Cervical Cancer Literacy Assessment Tool (C-CLAT): Validation, Cultural Adaptation and Psychometrics Research

BackgroundPerceived care quality and patient satisfaction have been important care quality indicators in recent decades, and healthcare professionals have been influential on women’s childbirth experience. This study investigated the measurement properties of the Persian version of the Pregnancy and Childbirth Questionnaire (PCQ), designed to measure mothers’ satisfaction with the quality of healthcare services provided during pregnancy and childbirth.MethodsThis is a cross-sectional methodological study. Instrument translation, face validity, content validity, structural validity, and reliability evaluation were performed to determine the measurement properties of the PCQ’s Persian version. A backward-forward approach was employed for the translation process. Impact scores were selected based on the items’ importance to measure face validity. Content validity index (CVI) and content validity ratio (CVR) were calculated to measure content validity, and exploratory and confirmatory factor analyses were used to measure structural validity. The cluster random sampling method was used, resulting in a sample of 250 eligible women referred to the health centers of Tabriz, Iran, who were 4 to 6 weeks after giving birth. Cronbach’s alpha coefficient and Intraclass Correlation Coefficient (ICC) using a test-retest approach were used to determine the questionnaire’s reliability.ResultsThe impact scores of all items were above 1.5, which indicates a suitable face validity. The content validity was also favorable (CVR = 0.95, CVI = 0.90). Exploratory factor analysis on 25 items led to the removal of item 2 due to a factor loading of less than 0.3 and the extraction of three factors explaining 65.07% of the variances. The results of the sample adequacy size were significant (< 0.001, and Kaiser-Meyer-Olkin = 0.886). The model’s validity was confirmed based on the confirmatory factor analysis fit indicators (i.e., RMSEA = 0.08, SRMR = 0.09, TLI = 0.91, CFI = 0.93, x2/df = 4.65). The tool’s reliability was also confirmed (Cronbach’s alpha = 0.88, and ICC (95% CI) = 0.93 (0.88 to 0.95)).ConclusionThe validity and reliability of the PCQ’s Persian version were suitable to measure the extent to which Iranian women are satisfied with the quality of prenatal and intrapartum care.

BackgroundWomen with severe preeclampsia often present with more health complaints compared to those with uncomplicated pregnancies. Estimating the quality of life of women affected with severe preeclampsia could provide direction for further interventions. However, the current measurement of the quality of life has not been culturally adapted and validated for this population. This study aimed to translate, culturally adapt, and test the reliability and validity of the World Health Organization Quality-of-Life-Bref Scale (WHOQOL-BREF) in southern Ethiopia among women with severe preeclampsia.MethodsAn institutional-based cross-sectional study was conducted in southern Ethiopia in selected hospitals with randomly recruited women with severe preeclampsia. Cultural adaptation and validation techniques were used to translate and adapt the WHOQOL-BREF scale. Face, content validity, forward and backward translations, and synthesis were computed using an expert panel. The scale was pretested and adjusted accordingly. Internal consistency (Cronbach’s alpha) and test–retest reliability (Intraclass Correlation Coefficient = ICC) were examined. Confirmatory factor analysis (CFA) was computed to test the fit of the structure to the local setting before conducting exploratory factor analysis (EFA). Multiple methods for determining the number of factors extracted (scree test, eigenvalues) were used. We compared the original English structure with the new structure in the study setting and extracted a new structure using EFA.ResultsThe internal consistency reliabilities ranged from 0.8045 to 0.9123 indicating good-to-excellent reliability. The item‑level content validity ranged from 0.86 to 1.00; the scale‑level content validity index was 0.97. In CFA, the model fit indices were unacceptable (Comparative Fit Index (CFI = 0.87), Root Mean Square Error of Approximation (RMSEA = 0.23), Standardized Root Mean Square Residual (SRMR = 0.38), Tucker Lewis Index (TLI = 0.85) and (PCLOSE = 0.00). Three new factor structures were extracted using EFA for current research with a total variance was 91%.ConclusionsThe failure of the original scale in this study population highlights the importance of culturally adapting tool to local settings. EFA confirmed a three-factor structure, inconsistent with the original English structure.

BackgroundAbuse against women causes great suffering for the victims and is an important health problem among women. To date, a few screening instruments for wife abuse exist for married women in Iran, but they only assess some of the wife abuse components. The aim of this study was to investigate the psychometric properties and factor structure of the Haj-Yahia’s Questionnaire in a sample of married women residing in Tehran.Materials and methodsThis is a cross-sectional study with a population consisting of married women in Tehran, among which 471 individuals were selected using convenience sampling method. Psychometric properties of the questionnaire were evaluated using face validity, content validity, construct validity, internal consistency, and stability. Confirmatory factor analysis was performed using the weighted least square mean and variance adjusted. We performed confirmatory factor analysis using Mplus version 8 software and for other calculations, we used STATA V14.ResultsThe quantitative results of face validity and content validity indicated that all items of the questionnaire were in acceptable range, and were retained in the study. In CFA results, the model fit indices were acceptable (TLI = 0.986, CFI = 0.987, RMSEA = 0.039 and SRMR = 0.057). Cronbach’s alpha coefficient for psychological abuse, physical abuse, sexual abuse, and economic abuse were estimated 0.90, 0.93, 0.79, and 0.78 respectively, and an alpha of 0.95 was found for the total questionnaire. The intra-cluster correlation index was 0.98.ConclusionsFindings showed that the Persian version of the questionnaire of violence against women made it possible to evaluate various dimensions of violence using 4 factors and showed good construct validity and internal reliability in the female population in Iran; therefore, it can be used in future studies.

The Patient-Reported Outcomes Measurement Information System (PROMIS) aims to address the lack of generalizable and universal measure of patient-reported outcomes to assess health-related quality of life. It has not been validated for patients with chronic kidney disease. We aim to validate the PROMIS-57 and PROMIS-29 questionnaires among kidney transplant recipients. A cross-sectional sample of stable kidney transplant recipients was recruited. Each participant completed PROMIS-57, a 57-question instrument covering seven domains-physical function, anxiety, depression, fatigue, pain, sleep disturbance, and social functioning-alongside validated legacy questionnaires [Patient Health Questionnaire (PHQ9), General Anxiety Disorder (GAD7), Edmonton Symptom Assessment Scale revised (ESASr), and Kidney Disease Quality of Life (KDQoL-36)]. PROMIS-29, a 29-question instrument, is nested within PROMIS-57 and measures the same domains. Structural validity of PROMIS was assessed with confirmatory factor analysis, reported using the Comparative Fit Index (CFI). Construct validity was assessed with known-groups comparisons. Internal consistency was evaluated with Cronbach's α and convergent validity was assessed with Spearman's Rho. Test-retest reliability was assessed through the intraclass correlation coefficient (ICC). Mean (± SD) age of the 177 participants was 50 (± 17), 57% were male and 55% Caucasian. Internal consistency of each domain was high (Cronbach's α > 0.88). Confirmatory factor analysis showed good structural validity for most domains (CFI > 0.95, RMSEA < 0.05). Test-retest reliability indicated good agreement (ICC > 0.6). Known-groups comparisons by clinical and socio-demographic differences were foundas hypothesized. Our results provide evidence that PROMIS-57 and PROMIS-29 are highly reliable and valid instruments among kidney transplant recipients. We propose it as a valuable tool to assess important domains of the illness experience.

Background:Death and dying care is an area with less attention in nursing. This even is evidenced as more challenging in some populations such as neonates. Neonatal intensive care unit (NICU) nurses should be aware of the quality of care they provide for dying neonates and their families to find the areas which need attention.Objective:The aim of this study was to assess the psychometric features of the Quality of Dying and Death (QODD) questionnaire in NICU nurses in Tehran, the capital city of Iran.Methods:This methodological study was conducted in 2017. For this purpose, using census method, 130 NICU nurses working in selected hospitals participated. After the backward–forward translation, based on the method proposed by the International Test Commission, the psychometric properties of the Persian QODD were examined through the assessment of the face, content and construct validity, internal consistency, and stability.Results:Final Persian QODD's content and face validity were accepted through a qualitative method. In the confirmatory factor analysis, the original version of QODD was not confirmed. Subsequently, an exploratory factor analysis was carried out in which phrases were included in three dimensions (symptom control, preparation for death of neonate, and professional attention) that explained 75% of the variance. Cronbach's alpha values ranged from 0.82 to 0.88 for these three dimensions. The intraclass correlation coefficient (ICC) was ICC = 0.94 between two tests performed with a 2-week interval on twenty eligible nurses.Conclusions:The Persian version of QODD has acceptable psychometric properties in nurses working with the neonatal population and can be used to investigate the NICU nurses' opinion on the QODD provided in NICU patients.

The face and construct validity of the Iranian version of the Yale Food Addiction Scale (YFAS) was evaluated, and the convergent validity and test-retest reliability of both Iranian and original versions of YFAS for obese women were assessed. The internal consistency of the YFAS was analysed. Exploratory factor analysis for dichotomous data was performed by varimax rotation, polychoric correlation coefficients and confirmatory factor analysis (CFA). Convergent validity was established by evaluating the correlation between the original and the Iranian versions of YFAS and the Binge Eating Scale (BES). The intraclass correlation coefficient (ICC) was measured between test-retest results. A weight management clinic in Tehran. 450 obese women. The single-factor structure indicated that the factor loadings for all the items were > 0·5, except for three items (explained proportion variance = 51 %). Based on CFA, the single factor had a better fit to the data after excluding three items. The Kuder-Richardson-20 coefficient was 0·86 for the total twenty-two items. The symptom count and diagnostic version of both the Iranian (ICC = 0·92 and 0·87, respectively) and original YFAS (ICC = 0·92 and 0·86, respectively) were stable over 2 weeks. Both the symptom count and the diagnostic version of these two scales had significant correlations with the measures of BES (P < 0·001). The initial reliability and validity of the Iranian version of the YFAS among obese women are supported. Further studies should be conducted on men and normal/overweight samples.

BackgroundThis study is to evaluate swallowing problems (dysphasia) in multiple sclerosis (MS) patients; the importance of using tools that are durable and appropriate is well understood. One of the most trusted tools is the dysphagia in multiple sclerosis (DYMUS) test. The aim of this study was to prepare a Persian version and to evaluate the validity and reliability of the test.Materials and MethodsThis methodological study was conducted on 236 MS patients in Southeast of Iran from August 2015 to February 2016. After translation and cultural adaptation of the test in Persian, the validity of this test was determined using expert opinions accordance with the International Quality of Life Assessment Project. In addition, exploratory factor analysis (EFA) was performed with varimax rotation. The confirmatory factor analysis (CFA) was conducted and the goodness of fit indices was calculated. Moreover, to test the reliability, Cronbach's alpha coefficient and intraclass correlation coefficient (ICC) were used.Results:In total, 236 MS patients were included in the study (81 males and 155 females). All the questions in the test's Persian version obtained an acceptable face and content validity (content validity ratio = 1, Scale content validity index/Ave = 1). EFA revealed that the scale has two factors (solid–liquid) with 67.5% cumulative variance. CFA indicated a good fit to the intended two-factor structure, and the ratio of Chi-square to the degree of freedom was 1.79, and the root mean square error of approximation was 0.058. The internal consistency of total test indicated the appropriate level (Cronbach's alpha coefficient = 0.775), and test–retest reliability total questionnaire was found to be ICC = 0.985, indicating its high reliability.Conclusion:The results of this study indicated that the Persian version of the DYMUS questionnaire had good reliability and validity for patients with MS.

Lack of perceived support and control during labor and childbirth is known as an important predictor of post-traumatic stress disorder following childbirth. However, there is no standard scale to measure perceived support and control for Iranian women. This study determined the validity and reliability of the support and control in birth questionnaire for Iranian women. Support and control in the birth questionnaire were translated into Persian by the forward and backward translation method in 2019. Among a total of 102 healthcare centers in Tabriz, 50 urban and 10 rural centers were selected randomly. Then, 660 women with vaginal childbirth during the postpartum period were extracted by each center and selected randomly. The validity of the Persian version was evaluated in terms of face, content, and construct validity. Internal consistency and reliability were assessed by Cronbach's alpha coefficient and intraclass correlation coefficient, respectively. Exploratory and confirmatory factor analyses were used for evaluating the construct validity of the tool. Cronbach's alpha coefficient (0.95) and intraclass correlation coefficient (0.99) were acceptable. In an exploratory analysis, three factors were extracted and these three factors explained 63.1% of the total variance. Items 14 and 17 were removed from the Persian version due to low factor loading and impact factor values. Confirmatory factor analysis supported the three factors extracted in the exploratory analysis. Confirmatory factor analysis showed suitable indexes of fitness for 31 items. Persian version of the support and control in the birth questionnaire is a valid and reliable tool for the Iranian women population.

Determinants and motives related to food selection have evolved in a globalized and changing world. The traditional and useful Food Choice Questionnaire (FCQ), created in 1995, needs to be updated, adapted to new scenarios, and validated. This study aimed to: (1) assess face validity (FV) of the original 36-item FCQ, (2) generate an Updated-FCQ (U-FCQ) and assess its content validity (CV) (instrument suitability), and (3) evaluate its construct validity and reliability in a Spanish-speaking population from Mexico. FV involved a panel of nutrition professionals (NPs) rating the original items' clarity, relevance, specificity, and representativeness. A literature review process updated the FCQ by adding new items. CV with a second NP panel allowed calculating content validity ratio (CVR). Construct validation was performed via exploratory and confirmatory factor analysis (EFA-CFA). Internal consistency through Cronbach's alpha (CA) and test-retest reliability via intra-class correlation (ICC) were assessed. The FV (n = 8) resulted in the modification of 11 original items. The literature review added 36 new items (15 from previous adaptations and 21 original items). The CV (n = 13) identified nine items (non-acceptable CVR), prompting reformulation of seven and removal of two. The NPs' feedback added six new items. The EFA-CFA (n = 788) developed a 75-item U-FCQ with eight dimensions: sensory appeal, mood, health and nutritional content, price, food identity, environmental and wildlife awareness, convenience, and image management. CA ranged from 0.74-0.97 (good-excellent) and ICC from 0.51-0.78 (moderate-good). This study provides a useful instrument for the assessment of food choices and lays the groundwork for future cross-cultural comparisons, expanding its applicability in wider settings.

BackgroundGestational diabetes mellitus (GDM) is a condition with significant prenatal and postnatal implications. This study aimed to validate the Summary of Diabetes Self-Care Activities (SDSCA) measure in Iranian women with GDM, focusing on its psychometric properties.MethodsThe Persian version of the SDSCA was evaluated in 180 Iranian women with GDM. Following COSMIN guidelines, the instrument was translated into Persian, and its psychometric properties were assessed, including content validity, face validity, construct validity, internal consistency, test-retest reliability, measurement error, responsiveness, and interpretability. Floor and ceiling effects were also examined.ResultsThe validity assessments showed strong content validity, with a Content Validity Index (CVI) of 0.93 and a Content Validity Ratio (CVR) of 0.97. Face validity yielded an impact score of 4.38. Exploratory factor analysis (EFA) identified three factors—diet, exercise, and blood sugar testing—accounting for 57.4% of the variance. Confirmatory factor analysis (CFA) confirmed the model’s excellent fit (CFI = 1.00, TLI = 0.99, NFI = 0.98, RFI = 0.96). The reliability analysis showed a Cronbach’s alpha of 0.78 and a McDonald’s omega of 0.91, with an intraclass correlation coefficient (ICC) of 0.92 (95% CI: 0.83–0.96). Ceiling effects were observed for blood sugar testing (26.7%), while floor effects were noted for exercise (6.7%) and blood sugar testing (6.1%). The Minimal Important Change (MIC) of 2.68 units exceeded the Smallest Detectable Change (SDC) of 1.11 units, indicating the tool’s ability to detect clinically meaningful changes.ConclusionsThe Persian version of the SDSCA demonstrates strong psychometric properties, including both reliability and validity, making it a suitable tool for assessing self-care behaviors in Iranian women with GDM. Its use in future research can enhance understanding of self-management in this population.

BackgroundThe exclusive breastfeeding (EBF) is undeniably proven significant in mothers’ health and infants’ growth and survival. Its persistence has many familial, social, and economical benefits. Social support is known to be an effective factor in EBF’s success and sustainability. However, Exclusive breastfeeding social support (EBFSS) scale validity and reliability is not evaluated in Iran. This study aimed to determine the psychometric properties of EBFSS during postpartum period in Tabriz city, Iran.MethodsIt is a cross-sectional study with descriptive survey method performed between March 2021 and August 2022. Psychometric properties were determined for the Persian version of EBFSS in six stages: translation process, evaluating content validity, face validity, construct validity, discriminant validity, and reliability. A group of experts (n = 10), followed by a group of women with EBF (n = 10), evaluated the instrument’s items based on content and face validities, respectively. A cross-sectional study using the multi-stage cluster random sampling method on 348 women with EBF in the first four months after delivery was conducted to determine the construct validity. The internal consistency and repeatability (test-retest on 30 women, 2 weeks apart) were used to find out the reliability.ResultsContent validity ratio (CVR), content validity index (CVI), and impact score were 0.98, 0.98, and 3.54 for EBFSS, respectively. This indicates a good content and face validity. Exploratory factor analysis (EFA) was performed on 16 items to examine the construct validity identified emotional, instrumental, and informational factors. These factors explained 59.26% of the cumulative variance. The fit indices (CFI = 0.98، TLI = 0.95، χ2/df = 4.20، RMSEA = 0.07 and SRMSEA = 0.05) confirmed the validity of the model in a confirmatory factor analysis (CFA). The internal consistency was examined through Cronbach’s alpha and McDonald’s omega coefficients that were 0.90 and 0.92, respectively. Finally, Repeatability and reproducibility were found 0.97 (95% CI: 0.92 to 0.99) using Intra-class correlation. This shows an appropriate reliability of the instrument.ConclusionsThe research findings indicate that the Persian version of the EBFSS has appropriate psychometric properties for evaluating the social support in Iranian women with EBF. This means healthcare providers can use it for screening social support in EBF. Researchers also can use it as a valid instrument.

Is there a Gulf War syndrome?

Forensic entomology research in Malaysia started in the 1950s but research in this field is still scarce and limited to a few institutions. The objective of this study is to develop and validate a selfconstructed questionnaire of the knowledge and perception of forensic entomology. A cross-sectional validation study among health-related undergraduate students was conducted at Universiti Teknologi MARA (UiTM) in Selangor, Malaysia. The knowledge and perception questionnaire on forensic entomology underwent a content development and validation process through a pilot and a fieldtesting study. Psychometric properties have been explored using Principal Component Analysis (PCA) with Varimax rotation, scree plot, eigenvalues, Monte Carlo simulation, suppress small coefficients value below 0.40, communalities, inter-item correlation, internal consistency, and test-retest analyses. The content of the knowledge and perception questionnaire for forensic entomology were conceptually equivalent. The questionnaire was refined after face validation by five students. The pilot testing was conducted on 30 students. The refined version was then field-tested among 232 students. The KaiserMeyer-Olkin KMO test was 0.868, and Bartlett’s test of sphericity was ≤ 0.001, indicating sampling adequacy. Two factors were identified which are knowledge and perception. The Cronbach’s alpha for knowledge and perception was 0.939 and 0.819, respectively. The intra-class correlation coefficient (ICC) ranged from 0.493 to 0.923. The knowledge and perception questionnaire for forensic entomology is valid, reliable, and fairly stable over time. This questionnaire could be used to evaluate the levels of knowledge and perception on forensic entomology among undergraduate students in Malaysia.

BackgroundBreast cancer is a prevalent cancer characterized by its aggressive nature and potential to cause mortality among women. The rising mortality rates and women’s inadequate perception of the disease’s severity in developing countries highlight the importance of screening using conventional methods and reliable scales. Since the validity and reliability of the breast cancer perception scale (BCPS) have not been established in the Iranian context. Therefore, this study aimed to determine the measurement properties of the BCPS in women residing in Tabriz, Iran.MethodsThe present study comprised a cross-sectional design, encompassing a sample of 372 Iranian women. The participants were selected through a multi-stage cluster random sampling technique conducted over a period spanning from November 2022 to February 2023. The measurement properties of the Iranian version of BCPS were assessed following the guidelines outlined in the COSMIN checklist. This involved conducting various steps, including the translation process, reliability testing (internal consistency, test-retest reliability, and measurement error), and methodological tests for validity (content validity, face validity, construct validity, and hypothesis testing). The study also investigated the factors of responsiveness and interpretability. The presence of floor and ceiling effects was assessed.ResultsThe internal consistency of the scale was assessed using Cronbach’s alpha, yielding a satisfactory value of 0.68. Additionally, McDonald’s omega (95% CI) was computed, resulting in a value of 0.70 (0.66 to 0.74). Furthermore, the test-retest reliability was evaluated, revealing a high intraclass correlation coefficient (ICC) of 0.97 (95% CI: 0.94 to 0.99). The CVI, CVR, and impact scores of the BCPS were determined to be 0.98, 0.95, and 3.70, respectively, indicating favorable levels of content and face validity. To assess construct validity, an examination of the Exploratory Factor Analysis (EFA) was conducted on a set of 24 items. This analysis revealed the presence of six distinct factors, which collectively accounted for 52% of the cumulative variance. The fit indices of the validity model (CFI = 0.91, NFI = 0.96, RFI = 0.94, TLI = 0.90, χ2/df = 2.03, RMSEA = 0.055 and SRMR = 0.055) were confirmed during the confirmatory factor analysis (CFA). The overall score of BCPS exhibited a ceiling effect of 0.3%. The floor effect observed in the overall score (BCPS) was found to be 0.5%. Concerning the validation of the hypothesis, Spearman’s correlation coefficient of 0.55 was obtained between the BCPS and the QLICP-BR V2.0. This correlation value signifies a statistically significant association. Furthermore, it is worth noting that the minimum important change (MIC) of 3.92 exhibited a higher value compared to the smallest detectable change (SDC) of 3.70, thus suggesting a satisfactory level of response.ConclusionsThe obtained findings suggest that the Iranian version of the BCPS demonstrates satisfactory psychometric properties for assessing the perception of breast cancer among Iranian women. Furthermore, it exhibits favorable responsiveness to clinical variations. Consequently, it can serve as a screening instrument for healthcare professionals to comprehend breast cancer and as a reliable tool in research endeavors.

Background:The Pelvic Girdle Questionnaire (PGQ) is a tool designed to evaluate pain and disability in pregnant women with pelvic girdle pain (PGP). This study was conducted with the aim of translating and determining the psychometric properties of PGQ in pregnant women in Iran.Materials and Methods:The present methodological cross-sectional study was conducted on 150 pregnant women living in Tehran in 2017. The original English version of PGQ was translated into Persian version after the permission of the tool designer using the back-translation method. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) methods were used to determine the construct validity, as well as Cronbach's alpha and intraclass correlation coefficient (ICC) to determine the reliability of the questionnaire.Results:The results of factor analysis showed that the study of this scale consists of two extracted subscales as activities and symptoms. EFA and CFA confirmed two factors that determined 70.22% variance. Furthermore, findings showed that high internal consistency with Cronbach's alpha = 0.961, for the total score of instrument and for the factors, ranged from 0.87 to 0.91. Cronbach's alpha symptoms and activities and total were 0.91, 0.87, and 0.87, respectively. ICC of symptoms and activities and total was 0.91 (95% confidence interval [CI]: 0.88–0.93), 0.81 (95% CI: 0.66–0.92), and 0.83 (95% CI: 0.68–0.93), respectively.Conclusion:The Persian version of PGP, as a valid and reliable tool, has the potential for studying and evaluating the activity and symptoms of PGP in pregnant women in Iran.