1. Choose a paper describing the development or validation of a measure of relevance in health disparities research (please give the full citation and/or upload the paper if that's possible).
Afulani, P., Diamond-Smith, N., Golub, G., Sudhinaraset, M. (2018) Development of a tool to measure person-centered maternity care in developing settings: validation in a rural and urban Kenyan population. Reproductive Health. 14:118.
2. What was the definition of the construct?
Person centered maternity care (PCMC): Providing maternity care that is respectful and responsive to individual women and their families’ preferences, needs, and values, and ensuring that their values guide all clinical decisions
3. How did the authors provide evidence on the validity of the measure? Could you think of additional approaches to validating the measure?
Afulani et al. (2017) assessed the psychometric properties of the PCMC scale as two separate surveys in a rural and urban population in Kenya administered by trained data collectors using RedCap or SurveyCTO. The authors used both face and expert validity to access whether the construct is fully represented by the items included in the instrument. They also tested construct validity with contrasted groups (rural vs urban) and statistical relationship between variables with factor analysis. Finally, criterion-related validity was tested using global satisfaction measures of healthcare demonstrating high correlation with the PCMC scale. Construct validity is difficult to test since not precedent literature on tools of person centered maternity care and satisfaction with healthcare is notoriously difficult to measure. I’m not sure how they could have approached validity differently considering this is such a new construct.
4. How did the authors provide evidence on the reliability of the measure? Could you think of additional approaches to evaluating the reliability of the measure?
The PCMC Scale assessed internal consistency with a Cronbach’s alpha calculation across urban and rural samples. Evaluation of the full PCMC Scale resulted in Cronbach’s alpha scores of 0.88 for the rural sample, 0.83 for urban sample and 0.86 for the combined sample. The subscales were highly correlated meaning the tool is better used as a whole and potentially not as functional for future studies that may want to measure individual components.
5. Describe the implications of a lack of measurement validity or reliability for future research applications.
The PCMC scale was deemed a valid and reliable tool to measure respectful maternity care in specific target populations in Kenya and Ethiopia but may not be generalizable to other populations. The separation of rural and urban samples may serve as s proxy for SES but they only looked at education completed not wealth or income. Also race/ethnicity was not reported.
Part 2:
1. Find a paper describing a health disparity (please give the full citation or, even better, upload the paper so everyone else can look at it too)
https://www.jstor.org/stable/41585364
2. Summarize the construct and measurement of the dimension of disparity (e.g., racial inequalities?, SES inequalities?) and the outcome measured (e.g., self-rated health).
Racial inequalities (indigenous vs Spanish-speaking women of mixed Spanish and indigenous heritage or “ladina”) and the outcome reproductive health care utilization as measured by prenatal care and delivery service as well as met demand for contraception.
3. What is the evidence for the validity and reliability of the measures?
The researchers analyzed data from the Guatemalan National Survey of Maternal and Infant Health. Ethnicity was measured through the self-report question, “Do you consider yourself indigenous, ladina or of another ethnicity?”, as well as self-reported language. The researchers classified women who reported Mayan language as native language as indigenous regardless of self-reported identity.
4. What is the reference category used for the disparity measure (ie, who is the comparison group)? Why does this reference category make sense (or not) for this research question?
The reference category is self-identified as non-indigenous. Yes, this makes sense since they are trying to tease out racial inequalities. But since there is a large overlap between self-identified indigenous ethnicity and low socioeconomic status they could have reframed the question based on fundamental causes of SES but this may not get at underly8ing racism in the health care context.
5. How is the disparity quantified or measured? Is this an absolute or relative measure or are both provided? Describe which type of measure you would prefer for this research area, or, if both, why.
Use of institutional delivery services-unity of analysis was delivery. Having given birth in a health care facility.
Use of prenatal care-Unite of analysis was pregnancy. Having visited a health care facility at least one during a pregnancy resulting in a live birth.
Contraceptive use: unit of analysis was a woman. Using one of the following methods in 30 days before the interview (pill, injectable, implant, condom, spermicide, IUD and male/female sterilization) amount women not wanting to have a child in the next 11 months.
Absolute measure provided, it would be interesting to look into empowerment measures related to decision making about reproductive health services.
Part 3:
1. Read someone else's response to part 1 above (identifying a construct) and comment, specifically noting whether you can see any additional implications of measurement quality for future research or whether you agree with those noted by your classmate.
I agree with the comments on maternal stress during pregnancy and the issues surrounding generalizability to a diversity of experience even within the same woman during different pregnancies. I also would have like to have read more in the article on how or if the researchers used expert validity to develop appropriate and representative questions.