Determining the psychometric properties of the Enhancing Decision-making

22 Background: The ability to act on and justify clinical decisions as autonomous accountable midwifery 23 practitioners, is encompassed within many international regulatory frameworks, yet decision-making 24 within midwifery is poorly defined. Decision-making theories from medicine and nursing may have 25 something to offer, but fail to take into consideration midwifery context and philosophy and the 26 decisional autonomy of women. Using a qualitative methodology, the Enhancing Decision-making 27 and Assessment in Midwifery (EDAM) framework was developed, which identified Good Clinical 28 Reasoning and Good Midwifery Practice as two conditions necessary to facilitate optimal midwifery 29 decision-making during 2nd stage labour. This study aims to confirm the robustness of EDAM as a 30 framework and measurement tool through testing of its factor structure, validity and reliability. 31 Method: A cross-sectional design for instrument development and a 2 (country; Australia/UK) x 2 32 (Decision-making; optimal/sub-optimal) between-subjects design for instrument evaluation using 33 exploratory and confirmatory factor analysis, internal consistency and known-groups validity. Two 34 ‘expert’ maternity panels, based in Australia and the UK, comprising of 42 participants assessed 16 35 midwifery real care episode vignettes using the empirically derived 26 item EDAM framework. Each 36 item was answered on a 5 point likert scale based on the level of agreement to which the participant 37 felt each item was present in each of the vignettes. Participants were then asked to rate the overall 38 decision-making (optimal/sub-optimal). 39 Findings: Post factor analysis the EDAM was reduced to a 19 item measure, and confirmed as two 40 distinct scales of ‘Clinical Reasoning’ (CR) and ‘Midwifery Practice’ (MP). The CR scale comprised of 41 two subscales; ‘the clinical reasoning process’ and ‘integration and intervention’. The MP scale also 42 comprised two subscales; women’s relationship with the midwife’ and ‘general midwifery practice’. 43