Development of a tool to assess students’ perceptions of respectful maternity care

Objectives: To develop and test a tool to measure Bachelor of Nursing students’ perceptions towards respectful maternity care in Nepal, a lower-middle income country. 

Design: A cross-sectional design was used. Phases of tool development included item generation, expert review for content validity testing, and psychometric testing. The draft tool had 42 items on a 5-point Likert response scale of 1 = strongly disagree to 5 = strongly agree. Psychometric testing included dimensionality, internal consistency, and test-retest reliability. A t-test assessed mean score differences between students who had witnessed or not witnessed disrespect and abuse. 

Settings: Two medical colleges in Chitwan, Nepal 

Participants: Undergraduate Bachelor of Nursing students (n = 171) undertaking their midwifery clinical practicum were invited to complete the online survey. 

Findings: Principal component analysis generated three factors: Respectful Care, Safety and Comfort, and Supportive Care and explained 37.44% of the variance. The 18-item tool demonstrated good internal reliability (Cronbach's alpha of 0.81). The mean total scale score was 71.23 (SD 7.47, range 52-88 out of 90). Pearson's correlation coefficient confirmed test-retest reliability at one week (r = 0.91, p <0.001). The magnitude of difference in mean scores between those who had witnessed or not witnessed disrespectful and abusive care was very small (η² = 0.04). 

Key conclusion: The new Student Perceptions of Respectful Maternity Care tool is the first valid and reliable measure of students’ perceptions of respectful maternity care. Validation of the newly developed tool in other low- and middle-income countries is recommended. 

Implications for practice: Measuring students’ perceptions provides information to educators on how best to enhance students’ understanding and provision of respectful care to women.