==== Front Biomed Res Int Biomed Res Int BMRI BioMed Research International 2314-6133 2314-6141 Hindawi 10.1155/2020/6879283 Research Article Psychometric Evaluation of the Persian Version of the Childbirth Experience Questionnaire (CEQ) https://orcid.org/0000-0001-5842-8059Kazemi Samiyeh 1 https://orcid.org/0000-0001-6047-330XDencker Anna 2 https://orcid.org/0000-0002-1955-5220Pazandeh Farzaneh pazandehf@gmail.com 3 4 https://orcid.org/0000-0002-5198-9539Montazeri Ali 5 https://orcid.org/0000-0002-7330-1037Sedigh-Mobarakabadi Sedigheh 4 https://orcid.org/0000-0002-3368-0036Hajian Sepideh 4 1Student Research Committee, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran 19968-35119, Iran 2Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg 457, 40530, Sweden 3School of Health Sciences, University of Nottingham, Nottingham NG7 2RD, UK 4Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran 19968-35119, Iran 5Population Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran 13157-95795, Iran Academic Editor: Gaetano Valenti 2020 10 12 2020 2020 687928321 8 2020 7 11 2020 30 11 2020 Copyright © 2020 Samiyeh Kazemi et al.2020This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Women's childbirth experience is an outcome indicator for evaluating maternity care. This study evaluated the psychometric properties of the Persian version of the Childbirth Experience Questionnaire (P-CEQ). The study recruited two hundred and fifty primiparous postpartum women in the 1-3 months following birth from one private and three public hospitals in Mazandaran province, Iran. First, face validity and content validity were evaluated. Moreover, confirmatory factor analysis (CFA) was conducted, and discriminant validity was assessed by applying the known-groups method. Intraclass correlation coefficient (ICC) was measured to confirm the stability and Cronbach's alpha to confirm the internal consistency. CFA also confirmed the values of fit indices (RMSEA = 0.05, SRMSR = 0.06, CFI >0.93, χ2/df = 1.80). ICC was 0.88 and Cronbach's alpha for all items was 0.85. Furthermore, discriminant validity of the P-CEQ was approved given that it effectively differentiated women whose stay in the labor unit exceeded twelve hours from those with a shorter stay. The P-CEQ questionnaire is a valid and reliable tool for assessing childbirth experiences. It is an easy-to-use questionnaire that can be used for evaluating quality of care in terms of women's childbirth experience. It can be used in maternity services that aim to improve quality of care during labor and childbirth. ==== Body 1. Introduction Childbirth is an invaluable process that affects the health of women and their babies and their emotional connection, as well as sexual activity and the desire to have further children [1, 2]. A positive childbirth experience creates a positive attitude toward normal childbirth by creating a sense of control, power, satisfaction, and reassurance for women [3, 4]. The negative childbirth experience is linked to lower rates of breastfeeding, increased maternal-infant communication disorders at birth, and may lead to postpartum depression and posttraumatic stress disorder (PTSD) [5, 6]. The World Health Organization (WHO) has issued guidelines recognizing a “positive childbirth experience” as a significant endpoint for all women undergoing labor [2]. In recent years, significant reductions in maternal and newborn mortality rates have been reported in Iran, mostly due to increased birth facilities and skilled birth attendants [7]. However, a review of the existing literature in Iran shows that the medicalization of childbirth has led to increasing medical interventions and technologies including early admission in labor, stimulation and induction of labor, episiotomy, and caesarean section [8, 9]. It is believed that the next priority in this country should be to improve the quality of childbirth care and women's childbirth experience and satisfaction [10]. There is consensus that women's childbirth experience has an important impact on quality assessment and improvement [2, 11]. The first step in improving childbirth care is to evaluate women's experience of childbirth. Therefore, there is a need for a valid and reliable tool. There are different tools for measuring the childbirth experience in different languages, but the Childbirth Experience Questionnaire (CEQ) [12] is a multidimensional tool that comprehensively evaluates women's perceptions of childbirth care. The CEQ validation was carried out in England, Spain, and more recently in China [13–15] and is widely used to evaluate the experiences of women in childbirth. The original Swedish version of the CEQ [12] was translated into Persian by Abbaspoor et al. [16]. However, the process of evaluating its psychometric properties was incomplete. Therefore, there was a need to evaluate the psychometric properties and to adapt it to the Iranian context. This study evaluated the CEQ's psychometric properties (validity and reliability) in Iran. 2. Materials and Methods 2.1. Study Setting A cross-sectional study was conducted at one private and three public hospitals in Mazandaran province (North of Iran) from March to November 2019. 2.2. Sample Size Calculation The sample size anticipated for the study was 220 women. This was based on a standard sample size which was ten times the number of items [17]. We also took missing items into consideration [18], and the final sample size was 250. 2.3. Sample and Procedure The questionnaire was given to a convenience sample of women at discharge after childbirth. The eligible participant women comprised literate primiparous women aged over 18 years, undergoing vaginal birth and giving birth to a healthy baby without any complications at a gestational age at birth of 37-42 weeks after a singleton and full-term pregnancy. First, we contacted postpartum women at the time of discharge from the hospital and arranged the date of the interviews. The P-CEQ is a self-administered questionnaire and was completed by postpartum women 1-3 months after birth when they came to the health facilities to receive maternal and neonatal care. It took roughly 15-20 minutes to complete each questionnaire. Women's obstetric characteristics were collected using their medical records. 2.4. CEQ Questionnaire The original CEQ was developed in Sweden [12]. It consists of 4 subscales namely: own capacity (8 items), professional support (5 items), perceived safety (6 items), and participation (3 items). The items were scored on a 4-point Likert scale: (1) Totally agree, (2) Mostly agree, (3) Mostly disagree, and (4) Totally disagree. The items regarding labor pain and senses of control and security were scored 0-100 on a visual analogue scale, which was converted to 1-4 as in the other items. The CEQ's scoring process has been detailed in literature [12]. 2.5. Linguistic Validation The original Swedish version [12] was translated into Persian by Abbaspoor et al. [16]. This Persian version was used with a few amendments to the items' wording. The interpretations of “labor and childbirth” were kept in all the items. However, in the earlier translated version, only the translation of “childbirth” was included. Moreover, the translation of “depressed” in item nine (I felt depressed) reflected sadness rather than depression. Item fourteen (My midwife devoted adequate time to my partner), which was excluded from the previous Persian translation, was also kept in the P-CEQ by replacing “my partner” with “my accompanying person.” 2.6. Evaluation of the Psychometric Properties First, face validity and content validity were evaluated, and then, construct validity was assessed using confirmatory factor analysis and discriminant validity. The reliability was assessed using internal consistency and test-retest. 2.6.1. Face and Content Validity The face validity of this instrument was investigated both quantitatively and qualitatively. First, face validity was assessed by asking ten experts in midwifery and reproductive health to evaluate the questionnaire. Then, twenty nulliparous pregnant women attending health centers were asked to comment on the questionnaire in terms of appropriateness and relevance, ambiguity or possible misinterpretation of the phrases, and difficulty of the phrases and words. In the quantitative step, efforts were made to merge or eliminate similar phrases and to determine the importance of individual phrases as impact scores on the basis of a 5-point Likert scale. The items with an impact score exceeding 1.5 were found appropriate and kept for further analyses [19]. Additionally, content validity was confirmed on the basis of the experts' comments and quantified based on the Content Validity Ratio (CVR) and the Content Validity Index (CVI). CVRs of over 0.62, and CVIs of over 0.79 were considered valid [19]. 2.6.2. Construct Validity Exploratory Factor Analysis (EFA) was not used to evaluate the questionnaire's factor structure, because we already had a model to test [12]. The Confirmatory Factor Analysis (CFA) was carried out instead. The fitness indices were used to assess the model's fitness. The fitness of the model was confirmed using the following thresholds: normed chi-square χ2/df <5.0, RMSEA <0.08, SRMSEA <0.08, and CFI ≥0.90 [20, 21]. 2.6.3. Discriminant Validity The discriminant validity was evaluated by testing P-CEQ score differences between subgroups that were expected to differ in the key variables. The total score of the childbirth experience and its domains' scores were therefore compared among the study samples, which differed by type of birth, labor duration [12, 22], and oxytocin augmentation [23]. Other items such as hospital type and perineal status after birth were compared between the study samples. Based on previous research, it was hypothesized that women with shorter labor time and without oxytocin augmentation were expected to have a better childbirth. The effect size was calculated based on Cohen's description [24] and was computed as the difference between group mean scores divided by the pooled standard deviation of two groups. Values “between 0.2 and 0.5,” “between 0.5 and 0.8,” and “higher than 0.8” were considered low, moderate, and high, respectively [24]. The Mann–Whitney U test was used to contrast the hypotheses [20]. 2.6.4. Reliability The reliability was determined using the internal consistency test (Cronbach's alpha coefficient) and test-retest reliability [25, 26]. A Cronbach's alpha of at least 0.70 was considered acceptable. The most acceptable test to determine stability is the intraclass correlation coefficient. Thus, test-retest reliability was measured using ICC, two-way mixed from a single measure [26]. To assess the reliability of the adapted version of the questionnaire in terms of stability, a subsample of 25 eligible women completed the questionnaire twice at a two-week interval. This formula was used for calculating ICC: MSR − MSE/MSR + (k − 1)MSE + (k/n) (MSC − MSE) [26], and ICC of 0.6 or above was acceptable. 2.7. Statistical Analysis Data were analyzed using SPSS Statistics for Windows version 20.0 (SPSS Inc., Chicago, IL, USA), Mplus7.4 and R X64 3.5.1 (psych package), and LISREL 8.8). The construct validity was assessed by confirmatory factor analysis. The Mann–Whitney U test was used to contrast the hypotheses of discriminant validity [17, 20, 21]. 2.8. Ethical Considerations This study was approved by the Ethics Committee of Shahid Beheshti University of Medical Sciences, Tehran, Iran (Code: IR.SBMU.PHARMACY.REC.1397.028). First, permission was sought from the study hospitals. The research objectives were explained to the participants, and they were also assured of their right to withdraw from the study at any stage of the study. Those who agreed and signed the consent form participated in the study. 3. Results 3.1. Description of Sample Out of 347 eligible participants, 250 (72%) women with a mean age of 30 ± 5.8 years consented to participate in the study. Labor lasted more than twelve hours in 27% of the participants, and 75% underwent episiotomy. Table 1 presents the demographic information of the participant women. 3.2. Descriptive Statistics of the P-CEQ The mean score of the overall childbirth experience was 59.08 ± 14.46. The mean scores of “own capacity,” “professional support,” “perceived safety,” and “participation” were 22.79 ± 5, 13.77 ± 3.77, 13.91 ± 3.73, and 8.61 ± 3.07, respectively. 3.3. Psychometric Properties 3.3.1. Face and Content Validity Some of the items were slightly modified based on the experts' comments during the face validity evaluation. Moreover, twenty nulliparous pregnant women identified all the items of the questionnaire to be transparent and easy to comprehend. The impact score ranged from 3.0 to 4.0 for each item (Table 2). According to the comments of ten experts, the impact scores of the items were calculated. The estimated CVI and CVR values were in the ranges of 0.83–1.00 and 0.80–1.00, respectively. All the items were therefore kept in the questionnaire (Table 2). 3.3.2. Construct Validity The fitness of the CFA was required for the evaluation of the factor structures. Acceptable values of fit indices indicated a good model fit (RMSEA = 0.05, SRMSR = 0.06, GFI = 0.91, CFI >0.93, χ2/df = 1.80) (Table 3). Figure 1 illustrates the four-factor model of the P-CEQ. The minimum and maximum coefficients of the item-scale relationship were 0.36-0.92. Moreover, all coefficients of the item-scale relationship in the CFA were significant (P < 0.001), indicating that all items were significantly correlated with their factors. 3.3.3. Discriminant Validity Discriminant validity was evaluated using the known-groups method and the independent Mann–Whitney U test to investigate the intergroup difference in the overall scores of childbirth experience and its domains. The total P-CEQ score and the scores of “own capacity” and “perceived safety” were significantly higher in the women with a shorter stay in the labor unit (less than 12 hours) than in those with a longer stay, suggesting small effect sizes. According to Table 4, no significant differences were observed in the total P-CEQ score and the scores of its domains between the women with or without oxytocin augmentation during labor (P = 0.91), hospital type (P = 0.92), type of birth (P = 0.030), and the state of the perineum following birth (P = 0.07). 3.3.4. Reliability Test Cronbach's alpha was estimated at 0.85 for the whole P-CEQ, 0.84 for “own capacity,” 0.69 for “participation,” 0.92 for “professional support,” and 0.78 for “perceived safety.” The overall ICC of the P-CEQ was 0.88, indicating that reliability for test-retesting was excellent, as shown in Table 5. 4. Discussion This study evaluated the psychometric properties of the CEQ and adapted it to the Iranian culture with a similar internal consistency to its English version [13]. The P-CEQ was found to be a valid and reliable measure of childbirth experience among Iranian women. The total Cronbach's alpha calculated for the P-CEQ was consistent with that obtained for its Spanish (0.88) and Chinese versions (0.88) compared to the Cronbach's alpha obtained for the English version (0.90), although it was not reported for the Swedish version [12–15]. The fit indices were verified by the CFA performed in the present analysis, and items 9, 17, and 18 of the P-CEQ were weakly correlated with the given factors. This may indicate that the data conveyed by items 17 and 18 were also included in items 13 and 16. The insignificant correlation of item 18 can be explained by the participants' inadequate understanding of this item and that of item 9 by its incompatibility with the setting and facilities of childbirth units in Iran. Our study reported higher scores in those with a shorter stay in the labor unit, though the effect size was very small. However, the Swedish study [12] reported significantly higher scores for the domains of the CEQ in women with a longer labor and in those without oxytocin augmentation. The discrepancy in results can be related to differences in the childbirth context and the samples between Sweden and Iran. For instance, spontaneous onset of labor was reported in the majority of the Swedish women, whereas merely 12% underwent instrumental birth. The largest effect size was obtained through comparing spontaneous vaginal birth with instrumental childbirth (instrumental vaginal birth and cesarean section) in the study conducted in Sweden [12]. The present study did not address this factor given that it did not include women undergoing cesarean section and only seven out of the 250 participants in our study underwent instrumental vaginal birth. The P-CEQ is a tool for evaluating women's childbirth care experiences. Given that women are increasingly vulnerable to the onset or relapse of mental disorders during pregnancy and the postpartum period, this screening tool may help providers to identify postpartum women with negative health experiences who are at risk of PTSD and serious mental disorders [27]. This may promote the long-term wellbeing of women and their babies [28] by supporting women at higher risk and referring them for nonpharmacological and psychopharmacological treatments [29]. 5. Limitations This study was carried out in both public and private hospitals that could be the strength of this study. Some clinical data such as the duration of labor (shorter or longer than 12 hours), oxytocin augmentation (use or no use), and the precise timing for the onset of labor were obtained using women's medical records, which can be considered a limitation of this study. The participants of our study were primiparous women with low-risk pregnancies. Multiparous women and those with complicated pregnancies may have different experiences. Thus, the use of the P-CEQ in multiparous women and those with high-risk pregnancies is warranted. 6. Conclusions The P-CEQ is a valid and reliable questionnaire for evaluating women's experiences during labor and childbirth and can be used in settings that aim to improve the quality of care during labor and childbirth. Acknowledgments The authors would like to express their sincere gratitude to all the postpartum women for their collaboration and time devoted to participating in this study. Data Availability The data will be available on reasonable request from the corresponding author (FP). Conflicts of Interest The authors declare no conflict of interests. Authors' Contributions As a self-funded project, this study was designed by the authors, who were also in charge of collecting, analyzing and interpreting the data and writing the manuscript. Samiyeh Kazemi, Farzaneh Pazandeh, Sedigheh Sedigh Mobarakabadi, Sepideh Hajian, and Ali Montazeri contributed to data collection and data analysis. They also contributed to drafting and revising the paper. Anna Dencker had substantial contribution to conception and design of the study and drafting the paper. Figure 1 The Persian model of the CEQ. Table 1 Demographic and obstetric characteristics of the postpartum women. Demographic and obstetric characteristics n (250) (%) Education High school or lower 103 41.2 College or higher 147 58.8 Occupation Employed 209 83.5 Home-maker 23 9.2 Self-employed 18 7.2 Abortion history Yes 48 19.2 No 202 80.8 Oxytocin augmentation Yes 169 67.6 No 81 32.4 Labor duration longer than 12 hours Yes 67 26.8 No 183 73.2 Type of childbirth Spontaneous vaginal 243 97.2 Instrumental 7 2.8 Perineal status after birth Tears (grade 1 and 2) 63 25.2 Episiotomy 187 74.8 Hospital type Public 211 84.4 Private 39 15.6 Mean SD Maternal age (years) 26 3 Gestational age (weeks) 38.5 1.3 Table 2 The impact score, CVI, and CVR for the P-CEQ. Items Impact score (n = 20 mothers) CVI (n = 10 experts) CVR (n = 10 experts) Item 1 3.6 0.98 1 Item 2 3.2 0.83 0.80 Item 3 3.8 1 1 Item 4 3.7 1 1 Item 5 3.2 0.83 0.80 Item 6 4 0.96 1 Item 7 3.3 0.83 0.80 Item 8 4 1 1 Item 9 3 0.90 1 Item 10 3.5 0.90 1 Item 11 4 1 1 Item 12 3.2 0.83 0.80 Item 13 4 1 1 Item 14 3 0.90 1 Item 15 3.3 0.83 0.80 Item 16 4 0.96 1 Item 17 3.2 0.83 0.80 Item 18 3 0.90 1 Item 19 3.5 0.90 1 Item 20 3.7 1 1 Item 21 4 1 1 Item 22 4 0.96 1 Table 3 Fit indices of the four-factor model of the P-CEQ. Model AGFI GFI SRMSR RMSEA NFI CFI X 2 P-CEQ (22 items) 0.90 0.91 0.06 0.05 0.92 0.93 263.07 AGFI: Adjusted Goodness of Fit Index; GFI: Goodness of Fit Index; SRMSR: Standardized Root Mean Square Residual; RMSEA: Root Mean Square Error of Approximation; NFI: Normed Fit Index; CFI: Comparative Fit Index; X2: Satorra-Bentler χ2. Table 4 P-CEQ overall and subscale scores by different groups (n = 250). Groups Own capacity Participation Professional support Perceived safety Mean CEQ score Hospital type Public (n = 211) 2.3 (0.6) 2.6 (0.6) 2.8 (0.6) 2.7 (0.5) 2.4 (0.5) Private (n = 39) 2.3 (0.5) 2.5 (0.5) 2.5 (0.5) 2.2 (0.4) 2.3 (0.4) P value 0.80 0.40 0.080 0.99 0.92 Cohen's effect size 0.05 0.10 0.09 0.33 0.22 Labor duration ≤12 h (n = 193) 2.5 (0.6) 2.6 (0.7) 2.7 (0.7) 2.6 (0.7) 2.6 (0.5) >12 h (n = 67) 2.3 (0.7) 2.5 (0.8) 2.5 (0.8) 2.3 (0.8) 2.3 (0.6) P value 0.001 0.510 0.087 0.005 0.007 Cohen's effect size 0.33 0.10 0.15 0.28 0.26 Oxytocin augmentation Yes (n = 169) 2.4 (0.7) 2.5 (0.7) 2.7 (0.7) 2.5 (0.7) 2.5 (0.6) No (n = 81) 2.4 (0.6) 2.6 (0.6) 2.6 (0.7) 2.5 (0.7) 2.5 (0.5) P value 0.852 0.429 0.081 0.998 0.912 Cohen's effect size 0.06 0.11 0.07 0.00 0.02 Type of birth Spontaneous vaginal (n = 243) 2.8 (0.5) 2.8 (0.8) 3.5 (0.5) 3 (0.6) 3 (0.4) Instrumental (n = 7) 2.5 (0.5) 2.6 (0.8) 3.5 (0.4) 2.6 (0.6) 2.9 (0.4) P value 0.082 0.18 0.50 0.01 0.030 Cohen's effect size 0.30 0.20 0.01 0.30 0.30 Perineal status after birth Episiotomy (n = 187) 2.7 (0.6) 2.8 (0.9) 3.6 (0.6) 3 (0.7) 3.1(0.6) Tears (grade 1 and 2) (n = 63) 2.6 (0.5) 2.6 (0.8) 3.5 (0.5) 2.8 (0.6) 2.9 (0.4) P value 0.42 0.50 0.43 0.035 0.07 Cohen's effect size 0.36 0.30 0.04 0.22 0.36 Data presented as mean (SD); Mann–Whitney U test was used to compute P values. The overall score of the CEQ was the mean score of the four subscales. Table 5 The reliability of the overall CEQ and subscales. Overall CEQ and subscales Number of items Cronbach's alpha ICC Own capacity 8 0.84 0.84 Professional support 5 0.92 0.89 Perceived safety 6 0.78 0.87 Participation 3 0.69 0.85 Overall 22 0.85 0.88 CEQ: Childbirth Experience Questionnaire; ICC: intraclass correlation. ==== Refs 1 Nilvér H. Begley C. Berg M. Measuring women’s childbirth experiences: a systematic review for identification and analysis of validated instruments BMC pregnancy and childbirth. 2017 17 1 p. 203 10.1186/s12884-017-1356-y 2-s2.0-85021378335 28662645 2 World Health Organization WHO recommendations on intrapartum care for a positive childbirth experience World Health Organization;2018-Licence:CCBY-NC-SA3.0IGO 2018 Geneva , http://creative http://commons.org/licencees/by-nc-sa/3.0/igo 3 Cook K. Loomis C. The impact of choice and control on women’s childbirth experiences The Journal of Perinatal Education 2012 21 3 158 168 10.1891/1058-1243.21.3.158 23730127 4 Reisz S. Jacobvitz D. George C. Birth and motherhood: childbirth experience and MOTHERS’ PERCEPTIONS of themselves and their babies Infant Mental Health Journal 2015 36 2 167 178 10.1002/imhj.21500 2-s2.0-84925221167 25704337 5 Bell A. F. Andersson E. The birth experience and women’s postnatal depression: a systematic review Midwifery 2016 39 112 123 10.1016/j.midw.2016.04.014 2-s2.0-84977108806 27321728 6 Nilsson C. Lundgren I. Karlström A. Hildingsson I. Self reported fear of childbirth and its association with women’s birth experience and mode of delivery: a longitudinal population-based study Women and Birth 2012 25 3 114 121 10.1016/j.wombi.2011.06.001 2-s2.0-84865342349 21764400 7 World Health Organization, Unicef Trends in maternal mortality: 1990-2015: estimates from WHO, UNICEF, UNFPA World Bank Group and the United Nations Population Division WHO https://apps.who.int/iris/handle/10665/194254 8 Kasegari F. A. Pazandeh F. Darvish S. Huss R. Nasiri M. Admitting women in active labour: a randomised controlled trial about the effects of protocol use on childbirth method and interventions Women and Birth. 2019 28 9 Pazandeh F. Huss R. Hirst J. House A. Baghban A. A. An evaluation of the quality of care for women with low risk pregnanacy: the use of evidence-based practice during labour and childbirth in four public hospitals in Tehran Midwifery 2015 31 11 1045 1053 10.1016/j.midw.2015.07.003 2-s2.0-84945484723 26292760 10 Pazandeh F. Potrata B. Huss R. Hirst J. House A. Women’s experiences of routine care during labour and childbirth and the influence of medicalisation: a qualitative study from Iran Midwifery 2017 53 63 70 10.1016/j.midw.2017.07.001 2-s2.0-85026467970 28763721 11 Hulton L. Matthews Z. Stones R. W. A framework for the evaluation of quality of care in maternity services 2000. services. http://www.socstats.soton.ac.uk/choices/ 12 Dencker A. Taft C. Bergqvist L. Lilja H. Berg M. Childbirth experience questionnaire (CEQ): development and evaluation of a multidimensional instrument BMC Pregnancy and Childbirth 2010 10 1 p. 81 10.1186/1471-2393-10-81 2-s2.0-78650807865 13 Walker K. F. Wilson P. Bugg G. J. Dencker A. Thornton J. G. Childbirth experience questionnaire: validating its use in the United Kingdom BMC Pregnancy and Childbirth 2015 15 1 p. 86 10.1186/s12884-015-0513-4 2-s2.0-84927548530 25884191 14 Soriano-Vidal F. J. Oliver-Roig A. Cabrero-García J. Congost-Maestre N. Dencker A. Richart-Martínez M. The Spanish version of the Childbirth Experience Questionnaire (CEQ-E): reliability and validity assessment BMC Pregnancy and Childbirth 2016 16 1 p. 372 10.1186/s12884-016-1100-z 2-s2.0-85000415208 27884123 15 Zhu X. Wang Y. Zhou H. Qiu L. Pang R. Adaptation of the Childbirth Experience Questionnaire (CEQ) in China: a multisite cross-sectional study PLoS One 2019 14 4 p. e0215373 10.1371/journal.pone.0215373 2-s2.0-85064665920 31017927 16 Abbaspoor Z. Moghaddam-Banaem L. Ronaghi S. Dencker A. Translation and cultural adaptation of the childbirth experience questionnaire (CEQ) in Iran Iranian journal of nursing and midwifery research. 2019 24 4 296 300 10.4103/ijnmr.IJNMR_103_18 2-s2.0-85068645735 31333745 17 Fayers P. M. Machin D. Scores and measurements: validity, reliability, sensitivity Quality of Life: the assessment, analysis and interpretation of patient-reported outcomes 2007 77 p. 108 18 Terwee C. B. Mokkink L. B. Knol D. L. Ostelo R. W. Bouter L. M. de Vet H. C. Rating the methodological quality in systematic reviews of studies on measurement properties: a scoring system for the COSMIN checklist Quality of Life Research 2012 21 4 651 657 10.1007/s11136-011-9960-1 2-s2.0-84863631281 21732199 19 Drost E. A. Validity and reliability in social science research Education Research and perspectives. 2011 38 1 p. 105 20 Kellar S. P. Kelvin E. A. Munro’s statistical methods for health care research Wolters Kluwer Health/Lippincott Williams & Wilkins 2013 21 Tabachnick B. G. Fidell L. S. Using Multivariate Statistics, 6th Edn, New International Edition 2013 Pearson Education Limited Harlow 22 Nystedt A. Högberg U. Lundman B. The negative birth experience of prolonged labour: a case–referent study Journal of Clinical Nursing 2005 14 5 579 586 10.1111/j.1365-2702.2004.01105.x 2-s2.0-17844393076 15840072 23 Waldenström U. Hildingsson I. Rubertsson C. Radestad I. A negative birth experience: prevalence and risk factors in a national sample Birth 2004 31 1 17 27 10.1111/j.0730-7659.2004.0270.x 2-s2.0-1642411461 15015989 24 Cohen J. Statistical Power Analysis for the Behavioral Sciences 2013 Academic press 10.4324/9780203771587 25 Cronbach L. J. Coefficient alpha and the internal structure of tests Psychometrika 1951 16 3 297 334 10.1007/BF02310555 2-s2.0-33845945922 26 Koo T. K. Li M. Y. A guideline of selecting and reporting intraclass correlation coefficients for reliability research Journal of Chiropractic Medicine 2016 15 2 155 163 10.1016/j.jcm.2016.02.012 2-s2.0-84962073666 27330520 27 Smith M. V. Shao L. Howell H. Lin H. Yonkers K. A. Perinatal depression and birth outcomes in a Healthy Start project Maternal and Child Health Journal 2011 15 3 401 409 10.1007/s10995-010-0595-6 2-s2.0-79955676862 20300813 28 Getinet W. Amare T. Boru B. Shumet S. Worku W. Azale T. Prevalence and risk factors for antenatal depression in Ethiopia: systematic review Depression Research and Treatment 2018 2018 12 10.1155/2018/3649269 2-s2.0-85050892880 649269 30112199 29 Biaggi A. Conroy S. Pawlby S. Pariante C. M. Identifying the women at risk of antenatal anxiety and depression: a systematic review Journal of Affective Disorders 2016 191 62 77 10.1016/j.jad.2015.11.014 2-s2.0-84948807792 26650969