Developing an Item Bank of Survey Questions to Measure Women's Experiences with Childbirth in Hospitals

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What was the research about?

Understanding patients’ expectations and their experiences can help hospitals improve care. Hospitals often send surveys to patients to ask about their care. To create surveys quickly, hospitals sometimes pick questions from an item bank. An item bank is a list of survey questions available to use about a specific topic.

In this study, the research team created an item bank about childbirth care. The team used the item bank to create and carry out a survey about women’s preferences and experiences with care during and after childbirth. The team looked at which questions related closely to women’s overall ratings of their hospital care.

What were the results?

The item bank had 100 questions about the care women prefer or how they felt after childbirth. For example, there were questions about managing pain during childbirth and making decisions about breastfeeding. The item bank also had 60 questions about women’s personal traits, such as age or education level.

Using the results of a survey created from the item bank, the research team made a list of questions that related most closely to women’s ratings of their care. This list included questions about how well staff communicated and showed concern and respect. Women’s responses to questions about managing pain and some personal traits also related closely to their ratings of care.

Who was in the study?

The study included 2,757 adult women who were at least 20 weeks pregnant. The women were racially and ethnically diverse and lived across the United States. Of these women, 38 percent had at least some college education. The women spoke English or Spanish.

What did the research team do?

To create the item bank, the team looked at existing surveys to find questions about women’s experiences with childbirth care. The team grouped 5,902 questions into 19 topics. When questions were similar, the team picked the best question.

The research team gave the survey to women when they were pregnant and again after they gave birth.

Community members, advocates for pregnant women, doctors, and nurses gave input to the study.

What were the limits of the study?

The item bank had questions about cesarean delivery. The item bank also had questions about places other than hospitals where women give birth. However, not many people responded to these questions. In addition, there were no questions about care during pregnancy or after going home from the hospital.

Future studies could test questions about care for patients who have cesarean delivery. Studies can also see if hospitals can easily use the item bank questions.

How can people use the results?

Hospitals can create surveys from the item bank to learn about women’s experience with childbirth care. Hospitals can use what they learn to help improve care.

Objective

To use the Patient-Reported Outcomes Management Information System (PROMIS®) methodology to develop an item bank of survey questions to measure the childbirth values, preferences, and experiences of women receiving childbirth and postpartum care services in a hospital and to use the item bank to develop a survey for validity testing

Study Design

Item bank are collections of survey questions that researchers can use to create new surveys quickly. With input from community partners, healthcare providers, and advocates for pregnant women, the research team developed an item bank of survey questions to measure hospital childbirth experience from the patient perspective. The team tested a subset of questions from the item bank and validated questions in the survey to see which items were predictors of hospital satisfaction.

First, the team performed a literature review to find patient-reported survey items that measure women’s values and preferences for childbirth services as well as experiences and outcomes, including satisfaction with hospital childbirth services. The team then developed domains and additional survey items by using methods adapted from PROMIS®, including focus groups with women to identify missing content domains.

Community partners prioritized questions from the item bank, which the research team used to develop a survey. Using responses from 30 English-speaking women, the team assessed the survey for content and construct validity, interpretability, and respondent and administrative burden for online administration. The team created a Spanish version using similar methods.

The research team fielded the values and preferences of questions in the survey online to a national sample of 2,757 adult women who were at least 20 weeks pregnant. Of these women, 38% had at least some college education. The respondents were racially and ethnically diverse. The women completed the experiences and outcomes survey questions after they gave birth.

Results

The literature review yielded 5,902 survey items focused on women’s values, preferences, experiences, and outcomes. These items fit into 15 content domains, such as pain assessment and pain management, and 46 subdomains. Using PROMIS® methods, the team created an item bank with 60 questions about personal characteristics and 100 questions about women’s values, preferences, experiences, and outcomes.

Nine items in the newly created survey related to women’s hospital childbirth satisfaction. These included the patient’s report of her mental health as being poor or fair, experiences with labor pain, and whether she received practical support for feeding the newborn.

Limitations

The research team focused its development of the item bank on the immediate childbirth experience in the hospital and did not look at other periods, such as before or after the hospital stay. The item bank questions included questions about the experience of women anticipating a cesarean delivery or giving birth in other settings, like birthing centers. However, not many women responded to these questions.

Conclusions and Relevance

The study developed an item bank to measure women’s hospital childbirth values, preferences, and experiences. Hospitals may consider using the item bank to create surveys to gather information to improve childbirth experiences.

Future Research Needs

Future studies could look at ways to include additional topics related to women’s experiences with prenatal care and postpartum care after hospital discharge. Research could also focus on care for women undergoing cesarean delivery.