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\begin{document}

\title{MATERNAL EMOTIONAL WELL-BEING: A SCALE DEVELOPMENT AND PSYCHOMETRIC
TESTING STUDY}



\author[1]{Hülya Türkmen}%
\author[1]{Benay Oğuz}%
\author[1]{Esra Çevik}%
\affil[1]{Balikesir Universitesi}%


\vspace{-1em}



  
  \date{June 16, 2024}


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\selectlanguage{english}
\begin{abstract}
\textbf{Objective:} This study was carried out to develop an instrument
to measure the emotional well-being of mothers in line with the
Deck-Chair theory of Jean Ball. \textbf{Design:} Scale development and
psychometric testing study. \textbf{Setting:} Turkey \textbf{Population
or Sample:} A total of 398 postpartum women were included.
\textbf{Methods:} MEWBS was administered to postpartum women being
prepared for discharge (n=398). Factor analyses were carried out to
determine the construct validity of the scale. Cronbach's alpha
coefficient was used to assess the reliability of the scale.
\textbf{Main Outcome Measures:} MEWBS is a valid and reliable scale.
\textbf{Results:} KMO value for EFA was found to be 0.806. As a result
of the factor analysis that was carried out with the varimax orthogonal
rotation technique, three factors explaining 51.825\% of the total
variance in the measured characteristic (Healthcare and Education,
Social Support, and Mother's Personality and Experiences) were
identified. The internal consistency coefficient of the scale revealed
that it was highly reliable (Cronbach's alpha=0.860). It was determined
that the scale did not have response bias (Hotelling's T
\textsuperscript{2}=397.260, p=0.000), and its factors were additive
(non-additivity: 0.000). \textbf{Conclusion:} The validity and
reliability test results of MEWBS demonstrated that it is a valid and
reliable measurement instrument to assess the emotional well-being of
postpartum mothers being prepared for discharge. MEWBS can guide
healthcare professionals in identifying the emotional well-being of
mothers in line with Jean Ball's deck-chair theory and providing care
accordingly. Therefore, healthcare professionals are advised to use
MEWBS in their routine practices and assessments of mothers.%
\end{abstract}%



\sloppy


\textbf{INTRODUCTION}

One of the most important roles of a woman in life is considered to be
motherhood. Motherhood brings about multiple changes in the woman's
life, especially physiological, economic, and psychosocial changes. In
the postpartum period, in addition to her existing responsibilities, the
mother assumes baby-related responsibilities such as the care and safety
of her baby, communication with her baby, the realization of her baby's
identity as an individual, and coping with problems. While mothers who
receive sufficient social support and healthcare services can perform
these responsibilities easily, those who are unable to receive social
support may have difficulties. As a consequence, mothers may experience
psychological issues such as mood disorders and depression, and thus,
they may neglect their self-care and the care of their
babies.\textsuperscript{1-6} The feeling of being cared for and
supported which is experienced by mothers who receive postpartum social
support increases their sense of bonding, self-esteem, self-management
skills, and self-efficacy.\textsuperscript{7} For the adjustment of the
woman to her motherhood roles, her well-being, and her capacity to cope
with potential problems, it is highly important for her to receive
comprehensive healthcare services which include social
support.\textsuperscript{2,8-10}

The purpose of care theories in the field of midwifery is to guide
midwifery practices. With the usage of theories, systematic and
comprehensive care in midwifery practices can be achieved by including
individual-centered approaches rather than task-centered approaches, as
well as holistic approaches. Care services provided based on theories
and models allow practitioners to reach their targeted goals more easily
and achieve successful care outcomes.\textsuperscript{11} In this
context, midwives can provide care to women in the pregnancy and
postpartum periods based on the ``Mother's Emotional Well-Being --
Deck-Chair Theory'' which was developed by Jean Ball with a holistic
approach. According to this theory by English midwife Jean Ball,
pregnancy and the postpartum period can be viewed as a period of
adaptation to a new role.\textsuperscript{12} In her book Reactions to
Motherhood: The Role of Post-Natal Care, Ball stated that for a woman to
adapt to motherhood, she needs to be put into an active position, while
in addition to physiological factors, psychological and emotional
factors in this period are effective in the woman's adoption of her
identity as a mother by motivating her parenthood roles. Accordingly,
the mother's state of well-being is influenced by the care she receives,
her environment, her identity, and her experiences. These factors are
associated with the care provided by midwives and other occupational
groups in obstetric services, the attitudes and resources in society,
and the support of family and peers. According to the care model of
Ball, midwives should provide care and support to women who are
emotionally developing toward a state of well-being and adjustment to
motherhood.\textsuperscript{5,8,12-15}

According to Jean Ball (1987), the emotional well-being of a mother is
affected by factors such as her self-esteem, self-image, life
experiences, satisfaction with parenthood, anxiety levels, environment
in the postpartum period, the 4th stage of labor, assessment of the
development of her baby, individual care plans, being supported in her
nutritional choices, the support she receives from her environment, and
her perceived level of family support.\textsuperscript{5,8,15} Ball
showed that an increase in these factors was associated with an increase
in the emotional well-being of mothers. She identified three themes that
affected the emotional well-being of a postpartum mother, namely the
personality of the mother, the support of her family and social
environment, and the support of healthcare professionals. Based on these
three themes, Ball proposed the deck-chair theory. Accordingly, the
bottom part of the chair represents the support and care provided by
healthcare professionals, the back of the chair represents the
personality traits, living conditions, and experiences of the mother,
and the middle part of the chair represents family and social support.
If the chair is in balance, this shows that the mother is emotionally
well and healthy. That is, in line with the chair metaphor, keeping
these factors in balance is important for the postpartum well-being of
the mother. If the chair is not placed on solid ground, it sinks when it
is sat on, and if its parts are incompatible with each other, even
though it supports the mother, it causes discomfort and stress. For a
state of complete well-being, all three parts of the chair should be in
balance, and the chair should be on solid ground. Furthermore, all
factors are interrelated, and balancing the shortcomings of one factor
with an emphasis on another will keep the emotional well-being of the
mother intact (Figure 1).\textsuperscript{5,8,13-17}

In the context of individual needs in obstetrics, to provide
comprehensive and high-quality care, it is needed to develop care
standards and appropriate assessment tools for midwives in line with
scientific knowledge. The content of this scientific knowledge is
founded on ``concepts'' and ``theories'', especially in the fields of
behavioral and social sciences. Thus, while developing a measurement
instrument, its basis should be a theoretical
framework.\textsuperscript{11} In this study, the deck-chair theory by
Jean Ball was adopted as a theoretical framework, and it was determined
that the emotional well-being of a mother is dependent on her
personality and experiences, social support status, and healthcare
support status. H\selectlanguage{ngerman}öglund and Larsson (2014) also utilized the deck-chair
theory of Jean Ball to plan their study and interpret its results. They
concluded that the well-being of women was affected not only by social
support but also by professional support.\textsuperscript{12} In a
dissertation study about nursing care activities which was planned based
on the deck-chair theory by Ball, Devi (2012) reported favorable results
in terms of the satisfaction levels and outcomes of mothers who were
provided with care using this approach.\textsuperscript{18} In the
literature review, no study on a measurement instrument for the
emotional well-being of mothers developed within a theoretical framework
could be encountered.\textsuperscript{19} Therefore, in this study, it
was aimed to develop an instrument to measure the emotional well-being
of mothers in line with the deck-chair theory of Jean Ball.

\textbf{METHODS}

Transparent Reporting of Evaluations with Nonrandomized Designs (TREND)
checklist guide was used in the manuscript.

\textbf{Sample}

The population of the study included postpartum women at the Postpartum
Care Service of Atatürk City Hospital in the Bal\selectlanguage{polish}ı\selectlanguage{english}kesir province of
Turkey. To conduct factor analyses in psychometric studies, it is
recommended to include a sample size of 5 to 10 times the number of
items on a scale. Other recommendations for scale development and
testing studies include a minimum of 200 participants for exploratory
factor analysis (EFA), a minimum of 200 participants for confirmatory
factor analysis (CFA), and a minimum of 400 participants in
total.\textsuperscript{20-24} As the draft scale form included 39 items,
it was planned to include at least 390 participants, while the sample of
the study consequently included 403 participants. However, because the
responses of 5 participants to the scale items included missing data,
the analyses excluded the data of these participants, and the study was
completed with 398 postpartum women.

The inclusion criteria for this study were being at least 18 years old,
having a living baby, and being ready to be discharged. Postpartum women
who were younger than 18 years old, those who were not ready to be
discharged, and those who had lost their babies were excluded. The data
collection forms were administered to the women who were at the
postpartum care service by the researchers. It took each participant
approximately 10 minutes to fill out the forms.

\textbf{Scale Development}

First of all, a literature review was conducted regarding the deck-chair
theory developed by Jean Ball about the emotional well-being of mothers.
Based on this theory, a theoretical framework was established so that
the items of the scale would be gathered under 3 conceptual frameworks
(personality and experiences of the mother, social support, and
healthcare and education).\textsuperscript{5,8,12,13,15-17}To find
publications about the emotional well-being of mothers, key phrases such
as ``personality of a mother'', ``experiences of a mother'', ``social
support'', ``health education'', ``healthcare'', ``emotional well-being
of a mother'', and ``deck-chair theory'' were used for searches on the
Cochrane Library, PubMed, Scopus, and Google Scholar databases.
Dissertation studies on this topic and existing measurement instruments
were also searched. No measurement instrument developed within a
theoretical framework regarding the emotional well-being of mothers was
encountered. Information about the topic was collected by the
researchers, and a broad item pool (39 items) was prepared.

In the second stage, the initial form of the scale (instructions, items,
response options) was submitted for the opinions of 16 experts regarding
its relevance, comprehensiveness, comprehensibility, and convenience of
usage. The consulted experts included 4 professors, 5 associate
professors, and 7 assistant professors who specialized in the field of
midwifery. The experts were asked to rate each item based on how much it
represented the emotional well-being of mothers in the scope of the
deck-chair theory by Jean Ball and provide written feedback, if
necessary, about words that were considered hard to understand or issues
that were considered missing.

In the third stage, the content validity of the scale was tested. The
initial form of the scale included 39 items. During the content validity
testing phase, no item needed to be removed based on the recommendations
of the experts.

\textbf{Measures}

Personal Information Form : This form, which was developed by the
researchers based on a review of the relevant literature, included 21
questions about the sociodemographic and obstetric characteristics of
the participants.\textsuperscript{2,5,12,15-17}

Maternal Emotional Well-Being Scale: The scale was developed by the
researchers to assess the emotional well-being of mothers within the
framework of the deck-chair theory developed by Jean Ball covering 3
conceptual frameworks (personality and experiences of the mother, social
support, and healthcare and education in
care).\textsuperscript{5,12,15-17} The item pool included 39 items. The
response options for each item were 1=absolutely disagree, 2=disagree,
3=somewhat agree, 4=agree, and 5=absolutely agree. The content validity
and linguistic validity of the scale were determined by consulting 16
experts in the field of midwifery before further analyses of the scale.
Following factor analyses, some items were removed from the scale, and
the final form of the Maternal Emotional Well-Being Scale consisted of
15 items and 3 dimensions (mother's personality and experiences = items
6, 7, 8, and 9; social support = items 16, 17, 18, 19, 20, 21, and 25,
and healthcare and education = items 29, 31, 32, and 36) (Appendix A).
There was no inversely scored item on the scale. The minimum and maximum
total scores were 15 and 75, and higher scores indicated higher levels
of emotional well-being.

\textbf{Validity}

\textbf{Content Validity}

The scale form was sent to 16 experts in the field of midwifery via
e-mail with clear instructions about the definition of each area,
scoring, and assessment criteria. In the assessments of the expert
opinions, using the Davis technique, the content validity index (CVI)
was calculated. The experts were asked to rate each item by selecting
one of the following: ``not suitable/should be removed'', ``somewhat
suitable/major revision required'', ``highly suitable/minor revision
required'', and ``completely suitable''.\textsuperscript{25} The CVI
value was calculated as 0.80. No item needed to be removed from the
scale based on its CVI value. A pilot implementation was made with the
participation of ten postpartum women with similar characteristics to
those in the sample, and it was concluded that the scale could be
applied to the main sample as there was no problem in the comprehension
of the scale items.

\textbf{Data Collection}

This study was conducted between February and September 2023. The latest
version of the scale following expert assessments was administered to
postpartum women at the Postpartum Care Service of Atat\selectlanguage{ngerman}ürk City Hospital
in the Bal\selectlanguage{polish}ı\selectlanguage{english}kesir province of Turkey (n=403). However, as 5 participants
responded to the scale items incompletely, their data were excluded from
the analyses, and the study was completed with the data of 398
participants.

\textbf{Data Analysis}

The collected data were analyzed using the SPSS (Statistical Package for
the Social Sciences) for Windows 25.0 program. Descriptive statistics of
the data (frequency, percentage, mean, and standard deviation) were
calculated.

CVI was calculated for each item of the scale. CVI values were
calculated with the following formula: {[}(number of experts with rating
``completely suitable'' + number of experts with rating ``highly
suitable/minor revision required)/total number of experts{]}. Items with
CVI values greater than 0.80 were accepted to indicate sufficient
content validity.\textsuperscript{25}

To test the construct validity of the scale, an exploratory factor
analysis (EFA) and a confirmatory factor analysis (CFA) were conducted.
The EFA and CFA were carried out on separate datasets. For the
separation of these datasets, the data points were listed as even and
odd numbers in SPSS. The points corresponding to odd numbers were used
for EFA (n=199), while those corresponding to even numbers were used for
CFA (n=199). The suitability of the data for factor analysis was tested
with the Kaiser-Meyer-Olkin (KMO) sample adequacy test and Bartlett's
test of sphericity. A lower eigenvalue threshold of 1 and scree plots
were used to confirm the number of factors. Principal component analysis
was used as the factorization method, while varimax rotation, which is
an orthogonal rotation method, was selected as the rotation method. The
threshold of factor load values for each item was determined as a
minimum of 0.40.\textsuperscript{20,24,26} As model fit indicators in
CFA, \selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}/df values smaller than five and RMSEA values
smaller than 0.08 are accepted to show a high goodness-of-fit. It was
accepted that CFI and GFI values needed to be greater than
0.09.\textsuperscript{20,27-30}

The reliability of the scale was tested with Cronbach's alpha and item
analyses. The response bias of the scale was tested using Hotelling's
T\selectlanguage{ngerman}². The homogeneity of the distribution of responses to each item was
tested to analyze response bias. This process involved checking whether
the mean scores of the items were significantly different from each
other. To determine whether the scale items were suitable for obtaining
a total score, Turkey's test of additivity was carried
out.\textsuperscript{31-34}

\textbf{RESULTS}

The sociodemographic and obstetric characteristics of the participants
are presented in Table 1. The mean age of the participants was
28.00±4.96 (min: 18, max: 43), their mean number of pregnancies was
2.01±1.18 (min: 1, max: 9), their mean number of childbirths was
1.77±0.98 (min: 1, max: 8), their mean number of miscarriages/curettages
was 1.19±0.55 (min: 1, max: 4), and their mean number of living children
was 1.77±0.97 (min: 1, max: 8). It was determined that 6.5\% of the
participants had chronic diseases (30.8\% hypothyroidism, 30.8\%
diabetes mellitus, 19.2\% asthma, 11.6\% hypertension, 3.8\% rheumatism,
and 3.8\% Crohn's disease). While 18.8\% of the participants stated that
they experienced pregnancy complications (54.6\% abortus imminens,
25.3\% bleeding, 18.7\% premature rupture of membranes, and 1.3\%
diabetes mellitus), 6\% said they experienced complications during labor
(45.9\% difficult labor, 37.5\% preterm labor, 12.5\% cord entanglement,
and 4.1\% cord prolapse), and 6.5\% reported that the health status of
their babies was not good (73.1\% respiratory distress and 26.9\%
preterm birth).

In the Kaiser-Meyer-Olkin (KMO) test that was conducted to decide
whether the sample size was sufficient, the KMO value was found to be
0.806. KMO values greater than 0.7 are generally considered
satisfactory.\textsuperscript{20,24,26,35,36} Accordingly, it was
determined that the sample size of this study was ``highly sufficient''
to conduct factor analyses. The result of the Bartlett's test of
sphericity revealed an acceptable chi-squared value
(\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}(276)=2571.919; p\textless{}0.01) (Table 2).

The 39-item Maternal Emotional Well-Being Scale was developed in this
study based on three dimensions in line with Jean Ball's theory. These
dimensions were ``social support, healthcare and education, and mother's
personality and experiences''. Accordingly, to identify the factor
structure of the scale, an EFA was performed. Principal component
analysis and varimax rotation were used in the EFA. The minimum factor
load value to be met was determined as 0.40. Fifteen items that were
found to have factor load values smaller than 0.40 in the EFA (items 1,
2, 3, 4, 10, 11, 12, 13, 14, 22, 23, 24, 26, 38, and 39) were removed
from the scale (Table 2).

According to the varimax rotation results, it was observed that a
four-factor structure was applicable. These factors explained 51.824\%
of the total variance in the measured characteristic (Table 2). In
multi-factor constructs, variance explanation rates between 40\% and
60\% are considered adequate.\textsuperscript{20,21,22,24,26} This shows
that a defined factor has a sufficient contribution to the total
variance.

As the factor loads of items 15, 27, 28, 34, and 35 were below 0.40
according to the CFA results, these items were removed from the scale
(before the items were removed: CMIN=555.970, CMIN/df=3.731,
RMSEA=0.118, CFI= 0.818, GFI= 0.775). Modifications were made for items
30, 33, and 37 under the Healthcare and Education factor, item 15 under
the Social Support factor, and item 5 under Mother's Personality and
Experiences factor to improve the model (for the improvements,
covariances were drawn between error terms with high modification index
(MI) values), and the resulting goodness-of-fit index values were
CMIN=180.685, df=83, CMIN/df=2.177, RMSEA=0.077, CFI=0.937, and
GFI=0.896, which showed an excellent
fit.\textsuperscript{20,27-30}According to the results of the CFA, in
total, 9 items were removed from the scale. The path coefficients of all
items under Factors 1, 2, and 3 were found to be statistically
significant. Based on the standardized path coefficients, the item with
the greatest effect on F1 was item 36 (\selectlanguage{greek}β\selectlanguage{english}\textsubscript{0:} 0.718), the
item with the greatest effect on F2 was item 17 (\selectlanguage{greek}β\selectlanguage{english}\textsubscript{0}:
0.887), and the item with the greatest effect on F3 was item 8
(\selectlanguage{greek}β\selectlanguage{english}\textsubscript{0}: 0.881) (Table 3).

The first-level CFA results of the scale are shown in Figure 2.
Accordingly, in the scale that consisted of 15 items, the lowest factor
load value was 0.43, while the highest was 0.89.

In reliability analyses, it is accepted that Cronbach's alpha (0[?]\selectlanguage{greek}α\selectlanguage{english}[?]\selectlanguage{english}1)
coefficients in the range of 0.61-0.80 indicate high reliability, while
those in the range of 0.81-1.00 indicate excellent
reliability.\textsuperscript{21,34} It was determined that the Maternal
Emotional Well-Being Scale, its social support dimension, and its
mother's personality and experiences dimension had excellent levels of
reliability, whereas the healthcare and education dimension had high
reliability. The overall reliability coefficient of the scale was
calculated as 0.860 (Table 4).

In the reliability analyses of the scale, it was determined that all
corrected item-total score correlation coefficients were greater than
0.20 and adequate (Table 5).

According to the results of the Hotelling's T\selectlanguage{ngerman}² analysis conducted to
test the presence of response bias in the scale, it was found that the
participants responded to the items based on their own opinions, and
there was no response bias (Hotelling's T\textsuperscript{2}=397.260,
p=0.000). Tukey's test of additivity was also conducted to determine the
additivity of the scale. As the significance level found in the test was
p=0.000, it was determined that the factors of the scale were additive
(non-additivity: 0.000). That is, a single total scale score could be
obtained by the addition of the scores of all scale items.

\textbf{Final Form of the Maternal Emotional Well-Being Scale}

Following the analyses, the final version of the Maternal Emotional
Well-Being Scale consisted of 15 items gathered under three dimensions.
The healthcare and education dimension included 4 items, the social
support dimension included 7 items, and the mother's personality and
experiences dimension included 4 items.

\textbf{DISCUSSION}

\textbf{Main findings}

To the best of the knowledge of the authors, the Maternal Emotional
Well-Being Scale is the first scale with demonstrated validity and
reliability that was developed to assess the emotional well-being of
mothers within a theoretical framework. According to the results of this
study, the Maternal Emotional Well-Being Scale was valid and reliable in
terms of its usage in mothers who are ready to be discharged in the
postpartum period. Its final form consists of 15 items, and higher
scores indicate better emotional well-being.

The factor analyses of the Maternal Emotional Well-Being Scale revealed
a 3-factor construct that included 15 items. The deck-chair theory
proposed by Jean Ball was beneficial for the development of this scale.
According to this theory, the emotional well-being of a mother is
influenced by her personality and experiences, the social support she
receives, and the healthcare services provided to her. By examining the
components forming the structure of the identified factors in this
context, the factors were named ''healthcare and education'', ''social
support'', and ''mother's personality and experiences''. The relevant
literature was also reviewed in this process. In the literature, other
studies in the context of Ball's deck-chair theory also focused on the
mother's personality and experiences, social support, and healthcare.
These factors were reported to affect the well-being of
mothers.\textsuperscript{12,18} The emotional well-being of a mother is
an issue that needs to be evaluated in the context of her motherhood.
The scale that was developed in this study consists of items relevant to
the emotional well-being of mothers. Positive responses of mothers to
these items indicate a high level of emotional well-being. The emotional
well-being of a mother is very important for the care and development of
her baby. A negative emotional state will affect mother-infant bonding,
communication, breastfeeding, baby care, and the development of the baby
negatively. Considering the problems that can be encountered in the
postpartum period, it is crucially important to prevent complications,
improve health, and provide the mother with the necessary advice in
terms of maternal and neonatal health, and important responsibilities
fall upon healthcare professionals in this vital
process.\textsuperscript{11,37,38} According to the deck-chair theory,
the emotional well-being of a mother can be ensured if a shortcoming in
one factor is balanced with the reinforcement of another factor. In this
sense, negative personality traits and experiences of the mother and
insufficient social support can be compensated by postpartum healthcare,
and this will be effective in ensuring the comfort of the mother and her
emotional response to postpartum
changes.\textsuperscript{8,14}Therefore, for the promotion of public
health, it is important to determine the emotional well-being levels of
mothers before they are discharged after childbirth and implement
interventions if necessary. The formation of the item pool in this study
based on these factors in the theory of Ball indicates that the scale is
suitable for this theoretical framework and can guide healthcare
professionals in the identification of the needs of mothers.

The homogeneity of the responses of the participants to all items was
analyzed based on Hotelling's T², and it was found that the participants
responded to the items based on their own opinions, and there was no
response bias (p=0.000).\textsuperscript{31,32,33} Additionally, the
results of the Tukey's test of additivity showed that a single total
scale score could be obtained by the addition of the scores of all scale
items (p=0.000).\textsuperscript{31}

In this study, the overall Cronbach's alpha (\selectlanguage{greek}α\selectlanguage{english}) coefficient of the scale
was found to be 0.860, which indicated its high reliability. Considering
the psychometric properties of the Maternal Emotional Well-Being Scale,
which was developed in Turkish, all results obtained in this study
provided supportive evidence of the validity and reliability of the
scale construct. It can be concluded that this scale is a valid and
reliable measurement instrument that can be used by healthcare
professionals providing care services to mothers in the postpartum
period to assess the emotional well-being levels of these mothers.

\textbf{Strengths and limitations}

To the best of our knowledge, this study is the first in the literature
to develop a scale to evaluate the emotional well-being of mothers
within a certain theoretical framework and demonstrate the validity and
reliability of this scale. It is recommended that the validity and
reliability of this scale be tested in further studies to reach more
generalizable results. A limitation of this study is that its results
may not be generalized to samples in countries other than Turkey. The
psychometric properties of the Maternal Emotional Well-Being Scale can
be re-evaluated in different cultures.

\textbf{Interpretation}

It can be stated that this study fills a significant gap in knowledge
regarding the determination of the emotional well-being levels of
mothers. The Maternal Emotional Well-Being Scale can be a useful tool to
guide healthcare professionals in their provision of care to mothers
with a comprehensive approach in clinical settings. Therefore,
healthcare professionals are advised to use the Maternal Emotional
Well-Being Scale in their routine practices and assessments of mothers.

\textbf{CONCLUSION}

In the literature, there is no valid and reliable measurement instrument
to assess the emotional well-being of mothers based on a theoretical
framework. The results of this study proved that the Maternal Emotional
Well-Being Scale is a valid and reliable instrument. It is a 5-point
Likert-type scale with no inversely scored item. The total score range
for the scale is 15-75. Higher scores indicate higher levels of
emotional well-being. The mean total scale score of the postpartum
mothers who participated in this study was found to be 61.81\selectlanguage{ngerman}±5.95
(Minimum=41.00; Maximum=75.00).

It is recommended that the validity and reliability of this scale be
tested in further studies to reach more generalizable results. The
psychometric properties of the Maternal Emotional Well-Being Scale can
be re-evaluated in different cultures.

\textbf{Author Contribution}

\textbf{Study conception and design:} Hülya TÜRKMEN, Benay O\selectlanguage{polish}Ğ\selectlanguage{english}UZ, Esra
\selectlanguage{ngerman}ÇEV\selectlanguage{polish}İ\selectlanguage{english}K

\textbf{Data collection:} H\selectlanguage{ngerman}ülya TÜRKMEN, Benay O\selectlanguage{polish}Ğ\selectlanguage{english}UZ

\textbf{Data analysis and interpretation:} H\selectlanguage{ngerman}ülya TÜRKMEN

\textbf{Drafting of the article:} Hülya TÜRKMEN, Benay O\selectlanguage{polish}Ğ\selectlanguage{english}UZ, Esra \selectlanguage{ngerman}ÇEV\selectlanguage{polish}İ\selectlanguage{english}K

\textbf{Critical revision of the article:} H\selectlanguage{ngerman}ülya TÜRKMEN, Benay O\selectlanguage{polish}Ğ\selectlanguage{english}UZ,
Esra \selectlanguage{ngerman}ÇEV\selectlanguage{polish}İ\selectlanguage{english}K

\textbf{Funding Statement}

This report is research supported by the Bal\selectlanguage{polish}ı\selectlanguage{english}kesir University Scientific
Research Project (Project No: 2023/097).

\textbf{Conflict of Interest}

There is no conflict of Interest.

\textbf{Acknowledgement}

The authors express thanks to the pregnant for participation in the
study.

\textbf{Ethical Statement with Approval Date}

\textbf{Ethical Considerations}

Approval from the Non-Invasive Clinical Studies Ethics Committee of
Bal\selectlanguage{polish}ı\selectlanguage{english}kesir University in Turkey (2022/97) and permission from the
Bal\selectlanguage{polish}ı\selectlanguage{english}kesir Provincial Directorate of Health
(E-51829602-604.01.01-209497122) were obtained to conduct the study.
Before collecting data, postpartum women were given written information
about the objective of the study, its duration, and that their
confidentiality would be ensured, and their consent was obtained.

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