Development and Validity Analysis of the Pragmatic Assessment of Role Transition and Onboarding for Midwives (Parto-M) Instrument: An Exploratory Study

This exploratory study addressed the significant gap in research regarding the transition of newly qualified midwives to practice. The purpose of this study was to develop an instrument to identify the areas of strength and domains of challenge for new graduate midwives in their role transition to independent practice. The study sought to answer the following research questions: Q1 What is essential to measure in an instrument assessing what is necessary for a new midwife to successfully bridge from education to orientation and onward after evaluation by new graduate midwives and subject matter experts? Q2 What is the calculated content validity index (CVI) of the Pragmatic Assessment of Role Transition and Onboarding for Midwives (PARTO-M) instrument as rated by the subject matter experts? The first phase entailed the creation of the PARTO-M instrument, which was constructed by leveraging an extensive literature review, the core competencies of the American College of Nurse-Midwives and the International Confederation of Midwives, and the researcher’s expertise as a midwife educator and midwifery practice director. The second phase focused on the assessment of the instrument's face and content validity. This phase involved deploying surveys to subject matter experts and new graduate midwives to gather critical feedback. The study involved two samples—17 subject matter experts and 14 new graduate midwives, which were considered adequate for the determination of content validity and avoiding chance agreement. The final phase of the study was dedicated to a thorough data analysis, refinement of the tool based on the data and feedback received, and ensuring the instrument's relevance, clarity, and applicability in real-world settings. There were seven domains of the instrument: outpatient skills, outpatient management, inpatient skills, inpatient management, orientation and onboarding, role transition, and midwifery demographics. Data analysis involved calculating the item content validity index and the scale content validity index (S-CVI) in each domain of the instrument. Significant content validity indices were achieved for the majority of instrument items. Per Polit et al. (2007), the S-CVI is significant if it is 0.90 or greater. The overall instrument S-CVI for relevance was significant with S-CVI of 0.953 for the subject matter experts and 0.908 for the new graduate midwives. Despite the overall high content validity, some items required refinement. For instance, the relevance S-CVI for the domain of outpatient skills did not meet the threshold of significance for either sample at 0.894 for both. During the survey process, qualitative insights reinforced the quantitative data. For example, the need for robust orientation programs and effective mentorship was repeatedly underscored by both new midwives and subject matter experts. Participants highlighted professional challenges such as imposter syndrome and burnout, advocating for more structured support, and training during the transition period. Through comprehensive analysis and iterative feedback, the PARTO-M instrument was validated, resulting in a foundational tool that paves the way for future research aimed at enhancing midwife role transition and retention. By addressing the systemic issues and providing a validated tool for assessing the transition experience, this study contributed valuable insights and a new instrument that could inform the development of supportive structures and interventions for new midwives.