Psychometric evaluation and adaptation of the COMICE questionnaire for Swedish midwifery students

The world needs skilled, well educated, and confident midwives, but there is a lack of instruments to measure confidence in the Swedish context. The aim was to psychometrically test and adapt the COMICE (Confidence Of Midwifery students on selected midwifery Competencies at completion of Education) questionnaire on Swedish midwifery students.

This is a national cross-sectional study of midwifery students from all 13 universities in Sweden in 2016-2017. The questionnaire comprised antenatal, intrapartum, postpartum and newborn care and underwent a principal component analysis. Analysis of variance was used to study associations with students' background characteristics.

A total of 238 students (78% response rate) completed the questionnaire. For antenatal care, two components were identified: performing routine midwifery assessments during pregnancy and identifying fetal and maternal risk factors while educating parents (KMO=0.895, p<0.001; Cronbach's alpha=0.848 and 0.827, respectively). For intrapartum care, three components emerged: managing physiological birth and providing support, managing complicated labor and birth, and identifying and providing lifesaving measures (KMO=0.905, p<0.001; Cronbach's alpha=0.917, 0.809, and 0.777, respectively). Postnatal and newborn care included managing uncomplicated care while educating parents and managing complications (KMO=0.941, p<0.001; Cronbach's alpha=0.993 and 0.558, respectively). Younger students (<31 years) reported greater confidence in routine antenatal assessments compared to older students (mean: 27.43 vs 26.01, p=0.004), managing physiological births (mean: 65.41 vs 62.85, p=0.01), and handling complicated labors (mean: 20.37 vs 19.05, p=0.046).

This study supports the Swedish version of the COMICE questionnaire as a tool to measure confidence among midwifery students in a Swedish context.