International Journal of Interdisciplinary and Multidisciplinary Studies (IJIMS), 2014, Vol 1, No.10, 171-179 . 171 Available online at http://www.ijims.com ISSN: 2348 – 0343 Maternal Perceptions of Quality of Antenatal Care Services in Sri Lanka: Development and Validation of a Multi-dimensional Instrument Supun D Wijesinghe 1* and Dulitha N Fernando 2 1 Consultant Community Physician, Ministry of Health, Sri Lanka 2 Emeritus Professor of Community Medicine, Faculty of Medicine, University of Colombo, Sri Lanka. * Corresponding author : Supun D Wijesinghe Abstract Maternal perception of antenatal care quality is an important attribute in understanding the relationship between quality and utilization of antenatal care services. However, measuring this in a developing country like Sri Lanka is a significant challenge due to non-availability of valid and reliable instruments. The aim of this study was to develop a valid and reliable instrument to measure maternal perceptions of quality of antenatal care services in Sri Lanka. The main outcome measure was the factor structure and internal consistency of the instrument. We used multiple qualitative methods to generate culturally suitable items for the instrument. It was validated using an exploratory factor analysis methodology among 170 antenatal mothers in 2 Medical Officer of Health areas. Reliability was estimated by measuring internal consistency and test retest method. The four factor model proposed by this paper was able to explain 73% of the total variance of the scale. The Cronbach‟s alpha value for the total scale was 0.965. Thus, the newly developed 26-item instrument demonstrated satisfactory level of validity and reliability, and it provides useful information that can be utilized by health care providers to identify the areas in antenatal care services that require improvement from a client‟s perspective. Keywords: client-perceived quality, scale development, exploratory factor analysis, validation, antenatal care quality Introduction Quality of care is considered as one of the major public health concerns of this century 1 . Patients‟ perceptions of the quality of services are widely recognized as a useful tool to improve health services in many developed countries 2 . Such perceptions are considered as one of the best measures of quality in healthcare 2 . Patient perceived quality is defined as subjective and dynamic perception of the extent to which expected health care is received by a person 3,4 . Since patient perceived quality provides an excellent feedback to the healthcare provider, it is of importance to characterize and measure patient perceptions of health care quality to understand more fully what drives those perceptions 5 . This is particularly important for reproductive health care services in developing countries, where advances in the technical quality may be inconsistent with practices passed informally from generation to generation, and where the latter may be perceived by mothers as more important than the former aspect 6 . In recent decades, much attention has been drawn to antenatal care as a potential intervention to improve both maternal and newborn health 7 . The antenatal period presents important opportunities for reaching pregnant women with number of interventions that may be vital to their health and well-being, and that of their infants 8,9 . Antenatal care is a critical area where quality can play a major role in ensuring the wellbeing of the mother (and the child) 9 and the maternal perception of quality of services is considered as a factor which has a greater influence on mothers‟ behaviours when