Cultural adaptation of the person-centered maternity care scale at governmental health facilities in Cambodia

Abstract

Background In Cambodia, the importance of valuing women’s childbirth experiences in improving quality of care has been understudied. This is largely because of absence of reliable Khmer tools for measuring women’s intrapartum care experiences. Generally, cross-cultural development of those tools often involves translation from a source language into a target language. Yet, few earlier studies considered Cambodian cultural context. Thus, we developed the Cambodian version of the Person-Centered Maternity Care (PCMC) scale, by culturally adapting its original to Cambodian context for ensuring cultural equivalence and content validity. Methods Three rounds of cognitive interviewing with 20 early postpartum women were conducted at two governmental health facilities in Cambodia. Cognitive interviewing was composed of structured questionnaire pretesting and qualitative probing. The issues identified in the process of transcribing and translating audio-recorded cognitive interviews were iteratively discussed among study team members, and further analyzed. Results A total of 14 issues related to cultural adaptations were identified in the 31 translated questions for the Cambodian version of the PCMC scale. Our study identified three key findings: (i) discrepancies between the WHO recommendations on intrapartum care and Cambodian field realities; (ii) discrepancies in recognition on PCMC between national experts and local women; and (iii) challenges in correctly collecting and interpreting less-educated women’s views on intrapartum care. Conclusion Not only women’s verbal data but also their non-verbal data and cultural contexts should be comprehensively counted, when reflecting Cambodian women’s intrapartum practice realities in the translated version. This is the first study that attempted to develop the tool for measuring Cambodian women’s experiences during childbirth, by addressing cross-cultural issues.

Validation of the person-centered maternity care scale at governmental health facilities in Cambodia

“…The present study provided evidence that the 20-item Kh-PCMC scale is a valid and reliable tool to measure women’s experience of maternity care among Cambodian postpartum women in facility settings. The preliminary work towards the development of this scale including cognitive interviewing and expert review ensured good content validity and acceptable cross-cultural validity [ 25 ]. The S-CVI/Avg of 0.96 also showed high content validity.…”

“…Item related to consent to procedure did not load well and was eliminated from the 20-item Kh-PCMC scale, which was included in “communication and autonomy” sub-scale in the Kenyan validation. The results of the preliminary study for cultural translation and adaptation of PCMC scale in Cambodia suggested that some global concepts of PCMC may not resonate with local women’s views and perceptions on PCMC [ 25 ]. For example, some Cambodian women did not distinguish well between the concepts of consent to procedures and explanation of procedures.…”

“…In this sense, the PCMC score found in this study is likely to overestimate actual levels. Relatedly, as noted in another paper [ 25 ], it was difficult to conduct an interview with a woman in private. This is because it was not culturally appropriate to keep her family member(s) away for an early postpartum woman.…”

Translation and adaptation of the person-centered maternity care scale to a Persian speaking population: A confirmatory factor analysis

“…The latter encompasses broader facets of a woman's experience than its counterpart(18). The rigorous development involving expert reviews, literature examination and cognitive interviews underscores the substantial content validity rendered by PCMC (19).…”

“…To date, the distinguished Person-Centered Maternity Care Scale has been solely validated tool representing as cornerstone accommodating each dimension prescribed by WHO Quality Care Framework equivalent for process indicators predicated onto standardized methodologies inclusive cognitive interviewing alongside psychometric con rmation (19).Originally developed in Kenya as reported by Afulani and colleagues (17), the scale was later validated in India (20) and consequently tested in Ghana(18). The tool offers unique insights into speci c domains, including dignity, respect, communication, autonomy and emotional support (21).…”