Journal of Caring Sciences, 2017, 6(2), 183-186 doi:10.15171/jcs.2017.018 http:// journals.tbzmed.ac.ir/ JCS Validity and Reliability of the Questionnaire for Assessing Women’s Reproductive History in Azar Cohort Study Mohammad Zakaria Pezeshki1,2, Atefeh Shadman3*, Mahasti Alizadeh1,2, Sevil Hakimi4, Fariba Heidari1 1Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran 2Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran 3Boo Ali children’s Hospital, Clinical Research Development Center, Ardebil University of Medical Sciences, Ardebil, Iran 4Department of Midwifery and Reproductive Health, Tabriz University of Medical Sciences, Tabriz, Iran ARTICLE INFO ABSTRACT Article Type: This study was done to evaluate the validity and reliability of women’s reproductive Short Communication history questionnaire which will be used in Azar Cohort study; a cohort that is conducted by Tabriz University of Medical Science in Shabestar county for identifying Article History: risk factors of no communicable diseases. Content and face validity were evaluated by Received: 10 Jun. 2016 ten experts in the field and quantified as content validity index (CVI) and content Accepted: 23 Nov. 2016 validity ratio (CVR). To assess the reliability, using test-retest approach, kappa statistic ePublished: 1 Jun. 2017 was calculated for categorical variables and intra-class correlation coefficient (ICC) was used for the quantitative items. The calculated CVI and CVR were 0.91and 0.94, respectively. Reliability for all items was high. The ICC was 0.99 and kappa statistic was equal to 1. The final version of questionnaire was redesigned in 26 items with 7 subscales. Please cite this paper as: Zakaria Pezshki M, Shadman A, Alizadeh M, Hakimi S, Heidari F. Validity and reliability of the questionnaire for assessing women’s reproductive history in Azar cohort study. J Caring Sci 2017; 6 (2): 185-88. doi:10.15171/jcs.2017.018. Introduction been designed in Tehran cohort3 to measure As a developing country, Iran is experiencing reproductive history of female participants. rapid epidemiological transition. The regional cohort studies in Iran such as Tehran Lipid Materials and methods and Glucose Study1 and Golestan Cohort Study2 were conducted to identify the The original questionnaire of woman's incidence and the risk factors of reproductive history included 18 items Noncommunicable disease (NCDs). including 6 subscales. It contains questions Following these regional studies, a about menstruation and menopause, nationwide cohort study, the prospective pregnancy, history of breast feeding, history of epidemiological research studies of the Iranian reproductive system problems, history of drug Adults (PERSIAN), was launched in the 2014 consumption associated with infertility and to identify risk factors of NCDs in different contraception, history of breast or cervical regions of Iran.3 Persian Cohort study includes cancer screening. ten cohorts in ten different regions of Iran. One We measured the face and content validity of these regions is East Azarbaijan province. of the questionnaire. Nine gynecologists from The cohort in this province, which was Alzahra hospital and three reproductive health nominated as Azar Cohort, is conducted by professionals from nursing faculty of Tabriz Tabriz University of Medical Science in University of Medical Sciences were selected Shabestar county.4 Our study was designed to by convenience sampling. For assessing the validate the original questionnaire that had face validity of questionnaire, we requested *Corresponding Author: Atefeh Shadman, (MD), email: [email protected]. This study was approved and funded by the deputy of research of Tabriz University of Medical Sciences (Project number: 93/3-6/1). © 2017 The Author(s). This work is published by Journal of Caring Sciences as an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc/4.0/). Non-commercial uses of the work are permitted, provided the original work is properly cited. Pezeshki et al. from experts to write their comments about the Tabriz University of Medical Sciences (Code location of items, correct scaling and Number 5/4/6323). grammatical structure of each item, and the necessity of adding new items or removing Results existing items. Regarding content validity, we The mean age of women was 46.6 years and requested from experts to review the the mean age at menarche was 13.6 years. questionnaire and assess each item based on 4 About 26.6% of the study population was criteria including relevancy, clarity, simplicity, postmenopausal. The mean age of menopause and necessity. CVR was calculated based on was 45.5 years for them. On average, each the responses to the necessity of questions (nE) woman gave a birth to 2.73 children, and and the formula of CVR= (nE-N/2)/ (N/2) was totally each woman had 21.8 months of used. To determine the cut-off point for CVR, breastfeeding. Thirty percent of women have 5 Law she’s table was used. According to Law ever had mammography and 93.33% of she, for 10 professionals, minimum required females had a history of Pap smear test. CVR for each item is 0.62. Content Validity Among contraceptive methods, 73.33% of Index (CVI) was used based on Waltz and women have been used oral contraceptives, 6 Basel content validity index. CVI for each item and 3.3 % relied on vasectomy. The CVI and was obtained by dividing the number of CVR were calculated for each item. Minimum professionals who ranked the items as and maximum CVR were 0.80 and 1, compatible or full compatible for each criterion respectively and for all items, so CVR was (relevancy, clarity, and simplicity) to the total higher than acceptance level (0.62). Total CVR number of professionals. The average value of for whole questionnaire (average of CVRs of three criteria was used as the total CVI for each all items) was 0.94. Minimum and maximum item. Minimal required amount of CVI for CVI (average of CVIs for relevancy, clarity and 7 each item was 0.79. simplicity criteria) were 0.80 and 0.96, To assess reliability of the questionnaire, 30 respectively. All items were satisfactory in females (35-70 years old), participating in the terms of CVI (higher than 0.79) and no items Azar cohort pilot project who met the were removed. Total CVI (average of CVIs of inclusion criteria (the permanent resident of all items) was 0.91. For all items of the this city, ability to response to the questions, questionnaire Kappa statistic and ICC were 1, and Iranian nationality) and exclusion criteria except for “duration of breastfeeding”, (refusal to participate in the study, having any “duration of consuming contraceptive drugs”, chronic disease history such as cardiovascular and “frequency of Pap smears”, in which the and pulmonary disease) were selected by ICC was 0.99. convenience sampling method. Necessary According to opinion of experts, the item of information obtained in their first visit and “menopause following surgery” was added to other follow ups were done by phone call. To the subscales of “history of menstruation and assess the reliability of questionnaire, we used menopause”, Moreover, three items were test–retest and intra-class correlation added to the subscales of “history of coefficient (ICC) for quantitative variables and reproductive problems” including “causes of Cohen's Kappa coefficient for qualitative uterus removal”, “age at uterus removal”, and variables. An intra-class correlation coefficient “causes of ovaries removal”. Items of or Kappa higher than 0.6 were considered as “Infertility causes” and “history of assisted 8 acceptable. Full description about the reproductive treatment” were placed in a new questionnaire and the study objectives was subscale of “Infertility and its treatments”. given to the participants and informed consent Also, subscale of “history of consumption of was obtained from them. The study protocol drug related to infertility and contraception” was approved by the ethics committee of was converted into two separate subscales of “history of infertility and its treatments” and 184 | Journal of Caring Sciences, June 2017; 6 (2), 183-186 Validity and reliability of the questionnaire “history of contraception”. Moreover, the item researchers of Azar Cohort study to use the of “history of consumption of drugs related to modified version of this validated infertility treatment” was replaced in “history questionnaire in their cohort study. of infertility and its treatments” subscale. Additionally, the item of “hormone Conclusion replacement therapies” was moved to the subscale of “history of menstruation and According to findings of this study, it seems menopause”. In the subscale of “contraceptive that the modifided questionnaire for methods”, four items were added including reproductive history of woman is a valid and “intrauterine device (IUD)”, “tubal ligation reliable measure. It may be used in Azar (TL)”, “vasectomy” and “condom”. Besides, cohort study by researchers. according to the comments of professionals, to improve face validity, “hysterectomy” was Acknowledgments replaced by “uterus removal”. Finally, This article is results of residency thesis questionnaire was restructured in 7 subscales supported by Tabriz University of Medical and 26 items. Sciences. The authors would like to express Discussion their gratitude to all individuals who participated in our study. Our results showed the need for modification of some items in the questionnaire. According Ethical issues to the comments of experts, several important questions were lacking in the initial tool. The None to be declared. items which were added to the questionnaire included the contraceptive methods, reason for Conflict of interest ovaries removal and uterus removal. Then, The authors declare no conflict of interest in modified questions were organized in suitable this study. subscale. The phrases containing medical terminology were replaced with the more References appropriate words. Regarding reliability, as it was expected, there was not much difference 1.