Linguistic and Cultural Adaptation and Validation of the Instrument for Measuring Perceptions of Obstetric Violence

Authors

DOI:

https://doi.org/10.5294/aqui.2025.25.2.7

Keywords:

Obstetric violence, violence against women, humanized childbirth, validation study, nursing education, obstetric nursing

Abstract

Introduction: Obstetric violence has recently been recognized in Ecuador as a type of gender-based violence against women during pregnancy, childbirth, or the postpartum period, affecting mothers, their children, families, and society in general. This study was conducted to justify the importance of including the topic of obstetric violence prevention in the training of health professionals in Ecuador. Objective: To linguistically and culturally adapt and validate the Perception of Obstetric Violence in Health Science Students (PercOV-S) instrument. Materials and Method: Methodological study of the adaptation of the instrument created in Spain, developed with the stages of linguistic review by the linguist, content review by eight key informants/experts and two students, and psychometric validation of data collected from 269 students. Results: After the changes, the original instrument retained the same number of items as the PercOV-S instrument, with 20 items of sociodemographic data and 33 items on the perception of obstetric violence, named PercOV-S-A. To validate the pilot test data, confirmatory factor analysis was performed, which explained 52.6% of the variance in three factors or domains: 1) Insensitive and cruel treatment; 2) Normalized violence; and 3) Neglect and manipulation. All factor loadings were greater than 0.42, except for two items. The internal reliability of the questionnaire, by domain, was greater than or equal to 95%. The overall score (3.42) on the PercOV-S-A scale, as well as the scores for the domains (3.53), (2.77), and (3.36), indicated a high perception of obstetric violence. Conclusions: The PercOV-S-A instrument is fully functional for its purpose, after being adapted and validated for the Ecuadorian context.

Downloads

Download data is not yet available.

References

Barros MM. A violência obstétrica como violência de gênero; 2023. https://repositorio.animaeducacao.com.br/bitstream/ANIMA/35752/1/ARTIGO CIENTÍFICO MARIELLEN %283%29.pdf

Schoene BEF, Oblasser C, Stoll K, Gross MM. Midwifery students witnessing violence during labour and birth and their attitudes towards supporting normal labour: A cross-sectional survey. Midwifery [Internet]. 2023;119:103626. DOI: https://doi.org/10.1016/j.midw.2023.103626

Blundell J. Lectures on the theory and practice of midwifery, delivered at guys hospital. Lancet. 1827;(222). DOI: https://doi.org/10.1016/S0140-6736(01)75285-3

Al Adib Mendiri M, Ibáñez Bernáldez M, Casado Blanco M, Santos Redondo P. La violencia obstétrica: un fenómeno vinculado a la violación de los derechos elementales de la mujer. Med Leg Costa Rica [Internet]. 2017;34(1):104–11. https://www.scielo.sa.cr/scielo.php?script=sci_arttext&pid=S1409-00152017000100104

Brandão T, Cañadas S, Galvis A, de los Ríos MM, Meijer M, Falcon K. Childbirth experiences related to obstetric violence in public health units in Quito, Ecuador. Int J Gynecol Obstet [Internet]. 2018;143(1):84–8. DOI: https://doi.org/10.1002/ijgo.12625

Ciello C, Carvalho C, Kondo C, Delage D, Niy D, Werner L, et al. Violência Obstétrica “Parirás com dor” [Internet]. Brasil: Rede Parto de Princípio; 2012. p. 188. https://www.senado.gov.br/comissoes/documentos/sscepi/doc%20vcm%20367.pdf

Yalley AA, Jarašiūnaitė-Fedosejeva G, Kömürcü-Akik B, de Abreu L. Addressing obstetric violence: a scoping review of interventions in healthcare and their impact on maternal care quality. Front Public Heal. 2024;12. DOI: https://doi.org/10.3389/fpubh.2024.1388858

Grilo Diniz CS, Rattner D, Lucas d’Oliveira AFP, de Aguiar JM, Niy DY. Disrespect and abuse in childbirth in Brazil: social activism, public policies and providers’ training. Reprod Health Matters. 2018;26(53):19–35. DOI: https://doi.org/10.1080/09688080.2018.1502019

Lansky S, De Souza KV, De Morais Peixoto ER, Oliveira BJ, Diniz CSG, Vieira NF, et al. Obstetric violence: influences of the senses of birth exhibition in pregnant women childbirth experience. Cienc e Saude Coletiva. 2019;24(8):2811–24. DOI: https://doi.org/10.1590/1413-81232018248.30102017

Fors M, Falcon K, Brandão T, Vaca A, Cañadas S, González CEV. Reliability and dimensionality of eprevo “experiencias de parto relacionadas a violencia obstétrica”: Development of a new instrument, Ecuador. Int J Womens Health. 2021;13:569–77. DOI: https://doi.org/10.2147/IJWH.S305741

Mena-Tudela D, Roman P, González-Chordá V, Rodriguez-Arrastia M, Gutiérrez-Cascajares L, Ropero-Padilla C. Experiences with obstetric violence among healthcare professionals and students in Spain: A constructivist grounded theory study [Internet]. Women and Birth; 2022. https://reader.elsevier.com/reader/sd/pii/S1871519222002980?token=9C5F8683CA5BB3C2CD6D3FCD24E26AC3736C9DBC2A9DE60E89F48FCB8FAA50616039E000999A35C57DA21C329777CF5A&originRegion=us-east-1&originCreation=20230219035532

Bohren MA, Mehrtash H, Fawole B, Maung TM, Balde MD, Maya E, et al. How women are treated during facility-based childbirth in four countries: a cross-sectional study with labour observations and community-based surveys. Lancet. 2019;394(10210):1750–63. DOI: https://doi.org/10.1016/S0140-6736(19)31992-0

Calvo Aguilar O, Torres Falcón M, Valdez Santiago R. Obstetric violence criminalised in Mexico: A comparative analysis of hospital complaints filed with the Medical Arbitration Commission. BMJ Sex Reprod Heal. 2020;46(1):38–45. DOI: https://doi.org/10.1136/bmjsrh-2018-200224

Villareal M. Profesionalización y control social en la Escuela Nacional de Enfermeras de la Universidad Central del Ecuador [Tesis de maestría]. Quito: Andina Simón Bolívar; 2016. https://repositorio.uasb.edu.ec/bitstream/10644/5496/1/T2233-MH-Villareal-Profesionalizacion.pdf

Bohren MA, Vogel JP, Hunter EC, Lutsiv O, Makh SK, Souza JP, et al. The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review. PLoS Med. 2015;12(6):1–32. DOI: https://doi.org/10.1371/journal.pmed.1001847

Brandão-Oliveira T, Martínez-Pérez A. Violencia gineco-obstétrica y justicia reproductiva. Una reflexión psicoantropológica. Vol. 7, Religación. Revista de Ciencias Sociales y Humanidades. 2022. e210990. DOI: https://doi.org/10.46652/rgn.v7i34.990

Ledesma Muñoz DB, Martens C, Brandão T. Violencia obstétrica en Ecuador: una realidad invisibilizada. Mundos Plur - Rev Latinoam Políticas y Acción Pública. 2023;10(1):39–57. DOI: https://doi.org/10.17141/mundosplurales.1.2023.5946

Gray T, Mohan S, Lindow S, Pandey U, Farrell T. Obstetric violence: Comparing medical student perceptions in India and the UK. Eur J Obstet Gynecol Reprod Biol [Internet]. 2021;261:98–102. DOI: https://doi.org/10.1016/j.ejogrb.2021.04.013

Mena-Tudela D, Cervera-Gasch A, Alemany-Anchel MJ, Andreu-Pejó L, González-Chordá VM. Design and validation of the percov-s questionnaire for measuring perceived obstetric violence in nursing, midwifery and medical students. Int J Environ Res Public Health. 2020;17(21):1–12. DOI: https://doi.org/10.3390/ijerph17218022

Biurrun-Garrido A, Brigidi S, Mena-Tudela D. Perception of health sciences and feminist medical students about obstetric violence. Enfermería Clínica (English Ed. 2023;33(3):234–43. DOI: https://doi.org/10.1016/j.enfcle.2023.02.007

Aguilar L, Castellanos M. Adaptación Lingüístico-Cultural de una Escala Argentina de Perfeccionismo Infantil al Contexto Venezolano. Rev la Univ Oviedo [Internet]. 2016;21(2):1–32. DOI: https://doi.org/10.17811/rema.21.2.2016.1-32

Ortiz-Gutiérrez S, Cruz-Avelar A. Translation and Cross-Cultural Adaptation of Health Assessment Tools. Actas Dermosifiliogr. 2018;109(3):202–6. DOI: https://doi.org/10.1016/j.ad.2017.09.012

INEC. Estadísticas Vitales INEC 2022 [Internet]. 2023. https://www.ecuadorencifras.gob.ec/documentos/web-inec/Poblacion_y_Demografia/Defunciones_Generales_2022/Principales_resultados_EDG_2022.pdf

Lira MT, Caballero E. Cross-Cultural Adaptation of Evaluation Instruments in Health: History and Reflections of Why, How and When. Rev Medica Clin Las Condes [Internet]. 2020;31(1):85–94. DOI: https://doi.org/10.1016/j.rmclc.2019.08.003

Dhakal P, Creedy DK, Gamble J, Newnham E, McInnes R. Effectiveness of an online education intervention to enhance student perceptions of Respectful Maternity Care: A quasi-experimental study. Nurse Educ Today [Internet]. 2022;114(April):105405. DOI: https://doi.org/10.1016/j.nedt.2022.105405

Leal M do C, Bittencourt S de A, Esteves-Pereira AP, Ayres BV da S, Silva LBRA de A, Thomaz EBAF, et al. Avanços na assistência ao parto no Brasil: resultados preliminares de dois estudos avaliativos. Cad Saude Publica. 2019;35(7):e00223018. DOI: https://doi.org/10.1590/0102-311x00223018

Patiño LC, Morales LF, Duque P. Violencia obstétrica : Conocimientos sobre concepciones y prácticas que tienen los estudiantes del pregrado de medicina y enfermería de la Universidad de Antioquia, Medellín [Tesis de pregrado] Medellín: Universidad de Antioquia; 2021. http://hdl.handle.net/10495/24461

Browne MW, Cudeck R. Alternative Ways of Assessing Model Fit. Sociol Methods Res. 1992;21(2):230–58. DOI: https://doi.org/10.1177/0049124192021002005

Lloret-Segura S, Ferreres-Traver A, Hernández-Baeza A, Tomás-Marco I. El análisis factorial exploratorio de los ítems: Una guía práctica, revisada y actualizada. An Psicol. 2014;30(3):1151–69. DOI: https://doi.org/10.6018/analesps.30.3.199361

Commission IT. International Test Commission Guidelines for Translating and Adapting Tests [Internet]. Gefunden am. 2017. Available from: http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:International+Test+Commission+Guidelines+for+Translating+and+Adapting+Tests#0 El enlace no direcciona al documento No es claro qué tipo de fuente es esta

Rodríguez-Acelas AL, de Ávila ML, Getial DY, de Abreu Almeida M, Cañon-Montañez W. Cross-cultural adaptation for Colombia and content validity of the RAC scale for assessing the risk of infection in hospitalized adults. Rev Cuid. 2022;13(1). DOI: https://doi.org/10.15649/cuidarte.2406

Urrutia Egaña M, Barrios Araya S, Gutiérrez Núñez M, Mayorga Camus M. Métodos óptimos para determinar validez de contenido. Rev Cuba Educ Medica Super. 2015;28(3):547–58.

Caicedo E, Zalazar M. Entrevistas cognitivas: Revisión, directrices de uso y aplicación en investigaciones psicológicas. Rev Avaliação Psicológica. 2018;17(3):362–70. DOI: https://doi.org/10.15689/ap.2018.1703.14883.09

Rubio Martín S, Susana Rubio Martín A. Enfermería Basada en la Evidencia: Investigación Clínica Aplicada a las Ciencias de la Salud. Enfermería en Cardiología. 2013;20(58-59):21-27.

Rodríguez-Ridríguez J, Reguant-Álvarez M. Calcular la fiabilidad de un cuestionario o escala mediante el SPSS: el coeficiente alfa de Cronbach. REIRE Rev d’Innovació i Recer en Educ. 2020;3:1–13. DOI: https://doi.org/10.1344/reire2020.13.230048

Mena-Tudela D. Implantación y evaluación de una estrategia interactiva de Práctica Basada en la Evidencia en alumnos de Enfermería. Universidad Jaume I; 2015. DOI: https://doi.org/10.1016/B978-84-9022-448-9.00007-7

Martínez-Galiano JM, Martinez-Vazquez S, Rodríguez-Almagro J, Hernández-Martinez A. The magnitude of the problem of obstetric violence and its associated factors: A cross-sectional study. Women and Birth [Internet]. 2021;34(5):e526–36. DOI: https://doi.org/10.1016/j.wombi.2020.10.002

Ecuador M de SP. Componente Normativo Neonatal. Minist Salud Pública [Internet]. 2008;1–64. http://www.unfpa.org.gt/sites/default/files/Guia_Tecnica_Atencion_del_Parto_Culturalmente_Adecuado.pdf

Vargas Vasquez AN, Pardo Torres MP. Validez y consistencia interna del instrumento Vínculo entre padres e hijos neonatos. Enfermería Glob. 2020;19(3):255–85. https://doi.org/10.6018/eglobal.403721

Rahman A, Iqbal Z, Waheed W, Hussain N. Translation and cultural adaptation of health questionnaires. J Pak Med Assoc. 2003;53(4):142–7. PMID: 12776898

Epstein J, Santo RM, Guillemin F. A review of guidelines for cross-cultural adaptation of questionnaires could not bring out a consensus. J Clin Epidemiol [Internet]. 2015;68(4):435–41. DOI: https://doi.org/10.1016/j.jclinepi.2014.11.021

Hernández A, Hidalgo MD, Hambleton RK, Gómez-Benito J. International test commission guidelines for test adaptation: A criterion checklist. Psicothema. 2020;32(3):390–8. DOI: https://doi.org/10.7334/psicothema2019.306

Mena-Tudela D, González-Chordá V, Soriano-Vidal FJ, Bonanad-Carrasco T, Centeno-Rico L, Vila-Candel R, et al. Changes in health sciences students’ perception of obstetric violence after an educational intervention. Nurse Educ Today [Internet]. 2020;88(February):104364. DOI: https://doi.org/10.1016/j.nedt.2020.104364

Mena-Tudela D, Cervera-Gasch Á, Andreu-Pejó L, Alemany-Anchel MJ, Valero-Chillerón MJ, Peris-Ferrando E, et al. Perception of obstetric violence in a sample of Spanish health sciences students: A cross-sectional study. Nurse Educ Today. 2022;110(December 2021). DOI: https://doi.org/10.1016/j.nedt.2022.105266

Biurrun-Garrido A, Brigidi S, Mena-Tudela D. Percepción de estudiantes de ciencias de la salud sobre la violencia obstétrica. Enfermería Clínica. 2023;33(3):234–43. DOI: https://doi.org/10.1016/j.enfcli.2023.02.005

Ecuador MSP. Atención del trabajo parto, parto y posparto inmediato. Guía de Práctica Clínica. [Internet]. 2015th ed. Vol. 1. MSP; 2015. p. 1–64. https://www.salud.gob.ec/wp-content/uploads/2014/05/GPC_Atencion_del_trabajo_parto_posparto_y_parto_inmediato.pdf

Organización Mundial de la Salud. Recomendaciones de la OMS Para los cuidados durante el parto , Transformar la atención a mujeres y neonatos para. Dep Salud Reprod e Investig Conex Organ Mund la Salud [Internet]. 2018;WHO-RHR-18(8):1–8. https://www.who.int/reproductivehealth/publications/intrapartum-care-guidelines/es/

Mena-Tudela D, Iglesias-Casás S, González-Chordá VM, Cervera-Gasch Á, Andreu-Pejó L, Valero-Chilleron MJ. Obstetric violence in Spain (Part I): Women’s perception and interterritorial differences. Int J Environ Res Public Health. 2020;17(21):1–14. DOI: https://doi.org/10.3390/ijerph17217726

Published

2025-08-25

How to Cite

Falcon, K., Riesco, M. L., Mena-Tudela, D., Estrella-Santos, A., & Fors López, M. M. (2025). Linguistic and Cultural Adaptation and Validation of the Instrument for Measuring Perceptions of Obstetric Violence. Aquichan, 25(2), e2527. https://doi.org/10.5294/aqui.2025.25.2.7

Issue

Section

Articles