Validation of the Chichewa Perinatal PTSD Questionnaire (PPQ) and Chichewa Child Health Worry Scale (CHWS)

Purpose: Malawi is the country with the highest preterm birth rate in the world [18.1 per 100 live births] (World Health Organization, 2014) and preterm birth is a known risk factor for parental emotional distress in the postpartum period (Lasiuk et al., 2013; Pierrehumbert et al., 2003). Research conducted on mothers of preterm infants in other countries have also shown that depressive, anxiety, and posttraumatic stress [PTS] symptoms and maternal worry about child’s health are common negative maternal emotional responses following preterm birth (Brandon et al., 2011; Davies et al., 2008; Olde, van der Hart, Kleber, & van Son, 2006). The majority of studies on PTS symptoms have been conducted in developed countries (Gondwe & Holditch-Davis, 2015). Studies on negative emotional responses following childbirth in Malawi have focused on depressive and anxiety symptoms after full-term birth (Stewart et al., 2009; Stewart, Umar, Tomenson, & Creed, 2013). Little is known about PTS symptoms and maternal worry about child’s health. Stewart et al. (2009) and (Stewart et al., 2013) translated the Self-Report Questionnaire (SRQ) and Edinburgh Postnatal Depression Scale for assessing general neurotic symptoms and perinatal depression respectively into Chichewa, one of Malawi’s native languages and the national language taught in schools.  These questionnaires were validated among mothers in the perinatal period (Stewart et al., 2009; Stewart et al., 2013). However, Chichewa instruments specifically measuring PTS symptoms and worry about child’s health following birth could not be located.  The Perinatal PTSD Questionnaire (PPQ) was developed by DeMier et al. (1996) and Quinnell and Hynan (1999) and is a commonly used tools to measure postpartum PTS symptoms in English speakers (Gondwe & Holditch-Davis, 2015).  The Child Health Worry Scale (CHWS) is an American-based instrument that measures how much mothers worry about infant medical problems, development, whether the infant will get sick or might die, and whether baby is eating and sleeping enough (Miles, Holditch-Davis, Burchinal, & Nelson, 1999). The purpose of the study was to translate and validate the PPQ and CHWS for assessment of PTS symptoms and worry about child’s health respectively among Malawian women

Methods: Validity of the Chichewa-PPQ and Chichewa-CHWS was assessed using the Chichewa-SRQ. The study was conducted at Kamuzu College of Nursing and Queen Elizabeth Central Hospital. Prior to data collection, instruments were translated and reviewed by five bilingual speakers. The instruments were then back translated and reviewed by four nursing professors and registered nurses and expert agreement of more than 60% was achieved before collecting data. A focus group discussion about the questionnaires was conducted with eight nurses-midwives from the graduate program at Kamuzu College of Nursing. Data was collected from 30 mothers using the SRQ, PPQ, and CHWS and in-depth follow-up interviews were conducted to assess ease and clarity of the items. Reliability was assessed by item correlations and Cronbach alpha was calculated. Validity was conducted by assessing the association between the PPQ and total score of the SRQ and between the CHWS and one subscale (depressive mood and depressive thoughts) of the SRQ.

Results: The results showed high reliability of each item on the PPQ high internal consistency for the whole instrument. Item reliability for the CHWS was also high and the internal consistency of the whole instrument was high. Validity of the instruments was also high correlation between the PPQ and SRQ and between the CHWS and the SRQ subscale. Mothers and midwives found the questions easy but they both agreed that being asked about fear of infant loss was very distressing.

Conclusion: These results showed that the PPQ and CHWS measured what they were intended to and that leaving distressing questions at the end of the questionnaire is helpful to avoid influencing responses to the other questions. Findings from this study contribute to the literature on negative emotional responses in the perinatal period.