Development and validation of a person-centered antenatal care scale for low- and middle-income countries

We aimed to develop and validate a tool to comprehensively measure person-centered antenatal care (PCANC) in low- and middle-income countries (LMICs). We followed standard procedures for scale development, including literature review, expert reviews, cognitive interviews, and pretesting to ensure content validity. Questions were iteratively revised at each stage and administered in surveys with pregnant and postpartum women in Ghana and Kenya. The survey data were used for psychometric analysis, resulting in a 36-item PCANC scale with three subscales: "dignity and respect," "communication and autonomy," and "responsive and supportive care." The Cronbach's alpha is 0.90 for the full scale and >0.7 for each subscale. The summative PCANC scores correlate with global measures of antenatal care quality, satisfaction, and future care location, suggesting good criterion validity. The PCANC scale has high validity and reliability and will facilitate efforts to measure and improve respectful and responsive antenatal care in LMICs.