Maternal Perceptions of Quality of Antenatal Care Services in Sri Lanka: Development and Validation of a Multi-dimensional Instrument

Supun D Wijesinghe 1* and Dulitha N Fernando 2 1 Consultant Community Physician, Ministry of Health, Sri Lanka 2 Emeritus Professor of Community Medicine, Faculty of Medicine, University of Colombo, Sri Lanka. Corresponding author : Supun D Wijesinghe Abstract Maternal perception of antenatal care quality is an important attribute in understanding the relationship between quality and utilization of antenatal care services. However, measuring this in a developing country like Sri Lanka is a significant challenge due to non-availability of valid and reliable instruments. The aim of this study was to develop a valid and reliable instrument to measure maternal perceptions of quality of antenatal care services in Sri Lanka. The main outcome measure was the factor structure and internal consistency of the instrument. We used multiple qualitative methods to generate culturally suitable items for the instrument. It was validated using an exploratory factor analysis methodology among 170 antenatal mothers in 2 Medical Officer of Health areas. Reliability was estimated by measuring internal consistency and test retest method. The four factor model proposed by this paper was able to explain 73% of the total variance of the scale. The Cronbach‟s alpha value for the total scale was 0.965. Thus, the newly developed 26-item instrument demonstrated satisfactory level of validity and reliability, and it provides useful information that can be utilized by health care providers to identify the areas in antenatal care services that require improvement from a client‟s perspective.