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What is meant by validity in maternal and newborn health measurement? A conceptual framework for understanding indicator validation

Author

Listed:
  • Lenka Benova
  • Ann-Beth Moller
  • Kathleen Hill
  • Lara M E Vaz
  • Alison Morgan
  • Claudia Hanson
  • Katherine Semrau
  • Shams Al Arifeen
  • Allisyn C Moran

Abstract

Background: Rigorous monitoring supports progress in achieving maternal and newborn mortality and morbidity reductions. Recent work to strengthen measurement for maternal and newborn health highlights the existence of a large number of indicators being used for this purpose. The definitions and data sources used to produce indicator estimates vary and challenges exist with completeness, accuracy, transparency, and timeliness of data. The objective of this study is to create a conceptual overview of how indicator validity is defined and understood by those who develop and use maternal and newborn health indicators. Methods: A conceptual framework of validity was developed using mixed methods. We were guided by principles for conceptual frameworks and by a review of the literature and key maternal and newborn health indicator guidance documents. We also conducted qualitative semi-structured interviews with 32 key informants chosen through purposive sampling. Results: We categorised indicator validity into three main types: criterion, convergent, and construct. Criterion or diagnostic validity, comparing a measure with a gold standard, has predominantly been used to assess indicators of care coverage and content. Studies assessing convergent validity quantify the extent to which two or more indicator measurement approaches, none of which is a gold-standard, relate. Key informants considered construct validity, or the accuracy of the operationalisation of a concept or phenomenon, a critical part of the overall assessment of indicator validity. Conclusion: Given concerns about the large number of maternal and newborn health indicators currently in use, a more consistent understanding of validity can help guide prioritization of key indicators and inform development of new indicators. All three types of validity are relevant for evaluating the performance of maternal and newborn health indicators. We highlight the need to establish a common language and understanding of indicator validity among the various global and local stakeholders working within maternal and newborn health.

Suggested Citation

  • Lenka Benova & Ann-Beth Moller & Kathleen Hill & Lara M E Vaz & Alison Morgan & Claudia Hanson & Katherine Semrau & Shams Al Arifeen & Allisyn C Moran, 2020. "What is meant by validity in maternal and newborn health measurement? A conceptual framework for understanding indicator validation," PLOS ONE, Public Library of Science, vol. 15(5), pages 1-19, May.
    • Handle: RePEc:plo:pone00:0233969
    DOI: 10.1371/journal.pone.0233969
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    References listed on IDEAS

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    1. Gretchen A Stevens & Leontine Alkema & Robert E Black & J Ties Boerma & Gary S Collins & Majid Ezzati & John T Grove & Daniel R Hogan & Margaret C Hogan & Richard Horton & Joy E Lawn & Ana Marušić & C, 2016. "Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement," PLOS Medicine, Public Library of Science, vol. 13(6), pages 1-8, June.
    2. Li Liu & Mengying Li & Li Yang & Lirong Ju & Biqin Tan & Neff Walker & Jennifer Bryce & Harry Campbell & Robert E Black & Yan Guo, 2013. "Measuring Coverage in MNCH: A Validation Study Linking Population Survey Derived Coverage to Maternal, Newborn, and Child Health Care Records in Rural China," PLOS ONE, Public Library of Science, vol. 8(5), pages 1-10, May.
    3. Ann-Beth Moller & Holly Newby & Claudia Hanson & Alison Morgan & Shams El Arifeen & Doris Chou & Theresa Diaz & Lale Say & Ian Askew & Allisyn C Moran, 2018. "Measures matter: A scoping review of maternal and newborn indicators," PLOS ONE, Public Library of Science, vol. 13(10), pages 1-19, October.
    4. Lenka Benova & Ann-Beth Moller & Allisyn C Moran, 2019. "“What gets measured better gets done better”: The landscape of validation of global maternal and newborn health indicators through key informant interviews," PLOS ONE, Public Library of Science, vol. 14(11), pages 1-16, November.
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