Table of Contents
Abstract
The Mother-Newborn Skin-to-skin contact Questionnaire (MSSCQ) is a specialized psychometric instrument designed to evaluate the Behavioral determinants of midwives regarding immediate postpartum care. Despite overwhelming clinical evidence supporting the physiological and psychological benefits of early Skin-to-skin contact for both mother and infant, implementation rates remain suboptimal in many healthcare settings. This scale was developed to systematically identify the barriers and facilitators that influence whether a midwife initiates this critical bonding practice.
Grounded in the Precede-Proceed health behavior model, the MSSCQ moves beyond simple knowledge assessment to capture a holistic view of the clinical environment. It measures three distinct domains: predisposing factors (such as personal attitudes and beliefs), enabling factors (like hospital preparations and resources), and reinforcing factors (including peer support and institutional encouragement). By quantifying these elements, the instrument provides healthcare administrators and researchers with actionable data to design targeted interventions.
Ultimately, the MSSCQ represents a significant advancement in maternal-fetal health psychology and nursing science. It offers a validated, theoretically sound method for diagnosing systemic and individual resistance to evidence-based practices, thereby bridging the gap between clinical guidelines and actual delivery room behavior.
📊 Psychometric Scorecard
82
Multidimensional
0.84
0.860
📍 Iran
Authors
Purpose
The primary purpose of the MSSCQ is to uncover the underlying reasons why Healthcare professionals, specifically midwives, fail to implement mandated Skin-to-skin contact protocols immediately after birth. While the clinical advantages of this practice—such as improved thermoregulation, enhanced breastfeeding success, and stronger maternal attachment—are well documented, there is a stark disconnect between policy and practice. This instrument fills a critical gap by providing a standardized metric to assess the behavioral and environmental drivers of this non-compliance.
For researchers and clinical supervisors, the MSSCQ serves as a diagnostic tool to evaluate the educational and ecological landscape of maternity wards. Instead of assuming that non-compliance stems solely from a lack of knowledge, the scale allows institutions to pinpoint whether the primary barriers are internal (e.g., negative attitudes), systemic (e.g., lack of time or resources), or social (e.g., lack of support from the medical team). This nuanced understanding is essential for developing effective, tailored continuing education and quality improvement programs.
Construct
The MSSCQ is theoretically anchored in the Precede-Proceed model, a comprehensive framework used in health promotion to analyze and modify behaviors. The scale operationalizes this model through three primary constructs that collectively dictate clinical behavior. The first construct, predisposing factors, encompasses the internal psychological landscape of the midwife, including their knowledge, personal values, and specific attitudes toward the health impacts of Skin-to-skin contact on both the mother and the newborn.
The second and third constructs address the external and systemic influences on behavior. Enabling factors measure the practical and environmental conditions that make the behavior possible, such as logistical preparations and institutional resources. Reinforcing factors evaluate the social and professional feedback loops that sustain the behavior over time, including encouragement from colleagues, support from the broader medical team, and the midwife's own occupational satisfaction. Together, these interconnected dimensions provide a multidimensional map of the behavioral ecosystem within the labor and delivery environment.
Validity
The validation of the MSSCQ involved a rigorous, multi-phase methodological approach. Initially, the researchers established strong content and face validity through extensive qualitative focus groups with practicing midwives, ensuring the items were grounded in real-world clinical experiences. This qualitative foundation was subsequently tested through quantitative structural equation modeling to confirm the theoretical framework.
Construct validity was robustly demonstrated through both exploratory and confirmatory factor analyses. The confirmatory models showed acceptable to good fit with the data, as evidenced by a relative chi-square of 2.64 and a Root Mean Square Error of Approximation (RMSEA) of 0.07. Additional fit indices, including a Goodness of Fit Index (GFI) of 0.90 and a Standardized Root Mean Square Residual (SRMR) of 0.06, further supported the structural integrity of the 82-item, 15-factor model. These metrics indicate that the scale accurately captures the complex, multi-layered constructs proposed by the Precede-Proceed model.
Reliability
The reliability of the MSSCQ was established through multiple psychometric evaluations, demonstrating both strong internal consistency and temporal stability. Cronbach's alpha coefficients for the scale and its underlying constructs ranged from 0.84 to 0.89. These values fall well within the optimal range for psychometric instruments, indicating that the items within each subscale are highly correlated and reliably measure their intended specific constructs without excessive redundancy.
In addition to internal consistency, the researchers evaluated the instrument's test-retest reliability to ensure its stability over time. Using a two-week interval, the Intraclass Correlation Coefficients (ICC) were found to be satisfactory, exceeding the established threshold of 0.40. This temporal stability is particularly important for an instrument designed to measure Behavioral determinants, as it confirms that the scale can reliably detect genuine changes in attitudes or environmental perceptions following targeted educational interventions, rather than fluctuating due to measurement error.
Factor Analysis
The underlying structure of the MSSCQ was initially investigated using an exploratory factor analysis (EFA) with principal component extraction and varimax rotation. The data proved highly suitable for this approach, yielding a Kaiser-Meyer-Olkin measure of 0.763. The EFA successfully extracted 15 distinct factors that collectively accounted for approximately 60.61% of the total variance. This data-driven approach allowed the researchers to refine the initial 120-item pool down to a more parsimonious 82 items by eliminating statements that cross-loaded or failed to load significantly on any factor.
Following the exploratory phase, a confirmatory factor analysis (CFA) was employed to test how well this 15-factor structure mapped onto the three higher-order constructs of the Precede-Proceed model. The CFA results validated this hierarchical structure, demonstrating that the 15 sub-factors correctly aligned with the predisposing, enabling, and reinforcing domains. Notably, the analysis revealed that specific factors, such as the midwife's attitude and encouragement from colleagues, carried the highest predictive weight within their respective constructs, highlighting the critical pathways that drive clinical behavior.
Subscales
| Subscale | Items | Description |
|---|---|---|
| Predisposing Construct | 38 items across 6 factors | Measures internal motivators including knowledge, beliefs, values, attitudes, personal priorities, skills, and self-confidence regarding maternal and neonatal health. |
| Enabling Construct | 18 items across 3 factors | Measures environmental and systemic facilitators, such as logistical preparations and institutional resources that make the behavior possible. |
| Reinforcing Construct | 26 items across 6 factors | Measures social and professional feedback loops, including medical team support, peer encouragement, and occupational satisfaction. |
Instrument
| Test Type | Self-report questionnaire |
| Format | 82 items |
| Language | Persian |
| Population | Healthcare professionals |
| Age Group | Adults |
| Administration | Self-administered |
Mother-Newborn Skin-to-Skin Contact Questionnaire Items
Items are currently not available
The individual items of this scale are not publicly available. Researchers interested in using this instrument should contact the original authors directly to request the scale materials.
Sample
The quantitative validation sample consisted of 292 midwives working in labor or operating rooms across 15 randomly selected hospitals in Tehran, Iran. The participants had a mean age of 36.06 years (SD = 8.4) and an average of 11.07 years (SD = 8.29) of clinical work experience.
Cite This Paper
Fatemeh Nahidi, Sedigheh Sadat Tavafian, Mohammad Heidarzadeh, Ebrahim Hajizadeh, Ali Montazeri (2014). Mother-Newborn Skin-to-skin contact Questionnaire. BMC pregnancy and childbirth. https://doi.org/10.1186/1471-2393-14-85
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Cite this article
Mohammed looti (2026). Mother-Newborn Skin-to-Skin Contact Questionnaire. PSYCHOLOGICAL SCALES. Retrieved from https://scales.arabpsychology.com/s/mother-newborn-skin-to-skin-contact-questionnaire/
Mohammed looti. "Mother-Newborn Skin-to-Skin Contact Questionnaire." PSYCHOLOGICAL SCALES, 13 Aug. 2026, https://scales.arabpsychology.com/s/mother-newborn-skin-to-skin-contact-questionnaire/.
Mohammed looti. "Mother-Newborn Skin-to-Skin Contact Questionnaire." PSYCHOLOGICAL SCALES, 2026. https://scales.arabpsychology.com/s/mother-newborn-skin-to-skin-contact-questionnaire/.
Mohammed looti (2026) 'Mother-Newborn Skin-to-Skin Contact Questionnaire', PSYCHOLOGICAL SCALES. Available at: https://scales.arabpsychology.com/s/mother-newborn-skin-to-skin-contact-questionnaire/.
[1] Mohammed looti, "Mother-Newborn Skin-to-Skin Contact Questionnaire," PSYCHOLOGICAL SCALES, vol. X, no. Y, ص Z-Z, August, 2026.
Mohammed looti. Mother-Newborn Skin-to-Skin Contact Questionnaire. PSYCHOLOGICAL SCALES. 2026;vol(issue):pages.