ANXIETY SCALE FOR PREGNANCY

211 Pages·2009·3.23 MB·English

ANXIETY SCALE FOR PREGNANCY: DEVELOPMENT AND VALIDATION
by
MARY MADELEINE R. DOYLE-WATERS
B.S.W., University ofBritish Columbia, 1978
B.A., University ofVictoria, 1985
A THESIS SUBMITTED IN PARTIALFULFILLMENT OF
THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF ARTS
in
THE FACULTY OF GRADUATE STUDIES
Department OfEducational Psychology And
Special Education
We acceptthis thesis as conforming
t he required st ndard
THE UNIVERS1TY OF BRITISH COLUMBIA
August 1994
© Mary Madeleine Rita Doyle-Waters, 1994
_____________________________
In presenting this thesis in partial fulfillment of the
requirements for an advanced degree at the University of British
Columbia, I agree that the Library shall make it freely available
for reference and study. I further agree that permission for
extensive copying of this thesis for scholarly purposes may be
granted by the head of my department or by his or her
representatives. It is understood that copying or publication of
this thesis for financial gain shall not be allowed without my
written permission.
(Signature)
Er/
Department of t1Ji
The University of British Columbia
Vancouver, Canada
Date C / /9/Z;/
11
ABSTRACT
Women encounterphysical, emotional, and psychological changes during
pregnancy. The literature indicates that some women find these changes to be stressful.
They may respond to this stress by feeling anxious. The frequency and intensity ofthe
anxiety reaction depends on how women perceive these stressors and on their ability to
cope with the anxiety. The studies that have investigated pregnancy and anxiety have
used general measures ofstate anxiety. A search for a measure ofanxiety that pertains to
pregnancy produced a number ofmeasures that were specific to one or several
dimensions ofpregnancy. There are no measures available that look at anxiety and the
multidimensional components ofpregnancy. Therefore the intent ofthis research project
was to develop and validate such a measure.
Spielberger’s theory and measure ofstate and trait anxiety was examined in detail.
The development ofThe Anxiety Scale For Pregnancy (ASP) was based on his research
ofstate anxiety. An extensive review ofthe literature on pregnancy led to the
construction ofthe items for this measure. The initial 82 items were pretested by a group
ofexperts in the field ofpregnancy and a sample of40 women. The revised items
comprised ten dimensions ofpregnancy and 73 items relating to those dimensions. This
version ofASP was field tested on a group of270 pregnant women.
Validation ofASP was through confirmatory factor analysis, group
differentiation, and concurrent validity. Confirmatory factor analysis ofthe ten
dimensions and 73 items did not produce a good fit ofthe model. The model was
respecified and resulted in a hypothesized model of 14 observed variables and five latent
constructs, baby, labour, marital, attractive, and support. The overall goodness-of-fit for
this model is excellent. Group differentiation was assesses throught the variables,
trimester, gravidity, age, and health during pregnancy. The mean differences between the
group variables and the subscales ofASP supportedprevious research in the domain of
pregnancy and anxiety. Concurrent validity was demonstratedthrough the strong
111
correlations between the scores ofASP and the State and Trait Anxiety Inventory, as well
as ASP and the State Self-Esteem Scale which produced, as expected, a strong negative
correlation. The results from this study indicate that the ASP is a valid measure offive
different dimensions relating to pregnancy and those dimensions are based on an
extensive review ofthe literature.
iv
TABLE OF CONTENTS
Page
ABSTRACT ii
.
TABLE OF CONTENTS iv
LIST OF APPENDICES vii
LIST OF TABLES viii
LIST OF FIGURES x
ACKNOWLEDGEMENT xii
CHAPTER
1. INTRODUCTION 1
Pregnancy and Anxiety 1
Problem and Purpose 6
Significance ofthe Study 7
2. REVIEW OF LITERATURE 9
General Anxiety Theory 9
Spielberger’s Theory ofState and Trait Anxiety 11
Development ofthe STAI 14
Measures Used in Pregnancy and Anxiety Studies 16
Developing a Measure ofAnxiety for Pregnancy 19
Factors Affecting Pregnancy 20
Background Factors 20
Adaptation to Pregnancy 22
Identification ofaMotherhood Role 23
Physiological Changes 24
Fetal Development 26
Emotional Changes 27
Self 29
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Page
Relationships 30
Sociological Factors 32
Labour 34
Postpartum 35
Limitations in the Literature 36
Summary 37
3. METHODOLOGY 39
Primary Purpose ofASP 39
Identifying Behaviours to Representthe Construct 40
Scale Specifications 40
Item Construction 41
Item Review 41
Results ofItem Review 42
Preliminary Item Tryouts 43
Field Test ofASP 44
Stratified Sample 46
Prenatal Classes 46
Women Admitted to Hospital 47
Ultra Sound Testing 47
Fetal Monitoring 47
Advanced Maternal Age (AMA) Program 48
Outpatient Clinic 48
Women Seeing Obstetricians 48
Women Living on a University Campus 49
Selection ofRespondents 49
Sample Size 49
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Page
Criteria for Sample Selection 50
The Test Package 50
Procedures for Administering the Test Package 51
Prenatal Classes 51
B.C.’s Women’s Hospital and Obstetric Offices 52
University ofBritish Columbia Campus 52
Statistical Properties ofItem Scores 52
Reliability and Validity Studies 53
Reliability 53
Validity 53
Concurrent Validity 53
Construct Validity 54
Group Differentiation 54
Factorial Composition 54
Convergent Validity 55
Summary 55
4. RESULTS 57
Distribution ofthe Questionnaires 57
Sample Characteristics 59
Health Characteristics 66
Sample Characteristics ofASP 72
Statistical Analyses ofASP 73
The Validity ofASP 73
Latent Structure 73
Model Specifications 74
Assessment ofthe Model Fit 79
vii
Page
Feasibility ofthe ParameterEstimates 79
Adequacy ofthe MeasurementModel 82
Goodness-of-Fit ofthe Overall Model 83
Goodness-of-Fit ofthe Individual Model Estimates 83
Sample Characteristics ofthe Revised ASP 84
Sample Characteristics ofSTAI and SSES 89
Group Differentiation 90
Convergent Validity 101
Summary 104
5. DISCUSSION 106
The Qualities ofASP 106
Limitations ofthis Study 111
Future Research 113
BIBLIOGRAPHY 116
LIST OF APPENDICES 122
A Literature References for ASP Items 122
B Review ofItems by the Experts 154
C Preliminary Items Given to Pretest Group 160
D Test Package 165
B Instructions for Prenatal Classes 175
F Instructions for B.C. Women’s Hospital 179
G Instructions for U.B.C 182
H Complete List ofOccupations 185
I Complete list ofEthnic Origins 189
J 10 Latent Dimensions ofASP 192
K Validated Dimensions ofASP 197
viii
LIST OF TABLES
Page
Table 1 Distribution ofQuestionnaires 58
Table 2 Pregnancies Experiencedby the Gravidas 60
Table 3 Miscarriages, Abortions, or Perinatal Deaths 61
Table 4 Educational Level ofthe Respondents 62
Table 5 Occupational Classifications ofthe Respondents 63
Table 6 Respondents’ Ethnic Origin 64
Table 7 Perceived Support People 65
Table 8 Total Number ofPerceived Support People 66
Table 9 Health Conditions Prior to this Pregnancy 67
Table 10 Conditions Specific to Pregnancy 68
Table 11 Responses to Other Conditions During Pregnancy 70
Table 12 Infections Experienced by the Sample 71
Table 13 Variables in the Confirmatory Factor Analysis Model 76
Table 14 Standardized ML Estimates ofthe Inter-Relations
Between the Latent Constructs 80
Table 15 StandardizedML Estimates ofthe Factor Loadings 81
Table 16 StandardizedML Estimates ofthe Error Variances 82
Table 17 Sample Scores from ASP 84
Table 18 Sample Scores for the Subscale Baby 85
Table 19 Sample Scores for the Subscale Labour 86
Table 20 Sample Scores for the Subscale Marital 87
Table 21 Sample Scores for the Subscale Attractive 88
Table 22 Sample Scores for the Subscale Support 88
Table 23 Group Differences for Trimester 92
Table 24 Group Differences for Health 95
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Page
Table 25 Group Differences for Gravidity 97
Table 26 Group Differences on Age 99
Table 27 Correlation Matrix ofthe Subscales 103
Table 28 Correlation Matrix ofthe Four Instruments 104