TY - JOUR T1 - Women’s report of mistreatment during facility-based childbirth: validity and reliability of community survey measures JF - BMJ Global Health JO - BMJ Global Health DO - 10.1136/bmjgh-2020-004822 VL - 5 IS - Suppl 2 SP - e004822 AU - Hannah Hogan Leslie AU - Jigyasa Sharma AU - Hedieh Mehrtash AU - Blair Olivia Berger AU - Theresa Azonima Irinyenikan AU - Mamadou Dioulde Balde AU - Nwe Oo Mon AU - Ernest Maya AU - Anne-Marie Soumah AU - Kwame Adu-Bonsaffoh AU - Thae Maung Maung AU - Meghan A Bohren AU - Özge Tunçalp Y1 - 2022/03/01 UR - http://gh.bmj.com/content/5/Suppl_2/e004822.abstract N2 - Background Accountability for mistreatment during facility-based childbirth requires valid tools to measure and compare birth experiences. We analyse the WHO ‘How women are treated during facility-based childbirth’ community survey to test whether items mapping the typology of mistreatment function as scales and to create brief item sets to capture mistreatment by domain.Methods The cross-sectional community survey was conducted at up to 8 weeks post partum among women giving birth at hospitals in Ghana, Guinea, Myanmar and Nigeria. The survey contained items assessing physical abuse, verbal abuse, stigma, failure to meet professional standards, poor rapport with healthcare workers, and health system conditions and constraints. For all domains except stigma, we applied item-response theory to assess item fit and correlation within domain. We tested shortened sets of survey items for sensitivity in detecting mistreatment by domain. Where items show concordance and scale reliability ≥0.60, we assessed convergent validity with dissatisfaction with care and agreement of scale scores between brief and full versions.Results 2672 women answered over 70 items on mistreatment during childbirth. Reliability exceeded 0.60 in all countries for items on poor rapport with healthcare workers and in three countries for items on failure to meet professional standards; brief scales generally showed high agreement with longer versions and correlation with dissatisfaction. Brief item sets were ≥85% sensitive in detecting mistreatment in each country, over 90% for domains of physical abuse and health system conditions and constraints.Conclusion Brief scales to measure two domains of mistreatment are largely comparable with longer versions and can be informative for these four distinct settings. Brief item sets efficiently captured prevalence of mistreatment in the five domains analysed; stigma items can be used and adapted in full. Item sets are suitable for confirmation by context and implementation to increase accountability and inform efforts to eliminate mistreatment during childbirth.Data are available upon request. The analytic study dataset from the “WHO Study: How women are treated during facility-based childbirth” is de-identified and archived through WHO/HRP’s electronic record management system. Data requests with an expression of interest in pursuing multi-country secondary analyses with a specific research question can be made to srhmph@who.int. More information about the study tools are available here: https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/s12874-018-0603-x and the primary publication from the study here: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31992-0/fulltext. ER -