Journal of Nursing Measurement, Volume 23, Number 2, 2015
© 2015 Springer Publishing Company 287
http://dx.doi.org/10.1891/1061-3749.23.2.287
Measuring Nurse Attitudes
About Childbirth: Revision and
Pilot Testing of the Nurse Attitudes and
Beliefs Questionnaire
Martha S. Levine, MS, RNC-OB, C-EFM
Nancy K. Lowe, CNM, PhD, FACNM, FAAN
University of Colorado Denver
Background and Purpose: Labor/delivery nurse attitudes and beliefs may affect nursing
care decisions and patient outcomes. This psychometric study was conducted to revise
the Nurse Attitudes and Beliefs Questionnaire-Revised (NABQ-R). Methods: The
NABQ-R contains 42 items scored with a 4-point Likert scale from 1 (strongly disagree)
to 4 (strongly agree). An online survey invitation was sent to Colorado intrapartum nurses
with 84 complete surveys returned. Results: The NABQ-R scores ranged from 82 to 156
and the Cronbach’s alpha was .90. An exploratory factor analysis was conducted, and
all items loaded on at least 1 factor. Conclusions: Our results support acceptable initial
psychometric properties for the NABQ-R consistent with existing theory indicating that
the NABQ-R shows promise for use in future studies.
Keywords: nursing; attitudes; psychometrics; perinatal; intrapartum
O
ver the past several decades, perinatal outcomes in the United States have been
below accepted national and international standards (World Health Organization
[WHO], 2012). During this same time frame, the United States has widely
accepted a medical model of childbirth. The medical model of childbirth is a set of atti-
tudes and beliefs wherein childbirth is treated as an illness requiring medical intervention
rather than a normal physiological process (Davis, 2010; Davis-Floyd, 2001). Sociologists
have described physician attitudes and beliefs about childbirth, and studies in Canada have
explored physicians’ attitudes and beliefs about childbirth, but very little is known about
U.S. registered nurses’ attitudes and beliefs (Davis, 2010; Davis-Floyd, 2001; Klein et al.,
2009; Klein et al., 2010; Reime et al., 2004).
Ajzen (2014) states in his theory of planned behavior that an individual’s attitudes and
beliefs can be used to predict their behavior. This theory has been supported in a wide variety
of research settings, including labor and delivery. In their concept clarification, Levine and
Lowe (2013) found that several concepts such as cognitive frame, perception, schema,
value, and attitudes and beliefs are essentially the same theoretical construct. In 2010,
Dunphy et al. studied Canadian obstetrician’s cognition and affect and found that several
aspects of physician cognition were significantly correlated with patient perinatal outcomes.
Consequently, it is logical that labor and delivery registered nurses’ (L/D RNs) attitudes and