consistent with the demographic characteristics of the participants in the original instrument development study. According to the original tool, 55.2% of mothers were aged 30-35 years, 96.5% were of German descent, 98.4% had a high school education or less, 77.6% were married, 85% had an average income, 76.6% had a low-risk pregnancy, 57.7% were prim parous women, and 73.6% had a vaginal delivery.\u003c/p\u003e\n\u003cp\u003eThe findings of the present research in determining face and content validity show that all scale items are relevant, clear and simple after minor changes are made. In addition, the obtained CVI values show that the Persian version of the questionnaire has very good content validity, which indicates its ability to effectively measure the QWC-MC. On the other hand, after conducting exploratory factor analysis and detailed examination of the results, a questionnaire with 33 items (without removing any item from the original questionnaire) and 4 identified factors was approved. Question one on the PC of exploratory factor analysis was placed in the SDM subgroup. In the original instrument, the subscale PC that measures professional competence showed insufficient data in the definition of the main one-dimensional model, and the residual correlation analysis has been shown to reflect the latent construct of professional competence as a quadratic factor(8)\u0026nbsp;.\u003c/p\u003e\n\u003cp\u003eAlthough the original tool was designed to evaluate the QWC-MC during prenatal care and the designer of the tool confirmed that this questionnaire can be used with changes to evaluate the quality of female-centered midwifery care for delivery and postpartum, this may be one of the possible reasons. Additionally, in our teaching hospitals, it is not possible to accompany (husband, sister, etc.) the mother\u0026apos;s request for care during labor and delivery; for this reason, question 1 of the PC subscale moved to the SDM subscale, and this has been scientifically accepted. Ultimately, there were 10 SDM items and 7 professional qualification questions. In the present study, the fit indices for the four-factor structure of the QWC-MC scale demonstrated good to acceptable fits.\u003c/p\u003e\n\u003cp\u003eAccording to our findings, in the study of Schulz, Wirtz (2021), the model showed good to acceptable model fit(8), so the results of this study with version The original matches. Additionally, the validity and reliability of the tool are consistent with those of its original version. In this study, a reliability coefficient of 0.88 was obtained for the entire tool. which shows the internal consistency with the original version of the instrument. In the original version of this tool, the Cronbach\u0026apos;s \u0026alpha; coefficients were \u0026ge; 0.86 for all assessment scales(8). The stability and reliability results obtained from the two implementations of this tool four weeks apart in the study were desirable and satisfactory. This indicates the stability of the results over time and shows that if this tool is used at different times, it will provide the same results, which is consistent with the results of the original version of this tool.\u003c/p\u003e\n\u003cp\u003eOur comprehensive search showed that the present instrument has not been psychometrically evaluated in other languages. Therefore, we have to compare this tool with other tools. In a number of recent studies, the PCMC questionnaire has been used to assess the quality of midwifery care for women. This scale includes 30 items that cover three sections: dignity and respect (6 items), communication and independence (9 items) and supportive care (15 items). For example, 0 (no, never), 1 (``yes, some times\u0026apos;\u0026apos;), 2 (``yes, most of the time\u0026apos;\u0026apos;), and 3 (``yes any time\u0026apos;\u0026apos;) were reverse coded. Therefore, high numbers indicate good care. Therefore, the score of the scale varies from zero to 90(23-26)\u0026nbsp;.\u0026nbsp;According to the psychometric analysis of the PCMC tool by Naito et al. (2023), for Cambodian women, the content validity index for the entire 30-item tool, Kh-PCMC, was 0.96. However, twenty items performed better in the psychometric analysis of the data in Cambodia. The 20-item Kh-PCMC scale had a Cronbach\u0026apos;s alpha of 0.86 for the whole instrument and 0.76-0.91 for the subscales, which indicates acceptable internal consistency\u0026nbsp;(27)\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e This questionnaire is not specific to women-centered midwifery care; moreover, it does not examine the professional competence of providers separately.\u003c/p\u003e\n\u003cp\u003eKhakbazan et al. (2022) focused on analyzing the concept of the quality of midwifery care (MCQ) through the design of a quality assessment tool and its psychometric analysis in maternity wards. The results of exploratory factor analysis confirmed a 39-item instrument with 4 factors that explained 49.61% of the variance of the variables of the whole instrument. The internal consistency of these four factors was 0.936 according to Cronbach\u0026apos;s alpha, and the intracluster correlation coefficient was 0.945 according to the test-retest results. The MCQ tool assesses midwives\u0026apos; views on the quality of postpartum midwifery care(28).\u003c/p\u003e\n\u003cp\u003eQWC-MC tool structures are the main components of the woman-centered midwifery care process and are used scales that are accepted internationally in the field of patient-centered care\u0026nbsp;(8). With this tool, the conceptual basis and assessment of woman-centered midwifery care can be enhanced through assessments aligned with standards set in other clinical care settings. The instrument measuring the QWC-MC in labor and delivery had relatively good to acceptable validity and reliability among Iranian women and can be a good, valid and comprehensive measurement tool that highlights women\u0026apos;s real experience with woman-centered care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations:\u0026nbsp;\u003c/strong\u003eThe present study, however, has weaknesses and limitations, such as the lack of generalizability of the results, due to place limitations. In the present study, the quality of woman-centered midwifery care was studied in selected hospitals of Jundishapur University, Ahvaz, and private and non-university hospitals were not considered. Therefore, it is suggested that in future studies, the psychometric characteristics of the mentioned questionnaire in private hospitals and postpartum care should also be assessed in a more comprehensive and national study.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe findings of the present study showed that the Persian version of the woman-centered midwifery care quality scale has acceptable validity and reliability among Iranian mothers. Additionally, the results of face and content validity evaluation indicate that this tool is attractive because it is suitable for evaluating the quality of midwifery care. Due to its desirable psychometric properties, ease of implementation and special evaluation ability, the use of this scale in labor and delivery is recommended. Additionally, the reliability of the Persian version of the scale showed that this questionnaire has good internal consistency. To further reinforce the validity of the Persian version of the scale, we proposed conducting more studies in clinical environments during pregnancy and after delivery. This helps to ensure the generalizability of the scale.\u003c/p\u003e\n"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eMMR\u003c/strong\u003e:\u0026nbsp;: Maternal mortality rate, \u003cstrong\u003ePCC\u003c/strong\u003e: Person-Centered Care, \u003cstrong\u003eWCC\u003c/strong\u003e: woman-centered Care\u003cstrong\u003e, PCMC\u003c/strong\u003e: Person-Centered Maternity Care, \u003cstrong\u003eKh-PCMC\u003c/strong\u003e: Khmer- Person Centered Maternity Care, \u003cstrong\u003eQWC-MC\u003c/strong\u003e: Quality of Woman-Centered Midwifery Care, \u003cstrong\u003eMCQ\u003c/strong\u003e: Midwifery Care Quality, \u003cstrong\u003eEFA\u003c/strong\u003e: Exploratory Factor Analysis, \u003cstrong\u003eCFA\u003c/strong\u003e: Confirmatory Factor Analysis, \u003cstrong\u003eCFI:\u003c/strong\u003e Comparative Fit Index, \u003cstrong\u003eRMSEA:\u003c/strong\u003e Root-mean-square Error of Approximation\u003cstrong\u003e, SRMR\u003c/strong\u003e: Standardized Root Mean Squared Residual\u003cstrong\u003e, CD\u003c/strong\u003e; Coefficients of Determination, \u003cstrong\u003eTLI\u003c/strong\u003e: Tucker‒Lewis Index, \u003cstrong\u003eCVI\u003c/strong\u003e: Content Validity Index, \u003cstrong\u003eCVR\u003c/strong\u003e: Content Validity Ratio\u003cstrong\u003e, ICC\u003c/strong\u003e: Interclass Correlation Coefficient, \u003cstrong\u003e\u0026chi;2:\u003c/strong\u003e Chi-square, \u003cstrong\u003eD\u003c/strong\u003eF: Degree of Freeness\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e This article is a part of the doctoral thesis of midwifery at Jundishapur University of Ahvaz\u003cspan dir=\"RTL\"\u003e.\u0026nbsp;\u003c/span\u003eWe would like to thank and appreciate the research and technology vice-chancellor of the university as well as all the mothers who participated in this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMA: data collection, data analysis, interpretation and drafting of the article. NJ and MJ: critically revised of the article, SGH: data analysis; all the authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The authors received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and analyzed\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThe research proposal was approved by the Ethics Committee of Ahvaz Jundishapur University of Medical Sciences (Ethics code: IR.AJUMS.REC.1402.506). Ethical considerations observed in this research include: permission to conduct the study, presentation of letter of introduction to hospital officials, announcement of study results if requested by the officials of the studied hospitals, and ensuring of confidentiality of information, the aims of the study were explained to the mothers and informed and written consent was obtained from them to participate in the study. All methods were performed in accordance with the relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHamal M, Dieleman M, De Brouwere V, de Cock Buning T. Social determinants of maternal health: a scoping review of factors influencing maternal mortality and maternal health service use in India. Public Health Reviews. 2020;41:1-24.\u003c/li\u003e\n\u003cli\u003eNelson P. Human rights and the 2030 development agenda. Critical Issues in Human Rights and Development: Edward Elgar Publishing; 2021. p. 395-418.\u003c/li\u003e\n\u003cli\u003eOrganization WH. WHO recommendations on intrapartum care for a positive childbirth experience: World Health Organization; 2018.\u003c/li\u003e\n\u003cli\u003eGu\u0026eacute;gan J-F, Suz\u0026aacute;n G, Kati-Coulibaly S, Bonpamgue DN, Moatti J-P. Sustainable Development Goal# 3,\u0026ldquo;health and well-being\u0026rdquo;, and the need for more integrative thinking. Veterinaria M\u0026eacute;xico OA. 2018;5(2):0-.\u003c/li\u003e\n\u003cli\u003eAkachi Y, Kruk ME. Quality of care: measuring a neglected driver of improved health. Bulletin of the World Health Organization. 2017;95(6):465.\u003c/li\u003e\n\u003cli\u003eBlanch-Hartigan D, Chawla N, Moser RP, Finney Rutten LJ, Hesse BW, Arora NK. Trends in cancer survivors\u0026rsquo; experience of patient-centered communication: results from the Health Information National Trends Survey (HINTS). Journal of cancer survivorship. 2016;10:1067-77.\u003c/li\u003e\n\u003cli\u003eNyhof BB, Jameel B, Dunn S, Grace SL, Khanlou N, Stewart DE, et al. Identifying strategies to implement patient-centred care for women: qualitative interviews with women. Patient Education and Counseling. 2020;103(7):1422-7.\u003c/li\u003e\n\u003cli\u003eSchulz AA, Wirtz MA. Assessment of the quality of woman-centred midwifery care from the mothers\u0026rsquo; perspective: A structural analysis of cross-sectional survey data. Zeitschrift f\u0026uuml;r Evidenz, Fortbildung und Qualit\u0026auml;t im Gesundheitswesen. 2021;166:8-17.\u003c/li\u003e\n\u003cli\u003eHeidari M, Akbarfahimi M, Salehi M, Nabavi SM. Survey validity of translation for Persian and cultural adaptation of Fatigue Impact Scale (FIS) questionnaire in multiple sclerosis patients in Iran. Modern Rehabilitation. 2012;6(3).\u003c/li\u003e\n\u003cli\u003eRybowiak V, Garst H, Frese M, Batinic B. Error orientation questionnaire (EOQ): Reliability, validity, and different language equivalence. Journal of Organizational Behavior: The International Journal of Industrial, Occupational and Organizational Psychology and Behavior. 1999;20(4):527-47.\u003c/li\u003e\n\u003cli\u003eArafat SY. Validation study can be a separate study design. Int J Med Sci Public Health. 2016;5(11):2421-2.\u003c/li\u003e\n\u003cli\u003eGrove SK, Gray JR, Faan PR. Understanding Nursing Research: First South Asia Edition, E-Book: Building an Evidence-Based Practice: Elsevier India; 2019.\u003c/li\u003e\n\u003cli\u003eJohnson E. Face Validity. In: Volkmar FR, editor. Encyclopedia of Autism Spectrum Disorders. Cham: Springer International Publishing; 2021. p. 1957-.\u003c/li\u003e\n\u003cli\u003ePolit DF, Beck CT, Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Research in nursing \u0026amp; health. 2007;30(4):459-67.\u003c/li\u003e\n\u003cli\u003eTaherdoost H, Sahibuddin S, Jalaliyoon N. Exploratory factor analysis; concepts and theory. Advances in applied and pure mathematics. 2022;27:375-82.\u003c/li\u003e\n\u003cli\u003eTinsley H, Brown S. Handbook of applied multivariate statistics and mathematical modeling: academic press. San Diego[Google Scholar]. 2000.\u003c/li\u003e\n\u003cli\u003eRobinson MA. Using multi‐item psychometric scales for research and practice in human resource management. Human resource management. 2018;57(3):739-50.\u003c/li\u003e\n\u003cli\u003eReisy L, Ziaee S, Mohamad E. Designing a questionnaire for diagnosis of vaginismus and determining its validity and reliability. Journal of Mazandaran University of Medical Sciences. 2015;25(125):81-94.\u003c/li\u003e\n\u003cli\u003eKoo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. Journal of chiropractic medicine. 2016;15(2):155-63.\u003c/li\u003e\n\u003cli\u003eBerg M, \u0026Oacute;lafsd\u0026oacute;ttir \u0026Oacute;A, Lundgren I. A midwifery model of woman-centred childbirth care\u0026ndash;In Swedish and Icelandic settings. Sexual \u0026amp; Reproductive Healthcare. 2012;3(2):79-87.\u003c/li\u003e\n\u003cli\u003eHall J. Spirituality, compassion and maternity care. The roar behind the silence London: Pinter \u0026amp; Martin Ltd. 2015:94-7.\u003c/li\u003e\n\u003cli\u003eBarlow J, Wright C, Sheasby J, Turner A, Hainsworth J. 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Person-centered maternity care during childbirth and associated factors at selected public hospitals in Addis Ababa, Ethiopia, 2021: a cross-sectional study. Reproductive Health. 2022;19(1):199.\u003c/li\u003e\n\u003cli\u003eAfulani PA, Phillips B, Aborigo RA, Moyer CA. Person-centred maternity care in low-income and middle-income countries: analysis of data from Kenya, Ghana, and India. The Lancet Global Health. 2019;7(1):e96-e109.\u003c/li\u003e\n\u003cli\u003eNaito YT, Fukuzawa R, Ganchimeg T, Afulani PA, Aiga H, Kim R, et al. Validation of the person-centered maternity care scale at governmental health facilities in Cambodia. PloS one. 2023;18(7):e0288051.\u003c/li\u003e\n\u003cli\u003eKhakbazan Z, Damghanian M, Zareiyan A, Abbaszadeh F. The concept of maternal care quality for women with low-risk pregnancy in the maternity ward: An integrative review. Nursing and Midwifery Studies. 2022;11(1):1-10.\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":"Woman-centered, Psychometric evaluation, Questionnaire","lastPublishedDoi":"10.21203/rs.3.rs-4756255/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4756255/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe role of service recipients in defining service quality can be considered an important competitive criterion. Therefore, health care providers are trying to use quality assessment tools that emphasize client-centered. This study aimed to translate and psychometrically evaluate the \u0026ldquo;quality of woman-centered midwifery care\u0026rdquo; (QWC_MC) in labor and childbirth for use in Iran.\u003c/p\u003e\u003ch2\u003emethods\u003c/h2\u003e \u003cp\u003eThis cross-sectional study was conducted in two parts: translation and psychometric evaluation. The process of translating the QWC_MC questionnaire to Persian followed the model proposed by Wild et al. Face validity was investigated using a qualitative method with the participation of 20 mothers. The content validity was evaluated by 10 experts using the content validity ratio and content validity index. The construct validity was investigated with exploratory and confirmatory factor analysis by completing the questionnaire with 350 mothers who were admitted to the postpartum ward of hospitals (Imam Khomeini, Taleghani and Sina) affiliated with the University of Medical Sciences Ahvaz; these mothers were selected by convenience sampling. Reliability and repeatability were assessed using Cronbach\u0026rsquo;s α and the ICC. SPSS. V26 and STATA. V14 was used for the data analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe QWC-MC scale has 33 questions, and the translation and psychometric properties of its Persian version were confirmed. EFA identified four factors that accounted for 58.20% of the total variance. The structural validity of the extracted factors was confirmed through confirmatory factor analysis. The reliability and repeatability using Cronbach\u0026rsquo;s α and the ICC for the entire questionnaire were 0.88 and 0.99, respectively.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe findings show that the Persian version of the QWC-MC has good to acceptable validity and reliability. Therefore, it can be used as an effective tool to measure and evaluate the quality of woman-centered midwifery care during labor and childbirth in Iran.\u003c/p\u003e","manuscriptTitle":"Translation and psychometric evaluation of the Persian version of the “Quality of Woman-Centered Midwifery Care Scale” in labor and childbirth","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-12 16:47:05","doi":"10.21203/rs.3.rs-4756255/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":"d885675b-e2d4-4659-a015-4863277a77f7","owner":[],"postedDate":"August 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-19T12:37:23+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-12 16:47:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4756255","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4756255","identity":"rs-4756255","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}