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Development and Preliminary Psychometric Evaluation of the PQoL-34 Questionnaire for the Comprehensive Assessment of Quality of Life During Pregnancy and Family Preparedness for Childbirth: A Cross-Sectional Online Study in Southern Kazakhstan

This cross-sectional study in southern Kazakhstan developed and preliminarily validated the PQoL-34 questionnaire, demonstrating its high content validity, strong internal consistency, and convergent validity as a comprehensive tool for assessing quality of life during pregnancy and family readiness for childbirth.

Original authors: Gulzira Dolanova¹, Gulzat Sarsenbayeva¹, Kulzhamila Kenessova¹

Published 2026-07-08

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CC BY 4.0

Original authors: Gulzira Dolanova¹, Gulzat Sarsenbayeva¹, Kulzhamila Kenessova¹

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine pregnancy as a long, complex journey. Usually, doctors check the "engine" (the baby's health) and the "fuel" (the mother's physical vitals). But this journey also depends on how the driver feels, who is riding shotgun, how well the map is read, and whether the family is ready to welcome a new passenger.

This paper is about building a new, specialized dashboard called the PQoL-34 to measure all those different parts of the journey at once, specifically for women in Southern Kazakhstan.

Here is a simple breakdown of what the researchers did and found:

1. The Problem: The Old Maps Were Missing Pieces

The researchers noticed that existing tools for measuring a pregnant woman's "Quality of Life" were like old maps that only showed the roads (physical health) but ignored the scenery, the weather, or the passengers. They wanted a new tool that could measure:

Physical Health: Is the body tired? Is sleep okay? Can she get to the doctor?
Mental State: Is she anxious? Does she feel calm?
Family Readiness: Is the partner helping? Is the family actually ready for the baby, or just emotionally supportive?
Knowledge: Does she understand what's happening? Does she trust the doctors?

2. Building the Dashboard (The PQoL-34)

The team created a 34-question checklist (the PQoL-34). Think of it as a 34-point inspection sheet for the pregnancy journey.

The Blueprint: They didn't just guess the questions. They looked at scientific literature and then asked a panel of 9 expert mechanics (doctors, psychiatrists, and public health specialists) to review every single question.
The Expert Check: The experts gave the questions a perfect score for being relevant and clear. They agreed, "Yes, these questions actually measure what we want them to measure."

3. The Test Drive

The researchers handed this new dashboard to 461 pregnant women in Southern Kazakhstan via an online survey. It was like a test drive to see if the dashboard worked smoothly.

What the Dashboard Told Them:

It Works Well Together: The questions were consistent. If a woman felt good about her physical health, she tended to feel good about her mental health too. The "internal consistency" score was very high (0.918), meaning the tool is reliable and doesn't give random answers.
It Matches the Driver's Feeling: When they asked the women, "On a scale of 1 to 10, how is your life right now?", the answers matched the dashboard's scores. Women who scored high on the dashboard also said their lives were good. This proves the tool is actually measuring "Quality of Life."
The Four Main Gauges: The dashboard has four distinct gauges (domains), and they all worked:
1. Physical Health: Mostly good, but some women reported pain or fatigue.
2. Mental Well-being: This was the highest-rated area; most women felt emotionally supported and calm.
3. Family Readiness: This was also very high. Families were involved and ready.
4. Knowledge & Medical Prep: Generally high, but there was a gap here.

4. A Specific Glitch Found: The "Class Attendance" Gauge

One interesting finding was about Domain E (Informational and Medical Preparedness).

Most women felt they understood their pregnancy and trusted their doctors.
However, one specific question stood out: "Do you attend classes for expectant mothers?"
This question had the lowest scores and the most varied answers. It's like the dashboard showed that while women felt informed, they weren't actually going to the educational classes. The researchers noted this item was a bit different from the others but kept it because it highlights a real-world issue: women might feel ready, but they aren't attending the preparation courses.

5. Who Took the Test?

The group tested was diverse:

Ages ranged from teenagers to women over 35.
About half lived in cities, and half in rural areas.
Most were married and had higher education.
Surprise Finding: Women in rural areas actually scored slightly higher on physical health, mental well-being, and medical knowledge than those in the cities. (The researchers noted this was an interesting observation but didn't explain why in this specific study).

6. The Bottom Line

The paper concludes that the PQoL-34 is a promising new tool.

It is valid (it measures what it says it measures).
It is reliable (it gives consistent results).
It successfully captures the "whole picture" of pregnancy, including the family's role, which older tools often missed.

What the paper does NOT say:
The paper does not claim that using this tool will automatically fix problems or that it is ready for immediate use in every hospital. It explicitly states this is a preliminary study. The dashboard is built and has passed its first test drive, but it needs more testing (like checking if it works in other regions of Kazakhstan and checking if the results stay the same over time) before it can be considered a standard tool for everyone.

In short: The researchers built a new, comprehensive "pregnancy health report card" that includes the family and the mother's mind, not just her body. They tested it on 461 women, and it worked well, showing that most women in the region are doing great, though there is room to improve attendance at childbirth preparation classes.

Technical Summary: Development and Preliminary Psychometric Evaluation of the PQoL-34 Questionnaire

Problem Statement
Quality of life (QoL) during pregnancy is a multidimensional construct involving physical health, psychological well-being, social support, and family readiness. While generic instruments (e.g., SF-36, WHOQOL-BREF) and some pregnancy-specific scales exist, there is a lack of locally adapted tools in Kazakhstan that simultaneously assess these dimensions, particularly distinguishing "family readiness for childbirth" and "informational/medical preparedness" as independent domains. Existing national studies have focused on satisfaction with care or isolated psychological states, leaving a gap for a comprehensive instrument to evaluate the holistic needs of pregnant women and their families in the Kazakhstani context.

Methodology
This study employed a quantitative cross-sectional online design conducted in the southern region of Kazakhstan between January and February 2026.

Instrument Development: The PQoL-34 (Pregnancy Quality of Life Questionnaire, 34 items) was developed based on a literature review. It comprises:
- 8 socio-demographic and obstetric items.
- 25 scale-based items across four domains: (1) Physical health and access to basic healthcare; (2) Psycho-emotional well-being and perceived support; (3) Social and family support and family readiness; (4) Informational and medical preparedness.
- 1 global self-rated QoL item (10-point scale).
- Responses use a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree), with reverse coding applied to specific negative items.
Content Validity: Assessed by a panel of nine specialists (obstetricians, GPs, public health experts, psychiatrist) using Item-Level Content Validity Index (I-CVI), Scale-Level CVI (S-CVI/Ave and S-CVI/UA), and modified kappa statistics.
Participants: A convenience sample of 461 pregnant women receiving outpatient antenatal care was recruited via WhatsApp through healthcare professionals.
Psychometric Analysis: Analyses included descriptive statistics, internal consistency (Cronbach's alpha), item analysis (corrected item-total correlations), preliminary factorability assessment (Kaiser–Meyer–Olkin measure and Bartlett's test of sphericity), and convergent validity testing via correlation with the global QoL item.

Key Contributions

Novel Instrument: Introduction of the PQoL-34, a bilingual (Kazakh/Russian) tool specifically designed for the Kazakhstani context.
Domain Specificity: Unlike generic scales, the PQoL-34 explicitly isolates "Family Readiness for Childbirth" (partner involvement, responsibility distribution, practical preparation) and "Informational/Medical Preparedness" as distinct domains, addressing a gap in current literature regarding family-oriented antenatal assessment.
Preliminary Validation: The study provides the first psychometric evidence for the instrument, establishing its content validity and internal consistency before full-scale validation.

Results

Content Validity: The instrument demonstrated excellent content validity. For relevance, I-CVI, S-CVI/Ave, and S-CVI/UA were all 1.000. For clarity, S-CVI/Ave was 0.991 and S-CVI/UA was 0.923.
Internal Consistency: The overall scale showed high internal consistency (Cronbach's $\alpha$ = 0.918). Domain-level alpha values ranged from 0.753 (Psycho-emotional well-being) to 0.853 (Social and family support), all meeting acceptable thresholds for preliminary evaluation.
Factorability: Data suitability for factor analysis was confirmed for all domains (KMO values ranged from 0.796 to 0.875; Bartlett's test $p < 0.001$ ).
Convergent Validity: All domain scores and the total PQoL-34 score showed statistically significant positive correlations with the global self-rated QoL item. The strongest association was found for the total score ( $\rho$ = 0.605; $p < 0.001$ ).
Descriptive Findings: Participants reported generally high QoL scores across all domains. A pronounced ceiling effect was observed in the "Social and family support" domain (47.5%) and "Psycho-emotional well-being" (35.4%). Notably, the item regarding attendance at childbirth preparation courses (E4) had the lowest mean score and highest variability, suggesting a potential gap in educational program participation.

Significance and Claims
The authors claim that the PQoL-34 is a promising basis for the comprehensive assessment of QoL and family readiness among pregnant women in Kazakhstan. The study highlights that:

Multidimensionality: The instrument successfully captures the interplay between physical, psychological, social, and informational aspects of pregnancy.
Family-Centric Approach: By including a specific domain for family readiness, the tool aligns with the cultural context where family involvement is central to decision-making and care.
Clinical Utility: The tool can help identify specific areas of need (e.g., low participation in educational courses or specific psychological stressors) to target antenatal support and counseling.

Modesty and Limitations
The paper explicitly frames this work as a preliminary psychometric evaluation rather than a full validation. The authors acknowledge several limitations:

The cross-sectional design precludes causal inferences.
The sample is limited to the southern region and may not represent all pregnant women in Kazakhstan.
Self-reporting may introduce social desirability bias.
Full factorial validation (Exploratory and Confirmatory Factor Analysis), test-retest reliability, and responsiveness to change have not yet been assessed.
The presence of ceiling effects suggests the instrument may struggle to differentiate between participants who already have very high levels of QoL and support.

Consequently, the authors conclude that further studies are required to address extended factorial validation, reliability across time, and applicability across diverse regions and populations before the instrument can be considered fully validated for widespread clinical or research use.