Psychometric Evaluation of the Wang Pregnancy Stress Scale: Revised for Taiwanese Women.

Background and Purpose: Develop and assess psychometric properties of the Wang Pregnancy Stress Scale for measuring stress among pregnant women in Taiwan. Methods: Data were collected in 3 obstetric and gynecological clinics in Taiwan; 485 pregnant women participated in this study. We used exploratory factor analysis and internal consistency reliability was measured using Cronbach's alpha. Results: A 4-factor structure emerged for the Wang Pregnancy Stress Scale. The internal reliability of the scale as measured by Cronbach's alpha was .898, with standardized alpha .905. Conclusions: The Wang Pregnancy Stress Scale has high reliability and validity in measuring pregnancy stress that would allow nurses or health care workers to measure women's stress levels during pregnancy. Nurses can use the assessed pregnancy stress to alter intervention of care for their pregnant clients.Keywords: pregnancy stress; scale development; reliability; validity; factor analysis; Taiwanese womenFew cross-cultural, reliable, and valid scales are available for measuring stress in pregnant women, with the exception of Chen's (Chen, Chen, & Huang, 1989) initial study of Taiwanese pregnant women in 1989. Chen's instrument, however, does not address socioeconomic aspects of pregnancy stress. The purpose of this research was to develop and assess psychometric properties of the Wang Pregnancy Stress Scale for measuring stress among pregnant women in Taiwan. The Wang Pregnancy Stress Scale includes items that address some socioeconomic aspects of pregnancy stress. Understanding pregnancy-related stressors is important for developing intervention programs that would help to facilitate nursing care of pregnant women among diverse cultural groups.BACKGROUND AND CONCEPTUAL FRAMEWORKFor many expectant mothers, pregnancy can be a stressful time. Some women experience very high levels of stress, whereas others see pregnancy as a welcome challenge. For pregnant women, loss of a job, divorce, or death of a family member can contribute to high levels of stress during pregnancy. Potential problems during pregnancy can include fetal development, learning and attention deficiency, anxiety, and depressive symptoms (North Dakota Pregnancy Risk Assessment Monitoring Systems, 2000).Depression during pregnancy can be associated with poor maternal self-care behaviors, which may influence the baby's health, and may place the mother at significant risk of developing postpartum depression (Dennis, Ross, & Grigoriadis, 2007). Studies have also indicated that high stress and mood disturbances during pregnancy are related to various negative maternal and birth outcomes (Flynn, Blow, & Marcus, 2006; Kinney, Munir, Crowley, & Miller, 2008; Marcus, Flynn, Blow, & Barry, 2003). Prenatal psychosocial stress is common, and high levels of stress are associated with negative maternal factors, such as alcohol consumption, drug usage, smoking, and depression, among other factors, known to contribute to poor pregnancy outcomes (Woods, Melville, Guo, Fan, & Gavin, 2010). Prenatal exposure to stressful life events is associated with significantly increased risk of autism disorder as well as other disorders, such as schizophrenia and depression (Kinney et al., 2008). Social support has been found to be important to postpartum women in adaptation to a new role, in helping new mothers to be more responsive to their babies, and in facilitating their intimate relationships (Baker & Taylor, 1997). Social support has an indirect effect on women's health after childbirth (Hung, 2007). Hung identified concerns about role attainment, concerns about negative body image, and concerns about lack of social support as postpartum stressors. Mothers' behaviors are influenced by their perception of the amount of positive support they have received (Henshaw, 2003).Asian women have less postpartum depression because of traditional postpartum rituals (Stern & Krukman, 1983). …