Background
Methods
Design
Item generation
Content validity
Face validity
The main study and data collection
Statistical analysis
Ethics
Results
Participants
Qualitative sample (n = 150) | EFA and CFA sample (n = 292) | Test-retest sample (n = 30) | |
---|---|---|---|
Age (years) | |||
Mean (SD) | 38.27(7.9) | 36.06(8.72) | 36.20(7.20) |
Work experience (years) | |||
Mean (SD) | 13(8.1) | 11.07(8.29) | 10.67(7.37) |
Employment status | Number (%) | Number (%) | Number (%) |
Official | 84(56) | 124(42.5) | 16(53.3) |
Contractual | 7(4.7) | 29(9.9) | 10(33.3) |
By project | 41(27.3) | 92(31.5) | 2(6.7) |
Mandatory service | 18(12) | 47(16.1) | 2(6.7) |
Marital status | Number (%) | Number (%) | Number (%) |
Single | 30(20) | 111(38.1) | 8(26.7) |
Married | 117(78) | 180(61.6) | 21(70.0) |
Divorced/Widow | 3(2) | 1(0.3) | 1(3.3) |
Degree in midwifery | Number (%) | Number (%) | Number (%) |
Associate’s Degree | 11(7.3) | 14(4.8) | 2(6.7) |
Bachelor’ Degree | 129(86) | 257(88.0) | 22(73.3) |
Master’ Degree | 10(6,7) | 21(7.2) | 6(20.0) |
Midwives’ interest in work environment | Number (%) | Number (%) | Number (%) |
Yes | 118(85.1) | 231(79.1) | 23(76.7) |
No | 32(21.3) | 61(20.9) | 7(23.3) |
Parity | Number (%) (n = 101) | Number (%) (n = 148) | Number (%) (n = 20) |
Once | 39(38.6) | 65.(43.9) | 8(40.0) |
Twice | 53(52.5) | 76(51.4) | 9(45.0) |
Three and more | 9(8.9) | 7(4.7) | 3(15.0) |
Exploratory factor analysis
Factor 1: Midwife’s attitude with 11 statements
|
Loadings
|
1. Skin contact improves mother’s physical health. | 0.647 |
2. Skin contact improves neonate’s physical health. | 0.572 |
3. Skin contact makes mother take better care of the child. | 0.764 |
4. Skin contact improves mother’s success in breastfeeding. | 0.727 |
5. Skin contact improves mother’s satisfaction. | 0.803 |
6. Skin contact improves mother’s mental health. | 0.835 |
7. Skin contact establishes verbal/emotional bonding between midwife and mother. | 0.592 |
8. Skin contact creates a sense of security in the newborn. | 0.703 |
9. Skin contact enhances mother’s love for the newborn. | 0.806 |
10. Skin contact reduces mother’s stress. | 0.673 |
11. Being skilled in performing skin contact by midwife improves the results. | 0.479 |
Test- re-test*
|
ICC = 0.842
|
Cronbach’s α coefficient of Factor 1
|
0.92
|
Eigen values
|
13.857
|
Explained variance (%)
|
16.50
|
Factor 3: Newborn’s health with 7 statements
|
Loadings
|
12. Skin contact improves newborn’s immunity system. | 0.562 |
13. Skin contact improves the development of the newborn. | 0.471 |
14. Skin contact establishes an emotional bond between parents and the newborn. | 0.446 |
15. Skin contact regulates the newborn’s blood oxygen level. | 0.428 |
16. Skin contact regulates the newborn’s heartbeat. | 0.773 |
17. Skin contact improves the newborn’s breathing. | 0.774 |
18. Skin contact regulates the newborn’s body temperature. | 0.695 |
Test- re-test*
|
ICC = 0.996
|
Cronbach’s α coefficient of Factor 3
|
0.81
|
Eigen values
|
3.464
|
Explained Variance (%)
|
4.94
|
Factor 5: Mother’s physical health with 4 statements
|
Loadings
|
19. Skin contact accelerates placental delivery. | 0.696 |
20. Skin contact accelerates the uterus’s return to normal. | 0.812 |
21. Skin contact promotes oxytocin release in mother. | 0.730 |
22. Skin contact reduces post-labor bleeding. | 0.795 |
Test- re-test*
|
ICC = 0.977
|
Cronbach’s α coefficient of Factor 5
|
0.84
|
Eigen values
|
3.328
|
Explained variance (%)
|
3.96
|
Factor 6: Midwife’s belief about obstacles of performing skin contact with 5 statements
|
Loadings
|
23. The newborn’s ill situation hinders skin contact. | 0.786 |
24. Skin contact is not feasible for ill mothers. | 0.776 |
25. Problems of mothers undergoing C-section affect skin contact. | 0.823 |
26. Problems of neonates born to C-section affect skin contact. | 0.784 |
27. Mother’s fatigue caused by nonstandard intervention during labor affects skin contact. | 0.652 |
Test- re-test*
|
ICC = 0.989
|
Cronbach’s α coefficient of Factor 6
|
0.84
|
Eigen values
|
2.800
|
Explained variance (%)
|
3.33
|
Factor 7: Midwife’s belief in self-efficacy with 7 statements
|
Loadings
|
28. I believe skin contact is essential. | |
29. I believe skin contact entails positive results. | 0.535 |
30. I believe skin contact is important. | 0.711 |
31. I believe I can perform skin contact with minimum facilities. | 0.345 |
32. I believe my recommendations for skin contact are acceptable for the mother. | 0.402 |
33. I believe I can use my knowledge to perform skin contact. | 0.573 |
34. I believe in positive results of the skin contact and I perform it. | 0.581 |
Test- re-test*
|
ICC = 0.980
|
Cronbach’s α coefficient of Factor 7
|
0.76
|
Eigen values
|
2.441
|
Explained variance (%)
|
2.91
|
Factor 8: Mental health with 4 statements
|
Loadings
|
35. Skin contact establishes an emotional bond between mother and newborn. | 0.640 |
36. Skin contact improves the acceptance of motherhood role by the mother. | 0.750 |
37. Skin contact creates a sense of security in mother and newborn. | 0.659 |
38. Skin contact results in future attachment between mother and child. | 0.612 |
Test- re-test*
|
ICC = 1.000
|
Cronbach’s α coefficient of Factor 8
|
0.73
|
Eigen values
|
2.203
|
Explained variance (%)
|
2.62
|
Total test-re test of predisposing factors structure
|
ICC = 0.995
|
Total Cronbach’s α coefficient of predisposing factors structure
|
0.89
|
Cumulative Variance (%)
|
44.64
|
Factor 13: Managerial-planning with 4 statements
|
Loadings
|
1. Presence of a supportive program in the ministry improves skin-to-skin contact. | 0.550 |
2. Skill-teaching programs in hospital improve skin-to-skin contact. | 0.609 |
3. Placing skin-to-skin contact in policies of the ministry of health will improve its implementation. | 0.479 |
4. Encouraging the midwife by hospital authorities will improve skin-to-skin contact. | 0.375 |
Test- re-test*
|
ICC = 1.000
|
Cronbach’s α coefficient of Factor 13
|
0.64
|
Eigen values
|
1.531
|
Explained variance (%)
|
1.82
|
Factor 12: Service provided to mother with 5 statement
|
Loadings
|
5. Physiologic delivery has a positive impact on skin-to-skin contact. | 0.011 |
6. Encouraging the mother to have skin contact in labor room will improve skin-to-skin contact. | 0.209 |
7. Collaboration of the labor-supporting team improves skin-to-skin contact. | 0.680 |
8. Availability of adequate human resources in labor room improves skin-to-skin contact. | 0.653 |
9. Professional ethical commitment of the midwife improves skin-to-skin contact. | 0.446 |
Test- re-test*
|
ICC = 1.000
|
Cronbach’s α coefficient of Factor 12
|
0.50
|
Eigen values
|
1.725
|
Explained variance (%)
|
2.05
|
Factor 2: Preparations with 9 statement
|
Loadings
|
10. Educating mothers during pregnancy improves skin-to-skin contact. | 0.246 |
11. Educating companions improves skin-to-skin contact. | 0.368 |
12. Educating the parents before pregnancy improves skin-to-skin contact. | 0.339 |
13. Legalizing skin-to-skin contact improves its implementation in hospitals. | 0.639 |
14. Including skin-to-skin contact in educational curricula of medical and midwifery students will improve its implementation. | 0.582 |
15. Mandating skin-to-skin contact to all hospitals will improve its implementation. | 0.699 |
16. Placing a point for skin-to-skin contact in ranking of hospitals will improve its implementation. | 0.821 |
17. Developing regulations for evaluating midwives based on skin-to-skin contact will improve its implementation. | 0.761 |
18. The supervision of authorities on correct skin-to-skin contact will improve its implementation. | 0.709 |
Test- re-test*
|
ICC = 1.000
|
Cronbach’s α coefficient of Factor 2
|
0.85
|
Eigen values
|
5.256
|
Explained variance (%)
|
6.26
|
Cumulative variance (%)
|
22.75
|
Total test-re test of enabling factors structure
|
ICC = 1.000
|
Total Cronbach’s α coefficient of enabling factors structure
|
0.85
|
Factor 4: Encouraging factors for midwives with 7 statements
|
Loadings
|
1. Encouraging colleagues improves skin-to-skin contact. | 0.074 |
2. Patient’s confidence in the delivery team improves skin-to-skin contact. | 0.478 |
3. Mother’s calmness during skin-to-skin contact will encourage the midwife. | 0.654 |
4. Newborn’s calmness during skin-to-skin contact will encourage the midwife. | 0.601 |
5. Mother’s satisfaction with skin-to-skin contact will encourage the midwife. | 0.672 |
6. Mother’s desire for skin-to-skin contact will encourage the midwife. | 0.647 |
7. Mother’s request for skin-to-skin contact will encourage the midwife to perform it. | 0.687 |
Test- re-test*
|
ICC = 1.000
|
Cronbach’s α coefficient of Factor 4
|
0.72
|
Eigen values
|
3.148
|
Explained variance (%)
|
4.12
|
Factor 9: Support of the medical team with 4 statements
|
Loadings
|
8. Physician’s support will improve skin-to-skin contact. | 0.676 |
9. Anesthesiologist’s support will improve skin-to-skin contact. | 0.753 |
10. Pediatrician’s support will improve skin-to-skin contact. | 0.761 |
11. Hospital authorities’ support will improve skin-to-skin contact. | 0.595 |
Test- re-test*
|
ICC = 1.000
|
Cronbach’s α coefficient of Factor 9
|
0.75
|
Eigen values
|
2.135
|
Explained variance (%)
|
2.54
|
Factor 10: Companion’s support with 3statements
|
Loadings
|
12. Presence of educated companion in the labor room improves skin-to-skin contact. | 0.439 |
13. Support of mother’s relatives improves skin-to-skin contact. | 0.776 |
14. The husband’s support improves skin-to-skin contact. | 0.776 |
Test- re-test*
|
ICC = 0.889
|
Cronbach’s α coefficient of Factor 10
|
0.68
|
Initial Eigen values
|
1.931
|
Explained variance (%)
|
2.30
|
Factor 11: Self-motivation with 4 statements
|
Loadings
|
15. Midwife’s awareness of advantages of skin-to-skin contact improves its implementation. | 0.708 |
16. Midwife’s desire for skin-to-skin contact will encourage her to perform it. | 0.683 |
17. Awareness of advantages of skin-to-skin contact through media will improve its implementation. | 0.372 |
18. Midwife’s support for skin contact will encourage its implementation. | 0.526 |
Test- re-test*
|
ICC = 1.000
|
Cronbach’s α coefficient of Factor 11
|
0.66
|
Eigen values
|
1.846
|
Explained variance (%)
|
2.20
|
Factor 14: Facilities and equipment with 5 statements
|
Loadings
|
19. Presence of an appropriate labor bed affects skin contact. | 0.471 |
20. The temperature of the labor room affects skin contact. | 0.643 |
21. Availability of private space during labor affects skin contact. | 0.557 |
22. Presence of an appropriate space in the operation room affects skin contact. | 0.405 |
23. Presence of a midwife to take care of the newborn affects skin contact. | 0.495 |
Test- re-test*
|
ICC = 1.000
|
Cronbach’s α coefficient of Factor 14
|
0.64
|
Eigen values
|
1.483
|
Explained variance (%)
|
1.77
|
Factor 15: Midwife’s occupational satisfaction with 3 statements
|
Loadings
|
24. Midwife’s occupational satisfaction affects skin contact. | 0.544 |
25. Eliminating the marginal responsibilities of midwives affects skin contact. | 0.556 |
26. Providing independence and granting the responsibility of normal delivery to midwife affects skin contact. | 0.312 |
Test- re-test*
|
ICC = 0.697
|
Cronbach’s α coefficient of Factor 15
|
0.60
|
Eigen values
|
1.401
|
Explained variance (%)
|
1.67
|
Cumulative variance (%)
|
60.61
|
Total test-re test of reinforcing factor structure
|
ICC = 0.964
|
Total test-re test of The MSSCQ
|
ICC = 0.94
|
Total Cronbach’s α coefficient of reinforcing factor structure
|
0.84
|
Cronbach’s alpha coefficient of The MSSCQ
|
0.92
|