Introduction
Nurses are the backbone of the healthcare system, forming over half of the world’s healthcare workforce. According to the State of the World’s Nursing 2020, there are 27.9 million nurses in the world, the majority of whom are female, and 38% are under the age of 35 [1]. Over the past decade, nursing careers have experienced significant growth in China, with over 5 million registered nurses by the end of 2021, of which 96.7% are female [2]. The young nurses under 35 years old account for 67% [2, 3]. Since 2016, the universal two-child policy in China [4], there has been an increase in the number of nurses returning to work after childbirth (NRWCs).
NRWCs face specific challenges, including work-related stress, time conflicts, and breastfeeding difficulties due to the unique nature of nursing in hospitals [5]. Studies have shown that support in many aspects is imperative for nurses to overcome these obstacles and adjust to clinical [6, 7]. Based on social support theory, this support can be categorized as informational, emotional, appraisal and instrumental suppor [8]. NRWCs may feel unfamiliar with the clinical work after maternity leave, so it is necessary to provide them with informational support and training to help them adapt quickly. Additionally, they need sufficient information to manage changes in family structure and child-feeding practices in their personal lives. Postpartum women often experience negative psychological effects such as anxiety or depression due to hormonal fluctuations and the combined pressures of work and personal life [9]. Studies have shown that mothers’ emotions have distinct effects on infants’ neural responses [10] and crying behavior [11]. Higher levels of social support predicted lower levels of maternal postpartum emotional distress [12]. Therefore, it is crucial for them to receive care and understanding from leaders, colleagues, and family members for emotional support. Additionally, recognition or praise can serve as appraisal support. Instrumental support involves providing a private space within the department for postpartum nurses to pump milk or breastfeed, as well as implementing breastfeeding leave policies alongside parental leave options for non-registered working caregivers (NRWCs) [13]. In summary, the specific types of support for NRWCs are not only related to the characteristics of nursing, but also to physiological, psychological, and instrumental needs.
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Social support plays a certain role in mitigating the adverse effects of work-related stress, physical discomfort, and psychological problems among nurses. Many studies have identified social support, particularly organizational and coworker support, contributed to coping with physio-psychosocial symptoms among nurses, reducing job burnout and turnover intention [14‐17]. Specifically, information support is instrumental in aiding NRWCs to swiftly adapt to clinical settings and minimize the challenges they encounter. Instrumental support, on the other hand, facilitates rest periods, breastfeeding breaks, and other essential activities, enhancing the overall work experience. Evaluation support acts as a motivator, encouraging nurses and bolstering their confidence in their professional abilities. Lastly, emotional support is invaluable in helping NRWCs express and process their emotions, fostering a healthy and supportive work environment. Therefore, ensuring adequate levels of social support is essential to promote well-being among nurses.
Various measurement instruments, such as the Social Support Rating Scale (SSRS) [18], the Postpartum Social Support Questionnaire (PSSQ) [19], and the Multidimensional Scale of Perceived Social Support (MSPSS) [20]. The SSRS encompasses three dimensions: support utilization, subjective support, and objective support [18], lacking information and instrumental support for NRWCs. The PSSQ consists of four factors: parent support, partner support, extended family and friends support, and in-law support, without covering organizational and coworker support [19]. The MSPSS assesses perceived social support from friends, family, and significant others, consisting of 12 items [21], while ignoring information and instrumental support for NRWCs. In summary, these scales do not encompass specific social supports crucial for NRWCs, such as breastfeeding facilities, nursing skills training, or evaluation of clinical nursing work. Consequently, these scales may not be suitable for assessing the social support experienced by NRWCs. Developing a reliable and validated scale for measuring social support among NRWCs is necessary. This study aims to develop a scale for measuring the social support among NRWCs and test the psychometric properties.
Methods
This is a psychometric study to develop and validate a perceived social support scale for the nurse returning to work after childbirth. The study involved three phases: item formation (phase 1); scale development (phase 2); and psychometric testing (phase 3). From February to October 2023, the study was conducted in hospitals of different levels spanning 12 provinces across China. This study was reported in compliance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations (Supplementary File 1).
Theoretical framework
The social support theory was adopted in this study. Originating in the 1970s, social support theory initially emerged within the field of psychiatry and gradually expanded its application to sociology and psychology [22]. Until now, scholars have held diverse perspectives on social support theory. Generally, it emphasizes that multiple groups offer multi-level assistance to disadvantaged individuals for better adaptation to their environment. Social support encompasses various dimensions, including emotional, appraisal, instrumental, and informational aspects; it can also be categorized based on its sources such as significant others, friends, family members, and the community [23]. In this study, nurses returning to work postpartum are considered a vulnerable group due to facing multiple demands and challenges in both their professional and personal lives. This theory helps researchers in identifying critical dimensions of support for these nurses, such as emotional support (empathy and understanding), evaluative support (feedback and affirmation), instrumental support (tangible assistance), and informational support (advice and guidance).
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Instrument development
Phase 1: items formation
The scale entries were initially developed following a review of literature from five databases (PubMed, Cochrane Library, Web of Science, Wan Fang, and China National Knowledge Infrastructure). Literature was reviewed on three topics: (1) literature related to nurses returning to work after childbirth, including: return-to-work experiences, return-to-work surveys, and return-to-work interventions; (2) literature related to social support theories, including: theory development and application; and (3) literature related to existing social support scales. Ultimately we drew on 15 relevant literature reviews and researcher experiences and derived 24 items from the four dimensions of social support theory (instrumental support, informational support, emotional support and evaluative support).
In order to enrich the pool of items for the scale further, we conducted interviews. Using purposive and snowball sampling methods, we conducted video interviews with nurses who returned to work after childbirth until data saturation was achieved. The interview outline included assessing their experiences returning to work, identifying challenges encountered, and determining their support needs. Ultimately, we interviewed 10 nurses who returned to work after childbirth and identified an additional 7 items not previously obtained from the literature: 2 items related to intimate relationships, 1 item related to occupational exposure, 3 items related to acceptance of work and parenting concepts, and 1 item related to patient understanding. Ultimately, a total of 31 items were formulated, comprising 7 items for emotional support, 8 for instrumental support, 9 for informational support, and 7 for evaluative support.
Phase 2: scale development
We selected a total of 15 specialists (6 in nursing management, 4 in psychology and 5 in obstetrics and gynaecology) for the Delphi expert consultation. Experts provided modification suggestions and rated the importance of each item on a 5-point scale (1: not important, 5: very important). Items with an average importance score below 4 or a coefficient of variation (CV) exceeding 0.25 should be excluded [24].
The average age of the experts was 47.93 ± 6.96 years. The average professional experience of the experts was 27.07 ± 9.44 years. The expert’s positive coefficient is 100%, and the authority coefficient (Cr) ranges from 0.85 to 1.00. Two rounds of Delphi expert consultation were conducted. In the first round, 2 items were added, 4 items were merged, and 7 items that met a significance score mean < 4 or a coefficient of variation > 0.25 were removed. In the second round, the average importance scores for the items ranged from 4.40 to 5.00, with CV between 0.00 and 0.20, and Kendall’s W at 0.154 (P < 0.05). None of these parameters met the removal criteria. Furthermore, based on expert recommendations, we merged four related items and revised the statement of some items. For example, the experts suggested that “I can receive advice on how to improve intimacy between couples” and “I can receive advice on how to improve relationships between mothers-in-law and daughters-in-law” should be merged, and for this reason we have merged these two entries into “I can receive advice on enhancing intimate relationships (marital, in-law relationships, etc.)”. Through 2 circles of expert consultation, the initial draft of the scale consists of 4 dimensions and 22 items.
Phase 3: psychometric testing
In this phase, we conducted a cross-sectional study consisting of three steps: test the content validity (step 1); test the construct validity and the internal consistency reliability (step 2); test the test-retest reliability(step 3).
For step 1, six nursing managers who had experience in returning to work performed content validation of the initial scale. Experts were requested to evaluate the relevance of items on a four-point scale (1: not relevant, 4: highly relevant).
For step 2, participants were recruited through a convenience sampling technique from hospitals in 12 provinces, in China. Eligible subjects were informed consent about the purpose of the study online. A total of 627 questionnaires including information sheets and consent forms were returned; out of which 588 were considered valid. Since exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) will be used to test the construct validity for this scale, it is recommended to allocate at least five to ten subjects per item [25]. The valid questionnaires were enough. Hence, 588 data were randomly divided into two parts using SPSS 26.0, of which 294 were used for EFA and the remaining 294 for CFA.
For step 3, four weeks later, electronic questionnaires were sent to 83 participants who agreed to the follow-up survey at enrollment, and 33 valid questionnaires were returned to access test-retest reliability.
Ethics statement
This study was approved by the ethics committees of the Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology (TJ-IRB20220968). All participants gave informed consent for this study.
Data analysis
The SPSS version 26.0 was used in the analysis. The content validity of the scale was determined by consulting six experts and expressed as the content validity index (CVI). Items indicated good content validity with an item-level CVI (I-CVI) ≥ 0.78 and a scale-level CVI (S-CVI) > 0.90 [26]. Test-retest reliability was assessed by calculating the correlation coefficients of two datasets from 33 participants collected four weeks apart. The correlation coefficients ≥ 0.70 suggested a strong correlation between measurements and good temporal stability [27]. The construct validity was tested through EFA and CFA. EFA with principal component analysis extraction and varimax rotation was performed to identify the structure of the underlying item and factors of interest. The number of extracted factors was determined based on eigenvalues > 1 [28]. Factor loads greater than 0.4 were considered significant [29]. Subsequently, the other portion of the dataset was used to assess model fit through CFA using various indices. Typically, χ2/df < 3, RMSEA < 0.1, RMR < 0.05, CFI > 09, GFI > 0.9, TLI > 0.9, NFI > 0.9, and LFI > 0.9 indicate acceptable model fit [30, 31]. The Cronbach’s α coefficient was used to determine the internal consistency of the scale, with α value of the total scale and its subscales > 0.7 considered satisfactory internal consistency [32].
Results
Socio-demographic characteristics of participants
Among the 627 questionnaires distributed from 12 provinces, 588 questionnaires were deemed valid, yielding a response rate of 94%. The participants exhibited an average age of 31.19 years, with a SD of 3.66, and an average work experience of 8.97 years, with a SD of 3.70. Notably, 20.6% of participants adhered to exclusive breastfeeding. Additional participant characteristics are delineated in Table 1.
Table 1
Participants characteristics (N = 588)
Measure | M (SD) / n (%) |
|---|---|
Age (years) | 31.19 ± 3.66 |
Work experience (years) | 8.97 ± 3.70 |
Degree | |
Junior college and below | 127 (21.6) |
Undergraduate course | 454 (77.2) |
Master’s degree or above | 7 (1.2) |
Job title | |
Staff nurse | 66 (11.2) |
Senior nurse | 361 (61.4) |
Supervisor nurse | 158 (26.9) |
Co-chief nurse | 2 (0.3) |
Chief nurse | 1 (0.2) |
Monthly income | |
≤ 5000 RMB (689 USD) | 181 (30.8) |
5001–10,000 RMB (690–1378 USD) | 361 (61.4) |
10,001–15,000 RMB (1379–2068 USD) | 43 (7.3) |
≥ 15,001 RMB (2067 USD) | 3 (0.5) |
Hospital grade | |
Grade I | 479 (81.5) |
Grade II | 87 (14.8) |
Grade III | 22 (3.7) |
Department | |
Internal Medicine | 208 (35.4) |
Surgery | 148 (25.2) |
Obstetrics and Gynecology | 51 (8.7) |
Pediatrics | 43 (7.3) |
Emergency /ICU | 51 (8.7) |
Other | 87 (14.8) |
Number of pregnancies | |
First | 368 (62.6) |
Second | 211 (35.9) |
Third and above | 9 (1.5) |
Maternity leave time (days) | 164.14 ± 14.55 |
Return to work time (months) | 5.93 ± 3.46 |
Feeding | |
Breastfeeding only | 121 (20.6) |
Formula feeding only | 240 (40.8) |
Both breast and formula feeding | 227 (38.6) |
Descriptive statistics of psychometric properties
EFA
Of the 588 questionnaires collected, 294 were utilized to test the EFA. Additionally, the high KMO statistic (0.921) indicated the adequacy of the sample size for EFA. Furthermore, the significant Bartlett’s test of sphericity (p < 0.001) substantiated sufficient inter-item correlations. The factor loadings of each item, which exceed the threshold of 0.4, are shown in Table 2. The EFA results identified that there were four principal domains with initial eigenvalues greater than 1, explaining 79.875% of the total variance, as detailed in Table 3.
Table 2
Rotated component matrix
Item | Factors | |||
|---|---|---|---|---|
Informational support | Appraisal support | Instrumental support | Emotional support | |
1 | 0.801 | |||
2 | 0.812 | |||
3 | 0.773 | |||
4 | 0.661 | |||
5 | 0.694 | |||
6 | 0.722 | |||
7 | 0.728 | |||
8 | 0.756 | |||
9 | 0.697 | |||
10 | 0.760 | |||
11 | 0.792 | |||
12 | 0.745 | |||
13 | 0.809 | |||
14 | 0.807 | |||
15 | 0.785 | |||
16 | 0.833 | |||
17 | 0.868 | |||
18 | 0.871 | |||
Table 3
Principal component analysis
Element | Initial Eigenvalues | Extraction Sums of Squared Loadings | Rotation Sums of Squared Loadings | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
Total | Variance % | Accumulate % | Total | Variance % | Accumulate % | Total | Variance % | Accumulate % | |||
1 | 10.506 | 58.364 | 58.364 | 10.506 | 58.364 | 58.364 | 4.065 | 22.581 | 22.581 | ||
2 | 1.464 | 8.131 | 66.495 | 1.464 | 8.131 | 66.495 | 3.719 | 20.659 | 43.240 | ||
3 | 1.289 | 7.160 | 73.655 | 1.289 | 7.160 | 73.655 | 3.511 | 19.504 | 62.744 | ||
4 | 1.120 | 6.220 | 79.875 | 1.120 | 6.220 | 79.875 | 3.084 | 17.131 | 79.875 | ||
CFA
A total of 294 questionnaires were employed to conduct CFA. Notably, the goodness-of-fit statistics revealed favorable results, with a χ2/df value of 1.984 and an RMSEA of 0.058. Furthermore, key fit indices, including CFI, NFI, GFI, RMR, SRMR, IFI, TLI, and PNFI, demonstrated values of 0.978, 0.957, 0.914, 0.042, 0.032, 0.978, 0.973, and 0.775, respectively. These indices met the fitting requirements, signifying a relatively good fit, as summarized in Table 4. The structural equation model of the scale is presented in Fig. 1.
Table 4
The fit indicators of confirmatory factor analysis
Parameters | Indicator level |
|---|---|
χ2/df | 1.984 (< 3) |
RMSEA | 0.058 (< 0.08) |
CFI | 0.978 (>0.9) |
NFI | 0.957 (>0.9) |
GFI | 0.914 (>0.9) |
RMR | 0.042 (< 0.05) |
SRMR | 0.032 (< 0.05) |
IFI | 0.978 (>0.9) |
TLI | 0.973 (>0.9) |
PNFI | 0.775 (>0.5) |
Fig. 1
Structure equation modeling of the scale
Note: F1 = Emotional support, F2 = Instrumental support, F3 = Informational support, F4 = Appraisal support, Q1-18 = Item1-18 ( see Table 5)
×
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Table 5
The final perceived social support scale
Domain/item number | Item text | Response options | ||||
|---|---|---|---|---|---|---|
Emotional support domain | ||||||
1 | My emotional fluctuations can be noticed. | Not at all | Slightly | Somewhat | Quite a lot | Very much |
2 | The thoughts I express can be responded to. | Not at all | Slightly | Somewhat | Quite a lot | Very much |
3 | When I’m unwell, my family can be by my side. | Not at all | Slightly | Somewhat | Quite a lot | Very much |
4 | My postpartum return-to-work status can be noticed. | Not at all | Slightly | Somewhat | Quite a lot | Very much |
Instrumental support domain | ||||||
5 | During nursing work, I have adequate breastfeeding or pumping time. | Not at all | Slightly | Somewhat | Quite a lot | Very much |
6 | The workplace provides a private lactation or pumping area. | Not at all | Slightly | Somewhat | Quite a lot | Very much |
7 | The workplace offers amenities such as a fridge and ice packs for milk storage. | Not at all | Slightly | Somewhat | Quite a lot | Very much |
8 | Nursing supervisors can implement parenting and lactation policies. | Not at all | Slightly | Somewhat | Quite a lot | Very much |
9 | Nursing supervisors can communicate in advance about my return-to-work arrangements. | Not at all | Slightly | Somewhat | Quite a lot | Very much |
Informational support domain | ||||||
10 | I can receive parenting knowledge and skills. | Not at all | Slightly | Somewhat | Quite a lot | Very much |
11 | I can receive knowledge and skills in postpartum health management. | Not at all | Slightly | Somewhat | Quite a lot | Very much |
12 | I can receive advice on enhancing intimate relationships (marital, in-law relationships, etc.). | Not at all | Slightly | Somewhat | Quite a lot | Very much |
13 | I can receive the necessary training for my postpartum return to work. | Not at all | Slightly | Somewhat | Quite a lot | Very much |
14 | I can receive guidance on improving the quality of nursing work. | Not at all | Slightly | Somewhat | Quite a lot | Very much |
Appraisal support domain | ||||||
15 | My efforts can be acknowledged. | Not at all | Slightly | Somewhat | Quite a lot | Very much |
16 | In nursing work, my opinions can be valued. | Not at all | Slightly | Somewhat | Quite a lot | Very much |
17 | In nursing work, I have a sense of being needed. | Not at all | Slightly | Somewhat | Quite a lot | Very much |
18 | My nursing work quality and efficiency can be recognized. | Not at all | Slightly | Somewhat | Quite a lot | Very much |
Content validity
Content validity was evaluated by six experts. The I-CVI ranged from 0.83 to 1.00, all surpassing the standard threshold of 0.78. Additionally, the S-CVI included two components, S-CVI/UA (Universal Agreement) and S-CVI/Ave (Average), which scored 0.94 and 0.99, respectively. Both results surpass the 0.9 benchmark.
Reliability
588 questionnaires were used to test the reliability. The total scale exhibited an impressive internal consistency, with Cronbach’s alpha coefficient of 0.957. For the four domains, Cronbach’s alpha coefficient ranged from 0.870 to 0.967 (Table 6). The test-retest reliability of the scale over time was further verified, with a coefficient of 0.809 for the overall scale and a range from 0.682 to 0.718 for each domain. Pearson’s correlation coefficients between the scale and each domain are displayed in Table 7.
Table 6
The reliability coefficients of the total scale and each domain
Domains | Items | Cronbach’s α coefficient | Test-retest reliability |
|---|---|---|---|
Emotional support | 4 | 0.899 | 0.718 |
Instrumental support | 5 | 0.870 | 0.714 |
Informational support | 5 | 0.945 | 0.682 |
Appraisal support | 4 | 0.967 | 0.778 |
The total scale | 18 | 0.957 | 0.809 |
Table 7
The correlation between domains and the total score
Domains | 1 | 2 | 3 | 4 | Total |
|---|---|---|---|---|---|
1 | 1 | ||||
2 | 0.635 | 1 | |||
3 | 0.690 | 0.685 | 1 | ||
4 | 0.632 | 0.641 | 0.717 | 1 | |
Total | 0.835 | 0.873 | 0.902 | 0.849 | 1 |
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Perceived social support
The final perceived social support scale is presented in Table 5, comprising four domains with 18 items. Domain 1 was emotional support (items 1, 2, 3, 4); domain 2 was instrumental support (items 5, 6, 7, 8, 9); domain 3 was informational support (items 10, 11, 12, 13, 14); and domain 4 was appraisal support (items 15, 16, 17, 18). Each item is scored on a 5-point Likert scale graded from 1 to 5. Response options (and scores) were as follows: not at all (1), slightly (2), somewhat (3), quite a lot (4), or very much (5).The total score is the sum of all items, ranging from 18 to 90 points, and higher values indicate higher degree of the perceived social support.
Discussion
The four dimensions of social support, namely emotion, instrument, information, and appraisal play a necessary role in facilitating the transition of NRWCs into clinical nursing practice. In this study, we developed a scale to assess social support among NRWCs. Based on data collected from NRWCs across 12 provinces in China, properties of the scale have been verified. The scale was designed as a self-perceived questionnaire aimed at identifying the level of social support experienced by NRWCs.
To ensure the rigor of scale development in this study, several steps were taken. Firstly, Social Support Theory served as the theoretical foundation for scale development, a widely recognized basis for numerous studies on social support [33, 34]. This ensured the rationality of our approach at a theoretical level. Secondly, adhering strictly to Social Support Theory and drawing insights from relevant literature as well as structured interviews conducted with NRWCs enabled us to form an item pool for the scale. We interviewed 10 such nurses and delved deep into their needs and experiences regarding social support upon returning to clinical work. Subsequently, we refined themes and extracted scale items from their perspective so that these items truly reflect the current situation faced by NRWCs in China. Thirdly, we sought consultation from 15 experts working at a tertiary hospital in Wuhan who possess extensive experience in clinical management and are familiar with both the working environment and the psychological state of NRWCs. Furthermore, the positive coefficient, the Cr, and the CV of experts are further tested in the process of research, so that the consultation experts have good representativeness [35]. Through two rounds, the scale items were refined to enhance their scientific and logical nature. Finally, a large sample of NRWCs was utilized to test the validity and reliability of the scale, ensuring its robustness. In summary, this Perceived Social Support Scale for NRWCs is underpinned by a solid theoretical basis and supported by relevant literature. It also benefits from extensive expert input, an ample number of samples for reliability and validity tests, as well as a rigorous statistical analysis process.
The perceived social support scale for NRWCs had satisfactory validity and reliability. Validity refers to the accuracy of scale measurements’ results, while reliability pertains to their consistency and stability [36]. Content validity measures how well the scale items align with the measured content. In this study, expert consultation was conducted to evaluate content validity resulting in an S-CVI higher than 0.90 along with I-CVI values exceeding 0.78, indicating that each item effectively reflects postpartum nurses’ current social support situation thus confirming good content validity [26]. Construct validity aims at understanding the inherent properties of measurement tools. The EFA was employed in this study to explore variable structures revealing 4 common factors containing 4 to 5 items each with load values greater than 0.40 per factor without multiple loading issues present. Then, CFA was carried out to test the models derived from EFA, the results showed that all indicators met the ideal standard, which further proved that the factor structure model fitted the empirical data well, indicating that the construct validity of the scale was good [30]. Cronbach’s α coefficient is usually used as an indicator for internal consistency reliability. In this study, Cronbach’s α coefficients were above 0.85 of both the total scale and each dimension, exhibiting high levels of internal consistency. These findings indicate a strong correlation among items within dimensions, suggesting excellent homogeneity of the scale [32]. The short-term stability of the scale was tested by test-retest reliability. The correlation coefficients of the scale over four weeks were verified to be 0.809 for the overall scale and a range from 0.682 to 0.718 for each domain, indicating good temporal stability of scale responses [27].
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With the increasing of nurses and the two-child policy being carried out in China, the number of NRWCs has increased significantly. The interruption caused by maternity leave disrupts continuity in nursing work. When these nurses return after maternity leave, they often face challenges adjusting back into their roles such as conflicts between work and family responsibilities, inability to adapt quickly to clinical knowledge updates or workflow changes, difficulties coping with high-pressure working environments, fear of making mistakes, and so on [37]. Consequently, the NRWCs experience elevated work pressure leading to higher rates of attrition [5]. Studies have indicated that social support plays a crucial role in helping nurses cope with stressors associated with their job demands [16, 38, 39]. It is essential to assess the social support received by NRWCs. Compared to existing scales such as the SSRS, MSPSS and PSSQ, the perceived social support scale for NRWCs developed in this study aligns more closely with the characteristics of nursing work. For example, item 5 “During nursing work, I have adequate breastfeeding or pumping time.” considers whether NRWCs have time to pump milk during their busy nursing shifts. Item 13 “I can receive the necessary training for my postpartum return to work.” assesses whether NRWCs could receive training after interruptions in their nursing work. The items included in the perceived social support scale for NRWC cover all aspects of social support required by NRWCs and can comprehensively evaluate their level of social support. The two dimensions of “instrumental support” and “appraisal support” within this scale fully consider the unique circumstances faced by NRWCs. Therefore, the perceived social support scale for NRWCs developed in this study would be more suitable for NRWCs. Nursing managers can objectively assess the status of NRWCs using this scale and provide support, such as traditional mindfulness-based programs or technology-mediated online interventions, to NRWCs with low social support scores [40, 41]. It also would provide some research data in future applications for the improvement of a series of policies and regulations such as nurses’ “maternity leave” and “lactation time”.
This study has several limitations. First, the perceived social support scale for NRWCs developed in this study is a self-assessment scale, thus the measurement results may be not objective and could depend on the participant’s current perception. Therefore, the evaluation of NRWCs should be supplemented with objective investigations to use the results of the perceived social support scale for NRWCs objectively. Second, more than 80% of the NRWCs in this study were nurses from Grade I hospitals. Further research is needed to determine whether the scale is applicable to nurses in hospitals of other grades. Finally, the scale’ validity and reliability were tested on NRWCs from 12 provinces in China, which may present cultural barriers to its international applicability. Future studies should consider these limitations.
Conclusion
The perceived social support scale for NRWCs was developed in this study, comprising 18 items. The results of EFA and CFA demonstrated that the scale exhibited good construct validity with four dimensions: instrumental support, emotional support, appraisal support, and information support. The content validity, test-retest, and internal consistency reliability of the scale were satisfactory. It is suggested that this scale can be devoted to evaluating social support among NRWCs.
Acknowledgements
We thank all nurses returning to work after childbirth who participated in the study for giving their free time.
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Declarations
Ethics approval and consent to participate
This study was approved by the ethics committees of the Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology (TJ-IRB20220968). The informed consent was obtained from all participants.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
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