Cross-cultural Adaptation and Validation of the Childbirth Fear Prior to Pregnancy Scale in Brazil

Kelly Jaqueline da Costa Galinari Tomazin1, Hélio Amante Miot1, Kathrin Stoll2, Ivana Regina Gonçalves3, Wilza Carla Spiri1, Tânia Roberta Limeira Felipe1, Milena Temer Jamas1, *
1 Department of Nursing, Botucato Medical School, São Paulo State University (Unesp), Av. Prof. Mário Rubens Guimarães Montenegro, 18618687, Botucatu, São Paulo, Brazil
2 Faculty of Medicine, University of British Columbia, 4500 Oak Street, Vancouver, Canadá
3 Clinical Hospital, São Paulo State University (Unesp), Av. Prof. Mário Rubens Guimarães Montenegro, 18618687, Botucatu, São Paulo, Brazil

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© 2021 Tomazin et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at São Paulo State University, Botucatu Medical School - Nursing Department., Av. Prof. Mário Rubens Guimarães Montenegro, S/N, 18618687, Botucatu, São Paulo, Brazil; Tel: +55 14 38801700; Fax: +55 14 38801328; E-mail:



The fear of childbirth can range from apprehension to intense fear (tokophobia), with serious consequences for maternal health. Therefore, a standardized scale is needed to measure the fear of childbirth before pregnancy.


This study aimed to adapt the Childbirth Fear Prior to Pregnancy (CFPP) scale to the Brazilian context and analyse its validity and reliability.


A cross-sectional survey was completed by 146 nursing students at two Brazilian universities. A committee of experts evaluated the cross-cultural adaptation of the CFPP scale. Construct validity was verified using item-total correlations and Exploratory Factor Analysis (EFA). The validity of divergent concurrent criteria was evaluated by associating the score obtained using the Brazilian CFPP with the Depression, Anxiety, and Stress Scale (DASS-21). Reliability was analysed using Cronbach’s alpha coefficient and test-retest.


Correlation analysis revealed a predominance of moderate inter-item correlation and strong item-total correlation (>0.62). The EFA indicated that all items related to a single factor, with factor loadings and communalities >0.5. These results reinforced the one-dimensionality of the Brazilian CFPP. The validity of divergent concurrent criteria was confirmed via weak correlations with DASS-21 scores (r = 0.32, p < 0.001). The Cronbach’s alpha (0.86) and the intra-class correlation coefficient (0.99) indicated reliability and strong temporal stability, respectively.


The Brazilian version of the CFPP provides evidence of validity and reliability to measure fear of childbirth before pregnancy in young adults in Brazil.

Keywords: Childbirth fear, Scale, Surveys and questionnaires, Validation studies, Psychometrics, Transcultural studies.