Assessing the Validity and Reliability of Three Indicators Self-Reported on the Pregnancy Risk Assessment Monitoring System Survey

Abstract

Objectives. We investigated the reliability and validity of three self-reported indicators from the Pregnancy Risk Assessment Monitoring System (PRAMS) survey.Methods. We used 2008 PRAMS (n515,646) data from 12 states that had implemented the 2003 revised U.S. Certificate of Live Birth. We estimated reliability by kappa coefficient and validity by sensitivity and specificity using the birth certificate data as the reference for the following: prenatal participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); Medicaid payment for delivery; and breastfeeding initiation. These indicators were examined across several demographic subgroups.results. The reliability was high for all three measures: 0.81 for WIC participation, 0.67 for Medicaid payment of delivery, and 0.72 for breastfeeding initiation. The validity of PRAMS indicators was also high: WIC participation (sensitivity 5 90.8%, specificity 5 90.6%), Medicaid payment for delivery (sensitivity 5 82.4%, specificity 5 85.6%), and breastfeeding initiation (sensitivity 5 94.3%, specificity 5 76.0%). The prevalence estimates were higher on PRAMS than the birth certificate for each of the indicators except Medicaid-paid delivery among non-Hispanic black women. Kappa values within most subgroups remained in the moderate range (0.40-0.80). Sensitivity and specificity values were lower for Hispanic women who responded to the PRAMS survey in Spanish and for breastfeeding initiation among women who delivered very low birthweight and very preterm infants.conclusion. The validity and reliability of the PRAMS data for measures assessed were high. Our findings support the use of PRAMS data for epidemiological surveillance, research, and planning.

Trends in breastfeeding initiation, continuation, and exclusivity by maternal prepregnancy weight: 2004–2011

“…PRAMS uses maternal self‐report and thus recall bias is possible, though unlikely , as well as social desirability bias toward increased breastfeeding. Additionally, PRAMS does not ask mothers to differentiate between direct breastfeeding versus pumping and bottle feeding, nor does it quantify the proportion breast milk versus formula, which may have implications on child health .…”

Provision of family planning vouchers and early initiation of postpartum contraceptive use among women living with HIV in southwestern Uganda: A randomized controlled trial

“…A blood sample was drawn at baseline to confirm HIV status and measure CD4 cell count. A structured face-to-face questionnaire was completed at enrollment to collect information on sociodemographics; depression and health [17]; reproductive history; partnership dynamics (for example, HIV serostatus disclosure, partner HIV serostatus); perception, use, and knowledge of contraception; decision-making [18][19][20][21][22][23]; food insecurity [24,25]; alcohol use in the last year [26]; HIV stigma [27]; social support [28]; and pregnancy intentions or aspiration [29][30][31].…”

Maternal pre-pregnancy body mass index, gestational weight gain and breastfeeding outcomes

“…While studies have demonstrated that PRAMS self-report measures of breastfeeding initiation show a high degree of agreement with the birth certi cate (47), similar studies evaluating post-hospital breastfeeding outcomes are not available. We estimate that on average, breastfeeding duration may have been mildly overestimated due to social desirability bias, however, we do not believe this would be differential with respect to the exposure of interest, and therefore feel any bias in the effect estimates reported is likely in the direction of the null hypothesis.…”