Academic journal article Journal of Nursing Measurement

Development and Psychometric Testing of the Rural Pregnancy Experience Scale (RPES)

Academic journal article Journal of Nursing Measurement

Development and Psychometric Testing of the Rural Pregnancy Experience Scale (RPES)

Article excerpt

Rural pregnant woman who lack local access to maternity care due to their remote living circumstances may experience stress and anxiety related to pregnancy and parturition. The Rural Pregnancy Experience Scale (RPES) was designed to assess the unique worry and concerns reflective of the stress and anxiety of rural pregnant women related to pregnancy and parturition. The items of the scale were designed based on the results of a qualitative study of the experiences of pregnant rural women, thereby building a priori content validity into the measure. The relevancy content validity index (CVI) for this instrument was 1.0 and the clarity CVI was .91, as rated by maternity care specialists. A field test of the RPES with 187 pregnant rural women from British Columbia indicated that it had two factors: financial worries and worries/concerns about maternity care services, which were consistent with the conceptual base of the tool. Cronbach's alpha for the total RPES was .91; for the financial worries subscale and the worries/concerns about maternity care services subscale, alpha were .89 and .88, respectively. Construct validity was supported by significant correlations between the total scores of the RPES and the Depression Anxiety Stress Scales (DASS [r = .39, p < .01]), and subscale scores on the RPES were significantly correlated and converged with the depression, anxiety, and stress subscales of the DASS supporting convergent validity (correlations ranged between .20; p < .05 and .43; p < .01). Construct validity was also supported by findings that the level of access and availability of maternity care services were significantly associated with RPES scores. It was concluded that the RPES is a reliable and valid measure of worries and concerns reflective of rural pregnant women's stress and anxiety related to pregnancy and parturition.

Keywords: anxiety; maternity care; parturition; pregnancy; rural women; stress

The majority of childbearing women reside in urban or suburban centers with easy access to maternity services. Maternity care options in rural or remote areas are more restricted because of a shortage of maternity care providers who are easily accessible. Although attempts have been made to develop models of care that address the shortage of rural maternity services, rural parturient women are increasingly required to seek obstetric services in referral centers or more in urban settings (Chamberlain & Barclay, 2000; Hutten-Czapski, 1999; Jasen, 1997; Kornelsen & Grzybowski, 2005c; Rourke, 1998). This is part of a general trend toward the centralization of care (Collier, 2010). Pregnant and parturient women who reside in rural areas may be required to leave home prior to the onset of labor, whereas some can remain in their home communities until the onset of labor if there is a referral hospital within an hour driving time. Women from rural areas who deliver outside of their home communities are likely to be subjected to circumstances that result in worry and concerns reflective of the stress and anxiety that are unique to this situation. The phenomenon of worry and associated stress and anxiety of a rural birth, particularly in those who reside in remote settings, has not been assessed quantitatively. Qualitative work with rural parturient women in British Columbia (Kornelsen & Grzybowski, 2005c) provides a strong rationale for studying emotional aspects of rural birth quantitatively. This article presents the development and psychometric evaluation of a scale that was developed based on this qualitative work, which bridges that gap-the Rural Pregnancy Experience Scale (RPES).

There are several instruments that quantify stress and anxiety during pregnancy. These scales typically measure stressful external events, physical sources of distress related to pregnancy (Omer, Elizur, Barnea, Friedlander & Palti, 1986) and/or internal events (thoughts and feelings) that may result in increased stress or anxiety (Arizmendi & Affonso, 1987). …

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