Anxiety during pregnancy so far almost exclusively has been studied to means of psychological instruments designed to measure anxiety in general. However, fear of childbirth is psychological domain of its own, and in the case, instruments for the identification of anxiety in general would be less suitable for adequately measuring this specific fear. The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ version A and B) has been developed to measure women’s feelings and fear about childbirth by means of the woman’s cognitive appraisal regarding the delivery process and its first psychometric properties was evaluated by Wijma et al. (Wijma et al. 1998). There is lack of methodological study validating the instrument of fear of childbirth, and no available measures to evaluate the effect of childbirth-preparation class on relieving fear of childbirth in Korean pregnant women.
The purpose of this study were to translate the W-DEQ version A (delivery expectancy for antenatal version) into Korean and examine its validity and reliability among Korean pregnant women.
Methods: With a cross-sectional study design, study participants were 228 mothers with 26 weeks and more gestational age. Data were collected through self-administered study questionnaires after receiving written consent for study participation. The W-DEQ was translated into Korean using translation guideline from World Health Organization. For this study Cronbach’s alpha were used to evaluate the reliability of the W-DEQ. Exploratory Factor Analysis (EFA), and known-group validity were conducted to examine construct validity.
The translation of the measures was performed based on a back-translation method in order to maintain the reliability and validity of translated measures. The questionnaire was first translated into Korean and then the back-translation was done by Three translators who are fluent in both English and Koran. The translation method consisted of reviewing, translating and adapting the measures from English to Korean (and back to English again). The last back translation was then compared with the first translation done by the researcher and a high concordance between them was found.
Results: A total of 281 pregnant women with gestational age ranging from 26 to 40 weeks were participated. About 74% of the pregnant women were nulliparous. The average age of a pregnant woman was 32 years old and the average age of a spouse was 35. More than a half (52%) had jobs, 96 percent were married, and 64 percent had planned pregnancies.
For reliability, Cronbach's alpha of the instrument was .89 and the 5 sub-factors are all about 0.7, meeting the minimum acceptance criteria. The reliability of the sub-components was isolation of .73, and the expectation .82, fear of pain .43, and loss of control .77 and the link for well-being of self and baby .61 observed in our study.
For validity, an exploratory factor analysis was conducted on the Korean version of W-DEQ. Kaiser-Meyer-Olkin (KMO) was .83 and Bartlett's test for sphericity was confirmed to run factor analysis (chi square= 3213.73, p<.001). The main components of each question were all at least .05 and greater factor loading values and the cumulative variance was 53.24%.
Upon explorative factor analysis, five factors were extracted based on eigen value greater than 1 and visual assessment of the scree plot. The five factors can be identified which had been defined in original instrument as isolation, expectation, fear of pain, loss of control, and concern for well-being of self and baby These results differ from the existing version of the Japanese version of the W-DEQ, with 4 subcomponents such as isolation, fear, lack of positive expectations, and risk. In the Japanese version, the question of loss of control was classified as a factor of fear, but in the Korean version of W-DEQ, the element of loss of control was separated and an independent factor analyzed. There may be cultural difference in this phenomenon.
The mean score of the maternal fear instrument ranged from 0 to 165. The mean score of the primiparous mother was 64.80 (SD±19.24) and the average of the gestational age mothers was 68.32 (SD±16.95). However, the difference between the two groups was not significant (t = -.051, p = .960)
Conclusion: The Korean version W-DEQ may be a useful tool for assessing and providing antenatal education for mothers’ experiencing emotional distress related to fear of childbirth during the prenatal period.