Development of the Uncertainty Scale for Women Hospitalized With High-Risk Pregnancies in South Korea

Published:November 03, 2021DOI:


      The purpose of the study was to develop the Uncertainty Scale for Women Hospitalized with High-Risk Pregnancies (USWHHP) and to evaluate its validity and reliability. The USWHHP was developed through four steps: generation of the initial items, evaluation of content validity, preliminary survey, and evaluation of validity and reliability in a sample survey. The final USWHHP scale includes 27 items in seven subdomains, which are scored using a 5-point Likert scale. The total possible score ranges from 27 to 135, and a higher score indicates a greater level of uncertainty. The USWHHP had a Cronbach’s alpha coefficient of 0.93. The USWHHP is an easy-to-apply questionnaire specifically designed to measure uncertainty levels of women hospitalized with high-risk pregnancies.


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        • Ahn T.G.
        • Hwang J.Y.
        Maternity care system for high risk pregnant women in obstetrically underserved area.
        Journal of the Korean Medical Association. 2016; 59: 436-442
        • Ahn T.G.
        • Kim T.
        • Kim Y.
        • Hwang J.Y.
        The current state of maternity care and suggestions for improvement in the management of high-risk pregnancies in South Korea.
        Journal of the Korean Society of Maternal and Child Health. 2018; 22: 134-141
        • Ashcroft T.J.
        Antecedents of uncertainty in women experiencing complications of pregnancy [Master’s thesis, Manitoba University].
        Manitoba University Research Repository. 1995;
        • Carter J.
        • Tribe R.M.
        • Shennan A.H.
        • Sandall J.
        Threatened preterm labour: Women’s experiences of risk and care management: A qualitative study.
        Midwifery. 2018; 64: 85-92
        • Çevik S.
        • Yağmur Y.
        Impact of intolerance of uncertainty on psychological well-being in pregnant women with or without miscarriage risk.
        Perspectives in Psychiatric Care. 2018; 54: 436-440
        • Cha K.
        • Kim K.
        Impact of uncertainty on resilience in cancer patients.
        Asian Oncology Nursing. 2012; 12: 139-146
        • Chuang L.L.
        • Liu S.C.
        • Chen Y.H.
        • Lin L.C.
        Predictors of adherence to relaxation guided imagery during pregnancy in women with preterm labor.
        Journal of Alternative and Complementary Medicine. 2015; 21: 563-568
        • Chung C.W.
        • Kim M.J.
        • Rhee M.H.
        • Do H.G.
        Functional status and psychosocial adjustment in gynecologic cancer patients receiving chemotherapy.
        Korean Journal of Women Health Nursing. 2005; 11: 58-66
        • Clauson M.I.
        Uncertainty and stress in women hospitalized with high-risk pregnancy.
        Clinical Nursing Research. 1996; 5: 309-325
        • Comrey A.L.
        Factor-analytic methods of scale development in personality and clinical psychology.
        Journal of Consulting and Clinical Psychology. 1988; 56: 754-761
        • Currie J.C.H.
        • Barber C.C.
        Pregnancy gone wrong: Women’s experiences of care in relation to coping with a medical complication in pregnancy.
        New Zealand College of Midwives Journal. 2016; 52: 35-40–40
        • da Silva K.D.L.
        • Fernandes F.E.M.
        • de Lima Pessoa T.
        • Lima S.I.V.C.
        • Oliveira A.G.
        • Martins R.R.
        Prevalence and profile of adverse drug reactions in high-risk pregnancy: A cohort study.
        BMC Pregnancy and Childbirth. 2019; 19 (Article 199)
        • DeVellis R.F.
        Scale development: Theory and applications.
        4th ed. Sage, 2016
        • Gourounti C.
        • Karpathiotaki N.
        • Vaslamatzis G.
        Psychosocial stress in high risk pregnancy.
        International Archives of Medicine. 2015; 8 (Article 95)
        • Hahn D.W.
        • Lee J.H.
        • Chon K.K.
        Korean adaptation of Spielberger’s STAI (K-STAI).
        Korean Journal of Health Psychology. 1996; 1: 1-14
        • Hilton B.A.
        The uncertainty stress scale: Its development and psychometric properties.
        Canadian Journal of Nursing Research. 1994; 26: 15-30
        • Hoglund E.
        • Dykes A.K.
        Living with uncertainty: A Swedish qualitative interview study of women at home on sick leave due to premature labour.
        Midwifery. 2013; 29: 468-473
        • Kang Y.H.
        Review on mid-range nursing theory: Uncertainty in illness theory.
        Korean Journal of Nursing Query. 2006; 15: 120-133
        • Kim H.
        • Park H.
        Health-care needs of high-risk pregnant women hospitalized in maternal-fetal intensive care units: A mixed-methods design.
        Korean Journal of Women Health Nursing. 2018; 24: 196-208
        • Kim H.Y.
        • Moon C.S.
        Integrated care center for high risk pregnancy and neonate: An analysis of process and problems in obstetrics.
        Korean Journal of Perinatology. 2014; 25: 140-152
        • Kim H.Y.
        • So H.S.
        A structural model for psychosocial adjustment in patients with early breast cancer.
        Journal of Korean Academy of Nursing. 2012; 42: 105-115
        • Kim S.H.
        • Cho Chung H.I.
        Stress, coping style and nursing needs for hospitalized pregnant women due to preterm labor.
        Korean Journal of Women Health Nursing. 2015; 21: 83-92
      1. Kim, S. N., & Cha, C. Y. (2018). Bed rest experience among high-risk primigravida. Academy of Qualitative Research, 19(1), 1–12.

        • Lynn M.R.
        Determination and quantification of content validity.
        Nursing Research. 1986; 35: 382-385
        • Mishel M.H.
        Uncertainty in illness.
        Journal of Nursing Scholarship. 1988; 20: 225-232
        • Moreira Rodrigues A.R.
        • Paiva Rodrigues D.
        • Moura da Silveira M.A.
        • de Maria Gomes Paiva A.
        • de Melo Fialho A.V.
        • Azevedo Queiroz A.B.
        Hospital admission in high-risk pregnancies: The social representations of pregnant women.
        Revista de Enfermagem Referência. 2020; 5 (Article e20040)
        • Nes L.S.
        Optimism, pessimism, and stress.
        in: Fink G. Stress: Concepts, cognition, emotion, and behavior. Elsevier Academic Press, 2016: 405-411
        • Oliveira D.
        • d. C.
        • Mandú E.N.T.
        Women with high-risk pregnancy: Experiences and perceptions of needs and care.
        Escola Anna Nery Revista de Enfermagem. 2015; 19: 93-101
        • Reed D.J.
        Coping with occupational stress: The role of optimism and coping flexibility.
        Psychology Research and Behavior Management. 2016; 9: 71-79
        • Rubarth L.B.
        • Schoening A.M.
        • Cosimano A.
        • Sandhurst H.
        Women’s experience of hospitalized bed rest during high-risk pregnancy.
        Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2012; 41: 398-407
        • Rubio D.M.
        • Berg-Weger M.
        • Tebb S.S.
        • Lee E.S.
        • Rauch S.
        Objectifying content validity: Conducting a content validity study in social work research.
        Social Work Research. 2003; 27: 94-104
        • Santini-Oliveira M.
        • Friedman R.K.
        • Veloso V.G.
        • Cunha C.B.
        • Pilotto J.H.
        • Marins L.M.S.
        • Grinsztejn B.
        Incidence of antiretroviral adverse drug reactions in pregnant women in two referral centers for HIV prevention of mother-to-child-transmission care and research in Rio de Janeiro, Brazil.
        Brazilian Journal of Infectious Diseases. 2014; 18: 372-378
        • Scheier M.F.
        • Carver C.S.
        • Bridges M.W.
        Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A reevaluation of the life orientation test.
        Journal of Personality and Social Psychology. 1994; 67: 1063-1078
        • Son H.J.
        • Park J.S.
        Relationship between preterm labor stress, fetal attachment and maternal role confidence in pregnant women with preterm labor.
        Journal of the Korean Society of Maternal and Child Health. 2014; 18: 86-96
        • Spielberger C.D.
        • Gorsuch R.L.
        • Lushene R.E.
        STAI manual for the state-trait anxiety, inventory.
        Consulting Psychologist Press, 1970
        • Statistics Korea
        2014 birth statistics.
        • Streiner D.L.
        • Norman G.R.
        • Cairney J.
        Health measurement scales: A practical guide to their development and use.
        Oxford University Press, 2015
        • Vitale S.G.
        • Laganà A.S.
        • Muscatello M.R.A.
        • La Rosa V.L.
        • Currò V.
        • Pandolfo G.
        • Bruno A.
        Psychopharmacotherapy in pregnancy and breastfeeding.
        Obstetrical & Gynecological Survey. 2016; 71: 721-733
        • Woodhart L.
        • Goldstone J.
        • Hartz D.
        The stories of women who are transferred due to threat of preterm birth.
        Women Birth. 2018; 31: 307-312


      Hyun Jin Kim, PhD, RN, is an assistant professor at Suwon Women’s University of Korea, College of Nursing, Republic of Korea.


      Hye-Ah Yeom, PhD, RN, ANP, is a professor at The Catholic University of Korea, College of Nursing, Republic of Korea.