{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T02:23:38Z","timestamp":1791426218616,"version":"4.3.3"},"reference-count":54,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T00:00:00Z","timestamp":1748304000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Union Horizon 2020 Research and Innovation Programme","award":["847567"],"award-info":[{"award-number":["847567"]}]},{"name":"UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction","award":["n\/a"],"award-info":[{"award-number":["n\/a"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec021\">\n<jats:title>Background<\/jats:title>\n<jats:p>Measuring person-centered maternity care outcomes typically consists of two types of measures: experiences of care and satisfaction with care. There are limited validated measurement tools for these measures, particularly in low- and middle-income countries (LMICs). The QUALI-DEC study aims to improve decision-making around caesarean section. We describe development of the QUALI-DEC Study Birth Experience and Satisfaction (QD-BES) scale, and scale validation in Argentina, Burkina Faso, Thailand, and Viet Nam.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec022\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We used a three-phase scale development and validation approach: 1) item development, 2) scale development, and 3) scale evaluation. We systematically identified existing tools, and assessed them using the QUALI-DEC theory of change, study context, and psychometric qualities. We proposed the 10-item QD-BES scale to balance feasibility, theoretical coverage, and comprehensiveness. We conducted a baseline exit survey with post-partum women in 32 hospitals in 4 countries. We conducted exploratory factor analysis (EFA), and confirmatory factor analysis (CFA).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec023\">\n<jats:title>Results<\/jats:title>\n<jats:p>3127 women participated, most were multiparous (61.0%), without previous caesarean section (77.2%), and preferred vaginal birth (72.8%) despite high rates of caesarean section (39.4%). EFA identified three dimensions: emotional satisfaction (3-items), support and respect by providers (4-items), and communication with providers (3-items), with high loading coefficients (0.5\u20130.97). CFA confirmed the three-dimension scale, with good model fit (CFI and IFI: 0.95, Cronbach\u2019s alpha: 0.70\u20130.90). Criterion validity was assessed by exploring characteristics of women, obstetric histories, and birth experiences.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec024\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>We present psychometric validation of a scale measuring women\u2019s satisfaction with care and experiences of childbirth care, using a systematic approach to development and validation in four LMICs. The 10-item QD-BES-scale is short, easily-administered, valid, and reliable. The QD-BES-scale is useful to contribute to the generation of new knowledge about quality of maternity care in LMICs, as well as help to meet the major challenge of implementing and measuring respectful care at scale.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0322132","type":"journal-article","created":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T18:09:45Z","timestamp":1748369385000},"page":"e0322132","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":9,"title":["Women\u2019s experiences of and satisfaction with childbirth: Development and validation of a measurement scale for low- and middle-income countries"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4179-4682","authenticated-orcid":true,"given":"Meghan A.","family":"Bohren","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charbel Abi","family":"Saad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Kabore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristi Sidney","family":"Annerstedt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Hanson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myriam","family":"de Loenzien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Tiendrebeogo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fadima","family":"Bocoum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marion","family":"Ravit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camille","family":"Etcheverry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pisake","family":"Lumbiganon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nampet","family":"Jampathong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillermo","family":"Carroli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celina","family":"Gialdini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quoc Nhu Hung","family":"Mac","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helle M\u00f6lsted","family":"Alvesson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrainolo","family":"Ravalihasy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre","family":"Dumont","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Pilar","family":"Betr\u00e1n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,5,27]]},"reference":[{"key":"pone.0322132.ref001","volume-title":"Crossing the global quality chasm: Improving health care worldwide","author":"National Academies of Sciences E, Medicine","year":"2018"},{"key":"pone.0322132.ref002","volume-title":"Delivering quality health services: A global imperative for universal health coverage","author":"World Health Organization, Organisation for Economic Co-operation Development, International Bank for Reconstruction Development","year":"2018"},{"issue":"11","key":"pone.0322132.ref003","article-title":"High-quality health systems in the Sustainable Development Goals era: time for a revolution","volume":"6","author":"ME Kruk","year":"2018","journal-title":"Lancet Glob Health"},{"key":"pone.0322132.ref004","volume-title":"Resolution A\/RES\/70\/1. Transforming our world: the 2030 agenda for sustainable development","author":"United Nations","year":"2015"},{"issue":"1","key":"pone.0322132.ref005","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1186\/s12978-019-0827-1","article-title":"Optimising the use of caesarean section: A generic formative research protocol for implementation preparation","volume":"16","author":"MA Bohren","year":"2019","journal-title":"Reprod Health"},{"issue":"1","key":"pone.0322132.ref006","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2012-001570","article-title":"A systematic review of evidence on the links between patient experience and clinical safety and effectiveness","volume":"3","author":"C Doyle","year":"2013","journal-title":"BMJ Open"},{"issue":"8","key":"pone.0322132.ref007","doi-asserted-by":"crossref","first-page":"563","DOI":"10.2471\/BLT.18.225201","article-title":"When the patient is the expert: Measuring patient experience and satisfaction with care","volume":"97","author":"E Larson","year":"2019","journal-title":"Bull World Health Organ"},{"issue":"8","key":"pone.0322132.ref008","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1111\/1471-0528.13451","article-title":"Quality of care for pregnant women and newborns-the WHO vision","volume":"122","author":"\u04e6 Tun\u00e7alp","year":"2015","journal-title":"BJOG"},{"issue":"11","key":"pone.0322132.ref009","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2020-003368","article-title":"Measuring experiences of facility-based care for pregnant women and newborns: A scoping review","volume":"5","author":"E Larson","year":"2020","journal-title":"BMJ Glob Health"},{"issue":"1","key":"pone.0322132.ref010","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1186\/s12884-017-1356-y","article-title":"Measuring women\u2019s childbirth experiences: A systematic review for identification and analysis of validated instruments","volume":"17","author":"H Nilv\u00e9r","year":"2017","journal-title":"BMC Pregnancy Childbirth"},{"key":"pone.0322132.ref011","article-title":"Within country inequalities in caesarean section rates: Observational study of 72 low and middle income countries","volume":"360","author":"AA Boatin","year":"2018","journal-title":"BMJ"},{"issue":"10155","key":"pone.0322132.ref012","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1016\/S0140-6736(18)31927-5","article-title":"Interventions to reduce unnecessary caesarean sections in healthy women and babies","volume":"392","author":"AP Betr\u00e1n","year":"2018","journal-title":"Lancet"},{"issue":"1","key":"pone.0322132.ref013","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12978-018-0570-z","article-title":"Women\u2019s and communities\u2019 views of targeted educational interventions to reduce unnecessary caesarean section: A qualitative evidence synthesis","volume":"15","author":"C Kingdon","year":"2018","journal-title":"Reprod Health"},{"issue":"9","key":"pone.0322132.ref014","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pone.0203274","article-title":"Non-clinical interventions to reduce unnecessary caesarean section targeted at organisations, facilities and systems: Systematic review of qualitative studies","volume":"13","author":"C Kingdon","year":"2018","journal-title":"PLoS One"},{"issue":"12","key":"pone.0322132.ref015","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-025073","article-title":"Interventions targeted at health professionals to reduce unnecessary caesarean sections: a qualitative evidence synthesis","volume":"8","author":"C Kingdon","year":"2018","journal-title":"BMJ Open"},{"issue":"1","key":"pone.0322132.ref016","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1186\/s13012-020-01029-4","article-title":"Implementation and evaluation of nonclinical interventions for appropriate use of cesarean section in low- and middle-income countries: Protocol for a multisite hybrid effectiveness-implementation type III trial","volume":"15","author":"A Dumont","year":"2020","journal-title":"Implement Sci"},{"issue":"1","key":"pone.0322132.ref017","doi-asserted-by":"crossref","first-page":"66","DOI":"10.2471\/BLT.19.236729","article-title":"Non-clinical interventions to reduce unnecessary caesarean sections: WHO recommendations","volume":"98","author":"N Opiyo","year":"2020","journal-title":"Bull World Health Organ"},{"issue":"6","key":"pone.0322132.ref018","first-page":"800","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"18","author":"E von Elm","year":"2007","journal-title":"Int J Surg"},{"key":"pone.0322132.ref019","doi-asserted-by":"crossref","first-page":"149","DOI":"10.3389\/fpubh.2018.00149","article-title":"Best practices for developing and validating scales for health, social, and behavioral research: A primer","volume":"6","author":"GO Boateng","year":"2018","journal-title":"Front Public Health"},{"key":"pone.0322132.ref020","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1111\/apa.14540","article-title":"Implementation of a labour companionship model in three public hospitals in Arab middle-income countries","volume":"107","author":"Labour Companionship Study Group","year":"2018","journal-title":"Acta Paediatr"},{"issue":"5","key":"pone.0322132.ref021","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1002\/nur.4770100503","article-title":"The Labour Agentry Scale: psychometric properties of an instrument measuring control during childbirth","volume":"10","author":"ED Hodnett","year":"1987","journal-title":"Res Nurs Health"},{"issue":"2","key":"pone.0322132.ref022","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1111\/j.1365-2648.2003.02981.x","article-title":"Factors related to childbirth satisfaction","volume":"46","author":"P Goodman","year":"2004","journal-title":"J Adv Nurs"},{"issue":"10210","key":"pone.0322132.ref023","doi-asserted-by":"crossref","first-page":"1750","DOI":"10.1016\/S0140-6736(19)31992-0","article-title":"How women are treated during facility-based childbirth in four countries: A cross-sectional study with labour observations and community-based surveys","volume":"394","author":"MA Bohren","year":"2019","journal-title":"Lancet"},{"issue":"1","key":"pone.0322132.ref024","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1186\/s12874-018-0603-x","article-title":"Methodological development of tools to measure how women are treated during facility-based childbirth in four countries: Labor observation and community survey","volume":"18","author":"MA Bohren","year":"2018","journal-title":"BMC Med Res Methodol"},{"issue":"1","key":"pone.0322132.ref025","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s12978-021-01080-4","article-title":"Optimizing the use of cesarean section in Argentina: Design and methodology of a formative research for the development of interventions","volume":"18","author":"S Ramos","year":"2021","journal-title":"Reprod Health"},{"issue":"1","key":"pone.0322132.ref026","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-053419","article-title":"Caesarean birth in public maternities in Argentina: A formative research study on the views of obstetricians, midwives and trainees","volume":"12","author":"C Perrotta","year":"2022","journal-title":"BMJ Open"},{"issue":"1","key":"pone.0322132.ref027","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1186\/s12884-023-05576-8","article-title":"\u201cBecause it eases my Childbirth Plan\u201d: A qualitative study on factors contributing to preferences for caesarean section in Thailand","volume":"23","author":"S Nuampa","year":"2023","journal-title":"BMC Pregnancy Childbirth"},{"issue":"1","key":"pone.0322132.ref028","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/s12978-023-01597-w","article-title":"Women\u2019s and health providers\u2019 perceptions of companionship during labor and childbirth: A formative study for the implementation of WHO companionship model in Burkina Faso","volume":"20","author":"F Yaya Bocoum","year":"2023","journal-title":"Reprod Health"},{"issue":"5","key":"pone.0322132.ref029","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-054946","article-title":"Factors influencing the implementation of labour companionship: Formative qualitative research in Thailand","volume":"12","author":"S Rungreangkulkij","year":"2022","journal-title":"BMJ Open"},{"issue":"2","key":"pone.0322132.ref030","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1002\/rfc2.16","article-title":"Women\u2019s mode of birth preferences and preparedness of hospitals to support vaginal birth in the public health sector in Argentina","volume":"1","author":"C Perrotta","year":"2022","journal-title":"Repro Female Child Health"},{"issue":"11","key":"pone.0322132.ref031","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0001264","article-title":"Caesarean section or vaginal delivery for low-risk pregnancy? Helping women make an informed choice in low- and middle-income countries","volume":"2","author":"A Dumont","year":"2022","journal-title":"PLOS Glob Public Health"},{"key":"pone.0322132.ref032","volume-title":"Trends in maternal mortality 2000 to 2020 Estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA\/Population Division","author":"World Health Organization","year":"2023"},{"issue":"4","key":"pone.0322132.ref033","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1111\/j.1471-0528.2010.02793.x","article-title":"Women\u2019s preference for caesarean section: A systematic review and meta-analysis of observational studies","volume":"118","author":"A Mazzoni","year":"2011","journal-title":"BJOG"},{"key":"pone.0322132.ref034","volume-title":"World bank data: fertility rate, total (births per woman) - Burkina Faso"},{"key":"pone.0322132.ref035","volume-title":"Trends in maternal mortality 2000 to 2017","author":"World Health Organization, United Nations Children\u2019s Fund, World Bank Group, the United Nations Population Division","year":"2019"},{"key":"pone.0322132.ref036","author":"Global Health Observatory"},{"key":"pone.0322132.ref037","article-title":"Determinants of non-medically indicated cesarean deliveries in Burkina Faso","author":"C Kabor\u00e9","year":"2016","journal-title":"Int J Gynaecol Obstet"},{"key":"pone.0322132.ref038","volume-title":"Thailand Multiple Indicator Cluster Survey 2022, Survey Findings Report July 2023","author":"UNICEF","year":"2023"},{"issue":"4","key":"pone.0322132.ref039","article-title":"Trend of cesarean section rates and correlations with adverse maternal and neonatal outcomes: A secondary analysis of thai universal coverage scheme data","volume":"9","author":"T Liabsuetrakul","year":"2019","journal-title":"AJP Rep"},{"key":"pone.0322132.ref040","first-page":"758","volume-title":"Survey measuring viet nam sustainable development goal indicators on children and women 2020-2021","author":"UNICEF","year":"2021"},{"issue":"1","key":"pone.0322132.ref041","doi-asserted-by":"crossref","first-page":"41","DOI":"10.3390\/healthcare8010041","article-title":"Reasons for increased caesarean section rate in vietnam: A qualitative study among vietnamese mothers and health care professionals","volume":"8","author":"M Takegata","year":"2020","journal-title":"Healthcare (Basel)"},{"issue":"7","key":"pone.0322132.ref042","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0213129","article-title":"Magnitude and correlates of caesarean section in urban and rural areas: A multivariate study in Vietnam","volume":"14","author":"M de Loenzien","year":"2019","journal-title":"PLoS One"},{"issue":"2","key":"pone.0322132.ref043","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"PA Harris","year":"2009","journal-title":"J Biomed Inform"},{"issue":"1","key":"pone.0322132.ref044","first-page":"53","article-title":"Structural equation modelling: guidelines for determining model fit","volume":"6","author":"D Hooper","year":"2008","journal-title":"Electron J Bus Res Methods"},{"issue":"3","key":"pone.0322132.ref045","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1177\/0049124189017003004","article-title":"A new incremental fit index for general structural equation models","volume":"17","author":"KA Bollen","year":"1989","journal-title":"Sociological Methods & Research"},{"key":"pone.0322132.ref046","first-page":"81","volume-title":"4 Reliability coefficients and generalizability theory. Handbook of Statistics. 26","author":"NM Webb","year":"2006"},{"issue":"2","key":"pone.0322132.ref047","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.jcm.2016.02.012","article-title":"A Guideline of selecting and reporting intraclass correlation coefficients for reliability research","volume":"15","author":"TK Koo","year":"2016","journal-title":"J Chiropr Med"},{"key":"pone.0322132.ref048","volume-title":"Introduction to classical and modern test theory","author":"L Crocker","year":"2008"},{"issue":"4","key":"pone.0322132.ref049","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1093\/intqhc\/mzl022","article-title":"The development and validation of the Concise Outpatient Department User Satisfaction Scale","volume":"18","author":"IF Tso","year":"2006","journal-title":"Int J Qual Health Care"},{"issue":"1","key":"pone.0322132.ref050","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.jclinepi.2006.03.012","article-title":"Quality criteria were proposed for measurement properties of health status questionnaires","volume":"60","author":"CB Terwee","year":"2007","journal-title":"J Clin Epidemiol"},{"issue":"4","key":"pone.0322132.ref051","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1046\/j.1365-2648.1999.00961.x","article-title":"Satisfaction in childbirth and perceptions of personal control in pain relief during labour","volume":"29","author":"BH McCrea","year":"1999","journal-title":"J Adv Nurs"},{"issue":"1","key":"pone.0322132.ref052","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1111\/j.1365-2648.2005.03462.x","article-title":"Relationship between quality of care, staffing levels, skill mix and nurse autonomy: literature review","volume":"51","author":"V Currie","year":"2005","journal-title":"J Adv Nurs"},{"issue":"4","key":"pone.0322132.ref053","doi-asserted-by":"crossref","DOI":"10.4102\/sajip.v30i4.168","article-title":"An item selection procedure to maximise scale reliability and validity","volume":"30","author":"J Raubenheimer","year":"2004","journal-title":"SA j ind psychol"},{"issue":"1","key":"pone.0322132.ref054","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1177\/1049731509336986","article-title":"Book review: Kline R B (2005) Principles and practice of structural equation modeling (2nd ed.)","volume":"20","author":"S Lin","year":"2009","journal-title":"Res Soc Work Pract"}],"updated-by":[{"DOI":"10.1371\/journal.pone.0331720","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T00:00:00Z","timestamp":1756944000000}}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0322132","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T18:09:59Z","timestamp":1748369399000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0322132"}},"subtitle":[],"editor":[{"given":"Abiodun","family":"Adanikin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,5,27]]},"references-count":54,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5,27]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0322132","relation":{"correction":[{"id-type":"doi","id":"10.1371\/journal.pone.0331720","asserted-by":"object"}]},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,27]]}}}