OBJECTIVES: This study aims to summarize evidence on cross-cultural validation of postpartum patient-reported outcome measures (PROMs) and provide recommendations to improve measurement of cultural differences in their global administration.
METHODS: PubMed database was searched using the terms: ‘postpartum’, ‘patient-reported outcomes’, and ‘systematic review’ in the title/abstract. Included systematic reviews examined multi-dimensional PROMs. Reviews evaluating unidimensional domains of postpartum health (e.g., pain, sleep, etc.) were excluded. An assessment of the cross-cultural validation of the most suitable PROMs designed for the postpartum population was conducted. A content analysis was conducted to summarize recommendations for improving their cross-cultural validity and administration.
RESULTS: Nine systematic reviews were identified. Four met inclusion criteria. These four reviews recommended three PROMs for comprehensive assessment of multiple domains of postpartum health/recovery: Postpartum Quality of Life (POQL), Maternal Concerns Questionnaire (MCQ), and Obstetric Quality of Recovery 11-item (ObsQOR-11). PQOL, developed in China, was cross-culturally validated for use in Iran. Though the language of translation did not align with the predominant language of the study setting (Azeri). There was limited reporting on cross-cultural validation of MCQ, and it is only available in English. ObsQOR-11 was validated from English into Arabic, Korean, and Hindi. A common limitation across validation processes was the lack of generalizability within local populations due to homogeneity in participants’ education/occupation.
CONCLUSIONS: There is limited cross-cultural validation/adaptation of postpartum PROMs despite the global burden of postpartum morbidity and mortality. While standard procedures for cultural validation of PROMs exist, the varying nature of global beliefs and systems surrounding the postpartum period calls for specific considerations for validation and localizing existing PROMs. To support validity in the administration of postpartum PROMs across cultures, tools should consider the localization of language and the understanding of local culture to prevent misinterpretation of items/domains/responses/results, as well as power dynamics between researchers and participants.
