Measuring self-care in pregnant women: psychometric study of the Portuguese self-care inventory

Self-care during pregnancy is important for maternal and fetal health and encompasses behaviors related to health maintenance, symptom monitoring, and management of health-related changes. However, evidence supporting the use of comprehensive, theory-based self-care measures among pregnant women remains limited. This study aimed to examine evidence supporting the validity and reliability of scores obtained with the Portuguese Self-Care Inventory (SCI) among pregnant women. A cross-sectional study was conducted with 886 pregnant women receiving antenatal care in Portugal. The SCI comprises three scales: Self-Care Maintenance, Self-Care Monitoring, and Self-Care Management. Evidence based on internal structure was examined using confirmatory factor analysis (CFA), including alternative models, discriminant validity, and cross-validation. Reliability was assessed using Cronbach’s alpha, McDonald’s omega, and composite reliability. Evidence based on relations with other variables was examined through correlations with Self-Care Self-Efficacy Scale (SCSES) scores. Differences across modes of administration were also examined. CFA supported the hypothesized structure of the three SCI scales (Self-Care Maintenance: CFI = 0.96, RMSEA = 0.06; Self-Care Monitoring: CFI = 1.00, RMSEA = 0.02; Self-Care Management: CFI = 0.95, RMSEA = 0.08). The items on sleep (#1) and on medication for symptoms (#17) were weak indicators. A simultaneous five-factor model showed acceptable fit (CFI = 0.94, RMSEA = 0.05), but latent correlations between dimensions were high (0.68–0.92), evidence of discriminant validity was limited, and a second-order model with a general self-care factor fitted comparably. Cronbach’s alpha was 0.76, 0.85, and 0.69 for Self-Care Maintenance, Self-Care Monitoring, and Self-Care Management, respectively. SCSES scores were positively correlated with the three scales ( r = 0.66–0.72, p < 0.001). Women interviewed face-to-face reported lower scores than those who completed self-administered questionnaires. The findings support the interpretation of the three SCI scale scores among pregnant women in Portugal, but not the separate interpretation of the first-order dimensions. The weak sleep and medication items and the differences across modes of administration warrant further research. The SCI may be useful for identifying areas of self-care in which additional antenatal support may be warranted.