Assessing Evidence-Informed Practices to Reduce Routine Interventions in Labor and Childbirth: Validating the Content of the Keeping Birth Normal Tool

Abstract

Background:The overuse of interventions in labor and childbirth increase the risk of mortality and morbidity in women. There are wide variations in the use of routine interventions locally, regionally, and globally. The reasons for this are complex and multifactorial. This study focuses its investigations at the microcosm of practice. It outlines the validation of the content of a new Tool to assess and support the implementation of evidence-informed practices by health-care professionals.Methods:Seven experts and eight women user representatives used a 4-point ordinal scale of relevance to rate 50 items in the Keeping Birth Normal (KBN) Tool. Item-level content validity index (I-CVI), an average scale-level content validity index (S-CVI/Ave), and qualitative comments were used to delete and improve items.Results:Eleven experts analyzed all 50 items. Four experts rated 35–49 items. The initial scale received an S-CVI/Ave of 0.88. Two items were deleted, improvements were made to 45 items, some were merged, and 7 new items were added. The final scale with 36 items received an S-CVI/Ave of 1.0 post item deletion and improvement.Discussion:The items in the KBN Tool are construct relevant and will undergo plausibility testing in a future study. Other forms of validity evidence on response processes and internal structure, which may be gathered, will depend on its further application in practice and research.