Measures & Metrics

The Birth Place Lab has developed novel instruments to measure respectful care, improve the evaluation of perinatal care, and assess provider attitudes to planned home birth.

Learn more about the instruments, find answers to commonly asked questions, and request access to our tools below.

Measuring Respectful Care

My Autonomy in Decision Making Scale (MADM)

Assessing experiences with perinatal care

 

Measures

Experiences of decision-making when interacting with perinatal providers.

  • 7 items, with 6 Likert response options ranging from strongly disagree to strongly agree
  • Higher scores indicate more autonomy in decision-making
  • Reliable and valid patient-reported experience instrument
  • MADM version 2.0 is the most recent version and should be used for all new studies
  • Is available under a Creative Commons license; see below for usage
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Measures of Respect Index (MOR)

Assessing respectful patient-provider interactions

 

Measures

The nature of respectful patient-provider interactions and their impact on a person’s comfort, behavior, and experiences of racism or discrimination. 

  • Two versions: 7 items and 14 items, with 6 Likert response options ranging from strongly disagree to strongly agree
  • Higher scores indicate more respectful care 
  • Reliable and valid patient-reported experience instrument
  • Is available under a Creative Commons license; see below for usage
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The Mistreatment Index (MIST-7)

Assessing mistreatment experienced in maternity care

Measures

Seven dimensions of human rights violations that align with the Bohren typology: physical abuse, sexual abuse, verbal abuse, stigma and discrimination, failure to meet professional standards of care, poor rapport between women and providers, and poor conditions and constraints presented by the health system.

  • Seven items, binary response (yes/no)
  • Higher scores indicate more types of mistreatment experienced
  • Reliable and valid patient-reported experience instrument
  • Is available under a Creative Commons license; see below for usage
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Place of Birth

The Birth Place Research Quality Index (ResQu Index)

Rating the quality of research examining the effects of birth place on health outcomes

Measures

The quality of research examining the effects of birth place on health outcomes.

  • 27 items across five domains
  • Higher values indicate higher quality; rates studies as strong, moderate, or weak
  • Reliable and valid tool; developed by an international, multi-disciplinary panel of 21 experts
  • The components of the index meet best practice standards for critical appraisal tools
  • First grading system to assess the quality of the available studies on birth place
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Provider Attitudes to Planned Home Birth (PAPHB) Scale

Measuring provider attitudes toward planned home birth

Measures

Can be used to assess similarities and differences among types of providers in readiness to offer community birth services or collaborate with community birth providers.

PAPHB, designed for midwives; PAPHB-M (multidisciplinary) which is designed for use across health disciplines; and PAPHB-I (international) which can compare attitudes among midwives from different countries.

  • PAPHB has 20 items; PAPHB-M has 17 items, PAPHB-I has 9 items
  • Higher scores mean more positive attitudes
  • Items assess the impact of participants’ education and exposure through personal or work experience
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Requesting the Measures and Metrics

Our tools can be used by:

  • Researchers who are examining experiences of respect and/or mistreatment during perinatal care, including researchers who seek to adapt our tools to be relevant and accessible to diverse communities around the world.
  • Health systems, care providers and facilities, to learn more about service-user experiences of care in their setting.
  • Health systems and policy makers to inform quality improvement and health and human resource allocation across birth settings.
  • Birthing people, to help them reflect on the care they received and provide feedback to their healthcare providers.

Some of our tools may require special permissions or licensing agreements, depending on the nature of planned use. Please complete the form below and you will receive additional information about next steps. Learn more in our FAQ.

The Measures and Metrics In Use

These maps show some of the countries where the tools are in currently in use. 

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Frequently Asked Questions