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Determining the psychometric properties of the Enhancing Decision-making Assessment in Midwifery (EDAM) measure in a cross cultural context

Jefford, Elaine; Jomeen, Julie; Martin, Colin R.

Authors

Elaine Jefford

Julie Jomeen

Colin R. Martin



Abstract

© 2016 Jefford et al. Background: The ability to act on and justify clinical decisions as autonomous accountable midwifery practitioners, is encompassed within many international regulatory frameworks, yet decision-making within midwifery is poorly defined. Decision-making theories from medicine and nursing may have something to offer, but fail to take into consideration midwifery context and philosophy and the decisional autonomy of women. Using an underpinning qualitative methodology, a decision-making framework was developed, which identified Good Clinical Reasoning and Good Midwifery Practice as two conditions necessary to facilitate optimal midwifery decision-making during 2nd stage labour. This study aims to confirm the robustness of the framework and describe the development of Enhancing Decision-making Assessment in Midwifery (EDAM) as a measurement tool through testing of its factor structure, validity and reliability. Method: A cross-sectional design for instrument development and a 2 (country; Australia/UK) x 2 (Decision-making; optimal/sub-optimal) between-subjects design for instrument evaluation using exploratory and confirmatory factor analysis, internal consistency and known-groups validity. Two 'expert' maternity panels, based in Australia and the UK, comprising of 42 participants assessed 16 midwifery real care episode vignettes using the empirically derived 26 item framework. Each item was answered on a 5 point likert scale based on the level of agreement to which the participant felt each item was present in each of the vignettes. Participants were then asked to rate the overall decision-making (optimal/sub-optimal). Findings: Post factor analysis the framework was reduced to a 19 item EDAM measure, and confirmed as two distinct scales of 'Clinical Reasoning' (CR) and 'Midwifery Practice' (MP). The CR scale comprised of two subscales; 'the clinical reasoning process' and 'integration and intervention'. The MP scale also comprised two subscales; women's relationship with the midwife' and 'general midwifery practice'. Conclusion: EDAM would generally appear to be a robust, valid and reliable psychometric instrument for measuring midwifery decision-making, which performs consistently across differing international contexts. The 'women's relationship with midwife' subscale marginally failed to meet the threshold for determining good instrument reliability, which may be due to its brevity. Further research using larger samples and in a wider international context to confirm the veracity of the instrument's measurement properties and its wider global utility, would be advantageous.

Citation

Jefford, E., Jomeen, J., & Martin, C. R. (2016). Determining the psychometric properties of the Enhancing Decision-making Assessment in Midwifery (EDAM) measure in a cross cultural context. BMC Pregnancy and Childbirth, 16(1), Article ARTN 95. https://doi.org/10.1186/s12884-016-0882-3

Acceptance Date Apr 20, 2016
Online Publication Date Apr 28, 2016
Publication Date Apr 28, 2016
Deposit Date May 3, 2016
Publicly Available Date May 3, 2016
Journal BMC pregnancy and childbirth
Print ISSN 1471-2393
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 16
Issue 1
Article Number ARTN 95
DOI https://doi.org/10.1186/s12884-016-0882-3
Keywords Enhancing Decision-making Assessment in Midwifery (EDAM), Midwifery, Decision-making, Assessment, Psychometric, Cross-cultural, Birth, Clinical reasoning, Midwifery practice
Public URL https://hull-repository.worktribe.com/output/437518
Publisher URL http://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-0882-3
Additional Information Copy of article: Jefford, E., Jomeen, J., & Martin, C. R. (2016). Determining the psychometric properties of the Enhancing Decision-making Assessment in Midwifery (EDAM) measure in a cross cultural context. BMC Pregnancy and Childbirth, 16, 95. http://doi.org/10.1186/s12884-016-0882-3
Contract Date May 3, 2016

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Copyright Statement
© 2016 Jefford et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.






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