Reviewer's report
Title:The Confidence and Trust in Delivery Questionnaire (CTDQ): A pilot
validation study.
Version: 1Date:9 December 2010
Reviewer: Albrecht Jahn
Reviewer's report:
This study with its aim of developing an instrument for the assessment of
maternal perceptions and confidence in child birth addresses a very important
issue. However, the study is a pilot indeed and thus cannot provide a proper
validation of the instrument contrary to the statement in the abstract (“Our data
suggest that the CTDQ is a short, reliable and valid instrument to assess
confidence and trust in delivery”).
Major Compulsory Revisions:
1. the authors rightly classify there study as a pilot study; as such I cannot
validate the instrument; the conclusions should be adjusted to this situation
2. Methodology - Selection bias and representativeness of study population:
The authors acknowledge the observation, that their study population is not
representative because of the high proportion of women with higher education.
Beyond that women were recruited in the maternity ward in a hospital, while
antenatal care in Germany is generally not provided by hospitals. Thus, these
women had a special reason, to attend a hospital in pregnancy, most probably
because of a complication. In addition, the hospital’s focus on integrative
medicine may have attracted a very selected clientele. There is an issue whether
a question like “When I think of labor and its pain I tend to eagerly anticipate it”
(what was the wording in German?) would work with all groups of pregnant
women. It is advised to attach the original questions as an accompanying file.
3. Methodology – the rationale for using the Visual analogue scale for external
validation is not obvious and needs justification or omission
4. Results – data from SOC
these data figure only in table one (under a misleading heading) with an overall
mean of 151,5. Not all readers will be familiar with the SOC and the way it is
analysed. It is recommended that the data are presented in more detail and that
the process of calculating correlation coefficients per subcategory is explained.
Which values were compared?
5. Results – table 1
The heading talks of demographic and socio-medical information. The table
should stick to this heading and provide background variables, including major
risk factors and hospitalisation in pregnancy. The results of the SOC (and VAS if
deemed important) should be presented in a separate table, comparable to table
2
6. Results - table 3
Firstly there are some inconsistencies: How can the total with trust in medical
competence by + 0.308 while all subcategories are negative? It is also surprising
to see to see a negative correlation between CTDQ Trust in medical competence
and SOC manageability. The direction of the correlation is impossible to judge,
because it is not shown if the direction in the seven level scale (from 1 to seven)
of the respective questions was the same or opposite. The figures have * or **
without an explanation of the meaning.
Minor Essentiel Revisions:
The issue of epidural anaesthesia (EA) is mentioned in the methodology but not
taken up later
There use of acronyms need to be restricted in order to improve readability.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests