Development and Preliminary Validation of the Traditional Chinese Antenatal Practice Scale among Pregnant Hong Kong Chinese Women

Article excerpt

Background and Purpose: There have been no valid assessment tools to measure traditional Chinese antenatal practice of safeguarding fetuses from danger. This study developed the Traditional Chinese Antenatal Practice Scale (TCAPS) and evaluated the preliminary psychometric characteristics. Methods: The TCAPS was developed in 2 phases. Phase I consisted of developing the TCAPS based on an extensive literature review followed by 3 focus groups, and then using a panel of 5 experts to test its content validity. Phase II established the preliminary psychometric properties of the TCAPS among 2,178 pregnant women. Results: Content validity was confirmed by a satisfactory level of agreement with content validity index (CVI) of 0.91. Structural validity testing achieved by exploratory factor analysis (EFA) revealed a 3-factor structure of the 13-item scale. A confirmatory factor analysis (CFA) was conducted using linear structural relations (LISREL) to confirm the structure. Further, convergent validity and known-groups analyses were used to support the good validity. The test-retest reliability and Cronbach's alpha of the TCAPS are .83 and .81, respectively, which suggests satisfactory reliability. Conclusions: Our data demonstrated good validity and reliability of the TCAPS that health professionals could use in clinical situations to acquire a more comprehensive view of Chinese women.

Keywords: Traditional Chinese Antenatal Practice Scale; psychometric evaluation; Chinese

The birth of a child is an important event for a family, and traditional antenatal practice is still applied to protect the fetus in many countries such as Turkey (Ayaz & Efe, 2008), Australia (Hoang, Le, & Kilpatrick, 2009), Thailand (Liamputtong, Yimyam, Parisunyakul, Baosoung, & Sansiriphun, 2005), and India (Wiley, 2002). What constitutes the appropriate management of pregnancy varies cross culturally, from numerous mandates for behavioral changes, or a long list of taboos, to minor modifications to the diet or activity patterns of pregnant women (Lee et al., 2009; Sleeboom-Faulkner, 2010). However, the means of reassuring women differ depending on the local context and the meaning of pregnancy (Ayaz & Efe, 2008). In China, the traditional antenatal practice involves being able to influence the fetus by the mother's behavior, thoughts, and activities (Nie, 2009; Sleeboom-Faulkner, 2010) to provide favorable internal and external environments to safeguard fetuses from dangers such as miscarriage, stillbirth, death of the mother, and imperfections in the newborn (Ip, 2009). We argue that this traditional practice may still be prevalent among contemporary Chinese mothers.


The basic concepts of traditional Chinese antenatal practice derive from the concept of yin and yang (Figure 1) in traditional Chinese medicine (TCM), a highly respected system of medical knowledge in China since 2000 BC (Kong & Liang, 2005; West, 2008). The TCM originates from the Taoist philosophy of one's harmony with the universe (Roemer, 2005). According to this theory, the human body, like the cosmos, can be fundamentally divided into a positive force (yang) and a negative force (yin), which complements each other. Health is thus seen as a harmonious equilibrium between yin and yang (Kong, 2010). The TCM has certain key concepts, including the qi (vital energy) that is kept in balance by the dual polarities of yin and yang (Kong & Liang, 2005), and the disturbance of the qi in a pregnant woman is thought to cause miscarriage or antenatal malformation (Yeh et al., 2009). The fetus is created through the harmonious intermingling of qi, yin, and yang (Noll & Wilms, 2010). Traditional Chinese antenatal practice is aimed at creating a model descendant who is long-lived, loyal and filial, humane, righteous, intelligent, wise, and free of disease (Noll & Wilms, 2010). It places great emphasis on dietary and behavioral instructions to restore physical and emotional harmony (Xuan, 2006), including balanced nutrition, regular lifestyle, stable emotions, and music stimulation (Stevens, 2004). …