Assessment of the person-centered maternity care scale: a global systematic review.

Background: Person-centered maternity care (PCMC) refers to respectful, responsive, and compassionate childbirth care. The PCMC scale enables quantitative measurement of PCMC. Despite the widespread use of the PCMC scale, no global synthesis exists. We, therefore, conducted a global systematic review of studies using the PCMC scale to quantitatively assess women's childbirth experiences, evaluate the scale's psychometric properties, and identify predictors of PCMC.

Methods: We searched PubMed, Web of Science, and Embase from inception to September 3, 2024. Included studies used the PCMC scale by Afulani et al. to examine the facility-based childbirth experiences of women in any setting, with no time or language restrictions. Three reviewers independently assessed titles, abstracts, and full texts. We assessed study quality using Joanna Briggs Institute critical appraisal tools. We utilized a standardized extraction template to extract full PCMC and sub-scale scores (standardizing scores to a 0-100 range for easier comparison), predictors, and psychometric properties. The primary outcome is the mean PCMC score.

Findings: Our initial search yielded 415 articles, of which 41 publications from 32 independent samples were included. Most studies were conducted in Africa (63%). Mean PCMC scores were generally lower in studies from Africa (under 75), moderate in Asia (60 to over 90), and higher in North America (over 80). The lowest score reported was 38.2/100 (SD = 15.8) in an observational study conducted in Sierra Leone, while the highest was 97.1/100 (SD = 2.9) following an intervention in India. The lowest scoring domain across countries was communication and autonomy, with the lowest score at 18.1/100 in a study in Ethiopia. Positive predictors of PCMC included higher wealth, education, early antenatal care, and birth in lower-level and private health facilities. Inconsistent predictors included age, marital status, and obstetric complications.

Interpretation: PCMC is sub-optimal globally, particularly in the domain of communication and autonomy. There are also inequities in PCMC driven by various sociodemographic and health systems-related factors. Interventions to improve women's experiences and to address the inequities are therefore needed.

Funding: None.