Development and validation of the infertility self-efficacy scale

Abstract

This study aimed to develop and validate a scale of perceived self-efficacy in people coping with infertility treatment. Self-efficacy is a psychological construct related to social learning theory that posits that an individual's perceived self-confidence to perform a certain behavior in a specific situation can mediate adaptive behaviors. For people choosing infertility treatment, self-efficacy related to various domains, such as managing the demand of treatment, or communicating with one's partner, provider, social network, has clinical and empirical relevance. Measurement development. Phase I included initial development and construct validity. Based on suggestions from the literature, professional experts, and focus groups with infertility patients, a 76-item pool was generated containing statements related to infertility treatment self-efficacy. The Infertility Self-Efficacy Scale (ISE) was subject to expert ratings by 8 reproductive health experts to assess the relative importance of each item for inclusion. Ninety-three individuals, who have experienced infertility treatment in the past two years, were administered the scale using a 1–9 Likert scale (not at all confident to extremely confident) along with three measures with related constructs to self-efficacy. Examples of ISE items include (I feel confidant I can…): Handle weight gain caused by hormonal treatments; Lessen anxiety about giving or receiving injections; Accept that our best efforts may not change my/our infertility; Stay in relationships with others who have infants or small children; Be romantic and intimate with my partner; Feel comfortable with my medical treatment plan. Phase 2 included concurrent validity and test/retest reliability. Fifty participants took the refined version ISE and were randomly assigned to either a concurrent validity group or concurrent validity/rest-retest reliability group. A final phase of confirmatory analyses and predictive validity will be assessed in a clinical field trial. Phase I participants were recruited from fertility clinics and infertility-related Internet portals, and included 76% women, 11% minorities, and 76% with primary- and 23% with secondary infertility. Similar profiles are targeted for remaining phases. An initial review of the repsonse distributions, content considerations, including expert ratings and commentary, and preliminary factor analyses suggested a 21-item scale comprising 5 factors for the ISE: self care (α=.87), affect regulation (α=.83), provider relationship (α=.76), treatment management (α=.76), and partner relationship (α=.73). The preliminary scale's internal consistency is excellent (Cronbach's α=.92). Construct validity is consistent and statistically significant. The psychosocial challenges associated with infertility treatment are unique to this medical problem and attending to these issues are relevant to optimizing patients' ability to manage the treatment experience. Existing mental health measures tend to be problem- or distress focused. In contrast, self-efficacy taps an individual's sense of confidence, or lack of, related to health promotion. As such, the ISE may be useful in clinical research and as a clinical tool to help guide patients in pro-actively managing their infertility experience.