Development and Psychometric Evaluation of the Paternal Pregnancy-Related Anxiety Scale (PPrAS)
Creators: name: Dabb, Carol
Publisher: name: Australian Catholic University
Year: 2024
Subjects: expectant father
pregnancy anxiety
pregnancy-related anxiety
scale development
Rasch analysis

description: Approximately 10% of expectant fathers experience anxiety during their partner’s pregnancy, with anxiety being linked to adverse outcomes for themselves and their families. The diagnosis and treatment of anxiety in expectant fathers is often overlooked in clinical practice, however researchers are increasingly recognising that men may experience pregnancy-related anxiety, characterised by pregnancy-specific concerns, worries, and fears. To address the current absence of a psychometrically sound measure of pregnancy-related anxiety which has been developed specifically for expectant fathers, the present research aimed to develop and evaluate a new measure, the Paternal Pregnancy-related Anxiety Scale (PPrAS).
Before generating potential items for the new scale, a comprehensive systematic review of qualitative and quantitative literature was conducted to examine men’s experiences during their partner’s pregnancy and identify the nature and breadth of their pregnancy-related concerns, worries, and fears. The systematic review identified 75 distinct concerns experienced by fathers during pregnancy, encompassed by 10 categories of concern, including: childbirth concerns, attitudes towards childbirth, baby concerns, acceptance of pregnancy, partner concerns, relationship concerns, worry about self, transition to parenthood, attitudes towards medical staff, and practical and financial concerns. 
An initial item pool including 113 items was generated on the basis of the systematic review findings. The item pool was then modified after being evaluated by members (N = 12) of an expert review panel, resulting in a final item pool of 95 items.
 Refinement of the item pool and subsequent psychometric evaluation of the newly developed scale was then conducted in several stages, using data collected from expectant fathers during two phases of data collection, using identical recruitment strategies. During Phase 1 of data collection (August 2022 to November 2022), 292 expectant fathers (Mage = 29.9 years, SD = 5.55) from Australia (N = 146) and the USA (N = 146) completed online questionnaires comprised of the revised item pool of 95 items and two additional measures, including an adapted maternal measure of pregnancy-related anxiety and a generic measure of anxiety. During Phase 2 of data collection (February 2023 to May 2023), 282 expectant fathers (Mage = 28.50, SD = 4.60), from Australia (N = 149), the USA (N = 116), and additional countries (N = 17), completed online questionnaires comprised of the newly developed PPrAS, two adapted maternal measures of pregnancy-related anxiety, two generic measures of anxiety, a measure of depression, and a measure of neuroticism.
Refinement of the item pool was conducted with the data collected during Phase 1 (N = 292). The revised item pool of 95 items was evaluated within the framework of the Rasch measurement model, to identify items for retention in the final scale. The resultant 33-item unidimensional scale demonstrated good fit, no evidence for differential item functioning, sound levels of targeting, and excellent internal consistency reliability. 
Additional psychometric evaluation of the 33-item PPrAS was then conducted with the data collected during Phase 2 (N = 282), using methodology consistent with Classical Test Theory (CTT) approaches. Findings indicated excellent internal consistency reliability (α = .96) and some evidence for construct validity. The PPrAS demonstrated significantly stronger correlations with the two convergent measures (general anxiety and an adapted maternal measure of pregnancy-related anxiety) than with the divergent measure of neuroticism. However, the size of the correlations between the PPrAS and the two convergent measures were not significantly different to the size of correlation with the divergent measure of depression, suggesting that the construct of pregnancy-related anxiety may not be as distinct from general anxiety or depression for expectant fathers as has been found previously in research with expectant mothers. 
Further psychometric evaluation assessed concurrent validity by examining the ability of the PPrAS to identify fathers classified as anxious versus non-anxious, using a subsample of expectant fathers (N = 152), drawn from all participants from Phase 1 and Phase 2 of data collection. Using binary logistic regression and a Receiver Operating Characteristic (ROC) curve, it was found that the PPrAS significantly predicted whether fathers were classified as anxious or non-anxious, displaying high sensitivity (96.0%) and specificity (97.4%). 
Overall, the research findings indicate that the PPrAS would be useful in clinical contexts, for identifying expectant fathers with high levels of pregnancy-related anxiety. While pregnancy-related anxiety in expectant fathers may not be as distinct from general anxiety or depression as seen in women; men are still likely to benefit from a paternal measure of pregnancy-related anxiety, given that expectant fathers may initially be reluctant to seek help specifically for anxiety or depression, but are instead more likely to engage in services that target practical skills (e.g., baby care classes). The PPrAS addresses this barrier to receiving support by providing a context for exploring men’s pregnancy-related concerns while assessing their levels of anxiety. With sound psychometric properties, the newly developed PPrAS provides researchers and clinicians an opportunity to extend the current understanding of paternal pregnancy-related anxiety and provide better support to fathers during pregnancy.