Validation of the Spanish version of mackey childbirth satisfaction rating scale

The outcomes of health care delivery are measured in terms of effectiveness and efficiency but also in terms of the individual’s experience as a patient. This experience involves pain, autonomy, a feeling of physical and mental well-being and satisfaction with the favorable results achieved [1], and provides a unique opportunity to better understand satisfaction with the quality of the health care provided [2]. Satisfaction with health care delivery is significantly associated with patients’ adherence to medical treatment [3], their quality of life [4] or simply improvements in their health status [5]. Therefore, patients’ experiences are increasingly being used internationally as an indicator of the quality and performance of health systems [6], and thousands of surveys are used by health care providers, administrators or policymakers to assess the quality of care, make decisions about provisions and organization of health care services, avoid malpractice and support a competitive edge in the health care area [7].

Patient satisfaction is a multi-dimensional concept that has received widespread research attention since the 1970s, and it has been evaluated from different points of view and with different goals [8], but without a measuring standard [9]. According to Weisman and Koch, patient satisfaction is only measurable by direct interaction. Consequently, many patient satisfaction surveys are designed specifically for each health service [10].

The field of obstetrics is not exempt from this trend. Maternal satisfaction (MS) after childbirth has consequences for the mother’s health and the well-being of her child [11], and a measure or index of MS provides a valuable outcome to improve the quality of maternity care services [12]. Although a low Apgar score, maternal or infant mortality rates and cesarean and instrumental delivery rates have been used to assess the outcomes of maternity care services, these are very restrictive parameters for assessing quality as they do not describe attitudes or processes [13‐16]. In contrast, an assessment of MS with maternity care services makes it possible to determine the mother’s experience during childbirth and measure the quality of the care provided, because such care is centered on the patient’s needs [1, 12]. As a result, MS has become one of the most widely used indicators nowadays [11].

Various researchers have highlighted six main factors associated with MS besides demographic features; pain and relief, self-control, self-efficacy, expectations, partner support, and provision of opportunity to have immediate contact with the newborn [11, 12, 17‐24].

Several questionnaires and scales have been created in multiple languages to measure the relation between MS and the childbirth experience [25], for instance the “Maternal Well-being in Childbirth Scale” [22], the “Women’s Views of Birth Labour Satisfaction Questionnaire” [17], the “Care in Obstetrics: Measure For Testing Satisfaction Scale” [23], the “Questionnaire Measuring Attitudes About Labor and Delivery” and the “Mackey Childbirth Satisfaction Rating Scale” (MCSRS) [11]. Of these, the latter (the MCSRS) is the most complete scale as it includes the most important factors associated with MS from our point of view. Created and used in the USA, the MCSRS has also been used in other countries such as the UK [26], Holland [27, 28], Belgium and Spain [29]. The MCSRS has 34 self-report items, all of which use a 5-point Likert scale from “very dissatisfied” to “very satisfied”, and it is aimed at mothers after a vaginal delivery. According to the authors, the MCSRS consists of six subscales: general satisfaction (three items), satisfaction with self (nine items), baby (three items), midwife (nine items), gynecologist (eight items), and partner (two items) [11]. Although all of the authors who have used the MCSRS have tested the internal consistency of the MCSRS and its subscales by means of Cronbach’s alpha, none of them have described or explored its factorial structure in depth, nor have they validated the psychometric behavior of its subscales. The only exploratory factorial analysis (EFA) of the MCSRS, which was carried out by Mas-Pons et al., concerned an adaptation to Spanish with two additional questions [29]. They used principal components analysis assuming continuous variables, but better statistical tools are now available that explicitly incorporate Likert scales [30]. In addition, no confirmatory factor analysis (CFA) has been performed on the subscales proposed by the authors of the MCSRS or the researchers who have used it. EFA and CFA analyses of the scale will contribute to a better use of the MCSRS and interpretation of the results of the subscales.

Defining the dimensions underlying the MCSRS and measuring the importance that women who have just delivered a baby give to each dimension would provide a better understanding of issues related to health care delivery, enabling practitioners to introduce changes that improve the experience of childbirth and thus improve the health of mothers and their newborns.

The primary goal of the present study was to describe the internal structure of the MCSRS by means of EFA and CFA, and to examine validity of concept and reliability.