Abstract
BackgroundFear of childbirth has negative consequences for a woman's physical and emotional wellbeing. The most commonly used measurement tool for childbirth fear is the Wijma Delivery Expectancy Questionnaire (WDEQ-A). Although originally conceptualized as unidimensional, subsequent investigations have suggested it is multidimensional. This study aimed to undertake a detailed psychometric assessment of the WDEQ-A; exploring the dimensionality and identifying possible subscales that may have clinical and research utility.MethodsWDEQ-A was administered to a sample of 1410 Australian women in mid-pregnancy. The dimensionality of WDEQ-A was explored using exploratory (EFA) and confirmatory factor analysis (CFA), and Rasch analysis.ResultsEFA identified a four factor solution. CFA failed to support the unidimensional structure of the original WDEQ-A, but confirmed the four factor solution identified by EFA. Rasch analysis was used to refine the four subscales (Negative emotions: five items; Lack of positive emotions: five items; Social isolation: four items; Moment of birth: three items). Each WDEQ-A Revised subscale showed good fit to the Rasch model and adequate internal consistency reliability. The correlation between Negative emotions and Lack of positive emotions was strong, however Moment of birth and Social isolation showed much lower intercorrelations, suggesting they should not be added to create a total score.ConclusionThis study supports the findings of other investigations that suggest the WDEQ-A is multidimensional and should not be used in its original form. The WDEQ-A Revised may provide researchers with a more refined, psychometrically sound tool to explore the differential impact of aspects of childbirth fear.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1157-8) contains supplementary material, which is available to authorized users.
Highlights
Fear of childbirth has negative consequences for a woman's physical and emotional wellbeing
The 33-item Wijma Delivery Expectancy/Experience Questionnaire (WDEQ-A) was originally conceptualized as a Pallant et al BMC Pregnancy and Childbirth (2016) 16:361 unidimensional measure, subsequent investigations by other researchers using factor analysis have suggested that it may be multidimensional, tapping a number of different aspects [9, 10, 14, 15]
Exploratory factor analysis The suitability of the first randomly selected datafile (n = 683) for factor analysis was confirmed with a KMO of .94 and a significant Bartlett’s Test of Sphericity (p < .001)
Summary
Fear of childbirth has negative consequences for a woman's physical and emotional wellbeing. Fear of childbirth has been linked with a number of negative consequences for a woman’s physical and emotional wellbeing. These include pregnancy complications, increased length of labour [1], use of anaesthesia during labour [2, 3], and increased risk of caesarean section deliveries [4, 5]. The 33-item WDEQ-A was originally conceptualized as a Pallant et al BMC Pregnancy and Childbirth (2016) 16:361 unidimensional measure, subsequent investigations by other researchers using factor analysis have suggested that it may be multidimensional, tapping a number of different aspects [9, 10, 14, 15]. To achieve a satisfactory solution the authors of that study found it was necessary to remove three items (items 26: ‘let happen’, and 28:‘funny’ and item 30: ‘obvious’), with the final four dimensions labeled Fear, Lack of positive anticipation, Isolation and Riskiness
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