Psychometric Properties of the Persian Version of Sound Sensitivity Symptoms Questionnaire: A Screening Measure for Hyperacusis and Misophonia.

The preparedness of the nursing workforce is a critical determinant of patient safety and healthcare quality, with academic performance serving as a key contributor to this preparedness. Self-efficacy plays a significant role in shaping the motivation and success of nursing students, necessitating the availability of valid and reliable instruments for its assessment. This study aimed to translate a multidimensional learning self-efficacy instrument for nursing students into Persian and evaluate its psychometric properties within the Iranian context. Employing a methodological design, the study recruited 450 nursing students through convenience sampling between September and December 2024. The instrument underwent translation/back-translation, with face validity (Impact Score > 1.5), content validity ratio (CVR = 0.8–1), and content validity index (CVI = 80–100%) established. Psychometric evaluation included construct, convergent, and discriminant validity, internal consistency, and test-retest reliability. Students from all academic years participated in construct validity testing through Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) using SPSS 24.0 and AMOS 24.0. EFA identified a five-factor structure explaining 73.43% of variance, supported by strong sampling adequacy (Kaiser-Meyer-Olkin = 0.87) and significant Bartlett’s test (p < 0.001). CFA confirmed model fit for the 21-item Nursing Learning Self-Efficacy (NLSE) instrument, with robust indices: Parsimonious Comparative Fit Index (PCFI = 0.75), Parsimonious Normed Fit Index (PNFI = 0.72), Incremental Fit Index (IFI = 0.93), and Comparative Fit Index (CFI = 0.93). Internal consistency (Cronbach’s α = 0.93) and test-retest reliability (Intraclass Correlation Coefficient = 0.89) were excellent. These findings establish the Persian version of the NLSE as a valid and reliable self-report instrument. By providing a culturally adapted instrument, this study equips nursing educators and researchers with a practical means to assess and enhance self-efficacy among nursing students, ultimately contributing to improved educational outcomes and a more competent nursing workforce capable of addressing Iran’s evolving healthcare demands.

Professional socialization is a critical process that influences hospital nurses' professional identity, competence, and ethical standards, ultimately impacting the quality of patient care. This study aimed to translate the Professional Socialization Scale (PSS) for Hospital Nurses into Persian and evaluate its psychometric properties among Iranian nurses. A cross-sectional methodological study was conducted in two phases: translation and psychometric evaluation. A stratified sample of 511 nurses from both public and private hospitals in Kermanshah City, Iran, participated in the study. The scale was translated into Persian using the Douglas and Craig model, and its content and face validity were assessed. Construct validity was evaluated through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The internal consistency of the scale was assessed using Cronbach's alpha and McDonald's omega coefficients, while test-retest reliability was evaluated using the intraclass correlation coefficient (ICC). The PSS scale maintained the meaning of the original English version and was clear and understandable for hospital nurses. In qualitative face validity, one item changed slightly and all items were retained in the quantitative face validity assessment. Each item's content validity ratio ranges from 0.71 to 1, the Item content validity index ranges from 0.79 to 1, while the Scale-level Content Validity Index was 0.89. The EFA and CFA confirmed a four-factor structure of the Persian version of the scale, with 21 items explaining 67.72% of the total variance. The model fit indices indicated excellent model fit. The scale demonstrated acceptable internal consistency (Cronbach's alpha = 0.908, McDonald's omega = 0.904) and test-retest reliability (ICC = 0.908). The Persian version of the PSS for Hospital Nurses is a valid and reliable instrument. Nursing managers should facilitate the professional socialization process for nurses. This scale can be used to assess the socialization of nurses and guide their career development.

This study describes translation, cross-cultural adaptation, and validation of the Attitude Towards Menopause (ATM) scale in Persian. A standard process was followed for translation and cross-cultural adaptation of the ATM scale into Persian. The content validity index and content validity ratio were used to measure content validity. The construct validity was tested using exploratory factor analysis and confirmatory factor analysis. The average variance extracted and construct reliability were used to indicate convergent and discriminant validity, respectively. Internal consistency and test-retest reliability of the Persian ATM scale were assessed using Cronbach α and intraclass correlation coefficient (ICC). A revised version of the ATM scale, including 26 items assigned to seven factors, was obtained in exploratory factor analysis. The factors were interpreted as negative affect, postmenopausal recovery, control of symptoms, sexuality, psychological losses, unpleasant confrontation, and menstrual freedom, explaining 66.18% of the total variance. The factor structure of the scale was confirmed using confirmatory factor analysis (Comparative Fit Index = 0.90, Tucker-Lewis Index = 0.88, Goodness-of-Fit Index = 0.90, Adjusted Goodness-of-Fit Index = 0.86, Root Mean Square Error of Approximation = 0.07, χ2 / df = 4.56). The values of Cronbach α coefficient and ICC indicated an acceptable level of reliability ( α = 0.70, ICC = 0.89). The construct reliability for all factors was more than or equal to 0.7 except for psychological losses, indicating good discriminating validity. The values of average variances extracted for subscales varied from 0.48 to 0.99, representing adequate convergent validity. The Persian version of the ATM scale is a reliable and valid tool to evaluate the attitudes of Iranian women toward menopause.

Children and adolescents with childhood-onset physical disabilities, including cerebral palsy (CP), face a significantly higher risk of developing mental health disorders due to factors such as reduced physical activity, participation limitations, sleep disturbances, pain, social isolation, rejection, bullying and victimization. Therefore, identifying mental health problems in this population is crucial for promoting their mental health and psychosocial well-being. This study aimed to investigate the reliability and construct validity of the self-report Strengths and Difficulties Questionnaire (SDQ) in children and adolescents with CP. The study included 120 children and adolescents with CP (mean age = 14.13 ± 2.2 years), representing the full spectrum of CP subtypes. Internal consistency was assessed using McDonald's omega (ω). Test-retest reliability was assessed using intraclass correlation coefficients (ICC) to estimate the level of consistency in scores for 50 children and adolescents who completed the SDQ again after 14 days. Three types of construct validity were assessed: factorial, convergent and known-group validity. Factorial validity was assessed based on the model fit of structural equation model-based confirmatory factor analysis (CFA). For CFA, the following fit indices were considered acceptable: a Root Mean Square Error of Approximation (RMSEA) < 0.08, a Goodness of Fit Index (GFI) ≥ 0.95 and a Standardized Root Mean Square Residual (SRMR) ≤ 0.08. Convergent validity was assessed by estimating correlations between the SDQ and Cerebral Palsy Quality of Life (CP QOL) scores using Pearson correlation coefficient (r). Internal consistency and test-retest reliability of both SDQ Total Difficulties Scale and SDQ Prosocial subscale were found to be acceptable (ω: 0.73-0.85; ICCs: 0.77-0.96). The SDQ's factor structure showed good fit (Total Difficulties Scale: RMSEA = 0.03, GFI = 0.95 and SRMR = 0.037; SDQ Prosocial: RMSEA = 0.025, GFI = 0.97 and SRMR = 0.066). Acceptable correlations between SDQ and CP-QOL scores (r = 0.53-0.93) supported convergent validity. Known-groups validity was confirmed, with children with CP showing significantly different SDQ scores compared to their TD peers (p < 0.05). Our findings provide evidence of adequate internal consistency reliability, test-retest reliability and construct validity for scores on the SDQ for children and adolescents with CP. ClinicalTrials.gov identifier: NCT06527508. This is the first study investigating the measurement properties of the self-report SDQ in children and adolescents with CP This study yielded satisfactory evidence for the factorial validity, convergent validity and known-group validity of the self-report SDQ, supporting its suitability as a tool for assessing the mental health status of children and adolescents CP aged 11-17 years. All items in the self-report SDQ were found to effectively measure the intended construct-mental health-demonstrating item homogeneity and supporting internal consistency The satisfactory agreement between SDQ scores obtained over a two-week interval demonstrated the instrument's temporal stability, indicating strong test-retest reliability.

This study aimed to assess the psychometric properties of the Farsi version of the Electroconvulsive Therapy-Related Anxiety Questionnaire (ERAQ). This methodological study was conducted among patients undergoing or with a history of Electro Convulsive Therapy (ECT) in Mashhad, Iran, during 2024-2025. Data were collected using a demographic profile form and the ERAQ. The questionnaire was translated into Farsi using the forward-backward translation method, and its face and content validity were assessed both qualitatively and quantitatively. To evaluate construct validity, exploratory factor analysis (n = 150) and confirmatory factor analysis (n = 150) were performed. Convergent validity was examined using Composite Reliability and Average Variance Extracted values, while discriminant validity was assessed through the Heterotrait-Monotrait ratio. Reliability was determined by estimating internal consistency through Cronbach's alpha and McDonald's omega coefficients. During exploratory factor analysis, item 9 was removed because its factor loading was less than 0.30, and the remaining 16 items were distributed across three factors: life disruption, socio-physical disruption, and memory disruption, which collectively explained 45% of the total variance. Confirmatory factor analysis demonstrated a good fit for the proposed model. All composite reliability, maximum reliability, and heterotrait-monotrait ratios supported the convergent and discriminant validity of the ERAQ. Additionally, Cronbach's alpha and McDonald's omega coefficients confirmed the acceptable internal consistency of the Farsi version of the ERAQ. Based on the findings of this study, the Farsi version of the ERAQ demonstrates sufficient validity and reliability to assess anxiety symptoms associated with ECT in the Iranian population.

IntroductionThe incidence of PCOS is notably elevated in Iran, making it crucial to examine the quality of life among these individuals. This study aimed to thoroughly evaluate the psychometric properties of the Iranian adaptations of the PCOSQoL-47 and PCOSQoL-42 questionnaires. The application of these tools is significant as they could enhance further research in in communities with similar social norms concerning marriage and sexuality.MethodsThis study employed a cross-sectional design. Following the linguistic validation of the Iranian adaptation of the PCOSQoL-47 and PCOSQoL-42, a panel of experts reviewed the items through an evaluation of the content validity index (CVI) and content validity ratio (CVR). Subsequently, a semi-structured interview was carried out to evaluate face validity. Consequently, discriminant validity was assessed using the known groups comparison. Convergent validity was evaluated by assessing the correlation between similar content on the PCOSQoL-47 and PCOSQoL-42, SF-12 and body image questionnaire. Responsiveness was assessed by comparing two scales scoring in baseline and eight-week follow-up data of prescription contraceptive Daine-35. In addition, reliability analyses including internal consistency and test–retest analysis were carried out.ResultsThe CVR in this study for the total scale was 0.98 for two scales, indicating a satisfactory result. The CVI for the scale was found to be 0.98 and 0.99 for PCOSQoL-42 and PCOSQoL-47, respectively suggesting that it had a good content validity. Known groups comparison revealed that the two scales effectively distinguished between sub-groups of women with varying symptoms specific to PCOS, thereby supporting their discriminant validity. Additionally, convergent validity was evaluated and, as anticipated, a strong positive correlation was observed between corresponding subscales of the two instruments. The paired t-test showed significant changes in PCOSQoL-47 and PCOSQoL-42 scores (p < 0.001) indicating as a responsive outcome measure to detect significant changes over time before and after treatment. Additional analyses indicated satisfactory results of PCOSQoL-42 for internal consistency (Cronbach’s alpha ranging from 0.72 to 0.78) and intraclass correlation coefficients (ranging 0.67 to 0.92; P < 0.05). regarding PCOSQoL-47, Cronbach’s alpha ranging from 0.80 to 0.82 and intraclass correlation coefficients (ranging 0.61 to 0.73; P < 0.05).ConclusionThe PCOSQoL-47 and PCOSQoL-42 have undergone thorough testing in Iran and may be utilized as outcome measures in forthcoming studies within this demographic.

BackgroundDigital health competence is increasingly recognized as a core competence for health care professionals. A comprehensive evaluation of knowledge, skills, performance, values, and attitudes necessary to adapt to evolving digital health technologies is essential. DigiHealthCom (Digital Health Competence) is a well-established instrument designed to assess digital health competence across diverse health care professionals.ObjectiveThis study aimed to translate and culturally adapt DigiHealthCom into simplified Chinese (Mandarin) and verify its reliability and validity in assessing digital health competence of Chinese health care professionals.MethodsDigiHealthCom was translated into Chinese following the guideline proposed by its original developers. The cultural adaptation involved expert review and cognitive interviewing. Internal consistency, test-retest reliability, content validity, convergent validity, discriminant validity, and factor structure were examined. Item analysis tested item discrimination, item correlation, and item homogeneity. Internal consistency was assessed using Cronbach α, and test-retest reliability was measured using the intraclass correlation coefficient. Content validity was assessed through both item and scale content validity indices. Convergent validity was measured by the Average Variance Extracted and Composite Reliability, while discriminant validity was measured by the heterotrait-monotrait ratio. A five-dimension model of DigiHealthCom was confirmed using confirmatory factor analysis.ResultsThe finalized Chinese version of the DigiHealthCom was completed after addressing differences between the back-translations and the original version. No discrepancies affecting item clarity were reported during cognitive interviewing. The validation process involved 398 eligible health care professionals from 36 cities across 15 provinces in China, with 43 participants undergoing a retest after a 2-week interval. Critical ratio values (range 16.05‐23.77, P<.001), item-total correlation coefficients (range 0.69‐0.89), and Cronbach α if the item deleted (range 0.91‐0.96) indicated satisfactory item discrimination, item correlation, and item homogeneity. Cronbach α for dimensions and the scale ranged from 0.94 to 0.98, indicating good internal consistency. The intraclass correlation coefficient was 0.90 (95% CI 0.81‐0.95), indicating good test-retest reliability. Item content validity index ranged from 0.82 to 1.00, and the scale content validity index was 0.97, indicating satisfactory content validity. Convergent validity (average variance extracted: 0.60‐0.79; composite reliability: 0.94‐0.95) and divergent validity (heterotrait-monotrait ratio: 0.72‐0.89) were satisfactory. Confirmatory factor analysis confirmed a well-fit five-dimension model (robust chi-square to df ratio=3.10, comparative fit index=0.91, Tucker-Lewis index=0.90, incremental fit index=0.91, root-mean-square error of approximation=0.07, standardized root-mean-square residual=0.05), with each item having a factor loading exceeding 0.40.ConclusionsThe Chinese version of DigiHealthCom has been proved to be reliable and valid. It is now available for assessing digital health competence among Chinese health care professionals. This assessment can be used to guide health care policy makers and educators in designing comprehensive and implementable educational programs and interventions.

IntroductionRecovery-oriented care in mental health is an increasing priority internationally, including in Iran. The Recovery Assessment Scale – Domains and Stages (RAS-DS) is widely used to assess personal recovery, but no validated Persian version exists. This study aimed to translate, culturally adapt, and evaluate the psychometric properties of the Persian version of the RAS-DS (P-RAS-DS) in Iran.MethodsThe study followed Beaton’s guidelines for translation and cross-cultural adaptation. Psychometric evaluation was conducted with 373 service users diagnosed with mental illness, recruited from psychiatric outpatient clinics in Tehran through convenience sampling. A cross-sectional design was used. Reliability was assessed using internal consistency (Cronbach’s alpha), test–retest reliability (intraclass correlation coefficient, ICC), standard error of measurement (SEM), and minimum detectable change (MDC). Content validity was assessed via the Content Validity Ratio (CVR) and Content Validity Index (CVI). Construct validity was evaluated through exploratory factor analysis (EFA), and Spearman’s rho was used to examine both convergent validity with the Warwick–Edinburgh Mental Well-being Scale (WEMWBS) and the Engagement in Meaningful Activities Survey (EMAS), and inter-factor correlations.ResultsService users had a mean age of 42.68 years (SD = 11.47) and were 41.3% female and 58.7% male. Two items were culturally modified during adaptation. The P-RAS-DS demonstrated excellent internal consistency (α = 0.940) and test–retest reliability (ICC = 0.941). SEM and MDC values were low (3.19 and 8.81, respectively), indicating good measurement precision. CVR and I-CVI values exceeded standard thresholds, supporting strong content validity. EFA extracted a four-factor structure (Self-determination and connectedness, Hope and Purpose, Personally valued activities, and Seeking support) accounting for 64.67% of the total variance. Inter-factor correlations ranged from weak to moderate (ρ = − 0.037 to 0.495), and self-determination and connectedness showed the strongest associations with other subscales and total score. Convergent validity was supported by moderate correlation with the WEMWBS (ρ = 0.582) and weak correlation with the EMAS (ρ = 0.268).ConclusionThe P-RAS-DS is a culturally appropriate, reliable, and valid instrument for assessing recovery in Persian-speaking individuals with mental illness. It can be used in clinical practice and research to evaluate personal recovery outcomes. Future research should include confirmatory factor analysis.Clinical trial numberNot applicable.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12888-025-07526-4.

The prevalence of depression in the community is high. Therefore, it is necessary to examine the information needs on depression in the community. This cross-sectional study aimed to translate and evaluate the psychometric properties of the Depression Information Needs Scale (DINS) among the general population. The translation and assessment of the validity and reliability of the DINS were conducted from February 2022 to May 2023 in Gonabad, Iran. The inclusion criteria in this study were individuals 18 years or older, those living in Gonabad for 1 year or more, and participants who provided written informed consent. Sample sizes of 546 and 629 were used for the exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), respectively. The reliability of the DINS was examined using three methods: McDonald's omega coefficient, test-retest reliability, and Cronbach's alpha coefficient. Most participants were women, had a bachelor's degree, and were married. The values of 0.959 for scale content validity index averaging (S-CVI/Ave) and 0.817 for content validity ratio (CVR) were calculated. In the EFA section, four factors with eigenvalues greater than 1 were extracted and explained 63.861% of the variance. Only two items were not placed in related or acceptable factors and were deleted. Finally, based on the results of the goodness-of-fit indexes (e.g., RMSEA = 0.074, CFI = 0.944, NFI = 0.930, and GFI = 0.911), the scale was approved with 18 items and 4 factors: lived experience (4 items), general (facts about depression) (6 items), research and policies (4 items), and specific treatments (4 items). For all the DINS items, the McDonald's omega coefficient, Cronbach's alpha coefficient, and Intraclass Correlation Coefficient (ICC) were 0.953, 0.950, and 0.957, respectively. The Persian version of the DINS was validated with 18 items and 4 factors, and this scale can be used to assess depression information needs in the general public and specific groups.

The Medication-Related Burden Quality of Life (MRB-QoL) is a patient-reported measure of medicines burden on functioning and well-being in people with long-term conditions (LTCs). The Arabic version has demonstrated good content validity; however, no data is available on its other psychometric properties. To evaluate the reliability and validity of the Arabic MRB-QoL tool. Four hundred patients (≥18 years) with LTCs were recruited from a tertiary hospital in the United Arab Emirates. Exploratory factor analysis (EFA) was performed using Principal Axis Factoring for extraction and Oblimin rotation. Cronbach's alpha, intraclass correlation coefficient (ICC), and minimum detectable change (MDC) assessed internal consistency, test-retest reliability, and measurement error, respectively. Structural, Known-group, convergent, and discriminant validity were evaluated using EFA, Mann Whitney U test, and Spearman's rank correlations tests, respectively. Convergent validity (r>0.3, moderate to high correlations) and discriminant validity (r<0.3, weak correlations) were examined through correlation with the Medication Regimen Complexity Index (MRCI), Drug Burden Index (DBI), and 12-item Short Form Health Survey (SF-12) measures. Known-group validity was assessed by comparing MRB-QoL scores across clinically diverse groups. EFA revealed a 31-item, four-factor structure accounting for 78.5% of the variance. Reliability results showed good internal consistency (Cronbach's α=0.973) and test-retest reliability (ICC=0.994). The MDC for the total MRB-QoL was 3.89, indicating that a change of more than 4 points between 2 measurements reflects a true difference with 95% confidence. There were weak correlations between domains of MRB-QoL and MRCI (r 0.120 to 0.152) indicating discriminant validity. Correlations between the mental component summary of the SF-12 and MRB-QoL (r=-0.387) and its domains (r -0.357 to -0.374) suggested convergent validity. Patients with polypharmacy and multimorbidity had higher median MRB-QoL scores, showing known-group validity. This study demonstrated that the Arabic MRB-QoL is a valid and reliable medication-related burden (MRB) measure with good construct validity, including structural, known-group, convergent, and discriminant validity. It also shows excellent reliability, with high internal consistency, low measurement error, and good test-retest reliability. These findings support its use as a psychometrically robust measure for assessing MRB and facilitating person-centred medicines optimisation services in Arabic-speaking populations.

PurposeThe brief negative symptoms scale (BNSS) is a concise instrument used to assess negative symptoms of subjects with schizophrenia covering five domains of negative symptoms and is suitable for use in clinical, experimental, and epidemiological settings. The original and translated version of BNSS has thus far been shown to have adequate psychometric properties. This study aimed to examine internal consistency, inter-rater and test-retest reliability, discriminant and convergent validity, and factor structure of the Japanese version of BNSS.Patients and methodsThe assessment was performed by 11 raters using interview videos of nine subjects. Reliability was calculated with Cronbach’s alpha for internal consistency and intra class correlation coefficient (ICC) for inter-rater reliability. Pearson’s correlation coefficients were calculated to estimate the test-retest reliability. In addition to BNSS, Scale for assessment of negative symptoms (SANS) and scale for assessment of positive symptoms (SAPS) was obtained to assess the convergent and discriminant validity. Factor structure was assessed using principle factor analysis.ResultsThe Japanese BNSS showed excellent internal consistency (Cronbach’s alpha=0.95), inter-rater reliability (intra class correlation coefficient=0.97), and test-retest reliability (r=0.94, p<0.001). The convergent validity shown by correlation with SANS total score (r=0.87, p<0.001) and discriminant validity shown by correlation with SAPS total score (r=0.17, p=−0.68) were also good. Principal factor analysis revealed a two-factor structure of BNSS, although the loading of each item differed from that in the literature.ConclusionOur pilot study demonstrated that Japanese BNSS had good psychometric properties which were achieved with relatively brief training. Further studies with more subjects and raters with various backgrounds recruited from multiple sites are warranted.

Objective To assess the psychometric properties of a new questionnaire evaluating patients’ confidence in managing their tinnitus, the 4C tinnitus management questionnaire (4C), which was designed to be used in the process of cognitive behavioural therapy. Design Retrospective cross-sectional based on patient records. Study samples 99 consecutive patients who sought help for tinnitus (with or without hyperacusis) from an audiology clinic in the UK. Pure tone average (PTA) hearing thresholds, Uncomfortable Loudness Levels (ULLs), and responses to the 4C questionnaire, Tinnitus Handicap Inventory (THI), Hyperacusis Questionnaire (HQ), and Screening for Anxiety and Depression in Tinnitus (SAD-T) questionnaire were gathered from the records of patients held at the audiology department. Results Cronbach’s alpha for the 4C was 0.91, indicating high internal consistency. Exploratory factor analysis suggested a one-factor solution. Discriminant validity was supported by weak correlations between 4C scores and PTA across ears and ULLmin (the across-frequency average ULL for the ear with lower average ULL). Convergent validity was supported by moderate correlations between 4C scores and scores for the THI, HQ, and SAD-T. Conclusions The 4C is an internally consistent questionnaire with high convergent and discriminant validity, which can be used to assess patients’ confidence in managing their tinnitus.

Apathy in Dementia: An Examination of the Psychometric Properties of the Apathy Evaluation Scale

BackgroundAlzheimer's disease (AD) is a progressive and debilitating disorder that strongly affects people with AD and their families. The changes in signs of the disease and its treatment lead to many challenges in people with AD that affect the performance and the ability of caregivers, their social life, and physical, emotional, and psychological aspects of caregivers' health. Therefore, this study was designed to develop and validate the Care Challenge Scale (CCS) for family caregivers of people with AD in the care context of Iran.MethodThis is a cross-sectional study, and the primary scale was based on 14 semi-structured interviews with family caregivers of Iranian people with AD. In the next phase, the psychometric features were assessed, including the face validity (qualitative and quantitative), content validity (qualitative and quantitative), item analysis, structural validity (exploratory and confirmatory factors), and construct validity (convergent and discriminant validity). Finally, the reliability was assessed using internal consistency (Cronbach's alpha, McDonald's omega coefficient, and the average inter-item correlation), stability (intraclass correlation coefficient), and absolute reliability.ResultsTotally, 435 Iranian family caregivers filled out online questionnaires, with a mean age of 50.26(±13.24) years. Based on the results of the qualitative phase, an item pool was generated with 389 items, and after deleting overlapping and unrelated items, the CCS with 14 items was created. The results of the quantitative phase showed that the CCS consists of two factors with 10 items each, which are named effective role-play challenge and lack of social–financial support, and they explained 42.23% of the total variance. Furthermore, the results of confirmatory factor analysis showed a good fitness of the scale structure model, and it had convergent and discriminant validity. The reliability indexes showed this scale has internal consistency and stability.ConclusionThe most care challenge among Iranian family caregivers of people with AD is effective role-play challenges and lack of social–financial support. The scale as designed has good validity, internal consistency, and stability that can be used by therapists, nurses, and researchers for the assessment of the challenges of this population.

Using Health-related quality of life (HRQL) in chronic patients with severe respiratory insufficiency (SRI) requires a valid instrument. Hence, this study aimed to translate and validate the Persian version of the Severe Respiratory Insufficiency Questionnaire in chronic patients with severe respiratory insufficiency. In this methodological study, the original version of the HRQL questionnaire in chronic patients with SRI was translated based on the approach presented by Wild et al. Face validity, content validity such as content validity index (CVI) and content validity ratio (CVR), convergent, and discriminant validity were evaluated. Moreover, construct validity evaluation was conducted by exploratory and confirmatory factor analyses (EFA & CFA).Reliability was also evaluated by calculating Cronbach's alpha and test-retest intraclass correlation coefficient (ICC). SPSS-16 and AMOS-24 software were used for data analysis. The target group approved the face validity of the questionnaire and the content validity index was 0.94. In total, 500 chronic patients with severe respiratory insufficiency participated in the construct validity. Seven factors were extracted in exploratory factor analysis as respiratory complaints, physical functioning, social relationship, anxiety, attendant symptoms and sleep, social functioning, and psychological well-being. These factors explained 73.91% of the total variance of the concept of HRQL in chronic patients with SRI. All factors confirmed in confirmatory factor analysis based on model fit indices [Comparative Fit Index (CFI)=0.94, Goodness of fit index (GFI)=0.94, Minimum Discrepancy Function by Degrees of Freedom divided (CMIN/DF) =2.99, and Root Mean Square Error of Approximation (RMSEA)=0.01]. Convergent and discriminant validity were also confirmed. Moreover, Cronbach's alpha coefficients of 0.84 and intraclass correlation coefficient of 0.82-0.96 with 15-day intervals confirmed the internal consistency of the instrument. According to the findings of the present study, the Persian version of the SRI questionnaire, with 7 subscales and 40 items, is a valid and reliable instrument to assess the HRQL in chronic patients with SRI.