Health Practices Questionnaire-II (HPQ-II)

Abstract

The Health Practices Questionnaire-II (HPQ-II) is a comprehensive self-report scale designed to assess a wide range of maternal behaviors and adherence to health recommendations during pregnancy. The instrument captures critical aspects of lifestyle, substance avoidance, nutrition, safety, and engagement with prenatal care providers. Developed as an evolution of the original Health Practices Questionnaire (HPQ), the HPQ-II is particularly useful in clinical and research settings for comparing health behaviors across different intervention groups, such as those receiving traditional care versus models like Centering Pregnancy.

The scale typically utilizes a five-point Likert-style response format to quantify the frequency of specific actions, allowing researchers to measure the degree to which expectant mothers engage in positive health practices or avoid risky behaviors. The HPQ-II provides a standardized method for quantifying behavioral changes and assessing the effectiveness of educational or clinical interventions targeting maternal and fetal health outcomes.

Keywords

Health Practices Questionnaire-II, HPQ-II, maternal health, pregnancy behaviors, prenatal care adherence, lifestyle assessment, self-report scale, obstetrics, risk behaviors, maternal-fetal health.

Authors

Kathleen Lindgren (Original HPQ), Kaylynn Shakespear (HPQ-II adaptation and application)

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Purpose

The primary purpose of the Health Practices Questionnaire-II (HPQ-II) is to systematically quantify and evaluate the frequency and quality of health behaviors adopted by women during their pregnancy. It serves as a crucial tool for researchers and clinicians seeking to measure adherence to recommended maternal health guidelines, identifying areas of risk, and tracking behavioral changes over the course of gestation.

By covering diverse domains—from physical activity and diet to substance use and utilization of prenatal care services—the HPQ-II allows for a detailed comparison of health outcomes related to different care models or demographic variables. The instrument helps distinguish between women who consistently engage in positive health practices and those who may require targeted educational or clinical support.

Construct

The HPQ-II measures the overarching construct of Maternal Health Practices and Behavioral Adherence during Pregnancy. This construct is recognized as multidimensional, encompassing both proactive health maintenance behaviors and the avoidance of known teratogenic or risky activities. The scale operationalizes this construct across several key sub-domains:

• Safety and Hygiene: Practices related to injury prevention (e.g., seat belt use), avoiding dangerous exposures, and personal hygiene (e.g., douching, dental care).
• Substance Avoidance: Frequency of use of harmful substances including alcohol, tobacco, illegal drugs, marijuana, excessive caffeine, and unrecommended herbs.
• Nutrition and Diet: Adherence to dietary recommendations, including adequate intake of fluids, fiber, calcium, vitamins, fruits, and vegetables, as well as appropriate weight gain.
• Lifestyle and Wellness: Engagement in positive behaviors such as exercise, adequate sleep (at least 8 hours), and relaxation activities.
• Prenatal Engagement: Behaviors reflecting active participation in prenatal care, such as timely initiation of care, attending visits, reporting concerns, and discussing medications/supplements.

Validity

While specific detailed validation studies for the HPQ-II (as used in the 2008 thesis) are often referenced back to the original HPQ (Lindgren, 2003), the instrument demonstrates strong Content Validity. The items included in the HPQ-II are directly derived from established public health recommendations and clinical guidelines for healthy pregnancy, ensuring that the scale measures behaviors relevant to the construct of maternal health practices.

Furthermore, the instrument exhibits Construct Validity through its application in comparative studies. For example, its use in comparing Centering Pregnancy participants against traditional care recipients (Shakespear, 2008) suggests that the scale is sensitive enough to differentiate between groups expected to exhibit variations in health behavior adherence, thus confirming its utility in measuring the intended construct.

Reliability

Detailed psychometric properties such as internal consistency (e.g., Cronbach’s Alpha) for the specific 35-item HPQ-II version used in the source content are typically reported in the primary validation article (Lindgren, 2003) or the subsequent research utilizing the scale. Generally, established health behavior questionnaires demonstrate acceptable to good reliability (Alpha > 0.70) across their subscales.

The consistency in the phrasing and the standardized Likert-type response scales across most items contribute to the overall Test-Retest Reliability when administered across short time intervals. Researchers should consult the foundational Lindgren (2003) paper for specific reliability coefficients for the original HPQ framework upon which the HPQ-II is based.

Factor Analysis

Specific details regarding the Factor Analysis of the HPQ-II are not explicitly provided in the secondary source material (Shakespear, 2008), which primarily uses the instrument for comparison rather than validation. However, given the broad range of behaviors covered, it is highly likely that the HPQ-II is a multi-factor scale, reflecting distinct dimensions of maternal health practices (e.g., Nutrition Factor, Substance Use Factor, and Prenatal Engagement Factor).

Exploratory or Confirmatory Factor Analysis would typically be employed during the development phase of such a scale to confirm that the items cluster into theoretically sound subscales. These subscales allow researchers to analyze specific areas of behavioral risk or strength, rather than relying solely on a single global health practice score.

Instrument

Test Type: Self-report scale/Questionnaire

Format: 35 items, primarily utilizing a 5-point frequency response scale (e.g., Never to Always/Daily), with one item requiring a check-all-that-apply response (Item 35) and one item requiring a quantitative response regarding alcohol consumption (Item 23).

Language Available: English (as presented in the source material).

Population Group: Pregnant women.

Age Group: Adult women of childbearing age.

Population Details: Used in studies involving women receiving prenatal care in various community settings (e.g., inner-city and small urban communities).

Test Methodology: The respondent is asked to report how often they perform a specific behavior during their pregnancy by selecting one answer from the provided options for each item.

Keywords

Prenatal health, maternal behavior, health promotion, risk assessment, Centering Pregnancy, obstetrics, health education, pregnancy outcomes, psychometric properties, self-report.

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Authors

Author ORCID Identifier: Not specified in source material.

Affiliation Email addresses: Not specified in source material.

Correspondence Address: Not specified in source material.

Permissions & Fee and Test Year

Permissions and Fee: Permissions must be sought from the primary author(s) of the original HPQ (Lindgren, 2003). The HPQ-II version referenced here was utilized in a publicly available Master’s thesis (Shakespear, 2008).

Test Year: The original HPQ was published around 2003 (Lindgren). The HPQ-II, as applied and detailed in the source content, was utilized in research finalized in 2008.

Reference’s

The instrument can be found on pages 79-83 of CENTERING PREGNANCY AND TRADITIONAL PRENATAL CARE: A COMPARISON OF HEALTH PRACTICES by Kaylynn Shakespear. The full document, which includes the HPQ-II instrument, is available online. The original document can be downloaded here: http://digitalcommons.usu.edu/cgi/viewcontent.cgi?article=1215&context=etd

• Lindgren‚ K. (2003). A Comparison of pregnancy health practices of women in inner-city and small urban communities. Journal of Obstetric Gynecologic and Neonatal Nursing‚ 32(3)‚ 313-321.
• Shakespear‚ Kaylynn. (2008). A thesis submitted in partial fulfillment of the requirements for the degree of master OF SCIENCE in Health‚ Physical Education and Recreation. UTAH STATE UNIVERSITY Logan‚ Utah.

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Items of the Health Practices Questionnaire-II (HPQ-II)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Below are questions about your behaviors during pregnancy. Report how often you perform that specific behavior using the five options. In this section‚ please choose only one answer.

1. How often do you practice a healthy lifestyle? Never‚ almost never‚ sometimes‚ almost always‚ always
2. How often do you get at least 8 hours of sleep a night? Never‚ almost never‚ sometimes‚ almost daily‚ daily
3. How often do you exercise at least 3 times per week? Never‚ almost never‚ sometimes‚ almost always‚ always
4. How often do you use a seat belt? Never‚ almost never‚ sometimes‚ almost always‚ always
5. How often do you drink more than 2 caffeinated beverages per day? Never‚ almost never‚ sometimes‚ almost daily‚ daily
6. How often do you use marijuana? Never‚ almost never‚ sometimes‚ almost daily‚ daily
7. How often do you use illegal drugs (other than marijuana)? Never‚ almost never‚ sometimes‚ almost daily‚ daily
8. How often do you engage in risky sexual practices (for example unprotected sex or multiple sexual partners)? Never‚ almost never‚ sometimes‚ often‚ frequently
9. How often do you report your concerns to your prenatal care provider? Never‚ almost never‚ sometimes‚ almost always‚ always
10. When you have questions‚ how often do you ask your prenatal care provider? Never‚ almost never‚ sometimes‚ almost always‚ always
11. When needed‚ how often do you discuss medication/supplement use with your prenatal care provider? Never‚ almost never‚ sometimes‚ almost always‚ always
12. How often do you use herbs that are not recommended? Never‚ almost never‚ sometimes‚ often‚ frequently
13. How often do you read food labels? Never‚ almost never‚ sometimes‚ often‚ frequently
14. How often do you douche? Never‚ almost never‚ sometimes‚ almost daily‚ daily
15. How often do you avoid excessively hot baths? Never‚ almost never‚ sometimes‚ almost always‚ always
16. How often do you avoid exposure to dangerous substances? Never‚ almost never‚ sometimes‚ almost always‚ always
17. How often do you take recommended vitamins? Never‚ almost never‚ sometimes‚ almost daily‚ daily
18. How often do you consume adequate amounts of calcium? Never‚ almost never‚ sometimes‚ almost daily‚ daily
19. How often do you consume at least five fruits/ vegetables a day? Never‚ almost never‚ sometimes‚ almost daily‚ daily
20. How often do you consume adequate amounts of fiber? Never‚ almost never‚ sometimes‚ almost daily‚ daily
21. How often do you smoke cigarettes? Never‚ almost never‚ sometimes‚ daily‚ multiple times per day
22. How often do you consume alcohol? Never‚ almost never‚ sometimes‚ almost daily‚ daily
23. How much alcohol do you consume‚ when you drink? Less than 1 drink‚ 1 drink‚ 2 drinks‚ 3 drinks‚ More than 3 drinks
24. How long had you been pregnant when you started prenatal care? Less than 1 month‚ 1 month‚ 2 months‚ 3 months‚ More than 3 months
25. Have often do you miss your prenatal care visits? Never‚ almost never‚ sometimes‚ almost always‚ always
26. How often do you receive regular dental care? Never‚ almost never‚ sometimes‚ almost always‚ always
27. How often do you engage in activities to learn about pregnancy/birth? Never‚ almost never‚ sometimes‚ almost always‚ always
28. How often do you discuss your pregnancy/birth with others? Never‚ almost never‚ sometimes‚ almost always‚ always
29. How often do you engage in relaxing activities? Never‚ almost never‚ sometimes‚ almost always‚ always Never‚ almost never‚ sometimes‚ almost always‚ always
30. How often do you seek to gain an appropriate amount of weight? Never‚ almost never‚ sometimes‚ almost always‚ always
31. How often do you drink adequate amounts of fluid? Never‚ almost never‚ sometimes‚ almost always‚ always
32. How often do you avoid the risks of toxoplasmosis? Never‚ almost never‚ sometimes‚ almost always‚ always
33. When suggested‚ how often do you attend a childbirth class? Never‚ almost never‚ sometimes‚ almost always‚ always
34. How valuable has your prenatal care been in during your pregnancy? not at all‚ slightly valuable‚ somewhat valuable‚ valuable‚ extremely valuable

35. Which of the behaviors have you adopted during your pregnancy? Check all the behaviors you have changed during your pregnancy.

• Getting at least 8 hours of sleep
• Exercising at least 3 times a week
• Wearing your seatbelt
• Drinking less than 2 caffeinated beverages a day
• Refraining from marijuana use
• Refraining from use of other illegal drugs
• Refraining from risky sexual practices
• Refraining from use of unrecommended herbs
• Reading food labels
• Not douching
• Not taking excessively hot baths
• Avoiding exposure to dangerous substances
• Taking recommended vitamins
• Consuming enough calcium
• Eating at least five fruits or vegetables each day
• Eating enough fiber each day
• Not smoking cigarettes
• Not consuming alcohol
• Receiving needed dental care
• Relaxation/ relaxing activities
• Seeking to gain an appropriate amount of weight
• Drinking adequate amounts of water