Validation of maternal report of nutrition‐related interventions and counselling during antenatal care in southern Nepal

Bryce, Emily; Katz, Joanne; Heidkamp, Rebecca; Lama, Tsering Pema; Khatry, Subarna K.; LeClerq, S. C.; Munos, Melinda

doi:10.1111/mcn.13303

Cited by 9 publications

(11 citation statements)

References 40 publications

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“…And 14-month recall is less than that of established household survey programmes which ask women to report on childbirth events that occurred in the preceding 2 or 5 years. To our knowledge, published validation studies to date have reported no relationship between recall period and accuracy of RMNCH indicators 47–49. Certainly, questions on experience of care are sensitive and prone to social desirability bias and to try to minimise this effect we used only women as data collectors who received intensive training, and improved clarity of questions through extensive piloting.…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, published validation studies to date have reported no relationship between recall period and accuracy of RMNCH indicators. [47][48][49] Certainly, questions on experience of care are sensitive and prone to social desirability bias and to try to minimise this effect we used only women as data collectors who received intensive training, and improved clarity of questions through extensive piloting. Regarding our study sample, the study was conducted in 10 PHC facilities and nearly half of the mothers had no formal education, our findings may be more reflective of this type of population, and less generalisable to mothers with higher levels of education, or mothers who deliver in other types of facilities or at home.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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To call or not to call: exploring the validity of telephone interviews to derive maternal self-reports of experiences with facility childbirth care in northern Nigeria

et al. 2022

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BackgroundTo institutionalise respectful maternity care, frequent data on the experience of childbirth care is needed by health facility staff and managers. Telephone interviews have been proposed as a low-cost alternative to derive timely and actionable maternal self-reports of experience of care. However, evidence on the validity of telephone interviews for this purpose is limited.MethodsEight indicators of positive maternity care experience and 18 indicators of negative maternity care experience were investigated. We compared the responses from exit interviews with women about their childbirth care experience (reference standard) to follow-up telephone interviews with the same women 14 months after childbirth. We calculated individual-level validity metrics including, agreement, sensitivity, specificity, area under the receiver operating characteristic curve (AUC). We compared the characteristics of women included in the telephone follow-up interviews to those from the exit interviews.ResultsDemographic characteristics were similar between the original exit interview group (n=388) and those subsequently reached for telephone interview (n=294). Seven of the eight positive maternity care experience indicators had reported prevalence higher than 50% at both exit and telephone interviews. For these indicators, agreement between the exit and the telephone interviews ranged between 50% and 92%; seven positive indicators met the criteria for validation analysis, but all had an AUC below 0.6. Reported prevalence for 15 of the 18 negative maternity care experience indicators was lower than 5% at exit and telephone interviews. For these 15 indicators, agreement between exit and telephone interview was high at over 80%. Just three negative indicators met the criteria for validation analysis, and all had an AUC below 0.6.ConclusionsThe telephone interviews conducted 14 months after childbirth did not yield results that were consistent with exit interviews conducted at the time of facility discharge. Women’s reports of experience of childbirth care may be influenced by the location of reporting or changes in the recall of experiences of care over time.

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Section: Discussionmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

To call or not to call: exploring the validity of telephone interviews to derive maternal self-reports of experiences with facility childbirth care in northern Nigeria

et al. 2022

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“…This study was a part of a larger effort to validate coverage indicators for various nutrition services through ANC, described in detail elsewhere 4 5. In brief, study staff were based at five government health posts and trained to directly observe and record the receipt of ANC services by enrolled women.…”

Section: Methodsmentioning

confidence: 99%

“…A study carried out by our research team in Nepal found that respondents tend to overestimate the receipt of IFA in pregnancy and that overestimation was not explained by either maternal or household characteristics 4. Women’s reports of the receipt of various counselling interventions, weight measurement and deworming were generally recalled more accurately than questions about other services such as counselling to not drink alcohol or tobacco 5…”

Section: Introductionmentioning

confidence: 91%

How does social desirability bias influence survey-based estimates of the use of antenatal care in rural Nepal? A validation study

Thorne‐Lyman¹,

Lama²,

Heidkamp³

et al. 2023

BMJ Open

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ObjectivesSocial desirability bias is often speculated to influence survey responses but seldom studied in healthcare. The objective was to explore whether social desirability scores (SDS) or the presence of interview observers is associated with inaccurate recall and overestimation of antenatal care (ANC) services.DesignLongitudinal validation study comparing recalled receipt of ANC services and nutrition components of ANC against direct observations of care. An adapted short form Marlowe-Crowne questionnaire was used to generate an SDS, and the presence of interview observers was treated as a separate exposure. We assessed accuracy and overestimation of recalled receipt of ANC services against observed receipt using log-binomial regression, adjusting for age, education, first-pregnancy and socioeconomic status.SettingRural Southern Nepal with recruitment from five government health posts.Participants401 pregnant women.ResultsSocial desirability scores did not significantly predict accuracy or overestimation of most types of ANC care except counselling on nausea. Higher SDS was associated with more accurate recall (adjusted RR, aRR 1.08 (95% CI 1.03, 1.12)) and less overestimation (aRR 0.85 (0.80, 0.91)). The presence of mothers-in-law or husbands during interviews was associated with greater overestimation of the number of ANC visits received by more than three visits (aRR 2.07 (1.11, 3.84)) and (aRR 4.19 (2.17, 8.10)), respectively. Those interviewed with friends present tended to overestimate the receipt of counselling on nausea, avoiding alcohol and not smoking.ConclusionThe presence of observers can lead to overestimation of the receipt of ANC care and support the conduct of interviews in private settings despite challenges of doing so in village contexts. Findings that the SDS did not predict the accuracy of most types of ANC care might reflect a reality that such questions may not be sensitive from a social-norms perspective. Additional local adaptation of SDS is recommended.

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“…Therefore, the validity of this question in such household surveys is unknown. Previous studies have investigated the validity of ANC coverage indicators like quality of care, nutritional interventions, nutrition counselling and iron-folic acid supplementation in the same Nepal cohort, but the validity of frequency of ANC visits has not been explored 11–13. The objective of this study is to examine the validity of maternal report of total number of ANC visits and factors associated with the accuracy of maternal report.…”

Section: Introductionmentioning

confidence: 99%

Validation of maternal recall of number of antenatal care visits attended in rural Southern Nepal: a longitudinal cohort study

Xie,

Munos,

Lama

et al. 2023

BMJ Open

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ObjectivesThis study aimed to examine the validity of maternal recall of total number of antenatal care (ANC) visits during pregnancy and factors associated with the accuracy of maternal recall.DesignThis was a longitudinal cohort study conducted from December 2018 through November 2020.SettingFive government health posts in the Sarlahi district of Southern Nepal.Participants402 pregnant women between ages 15 and 49 who presented for their first ANC visit at the study health posts.Main outcomesThe observed number of ANC visits (gold standard) and the reported number of ANC visits at the postpartum interview (maternal recall).ResultsOn average, women in the study who had a live birth attended 4.7 ANC visits. About 65% of them attended four or more ANC visits during pregnancy as recommended by the Nepal government, and 38.3% of maternal report matched the categorical ANC visits as observed by the gold standard. The individual validity was poor to moderate, with the highest area under the receiver operating characteristic curve (AUC) being 0.69 (95% CI: 0.65 to 0.74) in the 1–3 visits group. Population-level bias (as distinct from individual-level bias) was observed in the 1–3 visits and 4 visits groups, where 1–3 visits were under-reported (inflation factor (IF): 0.69) and 4 ANC visits were highly over-reported (IF: 2.12). The binary indicator ANC4+ (1–3 visits vs 4+ visits) showed better population-level validity (AUC: 0.69; IF: 1.17) compared with the categorical indicators (1–3 visits, 4 visits, 5–6 visits and more than 6 visits). Report accuracy was not associated with maternal characteristics but was related to ANC frequency. Women who attended more ANC visits were less likely to correctly report their total number of visits.ConclusionMaternal report of number of ANC visits during pregnancy may not be a valid indicator for measuring ANC coverage. Improvements are needed to measure the frequency of ANC visits.

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Validation of maternal report of nutrition‐related interventions and counselling during antenatal care in southern Nepal

Cited by 9 publications

References 40 publications

To call or not to call: exploring the validity of telephone interviews to derive maternal self-reports of experiences with facility childbirth care in northern Nigeria

To call or not to call: exploring the validity of telephone interviews to derive maternal self-reports of experiences with facility childbirth care in northern Nigeria

How does social desirability bias influence survey-based estimates of the use of antenatal care in rural Nepal? A validation study

Validation of maternal recall of number of antenatal care visits attended in rural Southern Nepal: a longitudinal cohort study

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