Validation of the adapted pregnancy-related anxiety scale in Northern Ghana (PrAS-NG)

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INTRODUCTION: Pregnancy-related anxiety refers to anxiety experienced throughout pregnancy, including concerns about labor, maternal and fetal wellbeing, healthcare access, and parental readiness. Pregnancy-related anxiety has significant adverse effects on maternal and neonatal outcomes, distinct from other mental health conditions during pregnancy. However, research in low- and middle-income countries, notably Ghana, remains limited, in part because of lack of culturally relevant, high-quality measures. This study aims to validate the adapted PrAS for use in Northern Ghana (PrAS-NG). METHODS: Using survey data from 586 pregnant women, we conducted a pre-registered assessment of the reliability and validity of the PrAS-NG. Reliability was evaluated using Cronbach's alpha and test-retest analyses. For internal validity, we conduct exploratory factor analysis and confirmatory factor analysis. Convergent and divergent validity were assessed through Pearson correlation analysis. RESULTS: Following an exploratory factor analysis of the initial 52-item scale, a refined, 22-item, 9-factor version (PrAS-NG22) was developed. A confirmatory factor analysis validated the scale with a comparative fit index of 0.96. The scale demonstrated full invariance across age, gestational age, and parity. Internal (α=0.90) and test-retest reliability were strong (ICC=0.81). The PrAS-NG22 was related to anxiety and psychological distress during pregnancy, suggestive of convergent validity. CONCLUSIONS: The results suggest the PrAS-NG22 is a valid, reliable, and culturally sensitive tool for pregnancy-related anxiety screening in Northern Ghana.

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