validation study

In Indonesia, several hospitals have designed various forms of discharge planning in line with the guidelines provided by the Indonesian Endocrinology Association. These initiatives were implemented to enhance the quality of healthcare service. Despite the efforts made by the government, the rate of non‑compliance (9%) and readmission (20%) has continued to increase. This indicates that there is a need to reevaluate the existing discharge planning module. Therefore, this study aims to validate the contents of the diabetes mellitus discharge planning module, which was incorporated into the summary of diabetes self‑care activity. The effectiveness of the intervention in improving the compliance of patients with self‑care activity was also evaluated.

This study used a mixed methodological approach, which combined an evaluation method and an experimental quantitative design. The content validity of the module used was carried out using professional judgment, involving competent experts in the bahteramas hospital in southeast Sulawesi, Indonesia. The sample population consisted of sixty‑five randomly selected respondents, who participated in the validation of the summary of Diabetes Self‑Care Activities (SDSCA) questionnaire, which had three phases, namely pre‑test, during, fieldwork, and post‑test.

The content validity of the module was tested using Aiken’s v, and the results ranged from 0.82 to 0.88 for each session, indicating that it was valid. Furthermore, the internal consistency (Cronbach’s alpha) obtained in this study was acceptable, with values ranging from 0.60 to 0.92. 

The results showed that the diabetes mellitus discharge planning module could be used to improve self‑care among patients.

Children with special needs require extensive medical and rehabilitative interventions, which pose significant challenges for their families. The Family Functioning Questionnaire in Rehabilitation (FFQR) assesses family performance in this context.

This study aimed to evaluate the reliability, validity, and cultural adaptation of the Persian version of the FFQR among Iranian parents of children with special needs.

This observational cross-sectional study focused on psychometric validation and cultural adaptation of the Persian FFQR. Rigorous evaluations of face and content validity, criterion validity, internal consistency, test-retest reliability, and construct validity were conducted. Participants included 250 parents of children aged 3 to 18 with special needs, recruited from rehabilitation facilities in Tehran province.

The translation process, along with assessments of face and content validity, led to adjustments in questionnaire items. The Persian version of the FFQR demonstrated excellent internal consistency (Cronbach's alpha = 0.946) and high test-retest reliability (correlation coefficient (ICC) = 0.94). However, criterion validity with the Child Adjustment and Parent Efficacy Scale-developmental disability was not established. Confirmatory factor analysis supported the original factor structure of the FFQR, affirming its cross-cultural applicability. Model fit indices indicated reasonable fit, although the chi-square test suggested an imperfect fit (χ² = 2409.03, df = 1074, P < 0.001).

The Persian FFQR proved to be a reliable and culturally relevant tool for assessing family functioning in rehabilitation of Iranian children with special needs. These findings highlight the importance of employing culturally sensitive measurement tools in research and clinical applications.

Stigma presents significant barriers to mental health treatment, influencing treatment decisions and recovery outcomes. Standardized rating scales play a crucial role in assessing Self-stigma, which is essential for intervention efforts aimed at improving mental health outcomes globally.

This study aims to investigate the internal consistency, face validity, content validity, and factor structure of the Persian version of the Self-stigma of Seeking Help (SSOSH) scale in a group of people with mental health disorders referred to the outpatient clinics of Roozbeh Psychiatry Hospital and several private clinics in Tehran, Iran.

First, a bilingual psychiatrist translated the scale into Persian. Content and face validity were then evaluated by six psychiatrists. A pilot test was conducted with ten patients to assess comprehensibility. A back translation into English was performed by a non-professional, and the result was compared to the original version by a bilingual psychiatrist. The final Persian version of the questionnaire was administered to 347 patients with various mental health disorders, recruited from Roozbeh Hospital, a referral psychiatry hospital, and several private clinics in Tehran. Demographic characteristics were collected via questionnaires, and the type of disorder was determined based on the specialist's evaluation. This process was conducted from October 2023 to May 2024. The Content Validity Index (CVI) and Content Validity Ratio (CVR) were calculated, and internal consistency was analyzed using Cronbach’s alpha and McDonald's Omega tests. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were performed to explore and understand the data structure.

The Persian version demonstrated reasonable comprehensibility and translation equivalence, ensuring both semantic and content equivalence. The SSOSH achieved a CVI > 0.8 and CVR > 0.96. All items obtained an acceptable score (greater than 1.5) for face validity. The internal consistency of the total score was good (α = 0.733, ω = 0.818). The EFA revealed that the Persian version had three factors accounting for 57% of the total variance, and the CFA suggested this model fits the data reasonably well, though there is room for improvement.

The Persian SSOSH scale exhibits good internal consistency and acceptable face and content validity for use in Persian-speaking patients with mental health disorders. While the three-factor structure identified by the EFA requires further investigation, the application of this tool among other Iranians warrants additional evaluation.

The left ventricular dysfunction 36 (LVD-36) questionnaire is considered to be a tool to assess the impact of left ventricle impairment on patients’ daily life. This methodological study was aimed to translate and assess the validity and reliability of the Persian draft of the LVD-36 questionnaire among Iranian heart failure (HF) patients.

We recruited stable HF patients who referred to an outpatient heart clinic in Isfahan, Iran. The LVD-36 questionnaire was translated using the forward-backward method. Twenty HF patients were recruited for content validity assessment and were asked to express their opinions about the comprehensibility and meaningfulness of each item. We invited 14 experts to assess validity through content validity index (CVI) and content validity ratio (CVR). Reliability was assessed by Cronbach’s alpha and intraclass correlation coefficient (ICC), with the latter evaluated after invitation of the participants to complete the questionnaire for the second time.

The translation process was performed uneventfully without any significant alterations. A total of 150 HF patients were recruited to assess the reliability of the questionnaire in this study (age: 64.6 ± 16 years, males: 58.6%). All items had acceptable CVI and CVR, ranging 0.85–1.00 and 0.57–1.00, respectively. Cronbach’s alpha was 0.971. All participants completed the questionnaire for the second time with no missing data. Test-retest reliability revealed an excellent ICC value of 0.981 (95% CI: 0.977–0.985).

The Persian version of the LVD-36 questionnaire is a simple, valid and reliable tool for evaluating the impact of left ventricle impairment on the well-being of Iranian HF patients.

Distinguishing between ruptured and non-ruptured acute appendicitis presents a significant challenge. This study aimed to validate the accuracy of RAMA-WeRA Risk Score in predicting ruptured appendicitis (RA) in emergency department.

This study was a multicenter diagnostic accuracy study conducted across six hospitals in Thailand from February 1, 2022, to January 20, 2023. The eligibility criteria included individuals aged >15 years suspected of acute appendicitis, presenting to the ED, and having an available pathology report following appendectomy or intraoperative diagnosis by the surgeon. We assessed the screening performance characteristics of RAMA-WeRA Risk Score, in detecting the ruptured appendicitis (RA) cases.

860 patients met the study criteria. 168 (19.38%) had RA and 692 (80.62%) patients had non-RA. The area under the receiver operating characteristic curve (AuROC) of RAMA-WeRA Risk Score was 75.11% (95% CI: 71.10, 79.11). The RAMA-WeRA Risk Score > 6 points (high-risk group) demonstrated a positive likelihood ratio (LR) of 3.22 in detecting the ruptured cases. The sensitivity and specificity of score in > 6 cutoff point was 43.8% (95%CI: 36.2, 51.6) and 86.4% (95%CI: 83.6, 88.9), respectively.

The RAMA-WeRA Risk Score can predict rupture in patients presenting with suspected acute appendicitis in the emergency department with total accuracy of 75% for high-risk cases. 

Sport Concussion Assessment Tool (SCAT) aids the physicians in early management of concussion among suspected athletes and its 6th version was published in 2023 in English. This study aimed to describe the translation and validation process of SCAT6 from English to Persian.

The Persian translation of SCAT6 and its evaluation has been done in seven stages: initial translation, appraisal of the initial translation, back translation, appraisal of the back-translation, validation (face and content validities), final reconciliation and testing by simulation.

Initial translation, was done by two bilingual translators followed by an initial appraisal, which was made by both translators and one general physician. Back translation was done by two naïve translators who were unfamiliar with SCAT6, followed by its appraisal by initial translators. Face and content validity of the translation were surveyed by medical professionals and athletes and the results of the validation process were provided to the reconciliation committee and this committee made the modifications needed. Finally, the use of Persian SCAT6 was simulated and the mean time needed to complete the Persian SCAT6 was roughly a little more than 10 minutes.

The present study provides the readers with the translation and cross-cultural adaptation process of SCAT6 from English to Persian. This translated version will be distributed among the Iranian sports community for assessing concussions among athletes.

MONTH Difficult Laryngoscopy Score was developed for effectively identifying difficult intubations in the emergency department (ED). This study aimed to evaluate the accuracy of MONTH Score in predicting difficult intubations in ED.

 We prospectively collected data on all patients undergoing intubation in the ED of Ramathibodi Hospital, Bangkok, Thailand. The screening performance characteristics of the MONTH score in identifying the difficult intubation in ED were analyzed. All data were analyzed using STATA software version 18.0.

  324 intubated patients with the median age of 73 (63-82) years were studied (63.58% male). The proportion of difficult intubations was 19.44%. The sensitivity and specificity of MONTH in predicting difficult intubations were 74.6% (95% CI: 61.6%-85.0%) and 92.8% (95% CI: 89.0%-95.6%), respectively. These measures in subgroup of patients with Intubation Difficulty Scale (IDS) score ≥ 6 were 44.1% (95%CI: 31.2-57.6) and 98.5% (95% CI: 96.2%- 99.6%), respectively. The area under the receiver operation characteristic (ROC) curve of MONTH in predicting difficult intubations was 0.895 (95% CI: 0.856- 0.926).

 It seems that the MONTH Difficult Laryngoscopy Score could be considered as a tool with high specificity and positive predictive values in identifying cases with difficult intubations in ED.

Social anxiety refers to an excessive concern or fear about social situations. It seems that social media, which has become one of the most popular and effective tools for communication today, can be one of the contexts of social anxiety. Due to the lack of a Persian instrument to assess social anxiety in the context of social networks, the current study was undertaken to analyze the psychometric criteria of the Iranian version of the Social Anxiety Scale for Social Media Users (SAS-SMU). The SAS-SMU is a 21-item questionnaire designed by Alkis and colleagues (2017) to measure social anxiety emerging from the social media platforms.

In this study, a total of 842 participants within the age range of 11 to 82 years old (mean age 33.11 ± 12.134), 59% female) answered the questions in an online survey. The original version of the scale was translated into Persian using the back translation procedure. All participants completed a Demographic Questionnaire, the SAS-SMU, and the Beck Anxiety Inventory. In order to analyze the collected data, internal and external consistency, factor analysis, construct validity, and confirmatory factor analysis (CFA) were examined. A significance level of less than 0.05 was considered to determine statistical significance.

Four subscales were obtained from the exploratory factor analysis (SCA, PCA, IA, and SEA), which were confirmed by the confirmatory factor analysis. Cronbach's alpha for internal consistency was found to be 0.931 for the total scale and 0.920, 0.846, 0.901, 0.828 for SCA, PCA, IA, and SEA, respectively. In addition, the test-retest scores of 30 participants (interval: between 2 to 3 weeks) for all four subscales (SCA = 0.641, PCA = 0.773, IA = 0.688, SEA = 0.727) indicated acceptable stability of the questionnaire over time.

This study validates the Persian version of the SAS-SMU for use in studies in the field of psychological problems related to social media and online communications.

In recent years, new findings on the relationship between human health and air pollutants have emerged, underscoring the necessity for appropriate site selection of air monitoring stations.

This analytical-cross-sectional study aimed to compare the concentration levels of PM10 and PM2.5, as measured by weight method, with data collected from an air quality monitoring station (AQMS) in Tehran. Initially, data were collected from the Tarbiat Modares AQMS. The accuracy of this data was then evaluated using a high-volume sampler and Grimm dust monitor situated approximately 200 meters away from the Tarbiat Modares station. The study period was between June 2017 and October 2017, and the frequency of sampling was every six days according to the instructions.

The results revealed that the average concentration levels of PM10, as measured during the sampling period by the high-volume sampler, the Grimm device, and the air quality measurement station, were 143.54 ± 33.84, 70.95 ± 7.06, and 110.06 ± 27.08 μg.m-3, respectively. The highest daily concentration of PM10 was recorded by the high-volume sampler device at 197.12 μg.m-3.

This study found a weak correlation between the aerosol concentration data obtained from the monitoring station and those obtained from the Grimm device and the high-volume sampler. Therefore, it is crucial to ensure the quality control and assurance of data collected from monitoring stations for accurate decision-making and planning.

Students are a significant source of data for the evaluation of clinical instructors’ performance. This study was undertaken with the aim of adaptation and validation of the Persian version of the Maastricht Clinical Teaching Questionnaire (MCTQ). The main objective of the researchers in this study was to evaluation the psychometric properties of the Persian version of the Maastricht Clinical Training Questionnaire (P-MCTQ) in Iran, considering cultural and social differences.

This methodological study was conducted from 2019 to 2021 at four teaching hospitals affiliated with Sabzevar University of Medical Sciences, Iran. Qualitative and quantitative face and content validity, and construct validity methods were used for the validity evaluation. Stability and internal consistency methods were used, respectively, for the reliability evaluation of the questionnaire. Exploratory Factor Analysis (EFA) stage, 264 students studying in the fields of nursing, midwifery, anesthesiology, operating room, emergency medicine, and laboratory sciences completed the P‑MCTQ.

The value of scale-content validity index (0.92) is indicative of the overall content validity of the questionnaire. EFA extracted a single‑factor structure that could explain the overall variance of the clinical education structure at about 76.61%. The alfa and intraclass correlation values were equal to 0.98 and 0.82, respectively, indicating the excellent internal consistency and high overall stability of the questionnaire.

The P‑MCTQ is a valid and reliable tool for the evaluation of the teaching performance of clinical instructors.

The present study was conducted to develop a standard questionnaire to assess the knowledge and practice of prosthodontists regarding the diagnosis and treatment of obstructive sleep apnea syndrome (OSA).

This study had questionnaire designing and cross‑sectional‑descriptive phases. Questionnaire domains were identified by a panel of eight experts. The face and content validity of the questionnaire was assessed by experts and four laypeople. The internal consistency reliability of the questionnaire was checked using Cronbach’s alpha coefficient. Moreover, its stability was tested using the test–retest method. The questionnaire was completed online by 282 Iranian prosthodontists and the relationship between different variables and scores of knowledge and practice of them with simple and multiple linear regression tests was were analyzed.

A 32‑item questionnaire was designed. The Scale Content Validity Index was >0.8 for clarity, simplicity, and necessity in all domains and the content validity of all questions was above 0.8. As for reliability, Cronbach’s alpha coefficient was above 0.7 on average. Faculty members had more knowledge (P = 0.04) and better practice (P = 0.001) compared to others. Prosthodontists who participated in sleep disorders training courses had higher scores in knowledge (P = 0.001) and practice (P = 0.001). Prosthodontists who referred patients to sleep disorders clinics had higher knowledge (P = 0.001) and practice (P = 0.001) than those who did not.

The questionnaire developed in this study can be considered a comprehensive and executable scale with appropriate reliability and validity. There is a positive relationship between being exposed to information and the level of knowledge and practice of prosthodontists about OSA.

Patient experience, along with clinical performance and safety, is known as a critical criterion for improving healthcare performance. This study aimed to assess the validity of the Persian version of the Picker Patient Experience Questionnaire.
Instrument &

This descriptive cross-sectional study was condcted in Nikan Gharb and Nikan Aqdasiyeh hospitals in Tehran from April to May 2022. The Persian version of the Picker Patient Experience Questionnaire was prepared based on the translation-retranslation method. The face and content validity of the questionnaire was evaluated with the opinions of 10 experts. To check the tool validity, all patients discharged from the two hospitals were interviewed by phone from April 21 to May 21, 2022. The main dimensions and constructs of the questionnaire were determined by the exploratory factor analysis method. The questionnaire reliability was evaluated using the test-retest method by participation of 30 subjects.

By checking the validity of the questionnaire, the items were included in 7 aspects which were in accordance with the main sections of the questionnaire (information and education, coordination of care, emotional support, respect for patient preferences, physical comfort, involvement of family and friends, and continuity and transition). The tool reliability for the 7 aspects by Cronbach's alpha was in the range of 0.744 to 0.911, and for the whole questionnaire was 0.804.

The Persian version of Picker Patient Experience Questionnaire has the necessary validity to evaluate the experience of hospitalized patients in Iranian hospitals.

Professionalism is essential to a strong trusted patient-doctor relationship, which is believed, could lead to more patient compliance and treatment outcomes. The purpose of our study was the development and psychometric analysis of an assessment tool for the professional behavior of dental students.

The study was done in the School of Dentistry, Tehran University of Medical Sciences. After providing a pool of various criteria to assess professionalism, an expert panel prepared the primary version of the tool. The tool was set in a questionnaire frame to explore the significance level and evaluation feasibility of each criterion. The questionnaire was completed by tutors of the “Medical Ethics” course (N=6). After necessary revisions, in order to evaluate face and content validity, the checklist was given to eight experienced dental educators to determine the relevance, clarity and simplicity of the questions. At the second stage, the final checklist with 37 items was given to dental educators to evaluate twenty students. To assess the reliability of this checklist, at least two professors evaluated each student and the weighted-  was calculated. Minor revisions were done according to feedbacks.

According to the obtained data, the total validity of the tool (S-CVI) was 100%. In all items, except just for one item, the weighted-  was greater than or equal to 0.5, showing sufficient reliability of these items.

The designed tool to evaluate the professionalism among dental students in different clinical departments seems to be both valid and reliable.

Frailty is a common problem in elderly individuals. However, this issue is not well investigated among heart failure (HF) patients with appropriate scales. We aimed to translate and evaluate Edmonton frailty scale (EFS) validity and reliability in Iranian HF adults.

We implemented this methodological study on stable HF patients referred to an outpatient heart clinic in Isfahan, Iran. The translation was done using the forward-backward method. Ten individuals were asked to comment about all items in terms of understandability and simplicity. Fifteen experts were invited, and their ratings on each item were collected to measure the content validity index (CVI) and content validity ratio (CVR). Cronbach’s alpha was used for the assessment of internal consistency. After completing the scale for the second time with a two-week interval, test-retest reliability with intraclass correlation coefficient (ICC) measurement was done.

The translation process was performed uneventfully. All items were reported to be simple and meaningful. CVI of items ranged from the minimum of 0.80 to a maximum of 1.00 plus an acceptable CVR of at least 0.60. Fifty HF patients (age: 67.2±14.1 years, males: 56%) completed the questionnaire twice without missing data. Cronbach’s alpha was first to be 0.550. After omitting three items about social support, drug usage, and nutrition, the value was raised to 0.711. Test-retest reliability showed a good index of consistency (ICC: 0.693, 95% confidence interval: 0.527-0.810).

Modified Persian EFS is a simple and meaningful tool with high validity and acceptable reliability for assessing frailty in HF individuals irrespective of age.

Statement of the Problem:

 It seems essential to detect toothache in children through a validated instrument. Dental Discomfort Questionnaire (DDQ) could specifically detect the behaviors that indicate toothache through parental reports.

Current study aimed to conduct a cross-cultural adaptation process and test the validity and reliability of the Persian version of DDQ (P-DDQ).

In this cross sectional study, 60 children aged 25 to 60 months and their parents who referred to the Pediatric Department of Shiraz Dental School were selected. Parents filled out the DDQ and one examiner recorded the dmft index. To adapt the DDQ questionnaire, conceptual and item equivalence, semantic equivalence and operational equivalence were performed. The dimensions of P-DDQ were evaluated using exploratory factor analysis (EFA). Test-retest reliability and internal consistency assessments were respectively carried out using weighted kappa coefficient (kw) and Cronbach’s alpha. Moreover, the construct validity was evaluated through Mann-Whitney U test and Spearman’s correlation coefficient. Kruskal-Wallis H and Dunn’s post-hoc tests were applied for discriminant validity.

The cross-cultural adaptation of P-DDQ was conducted and minor necessary modifications were applied. Test-retest reliability showed moderate and high levels of agreement for DDQ items except for two items. An acceptable internal consistency was observed between DDQ items (Cronbach’s alpha= 0.769). EFA showed that almost all 12 items of the questionnaire were included in three factors. Both construct and discriminant validities were established for P-DDQ.

P-DDQ was cross-culturally well-adapted, validated, and reliable questionnaire applied with the purpose of detecting toothache among children in Iran.

Compliance with health-related behaviors is a dilemma among heart failure (HF) patients. The present study aimed to assess the validity and reliability of a Persian translation of the revised heart failure compliance questionnaire (RHFCQ) in Iranian HF sufferers.

This methodological study was performed on outpatient HF individuals referred to a heart clinic in Isfahan, Iran. The forward-backward translation method was used for translation. Twenty subjects were invited to express their opinions on the provided items concerning simplicity and understandability. Twelve experts were invited to rate the items regarding the content validity index (CVI). Cronbach’s α was used to evaluate internal consistency. The patients were asked to complete the questionnaire for the second time after 2 weeks to investigate test-retest reliability using the intraclass correlation coefficient (ICC).

There were no obvious difficulties during the translation and assessment of the simplicity and comprehensiveness of the questionnaire items. The CVI of the items ranged from 0.833 to 1.000. Totally, 150 patients (age: 64.60±15.00 y, males: 58.0%) filled in the questionnaire twice with no missing data. The highest and lowest compliance rates were attributed to alcohol and exercise domains, respectively (83.00±7.70% and 45.55±12.00%, respectively). Cronbach’s α was 0.629. After the omission of 3 items related to smoking and alcohol cessation, Cronbach’s α rose to 0.655. The ICC showed an acceptable value of 0.576 (95% CI, 0.462 to 0.673).

The modified Persian RHFCQ is a simple and meaningful tool with acceptable moderate reliability and good validity for assessing compliance in Iranian HF patients.

The Ottawa Decisional Conflict Scale (ODCS) is one of the initiativesdeveloped to determine the information about the patient's decision and the factorthat influence the decision made. Therefore, a systematic and structured process of decision-making can expressthe difficult action to be taken by patients.

This study aimed to evaluate the psychometric properties of the Malaysian version of ODCS among cardiovascular patients undergoing major surgery.

This study used the forward-backward translation method to develop an instrument that enabled Malaysians to know about this variable. Therefore, the researcherdecided to make a transcultural adaptation and evaluate the decision-making of the Malaysia version of the ODCS, which seeks information about decision-makingand the factors that influence the choices made. This study was conducted from January 2015 to July 2016 through a convincing sampling of 520 cardiovascular patients who need to undergo major surgery with a focus on decision-making regarding the diseases.

The results obtained on the reliability tests showed good internal consistency for all items (Cronbach α=0.914-0.917). From the analysis,the Kaiser-Meyer-Olkin Measure of Sampling Adequacy was 0.886, while the significant value of Bartlett's Test of Sphericity was P<0.001. Therefore, the analysis concluded that the data were appropriate for principal component analysis.

The psychometric properties of the Malaysian version of the ODCS are considered appropriate to be administered to patients who need to undergo cardiac surgery. Patients' provision of information was able to decrease decisional conflict among them with cardiovascular disease.