Infertility Self-Efficacy Scale Research Articles

A Chinese version of the infertility self-efficacy scale: Reliability and validity assessment

ObjectiveTo translate, cross-culturally adapt and test the reliability and validity of a Chinese version of the Infertility Self-Efficacy scale. MethodsThe Infertility Self-Efficacy (ISE) scale was translated into Chinese using forward and backward translations, expert consultation, cognitive interviews and a pilot study. To test the scale's reliability and validity, 515 infertile women in two hospitals were recruited to evaluate the Chinese version of the scale. Content validity was assessed by means of expert consultation. Exploratory factor and confirmatory factor analyses were performed using SPSS 26.0 and Amos 24.0. Reliability tests of the scale included Cronbach's alpha coefficient, split-half reliability and test-retest reliability. ResultsThe Chinese version of the ISE scale contains 16 items and one dimension. Content validity of the scale was 0.96. Results of exploratory factor analysis suggested that the one factor model was suitable for the scale, and factor loading of all items was greater than 0.4. Model fitting parameters of confirmatory factor analysis of the ISE scale were χ2/df = 2.710, Root Mean Square Error Approximation (RMSEA) = 0.079, Standardized Root Mean Square Residual (SRMR) = 0.042, Comparative Fit Index (CFI) = 0.953, and Tucker–Lewis Index (TLI) = 0.939. Cronbach's alpha coefficient of the Chinese ISE was 0.980; split-half coefficient was 0.972 and retest reliability was 0.848 (P < 0.01). ConclusionThe Chinese ISE scale is a reliable and valid instrument to evaluate the self-efficacy of infertile Chinese women.

Learning from Online Video Education (LOVE) improves confidence in fertility treatments: a randomized controlled trial

Fertility treatments like in vitro fertilization (IVF) or oocyte cryopreservation (OC) require the daily use of injectable gonadotropins and has been associated with treatment burden and attrition from fertility treatment. We conducted a randomized clinical trial to determine (1) whether educational videos about fertility medications improved infertility self-efficacy scale (ISES), fertility quality of life treatment (FertiQoL-T), and Perceived stress scale (PSS) scores and (2) if such videos improved confidence and reduced medication errors during a first ovarian stimulation cycle. Participants were given access to an online portal with randomized access to either placebo control videos focused on an orientation to IVF or experimental videos that reviewed the preparation and administration of medications used during ovarian stimulation in addition to the placebo videos. Participants completed pre and post-treatment questionnaires. 368 patients enrolled and 257 participants completed the study. There were no differences in ISES, FertiQoL-T or PSS scores between the two groups in an intention-to-treat (p = 0.18, 0.72, and 0.92, respectively) or per-protocol analysis (p = 0.11, 0.38, and 0.37, respectively). In the per protocol analysis, participants who watched experimental videos were four-fold more likely to report confidence administering medications OR 4.70 (95% CI: 2.10, 11.1; p < 0.01) and were 63% less likely to make medication errors OR 0.37 (95% CI: 0.14, 0.90; p = 0.03). Participants had similar likelihoods of rating videos as helpful and recommending videos to others (p = 0.06 and 0.3, respectively). Educational videos about fertility medications may not influence psychological well-being but might improve confidence in medication administration and reduce medication errors. Trial registration number: NCT02979990.

The relationship between coping strategies and infertility self-efficacy with pregnancy outcomes of women undergoing in vitro fertilization: A prospective cohort study.

BackgroundAssisted reproductive technology treatments are stressful procedures, but there are individual differences in the emotional response to them. Differences in response to this stress may be related to the outcome of infertility treatment.ObjectiveThis study aimed to investigate the relationship between coping strategies and infertility self-efficacy with pregnancy outcomes of women undergoing in vitro fertilization/intracytoplasmic sperm injection treatment.Materials and MethodsThis was a prospective cohort study and the 154 infertile women were psychologically evaluated in 2 stages: once before ovarian stimulation and again during embryo transfer. The research measurements used were the Revised COPE, the Depression Anxiety Stress Scale (DASS-21) and the Infertility Self-Efficacy Scale.ResultsThere was no significant difference between the group of non-pregnant women and the positive pregnancy group in terms of coping strategies (mental rumination, self-blame, active confronting, goal replacement, avoidance) or self-efficacy in either of the 2 stages of ovarian stimulation and embryo transfer. The Mann-Whitney test did not show any statistical difference between the clinically pregnant women and the only laboratory positive pregnant group. Moreover, the self-blame and mental rumination strategies were positively related with anxiety and depression. Conversely, active confronting, goal replacement, avoidance and self-efficacy were associated with decreased depression, anxiety and stress levels.ConclusionIt can be concluded that there is no relationship between coping strategies and infertility self-efficacy with in vitro fertilization/intracytoplasmic sperm injection outcomes. Further research is needed to clarify the effects of other psychological factors on the pregnancy outcomes of assisted reproductive treatment.

Measurement the Self-efficacy Among Infertile Women in Al-Hilla City, Iraq

Objectives: This study aims to measure the self-efficacy among women who have infertility in Al-Hilla City, Iraq. Methods: We conducted a cross-sectional study in Al-Hilla City, Iraq, to measure the self-efficacy among infertile women. Using the non-probability purposive sampling method, 107 (Mean±SD age: 28.81±6.306 years) women with infertility were recruited. The study data were collected from the study samples using the infertility self-efficacy scale questionnaire. It is scored on a 3-point Likert scale to measure self-efficacy among infertile women. Results: The results show that the overall self-efficacy of infertile women is low. Also, there is a significant association between the self-efficacy of infertile women with all study parameters (P&lt;0.05) except the age and level of education. Discussion: The highest percentage of the study samples were less than 30 years and lived in the urban area. The overall self-efficacy among infertile women was low, and the correlation between self-efficacy and their demographical data was significant except for the age and level of education.

P–486 Psychological determinants of the decision to attend couples infertility counselling

Abstract Study question May specific psychological variables related to the experience of infertility have a predicting effect over the decision of accepting counselling? Summary answer Specific infertility related sources of sufferance including low levels of infertility self-efficacy and poor quality of life significantly predict the request for professional help. What is known already Available data on the access to infertility counselling services suggest that only 10–34% of patients who are offered such opportunity actually pursue it. Qualitative studies pointed out that this might be due to a lack of information about available support and to negative attitudes toward counselling. It seems also that women and men who accept counselling have worse levels of psychological distress. However, there is a lack of quantitative studies on the topic and among those available none used measures that are specific to the experience of infertility itself Study design, size, duration The data presented herein are part of a larger data collection promoted by the Italian Ministry of Health on the psychological impact of assisted reproduction. The present study is a cross-sectional research and involves a sample of 184 patients, composed by 92 women waiting for infertility treatment and their partners, enrolled between October 2019 and October 2020 at the Infertility and IVF Unit of the S. Orsola University Hospital in Bologna, Italy. Participants/materials, setting, methods Participants were voluntarily enrolled in the study at their first medical consult. They were informed about the possibility to attend free couples infertility counselling sessions and asked to fill in the following questionnaires: Infertility Self-Efficacy Scale (ISE); Fertility Quality of Life (FERTIQoL); Dyadic Adjustment Scale (DAS). To attend infertility counselling a shared agreement between partners was requested. Couples who agreed to the study but not to counselling sessions were provided only with questionnaires. Main results and the role of chance The 34.8% (n = 32 couples) of the sample accepted to receive counselling sessions. The two groups (counselling vs no-counselling) were comparable in all socio-demographic variables, aside for education, with higher education levels in the counselling group. Overall, the counselling group reported greater psychological sufferance than the no-counselling group, with lower scores at the ISE, FERTIQoL, and DAS questionnaires. Regarding which factors predicted the decision to attend counselling sessions, logistic regression analysis showed that: for the female partner’s dimensions low scores at the ISE and at the Emotional subscale of the FertiQoL were predictive of accepting counselling (when scores increased the odds of being in the counselling group would decrease by 46% and 8% respectively); for the male’s partner dimensions, predictive factors were low scores on the Social subscale and high scores on the Relational subscale of the FertiQoL (when scores increased the odds of being in the counselling group would decrease by 8% and increase by 10% respectively). In conclusion, impairments in self-efficacy, emotional well-being and social life may drive a greater need for help, but a close relationship with the partner may be also necessary to predispose men to accept couples infertility counselling. Limitations, reasons for caution Data were collected from a well enough homogeneous sample which may have helped in better enhancing the specificity of infertile couples’ needs. However, the small sample size and the fact that data were collected from a sole Italian clinic may impact the representativity of our results. Wider implications of the findings: Findings provide important information for clinical interventions with infertile couples. Patients accepting counselling might be having a worse adjustment to the experience of infertility. Besides, women and men may be affected in different ways. Men’s closeness to the partner might be a favourable factor and should be further studied. Trial registration number The study was approved by the Ethical Committee of the S. Orsola Hospital, University of Bologna (CE: 273/2018/Sper/AOUBO) and funded by the Italian Ministry of Health (J33C17000560001)

Self-efficacy, coping strategies and quality of life in women and men requiring assisted reproductive technology treatments for anatomical or non-anatomical infertility

ObjectiveTo examine the magnitude and the predictors of emotional reactions to an infertility diagnosis, comparing women and men who were clinically diagnosed with an anatomical cause of infertility or non-anatomical cause of infertility. Study designCross-sectional study involving a total of 133 adults waiting for infertility treatment at the IVF and Infertility Unit of the S. Orsola University Hospital in Bologna (Italy). Of these, 107 patients (55 with anatomical causes of infertility and 52 with non-anatomical causes of infertility; response rate: 80%) took part to the study. After providing informed written consent, each participant was asked to complete the Infertility Self-efficacy Scale, the Fertility Quality of Life, and the Brief Coping Orientation to Problem Experienced, which they returned at their second access to the Unit. Differences between the groups were analyzed through a series of univariate ANOVA, whereas a multiple regression analysis was used to jointly examine the predictors of fertility quality of life. ResultsResults showed both gender related and diagnosis related differences. Women had statistically significant lower scores than men on the Infertility Self-Efficacy Scale and on the global, emotional, and mind–body subscales of the Fertility Quality of Life, while they scored significantly higher on the emotion focused and socially supported subscales of the Coping Orientation to Problem Experienced. Independently of gender, patients with non-anatomical causes of infertility scored poorly than patients with anatomical causes of infertility on the relational subscale of the Fertility Quality of Life and on the Avoidant scale of the Brief Coping Orientation to Problem Experienced. Hierarchical multiple regression analyses revealed that higher levels of self-efficacy and a lower use of avoidant coping strategies predicted a more positive quality of life over and above gender and cause of infertility. ConclusionThis study partly confirms data on gender differences in experiencing the psychological burden of infertility and adds some new information, particularly with respect to the prediction of quality of life indicators over and above infertility cause.

Social support, self-efficacy, cognitive coping and psychological distress in infertile women.

The aims of this research were to investigate the relationship of social support, self-efficacy and cognitive coping with psychological distress, as well as, to determine the mediating role of self-efficacy and cognitive coping between social support and psychological distress in infertile women of Pakistan. This cross-sectional study was conducted to recruit 158 infertile women from six hospitals of Lahore, Pakistan. A demographic questionnaire, multidimensional scale of perceivedsocial support, infertility self-efficacy scale, coping strategies questionnaire and depression anxiety stress scale were used to assess the study variables. The results found that significantother, family and friends support was negatively associated with depression, anxiety and stress, however, no relationship was found between friends support and anxiety. Self-efficacy and active-practical coping had negative, whereas, avoidance-focused coping had positive relationship with depression, anxiety and stress. Active-distractive coping was negatively and religious-focused coping was positively associated with depression. Mediation analyses revealed that self-efficacy mediated the effect of social support on depression, anxiety and stress, but no mediation was found between friends support and anxiety. Moreover, avoidance-focused coping mediated the link between social support and depression, as well as, between significant other support and anxiety. Social support, self-efficacy, active-practical coping and active-distractive coping had significant negative associations with psychological distress. Hence, structured programs should be developed to enhance societal acceptance and to reduce the negative attitude of people towards infertility.

The effects of fertility-supporting health training on healthy lifestyle behaviors and infertility self-efficacy in infertile women: A quasi-experimental study

IntroductionIt is important to change behaviours and situations that affect fertility in a negative way (e.g. obesity, smoking and stress). Healthy lifestyle behaviours supporting fertility involve changing these habits. The development of healthy lifestyle behaviours which can support fertility can be achieved through taking personal responsibility to change unhealthy behaviours. This study was aimed at determining the effects of fertility supporting health training on healthy lifestyle behaviours and self-efficacy in infertile women. This study aimed to determine the effects of fertility supporting health training on changing healthy lifestyle behaviours and self-efficacy in infertile women. MethodsThe study used a pre-test/post-test quasi-experimental model with a control group and was carried out between March and October 2017. The power analysis calculated the number of infertile women in each group as 62 (N = 124). The women in the experimental group were provided with two sessions of fertility-supporting health training. Eight weeks after the first session, the post-test data were collected. Data collection included a “Personal Information Form”, the “Healthy Lifestyle Behavior Scale II (HLBS-II)” and the “Infertility Self-Efficacy Scale − Short Form (ISE-SF)”. ResultsThe HLBS-II post-test mean values were 136.52 ± 19.25 in the experimental group and 126.90 ± 17.02 in the control group, and the difference was significant (p < 0.05). The ISE-SF post-test mean values were significantly different for the experimental group (23.16 ± 4.13) compared to the control group (20.43 ± 4.19) (p = 0.000). ConclusionsWomen being treated for infertility may wish to participate in initiatives that promote fertility. Training, adopting healthy lifestyle behaviours and perceptions of self-efficacy can be improved.

Evaluation of acupressure effects on self-efficacy and pregnancy rate in infertile women under in vitro fertilization/intracytoplasmic sperm injection treatment: A randomized controlled trial.

CONTEXT:Infertility is one of the major stressful events in individual life, especially women. Self-efficacy means a person can perceive a potentially threatening and stressful situation as being amenable to influences of personal control.AIMS:This study was conducted to determine the acupressure effects on self-efficacy and pregnancy rate in infertile women under in vitro fertilization (IVF)/intracytoplasmic sperm injection treatment.SETTINGS AND DESIGN:This study was a randomized controlled trial in infertile women. It performed at Milad IVF Center, Mashhad, Iran, from September 2015 to August 2016.MATERIALS AND METHODS:The sample size was 144 participants. The participants were randomly divided into three groups: real and sham acupressure and control groups. Acupressure performed on the H7 and P6 acupoints on both the hands. The infertility self-efficacy scale was completed before and after intervention. Beta-human chorionic gonadotropin hormone assay was measured to determine pregnancy. Data analysis was done by Chi-square, Fisher's exact, paired sample t, Kruskal–Wallis, and ANOVA test and general linear model and multinomial logistic. Levels of significance were reported at P < 0.05.RESULTS:The mean age of women was 30.84 ± 5.34 years. The ovulation factor (P = 0.02) and spouse's job (P = 0.05) were statistically significant difference between the groups. The score of self-efficacy and frequency of clinical pregnancy were no significant difference among three groups. Using linear regression, only the score of primary self-efficacy (before intervention) was in a significant relationship with self-efficacy after the intervention (P < 0.001).CONCLUSION:To our results, we recommend more research for assessing acupressure effects on self-efficacy and clinical pregnancy rate in infertile women.

Psychometric Properties of the Korean Version of the Infertility Self-Efficacy Scale

The Infertility Self-Efficacy scale (ISE) is an instrument used to identify infertility-related self-efficacy. The purpose of this study was to assess the reliability and validity of the Korean version of the ISE developed by Cousineau et al. in 2006. The translated instrument was pilot-tested and administered to 314 women and men with a diagnosis of infertility. For estimating reliability, test-retest and the internal consistency reliability coefficients were calculated. Validity was evaluated through content validity, concurrent validity, and construct validity with exploratory and confirmatory factor analyses. The internal consistency reliability was satisfactory (Cronbach's alpha=.92, item-total correlations=.44-.80), and the intra-class correlation coefficient was .84 (p<.001). The overall content validity index was 98.1%, and the concurrent validity coefficient (correlations between the ISE scale andgeneral self-efficacy scale) was .31 (p<.001). The final model's fit indexes were acceptable (CFI=.96, NFI=.93, RMSEA=.07, GFI=.94, and SRMR=.03), indicating good construct validity. The Korean version of the ISE has high reliability (stability and homogeneity), and good content, concurrent, and construct validity (EFA and CFA). Validated Korean version of the ISE may help nurses identify infertility-related self-efficacy.

Psychometric properties of the Chinese version of the Infertility Self-Efficacy Scale

ObjectiveTo translate the English version of Infertility Self-Efficacy Scale into Chinese and to validate the psychometric properties of the Chinese version of the Infertility Self-Efficacy Scale (CISE). Method(s)Participants were recruited from the Gynecology Department of two city hospitals. Five main processes were involved in the formation of CISE [1]: scale translation based on expert consultation [2]; pre-test questionnaire development with infertile women's feedback (N = 20) [3]; factor structure assessed by exploratory and confirmatory factor analysis (N = 177) [4]; assessment of reliability by internal consistency (N = 177) and test-retest reliability (N = 21); and [5] assessment of convergent validity with Self-rating Anxiety Scale, Self-rating Depression Scale, and Simplified Coping Style Questionnaire (N = 177). ResultsThis study established a 16-item CISE. Factor analyses confirmed a one-component solution, which explained 54.59% of total variances and showed an acceptable model fit. Cronbach's α and test-retest correlation coefficients for the scale were 0.94 and 0.84, respectively. The CISE score was significantly correlated with anxiety (r = −0.47), depression (r = −0.60), positive coping style (r = 0.37), and certain negative coping style items. ConclusionThis 16-item CISE is a reliable and valid measure to evaluate perceived self-efficacy among a sample of Chinese women who underwent infertility treatment.

Cultural Validation of the Turkish Version of the Infertility Self-Efficacy Scale–Short Form (TISE-SF)

To translate and test the psychometric properties of the Turkish version of the Infertility Self-Efficacy Scale-Short Form (TISE-SF). The convenience sample consisted of 120 infertile women. A psychometric research design was used with content and construct validity and reliability. Cronbach's alpha of .78 showed moderate reliability, whereas item-total correlations ranged from .30 to .54. Factor analysis extracted a single component, explaining 40.3% of the variance. Kendall W showed agreement with each expert regarding the appropriateness of the items, confirming the content validity of the translated TISE-SF. The results supported the construct validity and reliability of the TISE-SF for measuring infertility self-efficacy in a population of Turkish women. Evaluating infertile women's perception of self-efficacy with the TISE-SF may be useful in clinical studies in Turkey. TISE-SF can be used by professionals as a counseling tool to help guide women in managing their treatments at infertility centers.

Stress and Anxiety Scores in First and Repeat IVF Cycles: A Pilot Study

BackgroundThe role of stress in reproduction, particularly during treatment for infertility, has been of considerable interest; however, few studies have objectively measured stress and anxiety over the course of the IVF cycle or compared the experience of first-time and repeat patients.MethodsThis prospective cohort pilot study enrolled 44 women undergoing IVF at a university-based clinic to complete the State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS) and Infertility Self-Efficacy Scale (ISES) at three time points prior to ovarian stimulation (T1), one day prior to oocyte retrieval (T2), and 5–7 days post embryo transfer (T3).ResultsMean STAI State scores were significantly elevated at all three time points (p<0.01). STAI State and PSS mean values did not change over time and did not differ in first-time vs. repeat patients. Self-efficacy (ISES) scores declined over time, with a greater decline for repeat patients. Of the 36 women who completed a cycle, 15 achieved clinical pregnancy. Using logistic regression modeling, all scores at T2 were correlated with pregnancy outcome with lower scores on the STAI State and PSS and higher scores on the ISES associated with higher pregnancy rates.ConclusionsStress and anxiety levels remained elevated across all cycles. Women with lower stress and anxiety levels on the day prior to oocyte retrieval had a higher pregnancy rate. These results emphasize the need to investigate stress reduction modalities throughout the IVF cycle.

Measuring self‐efficacy to deal with infertility: Psychometric properties and confirmatory factor analysis of the portuguese version of the infertility self‐efficacy scale

This study explores the psychometric properties and factor structure of the Portuguese version of the Infertility Self-Efficacy Scale (ISE-P), using translation and back-translation of the original version; principal component analysis; confirmatory factor analysis (CFA); and internal consistency, and test-retest reliability analyses. A total of 287 participants (156 women and 131 men) seeking medical treatment were recruited from public and private fertility centers. CFA revealed that the single-component model fit the data well. The instrument showed excellent internal consistency, good test-retest reliability, and correlations with other mental health measures suggesting good convergent and discriminant validity. In conclusion, The ISE-P is a valid and reliable Portuguese-language measure of perceived self-efficacy to cope with infertility.

Protective emotional regulation processes towards adjustment in infertile patients

Little is known about emotional regulation processes of psychological flexibility/acceptance, self-compassion, and coping styles in infertility and the way they may exert a protective function towards depression. The aim of the current study was to explore how these emotion regulation processes are related to depression and to the sense of self-efficacy to deal with infertility in infertile patients. Gender differences were also considered. One hundred couples without known fertility problems and 100 couples with an infertility diagnosis completed the instruments: Beck Depression Inventory, Coping Styles Questionnaire, Acceptance and Action Questionnaire, Self-Compassion Scale and Infertility Self-efficacy Scale. Infertile couples presented statistically significantly higher scores on depression and lower scores in psychological flexibility/acceptance and self-compassion than the control group. This pattern was particularly identified in women who also tended to use less an emotional/detached coping style and to perceive themselves as less confident to deal with infertility than men. Multiple regression analysis showed that psychological flexibility/acceptance was a significant predictor of depressive symptoms in men and women with infertility. Emotional regulation processes, such as psychological flexibility/acceptance and self-compassion, seem to be relevant to the understanding of depressive symptoms and psychological adjustment to infertility, suggesting that these issues should be addressed in a therapeutic context with these couples.

Stress and anxiety scores in first and repeat IVF cycles

OBJECTIVE: To describe stress and anxiety levels over three time points during the IVF cycle and to compare the experience of first-time and repeat IVF patients. DESIGN: Prospective cohort. MATERIALS AND METHODS: 44 women undergoing IVF at a university-based clinic completed the State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS) and Infertility Self-Efficacy Scale (ISES) at three time points: prior to ovarian stimulation (T1), one day prior to oocyte retrieval (T2), and 5-7 days post embryo transfer (T3). Statistical analysis: mixed model analysis, logistic regression modeling, Pearson correlation scores. RESULTS: Mean STAI-State scores were significantly elevated at all three time points (p< 0.01). STAI State, STAI Trait, and PSS mean values did not change over time and did not differ in first-time vs. repeat patients. Of the 36 women who completed a cycle, 15 achieved clinical pregnancy. All scores at T2 were correlated with pregnancy outcome.Tabled 1Logistic regression models predicting pregnancyT1 (n=36)T2 (n=35)T3 (n=32)Pregnant37.53 ± 12.3334.93 ± 11.1841.36 ± 14.20STAI StateNot pregnant43.57 ± 14.4444.35 ± 13.6342.61 ± 13.92p=0.200.050.80Pregnant35.93 ± 11.0033.67 ± 8.1034.29 ± 9.55STAI TraitNot pregnant38.86 ± 10.8841.30 ± 10.3440.56 ± 11.80p=0.420.030.12Pregnant12.67 ± 7.1211.53 ± 6.4916.14 ± 7.09PSSNot pregnant15.43 ± 6.1216.20 ± 5.0915.11 ± 6.50p=0.220.030.66Pregnant103.16 ± 25.00106.73 ± 17.3894.21 ± 25.28ISESNot pregnant91.33 ± 22.3584.95 ± 27.1385.44 ± 28.39p=0.160.020.36 Open table in a new tab CONCLUSION: Stress and anxiety levels were elevated in women in both first and repeat IVF cycles and remained elevated across the cycle. Women with lower stress and anxiety levels on the day prior to oocyte retrieval had a higher pregnancy rate. These results emphasize the need to investigate stress reduction modalities throughout the IVF cycle.

O-130: A randomized-controlled study of an online infertility psychoeducational program

This study sought to develop an evidence-based, online psycho-educational program grounded in cognitive behavioral and social learning theories to provide a comprehensive educational experience for infertility patients. The study goal was to determine if an online psycho-educational program could positively influence problematic fertility beliefs and attitudes, decisional conflict, and self-efficacy in the management of fertility treatment. A randomized-control study with 297 fertility patients (188 females and 109 males) from 3 major US treatment centers. Female patients were the primary study participants; >50% of their partners were recruited for an exploratory study. Patients seeking fertility treatment were recruited via flyers posted at fertility clinics to participate in an online study about how patients cope with fertility treatment. Using a rigorous research design that controls for assessment affects, patients were randomized into one for four groups, two of which received the online psycho-educational program and two groups which did not. The assessment battery, which was delivered online at a secure web portal, included measures of perceived distress, attitudes and beliefs about fertility problems, decisional conflict, ways of coping, and infertility self-efficacy. Participants exposed to the online psycho-educational program were asked to spend two 45-minute sessions using the program, which included 4 media-rich modules on basic fertility facts, coping skills, partner and provider communication. An online follow-up assessment battery was administered at one-month after baseline. The Solomon 4 analysis revealed several important findings. Overall, participants in the intervention group decreased their “sexual concern” score on the Fertility Problem Inventory (p=.03), and improved their self-efficacy on the “body integrity” subscale of the Infertility Self-Efficacy Scale (p=.04). In spite of pre-assessment reactivity to “planful problem solving”, participants further increased their use of this coping style after viewing the intervention (p<.01). An effect was also observed for decisional conflict whereby decisions for which participants felt “uninformed” (p=.02) and “unclear” (p=.06) improved at post-test. By gender, the intervention resulted in less distress for women in the areas of sexual concerns (p=.04) and rejection of childfree lifestyle (p=.06), and improvements in infertility self-efficacy around body integrity and decisional conflicts initially perceived “uninformed” (p=.02). For the men in the intervention group, improvements were observed in the area of relationship concern (p<.05) and decisional conflict where “clarity” was perceived as needed (p=.07). An online psycho-educational support program may offer a viable adjunct service for fertility clinics to offer patients seeking a fertility evaluation or treatment, and may be particularly effective in teaching skills for problem solving and decision making. The confidential nature of an online program may also serve as an important approach in helping patients grapple with intimate matters related to one’s relationship and sexual concerns, especially for patients who do not have access to counseling services or do not feel comfortable raising these issues with medical staff.

Development and validation of the Infertility Self-Efficacy scale

To develop and validate a scale of perceived self-efficacy for people coping with infertility treatment. Self-efficacy scale development involved: [1] item generation with medical experts in reproductive health; [2] a principal components analysis with varimax rotation to identify underlying item components; [3] test-retest reliability and construct (convergent and discriminant) validity with infertility patients, who were administered the Infertility Self-Efficacy (ISE) scale with other measures; and [4] expert acceptability, as determined by reproductive health professionals. Recruitment at a fertility center, a national infertility organization, and medical trials web pages. A total of 213 participants (159 women; 54 men) with a diagnosis of infertility in the past 2 years were recruited for the various study phases. None. Participants' infertility self-efficacy was assessed with an online assessment battery using the ISE scale; comparison mental health measures assessed current levels of fertility problem distress, perceived stress, and coping style. Reliability, validity, and component structure of the ISE was assessed. Measurement development yielded a brief 16-item ISE scale that taps an infertility patient's perception about his or her ability to engage in a set of cognitive, emotional, and behavioral skills related to the medical treatment of infertility. The single component of "cognitive/affect regulation" suggests this core set of skills is relevant to successfully managing the experience of infertility. The ISE correlations with comparison mental health measures were as expected, suggesting good convergent and discriminant validity. The ISE scale appears to be a reliable and valid measure of an individual's self confidence in areas related to health promotion during infertility treatment. Assessing an infertility patients' self-efficacy with the ISE may be useful in clinical research and as a counseling tool to help guide patients in actively managing their fertility treatment.

Development and validation of the infertility self-efficacy scale

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.