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A Psychometric Analysis of the Self-Report of Labor Pain

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A Psychometric Analysis of the Self-Report of Labor Pain A PSYCHOMETRIC ANALYSIS OF THE SELF-REPORT OF LABOR PAIN BY NANCY KAYE CRAWFORD LOWE B.S., Wheaton College, 1969 M.S., Northern Illinois University, 1977 THESIS Submitted as partial fulfillment of the requirements for the degree of Doctor of Philosophy in Nursing Sciences in the Graduate College of the University of Illinois at Chicago Health Sciences Center, 1986 Chicago, Illinois UNIVERSITY OF ILLINOIS AT CHICAGO HEALTH SCIENCES CENTER GRADUATE COLLEGE Certificate of Approval // //%%> Date / I HEREBY RECOMMEND THAT THE THESIS PREPARED UNDER MY SUPERVISION BY Nancy Kaye Crawford Lowe ENTITLED A Psychometric Analysis of the Self-report of Labor Pain BE ACCEPTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF Doctor of Philosophy In Charge of Thesis Recommendation concurred in f Mead of Department Committee on Final Examination 80173 Copyright by Nancy Keys Crawford Lowe 1986 To the loving memory of my father, Walter 0. Crawford, whose quest for knowledge and adventure was undaunted by a restricted formal education. My accomplishments are in a large part the result of the love for learning his active mind nurtured within me. iii ACKNOWLEDGMENT I am grateful to Dr. Joyce Roberts, my chairperson, for her mentorship and willingness to persevere with me despite our considerable geographic separation during the last year. Her tremendous encouragement and Insight during the evolution of the proposal was particularly valuable to the progression and completion of the stud/. I am deeply appreciative of the assistance of Dr. Karyn Holm. As my academic advisor and committee member, she provided the continuing support and facilitation necessary to see the project through to completion. I am also grateful to my other committee members: Dr. Alice Dan, Dr. Kathy Norr, and liinu Patel. Alice Dan assisted in the clarification of stud/ questions as the project evolved; Kathy Norr providbd interpretive insight from her work 1n childbirth research; and M1nu Patel was particularly helpful with the statistical analysis. This study was funded by a Health and Human Services National Research Service Award, and my graduate education partially f unded by a fellowship from the Graduate College of the University of Illinois at Chicago. I was honored by this financial support. The members of the nursing and medical staff of the Obstetric Department of Central DuPage Hospital, Winfield, Illinois, were extremely cooperative and supportive during the months of data collection. I am grateful for their hospitality and facilitation of the study. I am deeply thankful for my classmate and friend, Joy Wachs. The exchange of ideas, debate of issues, clarification of values, and ventilation of frustrations that occurred during the many lone hours of nur commute to "the city" provided an invaluable support during the years of our doctoral study. iv ACKNOWLEDGMENT (continued) I am also Indebted to the women who so willingly allowed me to share their labor and delivery experience. The added intrusion of my presence and questions during a most private experience in their lives was graciously accepted by them all. Three very unique young people, Michael, Melissa, and Mark, have not only given me the pleasure of being their mother but with unselfish love have supported me with their interest, hugs, popcorn, and persistent review of my grade reports. Finally, I am most grateful for the loving and unwavering support of my dearest friend and husband, Wayne. There are no words to express the strength and joy that his confidence in me has provided not only throughout my doctoral study but throughout the nineteen years that we have pursued life together. NKL V TABLE OF CONTENTS CHAPTER I THE STUDY PROBLEM 1 A. Introduction 1 B. Statement of the problem 3 C. Purposes of the study 3 D. Hypotheses 4 E. Need for the stud/ 5 F. Definition of terms 6 II REVIEW OF LITERATURE 8 A. Theories of pain 8 B. Physiology of labor pain 12 C. Clinical investigations of labor pain 17 D. Measurement of labor pain 21 E. Theoretical framework 36 III METHODOLOGY 43 A. Research setting 43 B. The sample 45 C. Procedure 48 D. Reliability and validity of instruments 51 1. McGill Pain Questionnaire 51 2. Self-Evaluation in Labor Questionnaire 53 3. Childbirth Experience Interview 54 4. Labor Agency and Delivery Agency Scales 55 5. Physical measures 55 E. Duration of the stud/ 56 F. Ethical considerations 56 IV DATA ANALYSIS AND RESULTS 57 A. Reliability and validity of the postpartum recall of labor pain.. 57 1. Intensity analysis 60 2. Pain rating analysis 69 B. Convergent and discriminant validity of pain measures 82 C. Effect of selected variables on pain report 88 1. Effects of selected variables on the postpartum recall of labor pain 89 a. Parity and the recall of labor pain 89 b. Childbirth preparation the recall of labor pain — 89 c. Anxiety, fe8r of pain, feelings of control, birth enjoyment and the recall of labor pain on the Present Pain Intensity scale 92 vi TABLE OF CONTENTS (continued) CHAPTER PAGE 2. Effects of selected variables on pain report during labor— 92 a. Parity and pain 92 b. Childbirth preparation and pain 101 c. Early labor pain 109 d. Active labor pain 109 e. Transitional labor pain 114 f. Second stage labor pain 117 3. Relationships among postpartum measures 120 a. Postpartum report of early labor pain 120 b. Postpartum report of active labor pain 122 c. Postpartum report of transitional labor pain 122 d. Postpartum report of second stage labor pain 122 D. Relationships between pain report during labor and physiologic variables 126 V. SUMMARY, DISCUSSION, IMPLICATIONS, AND CONCLUSIONS 127 A. Summary 127 B. Discussion 130 1. Sample characteristics 130 2. Reliability of postpartum recall of l8bor pain 131 3. Descriptive characteristics of parturition pain 133 4. Effects of selected variables on pain report 138 5. Convergent and discriminant validity of measures 139 6. Relationships between pain and selected antecedent, intervening, and labor-related variables 141 7. Relationships with physiologic variables 145 C. Collecting and analyzing data pertaining to the pain of parturition 145 D. Implications for research 147 E. Implications for nursing practice 149 F. Conclusions 149 VI APPENDICES 151 Appendix A 152 Appendix B 155 Appendix C 156 Appendix D 161 Appendix E 162 Appendix F 166 Appendix© 176 Appendix H 177 vii TABLE OF CONTENTS (continued) CHAPTER . JBML VII CITED LITERATURE 179 VIII VITA 186 viii LIST OF TABLES M PAGE I SUMMARY OF CLINICAL STUDIES OF PARTURITION PAIN 22 II DEMOGRAPHIC AND OBSTETRICAL DESCRIPTION OF SAMPLE 47 III MANOVA ANALYSIS FOR THE EFFECTS OF PITOCIN ADMINISTRATION ON PPI AND PRI PAIN SCALES 49 IV SUMMARY OF RESEARCH PROCEDURES AND SAMPLE SIZE 49 V COEFFICIENTS ALPHA FOR SUBSCALESOF THE SELF-EVALUATION IN LABOR QUESTIONNAIRE 54 VI TIME OF COMPLETION OF THE MCGILL PAIN QUESTIONNAIRE IN RELATION TO DELIVERY 58 VII CERVICAL DILATATION AND CONTRACTION FREQUENCY FOR EACH MPQ DATA COLLECTION POINT DURING THE FIRST STAGE OF LABOR 59 VIII PRESENT PAIN INTENSITY (PPI) DATA SUMMARY FOR PHASE-OF-LABOR AND TIME-OF-REPORT 61 IX PRESENT PAIN INTENSITY (PPI) MANOVAS FOR TIME-OF-REPORT AND PHASE-OF-LABOR 62 X PRESENT PAIN INTENSITY (PPI) PHASE-OF-LABOR FACTOR REPEATED CONSTRASTS 64 XI SQUARE ROOT TRANSFORMATION OF PRESENT PAIN INTENSITY(PPI) MANOVAS FOR TIME-OF-REPORT AND PHASE-OF-LABOR 71 XII PAIN RATING INDEX (PRI) DATA SUMMARY FOR PHASE-OF-LABOR AND TIME-OF-REPORT 72 XIII PAIN RATING INDEX (PRI) MANOVAS FOR TIME-OF-REPORT AND PHASE-OF-LABOR 73 XIV PAIN RATING INDEX (PRI) PHASE-OF-LABOR FACTOR REPEATED CONTRASTS 74 XV SQUARE ROOT TRANSFORMATION OF PAIN RATING INDEX (PRI) MANOVAS FOR TIME-OF-REPORT AND PHASE-OF-LABOR 81 XVI MULTITRAIT-MULTIMETHOD MATRIX FOR PAIN AND ANXIETY AS EVALUATED ACROSS ALL PHASES OF LABOR, /?= 6 83 iz LIST OF TABLES (continued) TABLE . PAGE XVII MULTITRAIT-MULTIMETHOD MATRIX FOR PAIN AND ANXIETY AS EVALUATED FOR ACTIVE AND SECOND STAGE LABOR, n =44 84 XVIII CORRELATION COEFFICIENTS OF COMPOSITE POSTPARTUM PMlN SCORES AND FEAR OF PAIN, CONFIDENCE IN ABILITY TO HANDLE LAB3R, FEELINGS OF CONTROL, AND BIRTH ENJOYMENT, n=44 86 XIX CORRELATION MATRIX OF IN-LABOR AND POSTPARTUM PRESENT PAIN INTENSITY (PPI) SCORES 87 XX CORRELATION MATRIX OF IN-LABOR AND POSTPARTUM PAIN RATING INDEX (PRI) SCORES 88 XXI MANOVA ANALYSIS FOR THE EFFECT OF PARITY ON THE POSTPARTUM RECALL OF LABOR PAIN 90 XXII MANOVA ANALYSIS FOR THF EFFECT OF CHILDBIRTH PREPARATION ON THE POSTPARTUM RECALL 0^ LABOR PAIN 91 XXIII MANCOVA ANALYSIS FOR THE EFFECTS OF ANXIETY, FEAR OF PAIN, CONTROL, AND BIRTH ENJOYMENT ON THE RELIABILITY OF POSTPARTUM RECALL ON THE PRESENT PAIN INTENSITY (PPI) 93 XXIV DEMOGRAPHIC AND OBSTETRICAL COMPARISON OF PRI Ml PARAS AND MULTIPARAS 94 XXV COMPARISON OF PRIMIPARAS AND MULTIPARAS ON THE FOUR SUBSCALES OF THE SELQ FOR EARLY AND ACTIVE LABOR 95 XXVI PAIN RATING INDEX (PRI) MANOVAS FOR PARITY AND PHASE-OF-LABOR 97 XXVII DEMOGRAPHIC AND OBSTETRICAL COMPARISON OF UNPREPARED, LAMAZE PREPARED, AND PREVIOUSLY LAMAZE PREPARED GROUPS... 102 XXVIII COMPARISON OF UNPREPARED, LAMAZE PREPARED, AND PREVIOUSLY LAMAZE PREPARED GROUPS ON THE FOUR SUBSCALES OF THE SELQ FOR EARLY AND ACTIVE LABOR 103 XXIX PAIN RATING INDEX (PRI) MANOVAS FOR LEVEL-OF-PREPARATION AND PHASE-OF-LABOR 105 X LIST OF TABLES (continued) IMLE. PME XXX CORRELATIONS OF EARLY LABOR VARIABLES, n = 23 110 XXXI ACTIVE LABOR PRI CORRELATIONS WITH EARLY LABOR SELQ SCORES, /?= 21 111 XXXII ACTIVE LABOR PRI CORRELATIONS WITH ACTIVE LABOR SELQ SCORES, n= 28 113 XXXIII ACTIVE LABOR PAIN RATING
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