Psychometric properties of a 20-item version of the Maternal–Fetal Attachment Scale in a sample of Italian expectant women

Objective: the Maternal-Fetal Attachment Scale (MFAS), a 24-item self-report questionnaire to measure the antenatal maternal feeling towards the unborn baby, was introduced by Mecca Cranley in 1981. Despite the widespread use of the questionnaire in clinical and research contexts, issues exist about its psychometric properties. An analysis of the literature showed the need for studies aimed at reviewing the MFAS by eliminating some items and modifying and "modernising" others. This study started from these suggestions and aimed to investigate the psychometric properties of a modified 20-item Italian version of the scale. Design: the original MFAS was back translated and then administered to a pilot sample of 20 pregnant women in order to identify items hard to understand, inappropriate or ambiguous. On the basis of qualitative information derived from this pilot phase, we developed a 20-item Italian version of the MFAS that was later administered to a large sample of pregnant women. Setting: antenatal education classes carried out in public and private structures of Italian central and insular regions. Participants: a sample of 482 women in middle and late pregnancy, attending antenatal education classes between February 2013 and October 2014. Measurements: the modified MFAS was administered together with other scales measuring maternal-fetal attachment, psychological well-being, relational variables. Internal consistencies were evaluated using Cronbach׳s alpha. Nomological validity was assessed via Pearson correlations. Exploratory and confirmatory factor analyses were used to test the factor structure. Findings: the hypothesised relationships with external criteria were partially substantiated. Exploratory factor analyses suggested a three-dimensional structure. Confirmatory factor analyses provided general support for an oblique three-factor model. Internal consistency was adequate for the total scale and for two of the three subscales. Key conclusion and implications for practice: the 20-item Italian version of the MFAS is a reliable measure of maternal attachment to the fetus in Italian women. Cranley׳s five dimensions were not confirmed; instead, three factors emerged that could be renamed ׳Future parental roletaking׳, ׳Present interaction with the baby׳ and ׳Giving of self and responsibility to the unborn child׳. As maternal-fetal attachment is considered a predictor of the quality of the postnatal mother-child relationship, the MFAS could be a helpful tool in pre- and perinatal research and midwifery care to develop prevention programs based on women specific needs. Moreover, the availability of this questionnaire can assist in expanding research and in facilitating trans cultural comparison in issues related to pregnancy.