140 Chapter 6 Figure 1. Flowchart of the study population Data collection This validation study has a three-step approach in testing: 1) content validity 2) internal reliability 3) discriminant validity. We determined the content validity by examining the BBS by an expert panel (15). Based on the method of Polit and Beck (2006), all the experts scored each item of the BBS on relevance (15). We calculated the content validity per item (I-CVI) and the scale validity (S-CVI) with the scores of the experts. In case, the I-CVI or S-CVI were too low, adjustments in the statements were made before the questionnaire was distributed among the maternity care professionals of the six MCNs. The BBS exists of two subscales: five statements on birth as a natural process (BBS-Nat) and six statements on birth as a medical process (BBS-Med). Each statement is rated on a 5-point Likert scale ranging from 1= “completely disagree” to 5= “completely agree”. Scores for each subscale are derived by calculating the mean scores of the responses, resulting in scores between 1 and 5. A higher score indicates stronger beliefs about birth as a natural (BBSNat) or as a medical (BBS-Med) process. The BBS was validated and the structure of the instrument was examined using factor analysis. This study confirms that the BBS measures the concept of beliefs about birth as a medical process (BBS-Med) and beliefs about birth as a natural process (BBS-Nat) (14). As a result, no adjustments have been made to the statements of the BBS. The statements of the BBS were previously
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