Modification of Life Events Questionnaire for use with Arabic-speaking pregnant women

Abstract

Background: There is compelling evidence in western literature that stress during pregnancy negatively affects birth outcomes resulting in preterm birth (PT) (<37 weeks gestation) and low birth weight (LBW) (<2500g). Life events have been recognized as intervening factors that create stress. There is no evidence that pregnant women in Arabic-speaking countries are exposed to the same stressful life events as women in Western countries, and that they perceive life events to be equally problematic. Studying life events as a risk factor for PT birth and LBW in Arabic-speaking women is limited by the lack of culturally sensitive instruments; there is no known questionnaire that measures life events in this population, which makes this study innovative. The purpose of this study is to modify and validate the Life Events Questionnaire (LEQ) (Norbeck, 1984) for use with Arabic-speaking pregnant women. Theoretical Framework: The conceptual model for this study was developed from stress and coping work by Lazarus and Folkman including ideas about mediating and moderating factors. Method and design: A Convenience sample of 125 pregnant Jordanian women was included in this study. The study used an exploratory sequential mixed method design and was conducted in two phases. The first phases included initial item pool evaluation; translation-back-translation and inclusion and exclusion of items of the LEQ. The second phase was testing the psychometric properties of the Arabic version of LEQ, which included content validity testing, followed by sample development evaluation, predictive validity and convergent validity testing and test-retest reliability. Data collection included a survey to conduct quantitative data and an interview to conduct the qualitative data. Results: Eight new events emerged from the qualitative interviews and combined with 64 existing life events to form the new list of events in the LEQ-A. There was a significant difference in the means of negative scores between pregnant Jordanian women and the means of negative events scores reported in the original LEQ for a sample of western females. The difference was also found in the rating of life events within the same sample of the pregnant Jordanian women. The LEQ-A had an excellent Content Validity Index (CVI) and proved to have adequate convergent and predictive validity as well as test retest reliability when tested in pregnant Jordanian women. Conclusion: The original LEQ content was not inclusive to all events that might be experienced in Arabic-speaking pregnant women, which reinforced the significance of this study and the choice of the exploratory sequential mixed method as the design to accomplish the study objectives. The outcome of this study was a culturally sensitive LEQ-A, which is expected to have a significant contribution to stress, and coping research and the development of interventions to improve birth outcomes in the Arab countries.