Development of the advocacy scale in midwifery

Objective: The aim of this study is to develop an advocacy scale in midwifery. Materials and Methods: This methodological study was conducted between Februrary and December 2024 with 260 midwives working in units where midwifery services are provided in healthcare institutions and who agreed to participate in the study. Data were collected online using the Individual Information Form and the Draft Midwifery Advocacy Scale via Google Forms. The content validity index, construct validity (exploratory and confirmatory factor analysis), and item analysis were applied as part of the validity analysis. Reliability was assessed using Cronbach's alpha coefficient, item-total correlation, and split-half reliability methods. The suitability of the sample size for factor analysis was determined using the Kaiser-Meyer-Olkin (KMO) test. At the same time, the correlation levels among the items were examined using Bartlett's test of sphericity. Data were analyzed using SPSS 25.0 and DataBeeg 1.0 software, and descriptive statistics, including frequency, percentage, mean, and standard deviation, were utilized. Ethical approval for conducting the study was obtained from the Manisa Celal Bayar University Faculty of Medicine Health Sciences Ethics Committee with the decision numbered 20.478.486/2213, dated January 17, 2024. Results: Based on the ICM Advocacy Toolkit for Midwives and a literature review, an initial item pool of 27 items was developed. Expert evaluations yielded a Content Validity Index (CVI) of 0.96. The Kaiser-Meyer-Olkin (KMO) test value was 0.912, confirming sample adequacy, and Bartlett's Test of Sphericity indicated data suitability for factor analysis. In the Exploratory Factor Analysis (EFA), four items were removed due to low factor loadings, resulting in a final scale of 22 items. Confirmatory Factor Analysis (CFA) supported a five-factor structure, with acceptable model fit indices (CMIN/DF = 2.240, RMSEA = 0.069, CFI = 0.897, SRMR = 0.060). The scale demonstrated high reliability (Cronbach's alpha = 0.912). Additionally, 61.9% of midwives were aged ≤34 years, and 71.2% held a bachelor's degree. Conclusion: The Midwifery Advocacy Scale is a valid and reliable measurement tool consisting of 22 items and five subdimensions, designed to assess midwives' advocacy levels. Keywords: Advocacy, Midwifery Advocacy, Midwifery, Scale Development