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      Validity and reliability of the Farsi version of Wijma delivery expectancy questionnaire: an exploratory and confirmatory factor analysis

      research-article
      Electronic Physician
      Electronic physician
      Fear, Anxiety, Childbirth, Parturition, Psychometric, Postpartum

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          Abstract

          Background

          Fear of childbirth may cause complications such as experiencing severe labour pain, postpartum depression, and impaired mother–fetus attachment.

          Objective

          To validate the Farsi version of the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) (versions A & B) in a sample of Iranian women.

          Methods

          The WDE-Q (versions A & B) was translated into Farsi, and the content validity of the scales was confirmed. In a cross-sectional study conducted in 2015, 405 pregnant women in the third trimester of pregnancy and 320 postpartum women completed the Farsi W-DEQ versions A & B, respectively. The construct validity and reliability of the scales were examined using exploratory and confirmatory factor analyses (EFA and CFA) and Cronbach’s alpha coefficient, respectively. SPSS version 18 and Lisrel version 8.80 were used for statistical analyses.

          Results

          Results of the CFA on 33 items could not confirm the one-factor structure proposed by Wijma (RMSEA= 0.14, SRMR=0.11, Chi-square/df=8.95, p<0.05, CFI=0.86, IFI=0.86) or other structures suggested by previous studies. We conducted an EFA on 33-item version A and found six factors with eigenvalue > 1. One item was not loaded on any factor. A CFA on 32 items of the W-DEQ (version B) yielded acceptable fit for the factorial structure found on version A (RMSEA= 0.075 (CI [0.071, 0.08]), SRMR=0.078, Chi-square/df=2.93, p<0.05, CFI=0.95, IFI=0.95). Cronbach’s Alpha coefficients for the 32-item Farsi W-DEQ (versions A & B) were 0.914 and 0.919, respectively.

          Conclusions

          Both Farsi W-DEQ are reliable and valid instruments to assess fear of childbirth in Iranian pregnant and postpartum women. Further research should be designed to examine the validity of the W-DEQ (A) in pregnant women regardless of gestational age.

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          Most cited references36

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          Starting at the beginning: an introduction to coefficient alpha and internal consistency.

          Cronbach's a is the most widely used index of the reliability of a scale. However, its use and interpretation can be subject to a number of errors. This article discusses the historical development of a from other indexes of internal consistency (split-half reliability and Kuder-Richardson 20) and discusses four myths associated with a: (a) that it is a fixed property of the scale, (b) that it measures only the internal consistency of the scale, (c) that higher values are always preferred over lower ones, and (d) that it is restricted to the range of 0 to 1. It provides some recommendations for acceptable values of a in different situations.
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            Women's fear of childbirth and preference for cesarean section--a cross-sectional study at various stages of pregnancy in Sweden.

            To investigate Swedish women's level of antenatal fear of childbirth at various gestational ages, and factors associated with intense fear and with preference for cesarean section. A cross-sectional study. All antenatal clinics in four geographical areas. Thousand six hundred and thirty-five pregnant women at various gestational ages recruited during September-October 2006. A questionnaire completed at the antenatal clinic. The women reported their appraisal of the approaching delivery according to the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). The level of fear of childbirth and preferred mode of delivery. Mean W-DEQ score was 62.8. The prevalence of intense fear of childbirth (W-DEQ score > or =85) was 15.8% and very intense fear (tocophobia) (W-DEQ score > or =100) 5.7%. Nulliparous women had a higher mean score than parous women, but more parous women reported an intense fear. Preference for cesarean section was associated with fear of childbirth (OR 11.79, 6.1-22.59 for nulliparous and OR 8.32, 4.36-15.85 for parous women) and for parous women also with a previous cesarean section (OR 18.54, 9.55-35.97), or an instrumental vaginal delivery (OR 2.34, 1.02-5.34). The level of fear of childbirth was not associated with the gestational age. When a woman requests a cesarean section, both primary fear of birth and traumatic childbirth experiences need to be considered and dealt with. The W-DEQ can be used at any time during pregnancy in order to identify pregnant women who suffer from intense fear of childbirth.
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              Fear of childbirth and duration of labour: a study of 2206 women with intended vaginal delivery.

              To assess the association between fear of childbirth and duration of labour. A prospective study of women from 32 weeks of gestation through to delivery. Akershus University Hospital, Norway. A total of 2206 pregnant women with a singleton pregnancy and intended vaginal delivery during the period 2008-10. Fear of childbirth was assessed by the Wijma Delivery Expectancy Questionnaire (W-DEQ) version A at 32 weeks of gestation, and defined as a W-DEQ sum score ≥ 85. Information on labour duration, use of epidural analgesia and mode of delivery was obtained from the maternal ward electronic birth records. Labour duration in hours: from 3-4 cm cervical dilatation and three uterine contractions per 10 minutes lasting ≥ 1 minute, until delivery of the child. Fear of childbirth (W-DEQ sum score ≥ 85) was present in 7.5% (165) of women. Labour duration was significantly longer in women with fear of childbirth compared with women with no such fear using a linear regression model (crude unstandardized coefficient 1.54; 95% confidence interval 0.87-2.22, corresponding to a difference of 1 hour and 32 minutes). After adjustment for parity, counselling for pregnancy concern, epidural analgesia, labour induction, labour augmentation, emergency caesarean delivery, instrumental vaginal delivery, offspring birthweight and maternal age, the difference attenuated, but remained statistically significant (adjusted unstandardized coefficient 0.78; 95% confidence interval 0.20-1.35, corresponding to a 47-minute difference). Duration of labour was longer in women with fear of childbirth than in women without fear of childbirth. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.
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                Author and article information

                Journal
                Electron Physician
                Electron Physician
                Electronic physician
                Electronic Physician
                Electronic physician
                2008-5842
                June 2017
                25 June 2017
                : 9
                : 6
                : 4606-4615
                Affiliations
                Ph.D. of Reproductive Health, Assistant Professor, Department of Midwifery, Faculty of Nursing & Midwifery, Sabzevar University of Medical Sciences, Sabzevar, Iran
                Author notes
                Corresponding author: Dr. Forough Mortazavi. Department of Midwifery, Faculty of Nursing & Midwifery, Sabzevar University of Medical Sciences, Sabzevar, Iran. Tel: +98.9151737039, Fax: +98.5144445648, Email: frmortazavi@ 123456yahoo.com
                Article
                epj-09-4606
                10.19082/4606
                5557142
                28848637
                b163d964-fa56-4344-8399-c55c150ab8ae
                © 2017 The Authors

                This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

                History
                : 22 April 2016
                : 02 September 2016
                Categories
                Original Article

                fear,anxiety,childbirth,parturition,psychometric,postpartum
                fear, anxiety, childbirth, parturition, psychometric, postpartum

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