Structural Validity of a Postpartum Care Center Evaluation Scale: An Exploratory Factor Analysis-Confirmatory Factor Analysis Approach

Purpose: This study examined the structural validity of a 6-domain evaluation framework for postpartum care centers in South Korea to assess whether the existing domain classification reflects the underlying factor structure of the indicators.Methods: The instrument initially comprised 98 indicators across 6 domains. Exploratory factor analysis (EFA) was conducted using 305 assessment records (2019–2023) to identify the latent structure, and the results informed an expert workshop for indicator refinement. Confirmatory factor analysis (CFA) was performed using 29 subdomainlevel aggregate scores derived from the refined 83-item structure and data from 355 postpartum care centers (2019–2025) to evaluate the model fit and factor loadings of the 6-domain structure.Results: EFA suggested a 6-factor structure that was interpretable and broadly consistent with, although not fully replicating, the predefined domains (KMO=0.945). Indicator refinement reduced the total number of items from 98 to 83, retaining 12 mandatory indicators in the final structure. The CFA using 29 subdomain-level aggregate scores demonstrated an acceptable model fit (comparative fit index=0.922, Tucker-Lewis index=0.912, root mean square error of approximation=0.073, standardized root mean square residual=0.051). Most subdomain-level observed variables showed standardized factor loadings above 0.50, supporting the 6-domain structure, although several variables showed relatively low loadings. The interfactor correlations were uniformly high, indicating that the domains functioned as an integrated rather than orthogonal system.Conclusion: The 6-domain framework demonstrates acceptable structural validity. High interdomain correlations suggest that postpartum care services operate as an integrated system, highlighting the need for future revisions to account for cross-domain interdependencies.