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Abstract
BackgroundHealth related quality of life is a critical concept during the perinatal period but remains under-researched. The International Consortium for Health Outcomes Measurement have included the Patient Reported Outcomes Measurement Information System (PROMIS®) Global Short Form (GSF) in their core outcome set for pregnancy and childbirth to measure health related quality of life. The PROMIS GSF has not been fully evaluated as a valid and reliable instrument in this population. This study assessed the psychometric properties of the PROMIS GSF during pregnancy and postpartum period.MethodsPROMIS GSF was administered to a sample of 309 pregnant women at four time-points during pregnancy (≤ 27 and 36-weeks) and postpartum (6- and 26-weeks). The structural validity, internal consistency reliability, construct validity, and responsiveness of the PROMIS GSF were evaluated. The internal structure of the PROMIS GSF was explored using Rasch Measurement Theory. Response format, item fit, differential item functioning (item bias), dimensionality of the scale and its targeting were assessed.ResultsTwo revised subscales (Mental Health: four items; and Physical Health: five items) showed good fit to the Rasch model. The revised mental health subscale demonstrated good internal consistency reliability during pregnancy and postpartum period (α = .88 and .87, respectively). The internal consistency reliability of the physical health subscale was adequate (α = .76 and .75, respectively). The revised mental health subscale was sensitive to group differences according to a history of mental health disorder, income, smoking status, drug use, stress levels and planned versus unplanned pregnancy. Differences in scores on the revised physical subscale were detected for groups based on obesity, income, drug use, smoking status, stress, and history of mental health disorders. Scores on both subscales recorded significant changes across the four time-points, spanning pregnancy and postpartum period.ConclusionsThe revised version of the PROMIS GSF was better able to measure mental and physical health during pregnancy and postpartum period compared to the original version. Findings support the clinical and research application of the PROMIS GSF within the International Consortium for Health Outcomes Measurement Standard Set of Outcome Measures for Pregnancy and Childbirth. Ongoing psychometric analysis of the PROMIS GSF is recommended in other maternity populations.
Highlights
Health related quality of life is a critical concept during the perinatal period but remains underresearched
While several socio-demographic, physical and psychological factors are known to influence the quality of life of pregnant women [4], the maternity model of care women receive during this time may have a significant impact on their future Health related quality of life (HRQoL)
At recruitment most participants were in their second trimester of pregnancy
Summary
Health related quality of life is a critical concept during the perinatal period but remains underresearched. While HRQoL is not generally well defined within the literature, it does refer to a multi-dimensional concept to examine the impact of health status on quality of life [1]. Adapting a definition by O’Connor [2], HRQoL for maternity populations can be defined as ‘a multidimensional concept referring to a woman’s perception of the influence of her pregnancy, birth and postpartum condition, her care provision and any intervention and treatment on her physical, mental, emotional, and social functioning. While several socio-demographic, physical and psychological factors are known to influence the quality of life of pregnant women [4], the maternity model of care women receive during this time may have a significant impact on their future HRQoL. Birth fear and birth related trauma are increasingly reported in the literature [12, 13]
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