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      What is meant by validity in maternal and newborn health measurement? A conceptual framework for understanding indicator validation

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          Abstract

          Background

          Rigorous monitoring supports progress in achieving maternal and newborn mortality and morbidity reductions. Recent work to strengthen measurement for maternal and newborn health highlights the existence of a large number of indicators being used for this purpose. The definitions and data sources used to produce indicator estimates vary and challenges exist with completeness, accuracy, transparency, and timeliness of data. The objective of this study is to create a conceptual overview of how indicator validity is defined and understood by those who develop and use maternal and newborn health indicators.

          Methods

          A conceptual framework of validity was developed using mixed methods. We were guided by principles for conceptual frameworks and by a review of the literature and key maternal and newborn health indicator guidance documents. We also conducted qualitative semi-structured interviews with 32 key informants chosen through purposive sampling.

          Results

          We categorised indicator validity into three main types: criterion, convergent, and construct. Criterion or diagnostic validity, comparing a measure with a gold standard, has predominantly been used to assess indicators of care coverage and content. Studies assessing convergent validity quantify the extent to which two or more indicator measurement approaches, none of which is a gold-standard, relate. Key informants considered construct validity, or the accuracy of the operationalisation of a concept or phenomenon, a critical part of the overall assessment of indicator validity.

          Conclusion

          Given concerns about the large number of maternal and newborn health indicators currently in use, a more consistent understanding of validity can help guide prioritization of key indicators and inform development of new indicators. All three types of validity are relevant for evaluating the performance of maternal and newborn health indicators. We highlight the need to establish a common language and understanding of indicator validity among the various global and local stakeholders working within maternal and newborn health.

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          Most cited references55

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          Construct validity in psychological tests.

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            Building a Conceptual Framework: Philosophy, Definitions, and Procedure

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              Measuring Coverage in MNCH: Testing the Validity of Women's Self-Report of Key Maternal and Newborn Health Interventions during the Peripartum Period in Mozambique

              Background As low-income countries strive to meet targets for Millennium Development Goals 4 and 5, there is growing need to track coverage and quality of high-impact peripartum interventions. At present, nationally representative household surveys conducted in low-income settings primarily measure contact with the health system, shedding little light on content or quality of care. The objective of this study is to validate the ability of women in Mozambique to report on facility-based care they and their newborns received during labor and one hour postpartum. Methods and Findings The study involved household interviews with women in Mozambique whose births were observed eight to ten months previously as part of a survey of the quality of maternal and newborn care at government health facilities. Of 487 women whose births were observed and who agreed to a follow-up interview, 304 were interviewed (62.4%). The validity of 34 indicators was tested using two measures: area under receiver operator characteristic curve (AUC) and inflation factor (IF); 27 indicators had sufficient numbers for robust analysis, of which four met acceptability criteria for both (AUC >0.6 and 0.75
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: SupervisionRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: MethodologyRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: MethodologyRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: MethodologyRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: MethodologyRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: MethodologyRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: MethodologyRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: SupervisionRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                29 May 2020
                2020
                : 15
                : 5
                : e0233969
                Affiliations
                [1 ] Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
                [2 ] Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
                [3 ] Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
                [4 ] Maternal Child Survival Program, Jhpiego, Washington, DC, United States of America
                [5 ] Population Reference Bureau, Washington, DC, United States of America
                [6 ] Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
                [7 ] Global Public Health, Karolinska Institutet, Stockholm, Sweden
                [8 ] Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
                [9 ] Division of Global Health Equity Brigham & Women’s Hospital, Department of Medicine, Ariadne Labs, Harvard Medical School, Boston, Massachusetts, United States of America
                [10 ] Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
                [11 ] Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
                Johns Hopkins School of Public Health, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0001-8595-365X
                http://orcid.org/0000-0003-3581-0938
                http://orcid.org/0000-0001-8066-7873
                Article
                PONE-D-19-29431
                10.1371/journal.pone.0233969
                7259779
                32470019
                49a6a2b7-cfdc-402c-8764-6c91153d3db7
                © 2020 Benova et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 23 October 2019
                : 15 May 2020
                Page count
                Figures: 3, Tables: 4, Pages: 19
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100000865, Bill and Melinda Gates Foundation;
                Award ID: MoNITOR
                This work received support from the Bill & Melinda Gates Foundation.
                Categories
                Research Article
                Medicine and Health Sciences
                Public and Occupational Health
                Global Health
                Biology and Life Sciences
                Developmental Biology
                Neonates
                Research and Analysis Methods
                Research Assessment
                Research Validity
                Medicine and Health Sciences
                Pediatrics
                Neonatology
                Neonatal Care
                Medicine and Health Sciences
                Health Care
                Neonatal Care
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Birth
                Labor and Delivery
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Birth
                Labor and Delivery
                Medicine and Health Sciences
                Health Care
                Health Care Policy
                Health Systems Strengthening
                Biology and Life Sciences
                Population Biology
                Population Metrics
                Death Rates
                Medicine and Health Sciences
                Health Care
                Health Statistics
                Morbidity
                Custom metadata
                The data in the form of interview notes is available open access under the DOI: https://doi.org/10.17037/DATA.00001403.

                Uncategorized
                Uncategorized

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