PROJECT SUMMARY/ABSTRACT (30 lines maximum)
Improving maternity care including the morbidity and mortality disparities amongst birthing people is a
national priority. U.S. professional perinatal care organizations recommend shared decision-making
(SDM) in maternity care as the way to provide person-centered, high-quality care to pregnant and
birthing people during their perinatal care; yet there is no valid and reliable measure of SDM for use by
patients. To address the SDM measurement gap, a reliable and valid measure is needed so that the
impact of SDM can be determined. The main objective of this proposal is to test the psychometric
properties of a revised previously developed measure of SDM. The measure, CHildbirth Options,
Information, and person-Centered Explanation (CHOICEs) evaluates SDM from the birthing person's
perspective and covers both prenatal and intrapartum hospital care. Pilot data provided preliminary
support for the psychometric properties of the CHOICEs items, but additional items are needed to
comprehensively measure SDM. The Revised-CHOICES and will be translated culturally and
linguistically into Spanish. To reach a representative, national sample, we will recruit 505 people who
have given birth within the previous six months through the Everyday Health apps: What to Expect, the
Baby Center, and What to Expect Español. To reach populations that do not traditionally participate in
research, we will use social networking recruitment through a community based, federally qualified
healthcare center, Mary's Center. The following aims will be addressed: Aim 1: Establish the
psychometric properties of a measure of shared decision-making in perinatal care in English
and Spanish. We will determine the score reliability, score validity and scalability of the Revised-
CHOICEs for prenatal and intrapartum care based on Rasch analysis and a Mokken non-parametric
scalability analysis. Validity testing will be conducted using Fit Indices from a Rasch analysis and
confirmatory factor analysis. Aim 2: Determine whether the shared decision-making items perform
equally across different clinical situations (first birth) and demographic groups (race, ethnicity,
age, education, income and insurance type). We will conduct statistical tests of mean differences in
scores across groups and differential item functioning (DIF) analysis based on Rasch analysis. Upon
completion of the proposed project, our expected outcome is a reliable and valid Revised-CHOICEs
measure of SDM for general use in perinatal care with instructions for interpretation of the scores.
Future research using the Revised-CHOICEs instrument will be done to focus on the impact of the use
of the measure on relevant clinical outcomes. This research aligns with AHRQ's mission to develop,
test, and evaluate meaningful person-centered measures addressing inequity and health outcomes.
