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.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
(χ2(276)=2571.919; p<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.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.20,27-30According 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
(β0: 0.718), the item with the greatest effect on F2 was
item 17 (β0: 0.887), and the item with the greatest
effect on F3 was item 8 (β0: 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≤α≤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.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 T² 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 T2=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.