Quality of the development of self-report instruments assessing women’s antepartum expectations of motherhood: a systematic review

The selection of valid and reliable instruments for research and clinical purposes is needed to increase our understanding of the role that expectations of motherhood have in early identification and treatment of perinatal mental health difficulties. We aimed to identify and assess the psychometric properties of self-report measures of expectations of motherhood. A systematic review was conducted and articles describing the development or validation of quantitative self-report measures of expectations of motherhood were included. The developmental quality (risk of bias) and psychometric properties of each measure were assessed according to the 2018 COSMIN guidelines. Twenty-five articles describing 16 measures were identified and included. Eleven measures were designed to assess a broad range of expectations, while the remaining measures mainly assessed expectations of childbirth. The quality of measure development was mostly poor and rated as adequate or better for only three measures. The most suitable measures with the strongest evidence of good psychometric properties are the Slade-Pais Expectations About Childbirth Scale and the Rigidity of Maternal Beliefs Scale. This systematic review of measures of expectations has identified relatively few measures with adequate psychometric properties. Further development of existing measures is needed for use in both research and clinical settings. <b>KEY POINTS</b> <b>What is already known about this topic:</b>Maternal mental health difficulties can have significant and long-term adverse consequences on mothers, their children, and families.Previous evidence suggests that holding unrealistic maternal expectations may contribute to postpartum mental health difficulties.Early identification of the potentially modifiable risk factor of maternal expectations may contribute to improving postpartum mental health outcomes. Maternal mental health difficulties can have significant and long-term adverse consequences on mothers, their children, and families. Previous evidence suggests that holding unrealistic maternal expectations may contribute to postpartum mental health difficulties. Early identification of the potentially modifiable risk factor of maternal expectations may contribute to improving postpartum mental health outcomes. <b>What this topic adds:</b>This is the first systematic review to assess the developmental quality and psychometric properties of 16 measures of expectations of motherhood.The Slade-Pais Expectations About Childbirth Scale had the strongest evidence for good psychometric properties.For the majority of the measures, adequate methods for ensuring good content validity during measure development and validation were not used. This is the first systematic review to assess the developmental quality and psychometric properties of 16 measures of expectations of motherhood. The Slade-Pais Expectations About Childbirth Scale had the strongest evidence for good psychometric properties. For the majority of the measures, adequate methods for ensuring good content validity during measure development and validation were not used.

为加深我们对母亲身份预期在围产期心理健康问题早期识别与治疗中所起作用的认知，亟需筛选适用于科研与临床场景的有效且可靠的测评工具。本研究旨在识别并评估母亲身份预期自评量表（self-report measures）的心理测量学特性（psychometric properties）。我们开展了一项系统综述，纳入所有描述母亲身份预期量化自评量表的开发或验证过程的文献。依据2018年COSMIN指南，对每一种量表的开发质量（偏倚风险）与心理测量学特性进行了评估。最终共纳入25篇文献，涉及16种测评工具。其中11种量表旨在评估广泛维度的母亲身份预期，其余量表则主要针对分娩预期进行测评。量表开发质量整体欠佳，仅3种量表被评为达标及以上等级。心理测量学特性证据最为充分、适配性最佳的量表为Slade-Pais分娩预期量表（Slade-Pais Expectations About Childbirth Scale）与母亲信念僵化量表（Rigidity of Maternal Beliefs Scale）。本系统综述发现，具备合格心理测量学特性的母亲身份预期测评工具相对匮乏，现有量表仍需进一步开发以适配科研与临床场景的使用需求。

**核心要点**
**该领域已有研究认知：**
母亲心理健康问题会对母亲自身、子女及家庭造成显著且长期的不良影响。既往研究表明，持有不切实际的母亲身份预期可能会增加产后心理健康问题的发生风险。早期识别母亲身份预期这一潜在可改变风险因素，有助于改善产后心理健康结局。母亲心理健康问题会对母亲自身、子女及家庭造成显著且长期的不良影响。既往研究表明，持有不切实际的母亲身份预期可能会增加产后心理健康问题的发生风险。早期识别母亲身份预期这一潜在可改变风险因素，有助于改善产后心理健康结局。

**本研究新增贡献：**
这是首项针对16种母亲身份预期测评工具的开发质量与心理测量学特性开展评估的系统综述。Slade-Pais分娩预期量表具备最为充分的良好心理测量学特性证据。绝大多数量表在开发与验证过程中，未采用能够保障良好内容效度（content validity）的合规方法。这是首项针对16种母亲身份预期测评工具的开发质量与心理测量学特性开展评估的系统综述。Slade-Pais分娩预期量表具备最为充分的良好心理测量学特性证据。绝大多数量表在开发与验证过程中，未采用能够保障良好内容效度的合规方法。