TY - JOUR T1 - Development of measures for assessing mistreatment of women during facility-based childbirth based on labour observations JF - BMJ Global Health JO - BMJ Global Health DO - 10.1136/bmjgh-2020-004080 VL - 5 IS - Suppl 2 SP - e004080 AU - Blair O Berger AU - Donna M Strobino AU - Hedieh Mehrtash AU - Meghan A Bohren AU - Kwame Adu-Bonsaffoh AU - Hannah H Leslie AU - Theresa Azonima Irinyenikan AU - Thae Maung Maung AU - Mamadou Dioulde Balde AU - Özge Tunçalp Y1 - 2022/03/01 UR - http://gh.bmj.com/content/5/Suppl_2/e004080.abstract N2 - Introduction Mistreatment of women during childbirth is increasingly recognised as a significant issue globally. Research and programmatic efforts targeting this phenomenon have been limited by a lack of validated measurement tools. This study aimed to develop a set of concise, valid and reliable multidimensional measures for mistreatment using labour observations applicable across multiple settings.Methods Data from continuous labour observations of 1974 women in Nigeria (n=407), Ghana (n=912) and Guinea (n=655) were used from the cross-sectional WHO’s multicountry study ‘How women are treated during facility-based childbirth’ (2016–2018). Exploratory factor analysis was conducted to develop a scale measuring interpersonal abuse. Two indexes were developed through a modified Organisation for Economic Co-operation and Development approach for generating composite indexes. Measures were evaluated for performance, validity and internal reliability.Results Three mistreatment measures were developed: a 7-item Interpersonal Abuse Scale, a 3-item Exams & Procedures Index and a 12-item Unsupportive Birth Environment Index. Factor analysis results showed a consistent unidimensional factor structure for the Interpersonal Abuse Scale in all three countries based on factor loadings and interitem correlations, indicating good structural construct validity. The scale had a reliability coefficient of 0.71 in Nigeria and approached 0.60 in Ghana and Guinea. Low correlations (Spearman correlation range: −0.06–0.19; p≥0.05) between mistreatment measures supported our decision to develop three separate measures. Predictive criterion validation yielded mixed results across countries. Both items within measures and measure scores were internally consistent across countries; each item co-occurred with other items in a measure, and scores consistently distinguished between ‘high’ and ‘low’ mistreatment levels.Conclusion The set of concise, comprehensive multidimensional measures of mistreatment can be used in future research and quality improvement initiatives targeting mistreatment to quantify burden, identify risk factors and determine its impact on health and well-being outcomes. Further validation and reliability testing of the measures in other contexts is needed.Data are available on request. The analytical study dataset from the 'How women are treated during facility-based childbirth' WHO study is deidentified and, archived through WHO/HRP’s electronic recordmanagement system. Data requests with an expression of interest in pursuing multicountrysecondary analyses with a specific research question can be made to srhmph@who.int. Moreinformation about the study tools are available here:https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/s12874-018-0603-x and theprimary publication from the study here:https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31992-0/fulltext. ER -