/library/oar/handle/123456789/343 2026-11-06T17:52:19Z /library/oar/handle/123456789/148793 Title: Development, content validation and pilot reliability testing of the midwives' perspectives towards birth plans questionnaire Authors: Agius, Elisa; Borg Inguanez, Monique; Spiteri, Georgette Abstract: Introduction: A birth plan is a fundamental tool for promoting autonomy during childbirth and woman-centred care. Despite its recognised benefits, there is a notable gap in the literature addressing midwives' perspectives and attitudes towards their use, with research being predominantly qualitative and quantitative data remaining scarce due to a lack of rigorously developed quantitative instruments addressing this topic. To address this, the Midwives' Perspectives Towards Birth Plans Questionnaire (MBPQ) was developed to provide a content-validated descriptive instrument to profile midwives' perspectives regarding the development and implementation of birth plans into clinical practice. Methods: The MBPQ was conceptualised as a multidimensional descriptive inventory comprising formative content domains, rather than a reflective psychometric scale intended to generate a single aggregate score. Instrument development followed a structured three-stage process. Following item generation from a critical literature review, face validity was established through review by academic professionals. Content validity was then quantified by six subject-matter experts using the Content Validity Index (CVI), the modified Kappa statistic to assess inter-rater agreement, and the Content Validity Ratio (CVR). A pilot study at a public hospital in Malta assessed feasibility (n = 15) and test-retest reliability (n = 13) using Kappa and Kendall's tau-b statistics. Results: Pilot testing demonstrated satisfactory feasibility, with a 100% response rate and an average completion time of approximately 10 min. Most closed-ended items demonstrated acceptable temporal stability across the test-retest interval, with moderate-to-excellent agreement coefficients observed for the majority of items. Conclusions: The MBPQ represents an initial content-validated descriptive framework for exploring midwives perspectives and attitudes regarding the development and implementation of birth plans. The instrument demonstrated strong content validity, high expert agreement, satisfactory feasibility and acceptable temporal stability across most items. The MBPQ may support clinical auditing, service evaluation, and exploratory research examining factors that influence birth plan implementation within maternity care settings. Further testing in broader and more diverse populations may support future refinement and contextual adaptation of the instrument. 2026-01-01T00:00:00Z /library/oar/handle/123456789/148275 Title: Developing the future of midwifery education : a tool to explore perceptions of professional doctorate education in small–resource contexts Authors: Attard, Josephine; Camilleri, Liberato; Spiteri, Georgette Abstract: Background: Professional Doctorate (PD) programmes offer a distinctive route for advancing midwifery practice and leadership. However, there is a lack of validated instruments that capture the perceptions of midwives and nurses, particularly in a way that reflects diverse educational and professional contexts.; Aim: This study aimed to identify the key components that underpin the development of a PD programme and to design and conduct a preliminary validation of a questionnaire intended to explore the perceptions of PD education in midwifery.; Methods: An exploratory sequential mixed–methods design was employed. In the initial qualitative phase, interviews were conducted with academic coordinators and leads of existing PD programmes across multiple institutions in the United Kingdom. Insights from these interviews informed the item generation for a new questionnaire. A panel of subject experts reviewed content and face validity of this questionnaire, and internal consistency was assessed to establish reliability.; Results: Qualitative analysis supported the development of a structured, self–administered questionnaire, the Perspectives on a Professional Doctorate in Education for Midwifery and Nursing (P–PRODEMN). The instrument demonstrated promising initial validity and acceptable internal consistency within this preliminary sample. Seven essential domains were identified as central to PD programme design and delivery: programme structure, candidate selection, learning outcomes, supervision and support, implementation challenges and enabling factors, quality assurance, and sustainability.; Conclusion: This study introduces a novel, evidence–informed questionnaire for evaluating perceptions of PD education in midwifery and nursing. The P–PRODEMN tool is conceptually robust and can be adaptable to varied educational settings, offering value to institutions aiming to develop or refine PD programmes that meet contemporary professional and academic expectations. 2026-01-01T00:00:00Z /library/oar/handle/123456789/147877 Title: Maternal health literacy in nutrition and food safety during pregnancy and its role in emotional appraisal and decision-making Authors: Zahra, Nina; Jones, Petra; Spiteri, Georgette Abstract: Optimal nutrition and food safety during pregnancy are central to maternal and foetal health; however, engagement with dietary guidance involves more than access to information. Framed through a health literacy lens, this qualitative study explored how pregnant women in Malta access, understand, appraise, and apply nutrition and food safety information within emotional, social, and structural contexts. Semistructured interviews were conducted with 11 purposely selected pregnant women across varying stages of pregnancy and gravidity, and data were analysed using reflexive thematic analysis. Findings suggest that participants demonstrated strong awareness of dietary recommendations and food safety risks, yet understanding was largely procedural and rule-based, with limited explanatory depth. Decision-making extended beyond knowledge to include emotional appraisal, moral responsibility towards the foetus, and risk-avoidance strategies. Health literacy was enacted relationally and influenced by gravidity, prior obstetric experiences, digital information environments, timing of professional guidance, and access to resources. Participants frequently relied on self-directed digital inquiry to compensate for perceived gaps in early antenatal care, highlighting both the importance of digital health literacy and the challenges of navigating inconsistent information. Socio-demographic factors, including professional background, financial capacity, and time constraints, further shaped confidence and engagement. These findings suggest that maternal nutrition and food safety practices reflect functional, interactive, and critical health literacy processes embedded within socio-structural conditions. Strengthening early, equitable, and context-sensitive antenatal education may support informed decisionmaking while reducing anxiety and improving maternal and foetal wellbeing. Description: Supplementary information is provided within this record. 2026-01-01T00:00:00Z /library/oar/handle/123456789/147785 Title: Global landscape of locally produced alcohol-based handrub in health care settings : a scoping review Authors: Saito, Hiroki; Tartari, Ermira; Garlasco, Jacopo; Pittet, Didier; Allegranzi, Benedetta Abstract: Background: Reliable access to alcohol-based handrub (ABHR) is essential for hand hygiene and infection prevention, yet many low- and middle-income countries (LMICs) continue to face supply constraints. A 2011 WHO global assessment demonstrated that WHO-recommended ABHR formulations produced locally at low cost, were well accepted by healthcare workers, but also highlighted persistent barriers, including challenges in procuring ingredients and dispensers and in ensuring adequate quality control. This review aimed to provide an updated global synthesis of evidence on local ABHR production in healthcare settings. Methods: Following the Joanna Briggs Institute framework and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, we systematically searched Embase, Medline, and CINAHL from inception to 19 March 2025. Two reviewers independently conducted title-abstract screening, full-text screening and data extraction. Primary research articles reporting local ABHR production in healthcare settings in LMICs were eligible for data extraction and descriptive synthesis. Results: Of 2343 articles screened, 31 studies from 19 countries were included (2006–2023). Over half (n = 18, 58%) were conducted during the COVID-19 pandemic; 22 described health-facility production and 9 described factorylevel manufacturing. Of the 22 health-facility production studies, 12 (55%) used WHO Formulation 1 (ethanol-based) or modifications thereof. Pharmacists most commonly led production at the health-facility level. Only 6% (two articles) reported the source of alcohol, and less than half evaluated efficacy or organoleptic properties (13 and 12, respectively). Most funded studies relied on high-income-country (HIC) grants (17 of 24, 71%). Conclusions: Local ABHR production remains infrequently reported in the literature, although publications increased during the COVID-19 pandemic. Heavy reliance on short-term, HIC-funded initiatives raises concerns about the longterm scalability and sustainability of local ABHR production in LMICs. Strengthening national regulatory capacity, quality-control laboratories, and sustainable financing is critical to maintain safe ABHR access beyond pandemic contexts, for resilient national supply chains and in-country quality control capacity. 2026-01-01T00:00:00Z