Fields providing complex healthcare services, such as obstetrics and gynecology, require a strong foundation of knowledge as well as the use of advanced technology, problem solving, and critical decision making. All of these factors should be taken into consideration in women’s health nursing education while preparing students for clinical practice in order to ensure the safety and quality of care provided for both women/mothers and fetuses/infants [1, 3-5].

Some non-systematic practices arise in the training and testing of obstetric skills. Evaluation of cervical dilatation, amniocentesis, breech delivery, and management of shoulder dystocia can be taught as skill-development practices in obstetrics. The most essential element in labor is the assessment of fetal head level by vaginal examination. According to a study by Dupuis et al. [6], 88% of assistants and 67% of other health staff make mistakes while determining the level of a high fetal head. In the study by Maslovitz et al. [7], team performances of midwives and gynecology assistants in obstetric emergencies were assessed and it was found that the most frequent mistakes in obstetric emergencies were due to lack of clinical skills. Bambini et al. and Goldenberg et al. both reported that preclinical skill training leads to an increase in decision making in critical situations and in cognitive, psychomotor, communication, discussion, and teaching skills [9, 10].

Self-efficacy was first put forward within the scope of cognitive behavior change and a strong sense of individual competence has been found to be associated with better health, higher success, and more social integration [11]. The individual should believe that he or she has the necessary knowledge, skills, and abilities to fulfill a particular duty. If people are not convinced, or in other words, if they do not have a high enough sense of self-efficacy, they may never use the skills they were taught. People with a low sense of self-efficacy focus more on the probabilities of failure and how the difficulties that may arise can overcome their own abilities, which negatively impacts motivation [12]. People with a strong sense of self-efficacy tend to be more comfortable, confident, and strong in difficult times and periods of hard work. When they face failure, they attempt to eliminate the problem by trying harder [13].

Self-efficacy is defined as one’s belief about one’s capacity to manage and perform future actions or handle situations [13]. An individual’s feelings, thinking style, motivation, and actions are affected by self-efficacy beliefs. Expectations about self-efficacy determine the type of the activity, the amount of the effort, and the duration of the effort [14]. In short, self-efficacy can be defined as the awareness of and belief in an individual’s capabilities to overcome tasks related to any field [15]. General self-efficacy is defined as the individual’s belief about her or his capability to execute behaviors in a general or specific area, the latter also being known as specific self-efficacy [16, 17].

In the field of healthcare, the concept of self-efficacy has been considered as an important concept for nurses and midwives, who have essential roles in healthcare and the health improvement of society [18]. For this reason, determining gynecological intervention self-efficacy, as a specific type of self-efficacy, is vital for midwifery and nursing students. In a review of the literature, no measures could be found related to gynecological intervention self-efficacy for nursing and midwifery students. For this reason, it was decided to develop a gynecological intervention self-efficacy scale, the Obstetric Intervention Self-Efficacy Scale (OISES), in the present study. Differences according to department, grade level, and gender were also examined during the development of the OISES.

The results of this study proved that the OISES has a single factor with an eigenvalue of 14.79, explaining 67.21% of the total variance, respectively. The eigenvalue of a factor should be higher than 1.0 [19]. Thus, the OISES with a single factor has an acceptable eigenvalue.

In the related literature, item loadings lower than 0.30 [19] or 0.50 or 0.70 [20] could be a reason for item deletion. In this study, the OISES items’ factor loadings were all higher than 0.50, so no omission was necessary in the second EFA. This also shows that the factor loadings of the OISES items are acceptable.

In the literature, a reliability level of 0.60 or higher is acceptable for the reliability of a scale [21]. In this respect, the present reliability analysis results revealed that the reliability score of the OISES is quite high. Moreover, item analysis of the OISES was examined and the scale was found to have sufficient item discrimination powers. According to Büyüköztürk, values of 0.30 and higher for item-total correlations are acceptable [19]. As a result, the OISES is a valid and reliable instrument. This research is crucial for developing a new scale to measure the obstetric intervention self-efficacy of nursing and midwifery students.

Despite the higher values of validity and reliability scores, there are some limitations to this test construction study. For example, as no other scale to determine obstetric intervention self-efficacy was identified in the literature review, concurrent validity could not be studied. Moreover, the lack of test-retest reliability analysis is another limitation of the study. Future research can accordingly focus on the concurrent validity and test-retest reliability of the OISES.

The OISES scores of students were investigated according to gender, department, and grade level via independent samples t-test and Welch’s t-test with Tukey’s HSD in this study. The OISES scores of students varied according to gender. This result was reasonable, because all of the male students were in the nursing department and midwifery had no male students, and nursing students do not have lectures related to obstetric interventions.

The OISES scores also changed according to the department. The mean OISES score of midwifery students was significantly and statistically higher than that of nursing students. The scale items mostly consisted of obstetric intervention behaviors, while nursing students only have a few courses that touch upon obstetric nursing called “Women’s Health and Diseases”, “Perinatology”, and “Women’s Sexual Health”. Midwifery students, on the other hand, have many courses on these topics. For this reason, nursing students may not feel as competent about obstetric interventions as midwifery students do, and so students of the midwifery department may have relatively higher OISES scores than nursing department students. This result may be accepted as a kind of discriminant validity of the scale, because of the difference between nursing and midwifery curricula. In other words, the OISES aims to measure self-efficacy related to obstetric intervention skills, and because the nursing curriculum rarely covers such topics, the scale can discriminate between the obstetric intervention self-efficacy of nursing and midwifery students.

The results also showed that OISES scores of the students changed according to grade level. The OISES scores of the freshmen were the lowest, and seniors’ OISES scores were higher than those of students in their third, second, and first years. Interestingly, first-year students’ OISES scores did not significantly differ from those of second-year students. No related research on this topic was found in our literature review, but we may still suggest some explanations for these differences according to grade level. First, the difference between freshmen and the upper grade levels may arise from health intervention knowledge skills. The first-year students only take introductory courses and do not have courses related to intervention. It is thus reasonable to expect that students at higher grade levels may feel more self-efficient than those at lower grade levels, because as the timespan of the students’ health education increases, their intervention knowledge and experience also increase. The courses that they take also become more interventional and experiential as the grade level advances. This assumption is supported by our findings, except for the mean OISES score of sophomore students. While the mean OISES score of sophomore students was higher than that of freshmen, this difference was not statistically significant. Such a result might be related to specific characteristics of the second-year students or the sample as a whole, or the courses that sophomore students take. For example, first-year courses are English, Basic Principles and Applications in Nursing/Midwifery, Physiology, Anatomy, Microbiology, Physical Examination in Nursing/Midwifery, and Pharmacology. Almost all of these courses are theoretical and do not include intervention skills. In the second year, however, courses covering intervention skills and knowledge are given to the students of both departments. For instance, internal diseases, surgical diseases, women’s health and diseases, first aid and emergency care, pathology, histology, and infectious diseases are addressed. The second-year midwifery department students also take courses on normal pregnancy and medical care and basic principles and applications in midwifery. More experiential and interventional courses may help develop the self-efficacy of these second-year students, but it may not be enough to make a significant difference as they are taking such interventional courses for the first time in their curriculum. As this is an unexpected and interesting result, the OISES may be applied to all grade levels among samples of different midwifery and nursing students in future studies. Such interventional courses for the students cumulatively increase until they graduate, and so students may feel more confident about obstetric intervention as their grade levels advance and their interventional training accumulates. However, this is only applicable for midwifery students, because they have courses related to the obstetric field.

The OISES can be applied to all class levels among different midwifery and nursing student samples in future studies. It is thought that this will serve as a helpful evaluation tool and make new contributions to the literature.

The authors declare no competing interests.