Determinants of childbirth self-efficacy among multi-ethnic pregnant women in Singapore: A structural equation modelling approach

Objective: This study aims to examine the relationships among sociodemographic and obstetric factors, fear of childbirth, psychosocial well-being and childbirth self-efficacy using a structural equation modelling approach. Design: It adopted an exploratory cross-sectional study among 205 multi-ethnic pregnant women in Singapore. We used structural equation modelling to examine our hypothetical model, which integrates the concepts of Bandura's self-efficacy theory and previous literature reviews. The Childbirth Self-Efficacy Inventory, the Childbirth Attitudes Questionnaire and the World Health Organisation (Five) Well-Being Index were employed to measure childbirth self-efficacy, fear of childbirth and psychological well-being, respectively. Findings: The structural equation model showed that multiparous women (beta = 0. 24, P < 0.01), with better psychological well-being (beta = 0.26, P < 0.001) were more likely to have higher childbirth self-efficacy; whereas Chinese women (beta = -0.32, P < 0.01) with previous caesarean section (beta = -0.17, P < 0.05) and higher fear of childbirth (beta = -0.30, P < 0.001) were more likely to have lower childbirth self-efficacy. The structural equation model had good fit with the data (incremental fit index = 0.925, Tucker-Lewis index = 0.911, comparative fit index = 0.923, and root means square error of approximation = 0.048). Conclusion: Findings of this study highlight that ethnic Chinese, multiparous women, previous caesarean section, psychological well-being and fear of childbirth were determinants of childbirth self-efficacy among pregnant women in Singapore. Enhancement of self-efficacy can increase coping ability and reduce fear of childbirth and thus promote normal childbirth. Future self-efficacy enhancing interventions among pregnant women should be tailored by age, ethnicity, parity and prior modes of birth. (C) 2020 Elsevier Ltd. All rights reserved.