The value of prenatal care in improving maternal and neonatal outcomes has been evident in research for many years, and yet in the U.S. where prenatal care is widely accessible to women, maternal and neonatal morbidity and mortality remain higher than many developing countries (CDC, 2019). Attributes of prenatal care have been studied, such as the number of visits and timing of entry into care. Additional aspects of prenatal care deserve exploration in order to make improvements in this established, valuable intervention. A woman’s engagement in her care during pregnancy has not been previously measured. The focus of this dissertation research was to develop a sound instrument to measure Patient Engagement in Prenatal Care (PEPC).

The first manuscript, Nurses’ Unique Opportunity to Promote Patient Engagement in Prenatal Care, provides an analysis of the concept of PEPC. The second manuscript, Instrument Development and Initial Testing of the Patient Engagement in Prenatal Care Scale, reports the development of the PEPC scale items, the first administration of the survey to a sample of 202 pregnant women, and data analysis including initial psychometric testing. Content validity index (CVI), internal consistency reliability, and exploratory factor analysis (EFA) were assessed for the Phase 1 study. The CVI of the 18-item scale was satisfactory (S-CVI = .92), and the reliability was acceptable (Cronbach’s a = .86). Three items were removed through EFA and resulted in a three factors structure. The alpha coefficients for the final 15-items and three subscales were all acceptable (Cronbach’s a = .73- .89).

The third manuscript, Psychometric Development of the Patient Engagement in Prenatal Care Scale, reports a subsequent Phase 2 research study in which the 15-item PEPC scale was administered to a second sample of 205 pregnant women, with psychometric testing and instrument revision. The coefficient alpha and confirmatory factor analysis (CFA) were used to assess the internal reliability and construct validity, respectively. The alpha coefficient of the 15-item scale showed good reliability (Cronbach’s a = .81). The CFA supported 3-factor loading model with acceptable model indices values in the final 12-item PEPC. The final 12-item scale demonstrated acceptable reliability in this sample (a = .77).

This dissertation portfolio begins with laying the theoretical foundation of PEPC as a concept and advances to the creation of a sound instrument with initial psychometric testing. The resulting PEPC-12 scale was a brief instrument that will be easy to administer and useful in future clinical studies.

Date of publication

Spring 4-3-2019

Document Type




Persistent identifier


Committee members

Shih-Yu "Sylvia" Lee, Zhaomin He, Danita Alfred, Ora Strickland


Doctorate of Philosophy in Nursing