Is the Birthing Unit Design Spatial Evaluation Tool valid for diverse groups?

Background: Awareness of the impact of the built environment on health care outcomes and experiences has led to efforts to redesign birthing environments. The Birth Unit Design Spatial Evaluation Tool was developed to inform such improvements, but it has only been validated with caseload midwives and women birthing in caseload models of care. 

Aim: To assess the content validity of the tool with four new participant groups: Birth unit midwives, Aboriginal or Torres Strait Islander women; women who had anticipated a vaginal birth after a caesarean; and women from refugee or culturally and linguistically diverse backgrounds. 

Methods: Participants completed a Likert-scale survey to rate the relevance of The Birth Unit Design Spatial Evaluation Tool's 69 items. Item-level content validity and Survey-level validity indices were calculated, with the achievement of validity set at >0.78 and >0.9 respectively. 

Results: Item-level content validity was achieved on 37 items for birth unit midwives (n = 10); 35 items for Aboriginal or Torres Strait Islander women (n = 6); 33 items for women who had anticipated a vaginal birth after a caesarean (n = 6); and 28 items for women from refugee or culturally and linguistically diverse backgrounds (n = 20). Survey-level content validity was not demonstrated in any group. 

Conclusion: Birth environment design remains significant to women and midwives, but the Birth Unit Design Spatial Evaluation Tool was not validated for these participant groups. Further research is needed, using innovative methodologies to address the subconscious level on which environment may influence experience and to disentangle the influence of confounding factors.