Health Science Monitor

en Design and Psychometric Assessment Tool of Perceived Barriers to Advocacy for Normal Birth Among Obstetricians and Midwives: an Exploratory Sequential Mixed-method Study ارتقای سلامت، پیشگیری و کنترل بیماری‌ ها Health Promotion, Protection, and Disease Control پژوهشي Research Article Background Promoting normal birth is a key priority in maternal health. Midwives and obstetricians, as primary healthcare providers, play a crucial role in advocating for normal birth. This study aimed to develop and validate a psychometric tool to assess perceived barriers to advocating for normal birth among midwives and obstetricians. Methods This study employed an exploratory sequential mixed-method design in the form of a tool design. In the first phase, an exploratory qualitative approach based on grounded theory was applied. Twenty-two in-depth and semi-structured interviews were conducted in 16 public and private hospitals in Tehran, using purposive sampling, and analyzed using MAXQDA 10 software. After evaluating content validity, 80 items were included in factor analysis. In the quantitative phase of Psychometric testing, the questionnaire was distributed to 350 participants using a cluster sampling method. Exploratory factor analysis with varimax rotation was conducted to evaluate and identify 17 underlying factors. Reliability of the instrument was evaluated using Cronbach’s α coefficients and a test-retest procedure. Results After qualitative data analysis, an initial set of 106 main items was developed and subjected to content validity evaluation by a panel of experts. The impact score, CVI, and CVR were 0.92 and 0.94, respectively. The items were then reduced to 80, which were included in an exploratory factor analysis based on a sample of 324 participants, resulting in 17 factors. Finally, 78 items across eight domains were confirmed (KMO = 0.881). The Cronbach’s α coefficient for the entire questionnaire was 0.97, indicating excellent internal consistency. The questionnaire underwent rigorous validation. Conclusion This tool effectively measures the views of midwives and obstetricians on barriers to advocating for normal birth, guiding targeted interventions, and engaging key stakeholders in improvements. Advocacy, Barriers, Midwives, Obstetricians, Psychometric analysis, Vaginal birth 234 242 http://hsm.umsu.ac.ir/browse.php?a_code=A-10-341-1&slc_lang=en&sid=1 Tayebeh Samieizadehtoosi samieizadeh.toosi@gmail.com 10031947532846004228 10031947532846004228 No Department of Health, Chabahar School of Nursing, IranShahr University of Medical Sciences, Iranshahr, Iran Mohammad Ali Rezaei rezaei47@yahoo.com 10031947532846004229 10031947532846004229 No Department of Nursing, School of Nursing and Midwifery, Bam University of Medical Sciences, Bam, Iran Neda Mohammadinia nedamohammadinia55@gmail.com 10031947532846004230 10031947532846004230 Yes Department of Community Health Nursing, School of Nursing and Midwifery, Bam University of Medical Sciences, Bam, Iran Nahid Akbari akbari1420@gmail.com 10031947532846004231 10031947532846004231 No Department of Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran Ali Ramezankhani dr. aliramezankhani@gmail.com 10031947532846004232 10031947532846004232 No Department of Health, School of Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran Yadollah Mehrabi ymehrabi@gmail.com 10031947532846004233 10031947532846004233 No Department of Epidemiology, School of Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran