Development, content validation and pilot reliability testing of the midwives' perspectives towards birth plans questionnaire

Abstract

Introduction: A birth plan is a fundamental tool for promoting autonomy during childbirth and woman-centred care. Despite its recognised benefits, there is a notable gap in the literature addressing midwives' perspectives and attitudes towards their use, with research being predominantly qualitative and quantitative data remaining scarce due to a lack of rigorously developed quantitative instruments addressing this topic. To address this, the Midwives' Perspectives Towards Birth Plans Questionnaire (MBPQ) was developed to provide a content-validated descriptive instrument to profile midwives' perspectives regarding the development and implementation of birth plans into clinical practice. Methods: The MBPQ was conceptualised as a multidimensional descriptive inventory comprising formative content domains, rather than a reflective psychometric scale intended to generate a single aggregate score. Instrument development followed a structured three-stage process. Following item generation from a critical literature review, face validity was established through review by academic professionals. Content validity was then quantified by six subject-matter experts using the Content Validity Index (CVI), the modified Kappa statistic to assess inter-rater agreement, and the Content Validity Ratio (CVR). A pilot study at a public hospital in Malta assessed feasibility (n = 15) and test-retest reliability (n = 13) using Kappa and Kendall's tau-b statistics. Results: Pilot testing demonstrated satisfactory feasibility, with a 100% response rate and an average completion time of approximately 10 min. Most closed-ended items demonstrated acceptable temporal stability across the test-retest interval, with moderate-to-excellent agreement coefficients observed for the majority of items. Conclusions: The MBPQ represents an initial content-validated descriptive framework for exploring midwives perspectives and attitudes regarding the development and implementation of birth plans. The instrument demonstrated strong content validity, high expert agreement, satisfactory feasibility and acceptable temporal stability across most items. The MBPQ may support clinical auditing, service evaluation, and exploratory research examining factors that influence birth plan implementation within maternity care settings. Further testing in broader and more diverse populations may support future refinement and contextual adaptation of the instrument.