Cross-cultural validation and psychometric evaluation of the revised emancipated decision-making scale in Portuguese pregnant women

Active participation in healthcare decisions during childbirth is strongly associated with greater satisfaction and improved health outcomes. Shared decision-making is particularly critical in women's health, where choices have often been shaped by patriarchal norms and a historically paternalistic healthcare system. This study aimed to evaluate the psychometric properties of a culturally adapted Portuguese version of the Revised Emancipated Decision-Making Scale (EDMr) for use among pregnant women. A two-phase methodological approach was employed, involving the cultural adaptation of the instrument and the assessment of its psychometric properties in a non-probabilistic sample of 241 pregnant women in Portugal. Exploratory Factor Analysis and Confirmatory Factor Analysis were performed on separate subsamples to enhance methodological rigor. The original three-factor model evolved into a five-factor structure: Personal Knowledge, Flexible Environment (subdivided into Feeling Supported and Feeling Respected), and Social Norms (subdivided into Sense of Pressure and Negative Reactions). The final model demonstrated solid psychometric properties, with acceptable to high internal consistency across subscales, with Cronbach's alpha values ranging from 0.68 (Sense of Pressure) to 0.86 (Personal Knowledge). The findings support its theoretical soundness and cultural relevance, confirming its utility in assessing women's autonomy in healthcare decision-making during pregnancy and childbirth. Further research is recommended to explore its applicability in broader populations and across diverse clinical contexts. This represents the first validation of the EDMr outside the United States. • First EDMr validation outside United States confirms strong cross-cultural relevance. • Revised five-factor model shows solid psychometrics in Portuguese sample. • EDMr-PT assesses emancipated decision-making among Portuguese women. • Supports research, clinical, and cross-cultural use in women's health decisions.