Development and Initial Psychometric Testing of the Midwifery Practice Climate Scale - Part 2.
INTRODUCTION
A supportive practice climate is demonstrated to improve patient outcomes, health care provider well-being, and workforce stability. Midwives are an integral component to improving maternal health care; however, there has been limited research into the qualities and measurement of a supportive practice climate for midwives.


METHODS
The Midwifery Practice Climate Scale is a self-report instrument designed to measure midwives' perceptions of their work environments. We tested the scale's validity and reliability in multiphase, national cross-sectional survey of the full roster of certified nurse-midwives and certified midwives practicing in the United States. To test structural validity and reliability testing, 2 subsamples of 330 participants were randomly extracted from the sample of 2887 for exploratory and confirmatory factor analyses and internal consistency determination. Convergent validity was tested in the remaining sample of 1673 respondents.


RESULTS
Exploratory factor analysis revealed 2 5-subscale structures consistent with the loading values and theoretical structure. Confirmatory factor analysis revealed a mediocre fit of the models identified in the exploratory analysis. Consequently, items were systematically reviewed for redundancy, skew, and generalizability and 24 items were removed from the scale. The resulting structure is a 10-item scale comprising 2 subscales: Practice Leadership and Participation and Support for the Midwifery Model of Care. The revised Midwifery Practice Climate Scale was a good fit with the data demonstrating adequate construct validity (χ2 = 60.397, df = 34, P < 0.001; comparative fit index, 0.987; root mean square of approximation, 0.049) and internal consistency (α = 0.89-0.84).


DISCUSSION
These findings indicate that the Midwifery Practice Climate Scale accurately and reliably measures the midwives' perceptions of their practice environment. The next steps include determining the scale's sensitivity to change and assessing the relationship with maternal health outcomes.
['Thumm|E Brie|EB|https://orcid.org/0000-0001-7646-5195', 'Shaffer|Jonathan|J|', 'Meek|Paula|P|']
D000328:Adult D003430:Cross-Sectional Studies D005163:Factor Analysis, Statistical D005260:Female D006801:Humans D008297:Male D008427:Maternal Health Services D008875:Middle Aged D008880:Midwifery D009721:Nurse Midwives D015279:Organizational Culture D011247:Pregnancy D011594:Psychometrics D015203:Reproducibility of Results D011795:Surveys and Questionnaires D017132:Workplace
practice climate maternity practice environment midwife scale development