141 Validation of the Birth Beliefs Scale for maternity care professionals in the Netherlands translated into Dutch by a bilingual researcher and was used in several studies (16,17). The BBS is distributed among maternity care professionals of the six MCNs as part of a larger questionnaire about perceptions, beliefs, self-efficacy, and shared decision-making on IOL. The questionnaire included validated tools, questions that have been used in previous studies, and additional questions about professionals’ characteristics. All midwives and obstetricians working in each of the six MCNs were eligible to participate and were invited to fill out an online questionnaire. Data collection was from November 2022 to March 2023. We aimed to achieve the highest possible response by sending four reminders (after 2, 4, 6, and 8 weeks). Unfinished questionnaires were not included. The questionnaires were saved anonymously on a secured hard drive of Zuyd University, only accessible for the researchers of the VALIDstudy. Derived data supporting the findings of this study are available from the corresponding author (DCZ) on request. Data analysis Statistical analyses for internal reliability and discriminant validity were performed, using data from the questionnaires completed by the maternity care professionals. Professionals’ background variables were described in terms of frequencies and percentages for categorical variables and means and standard deviations for continuous variables. Subsequently, internal reliability was tested using Cronbach’s alpha, with α >0.70 as the cut-off for acceptable internal reliability (18). To validate the BBS for maternity care professionals, this study first investigated whether the BBS discriminated between community midwives, hospital-based midwives, and obstetricians (including trainees) on the two subscales (19). We expected midwives to have higher scores on natural beliefs and lower scores on medical beliefs compared to obstetricians (11,12). We expected hospital-based midwives to score in between these two groups (20). Knowngroup discriminant validity was tested using ANOVA with post-hoc Bonferroni correction (21). The six MCNs were divided in two groups: the three MCNs with a high percentage of IOL (MCN with a high percentage IOL) and the three MCNs with a low percentage of IOL (MCN with a low percentage IOL). Once discriminant validity was confirmed, potential relationships between type of MCN, years of work experience, place of training, and birth beliefs were explored using regression analysis. Place of training was divided in training inland and abroad. P-values of <0.05 were considered statistically significant (21). Data were analysed using SPSS Statistics© version 29.0. 6
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