To what extent are the items in each domain of the Keeping Birth Normal Tool relevant to evidenced-informed skills to reduce overuse of medical interventions in intrapartum care

Background: Overuse of medical interventions in labour and birth increases the risk of mortality and morbidity in women. There are wide variation in the use of interventions both regionally and globally. One of the reasons... [ view full abstract ]

Background: Overuse of medical interventions in labour and birth increases the risk of mortality and morbidity in women. There are wide variation in the use of interventions both regionally and globally. One of the reasons attributed to these variations is the poor implementation of evidence. This study validates the content of a new Tool to assess and support implementation where it is lacking.

Methods: Seven experts and eight women user representatives used a 4-point ordinal scale of relevance to rate fifty items in the Keeping Birth Normal Tool. Item-level content validity index (I-CVI), an average scale-level content validity index (S-CVI/Ave) and qualitative comments was used to delete and improve items.  

Results: Eleven experts analysed all fifty items. Four experts rated thirty-five to forty-nine items. The initial scale received an S-CVI/Ave of 0.88. Two items were deleted, forty-five items improvement were made and seven new items added. The scale received an S-CVI/Ave of 1.0 post item deletion and improvement. Three further minor item improvements were made.

Discussion: The items in the KBN Tool are construct relevant. Future studies must gather evidence on response processes and internal structure to develop a Tool that is construct valid.