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Prenatal attachment: using measurement invariance to test the validity of comparisons across eight culturally diverse countries |
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| Authors: | Foley Sarah Hughes Claire Murray Aja Louise Baban Adriana Fernando Asvini D. Madrid Bernadette Osafo Joseph Sikander Siham Abbasi Fahad Walker Susan Luong-Thanh Bao-Yen Vo Thang Van Tomlinson Mark Fearon Pasco Ward Catherine L. Valdebenito Sara Eisner Manuel |
| Affiliation: | 1.Centre for Family Research, University of Cambridge, Cambridge, UK ;2.Department of Psychology, University of Edinburgh, Edinburgh, UK ;3.Department of Psychology, Babes-Bolyai University, Cluj-Napoca, Romania ;4.Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka ;5.Child Protection Unit, University of the Philippines, Manila, Philippines ;6.Department of Psychology, University of Ghana, Legon, Accra, Ghana ;7.Health Services Academy, Islamabad, Pakistan ;8.Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica ;9.Institute for Community Health Research, Faculty of Public Health, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam ;10.Department of Psychology, Stellenbosch University, Stellenbosch, South African Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa ;11.School of Nursing and Midwifery, Queens University, Belfast, UK ;12.Research Department of Clinical, Educational and Health Psychology, University College London, London, UK ;13.Department of Psychology, University of Cape Town, Cape Town, South Africa ;14.Institute of Criminology, University of Cambridge, Cambridge, UK ; |
| Abstract: | Studies in high-income countries (HICs) have shown that variability in maternal-fetal attachment (MFA) predict important maternal health and child outcomes. However, the validity of MFA ratings in low- and middle-income countries (LMICs) remains unknown. Addressing this gap, we assessed measurement invariance to test the conceptual equivalence of the Prenatal Attachment Inventory (PAI: Muller, 1993) across eight LMICs. Our aim was to determine whether the PAI yields similar information from pregnant women across different cultural contexts. We administered the 18-item PAI to 1181 mothers in the third trimester (Mean age = 28.27 years old, SD = 5.81 years, range = 18–48 years) expecting their first infant (n = 359) or a later-born infant (n = 820) as part of a prospective birth cohort study involving eight middle-income countries: Ghana, Jamaica, Pakistan, Philippines, Romania, South Africa, Sri Lanka and Vietnam. We used Multiple Group Confirmatory Factor Analyses to assess across-site measurement invariance. A single latent factor with partial measurement invariance was found across all sites except Pakistan. Group comparisons showed that mean levels of MFA were lowest for expectant mothers in Vietnam and highest for expectant mothers in Sri Lanka. MFA was higher in first-time mothers than in mothers expecting a later-born child. The PAI yields similar information about MFA across culturally distinct middle-income countries. These findings strengthen confidence in the use of the tool across different settings; future studies should explore the use of the PAI as a screen for maternal behaviour that place children at risk. |
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