Development and validation of a virtual learning management system usability questionnaire: A case study.

Background: Pediculosis is a common ectoparasitic infestation that involves especially the skin of children worldwide. Studying the children’s perception of the disease’s risk factors, the effectiveness of personal preventive measures, and its implications for their health could be a major leap forward in health promotion activities. Objectives: This study aimed to develop and evaluate the psychometric properties of the Children’s Perception Scale of Head Lice Infestation (CPS-HLI) and its initial feasibility assessment for use on Iranian and possibly other elementary school children. Methods: The scale’s items were retained based on an extensive literature search and classified into the underlying constructs of the extended health belief model (EHBM). An expert panel endorsed the qualitative content and face validity of the preliminary draft, and 47 items remained for quantitative validity testing on a sample of 362 elementary school students in the city of Paveh, West of Iran. Explanatory and confirmatory factor analyses (EFA and CFA) were employed to test the content and structural validity of the constructed instrument. Cronbach's alpha and intra-class correlation coefficients were calculated to assess the internal consistency and reliability of the scale. Results: The values of Lawshe's content validity index (0.90) and content validity ratio (0.77), the subscales’ Cronbach's alpha (0.59), and intra-class correlation (0.72) coefficients confirmed plausible internal consistency of the scale. The values of root mean square error of approximation (RMSEA) (< 0.08 with χ2 < 0.05), Tucker-Lewis index (TLI), and comparative fit index (CFI) > 0.9 approved the applied statistical model’s goodness of fit. The ranges of Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy for the underlying subscales (0.49 - 0.74) and the statistically significant result of Bartlett’s test of sphericity (P < 0.001) confirmed the patterned relationship among the constructed scale’s items. The principal component analysis that was performed using STATA favored the 11-factor solution. Conclusions: The study findings support the construct validity of CPS-HLI for use in studies on children’s perception of head lice infestation risk factors, the effectiveness of personal preventive measures, and the disease implications for their health and well-being. Further cross-cultural and cross-national validation studies are recommended for using the instrument in a wider range of populations and settings.

Background & Objective: Physicians require to develop some abilities such as self-assessment, critical thinking, self-regulatory learning, and lifelong learning. Reflection is one of the essential educational concepts that make it possible to cultivate and create such abilities in medical students and health professionals. The aim of this study was translation and psychometric evaluation of Kember reflective thinking questionnaire in Iranian physicians. Materials & Methods: First, the Kember reflective thinking questionnaire was translated according to backward-forward translation procedure. Then, face validity was evaluated by examining the opinion of experts. Next, content validity was assessed by calculating content validity index and content validity ratio. Subsequently, exploratory factor analysis and confirmatory factor analysis was studied among 280 specialist and general physicians. Then, reliability was examined by calculating the intra-class correlation coefficient and investigating Cronbach's alpha coefficient. Results: Cronbach's alpha coefficient for the whole scale was 0.849 and the intra-class correlation coefficient was 0.714. Content validity index was 0.849 and content validity ratio was 0.825. Exploratory factor analysis and confirmatory factor analysis resulted in a four-factors model including habitual action, understanding, reflection and critical reflection in the Iranian medical community. Conclusion: The Persian version of Kember reflective thinking questionnaire with four factors has the desired reliability and validity in the Iranian medical community. Due to the appropriate psychometric properties, and ease of implementation, it can be used to evaluate the level of reflection of doctors.

Introduction: Gender dysphoria is one of the significant challenges in healthcare systems, and primary healthcare providers play a key role in caring for and referring these individuals. However, their insufficient knowledge and attitudes may lead to inadequate care. Given the lack of a standard Persian tool for measuring these variables, this study aimed to psychometrically evaluate a questionnaire assessing the knowledge and attitudes of primary healthcare providers regarding gender dysphoria. Methods: This descriptive cross-sectional study was conducted in 2024 in Tabriz, involving three phases: translation, back-translation, validity, and reliability. The study sample for content validity included 15 experts, 30 healthcare providers for reliability, and 205 primary healthcare providers for construct validity. The research tool consisted of questionnaires assessing attitudes and knowledge about transgender individuals, which were translated into Persian and culturally adapted. Content validity was evaluated using content validity ratio (CVR) and content validity index (CVI), and construct validity was assessed through confirmatory factor analysis (CFA). The reliability was calculated using Cronbach’s alpha coefficient and the intra-class correlation coefficient (ICC). Results: The results of this study indicated that the overall CVI was 0.81 and the CVR was 0.93. For the knowledge section, CVI was 0.76 and CVR was 0.94, while for the attitude section, CVI was 0.85 and CVR was 0.91. In confirmatory factor analysis, the factor loadings for the attitude section were above 0.30, but some questions in the knowledge section had factor loadings lower than 0.30. The comparative fit index (CFI), goodness of fit index (GFI), normed fit index (NFI), and root mean square error of approximation (RMSEA) were 0.96, 0.90, 0.85, and 0.057, respectively, all indicating a good model fit. Additionally, the Cronbach’s alpha coefficient for the entire questionnaire was 0.86, and for the knowledge and attitude sections, it was 0.65 and 0.88, respectively. The ICC obtained from the test-retest method was 0.76, confirming the reliability of the questionnaire. Conclusion: The results of this study showed that the tool for measuring the knowledge and attitude of primary healthcare providers regarding gender dysphoria has good validity and reliability. The confirmatory factor analysis results indicated that the two-factor structure (knowledge and attitude) fits well, although some items in the knowledge section had lower factor loadings. This questionnaire can be helpful in designing educational and research programs in this area. Practical Implications: The questionnaire could be used as a screening tool in educational programs related to gender dysphoria, assessing the impact of educational interventions, and evaluating educational needs in healthcare policy-making.

BACKGROUND:Assessment of the patient safety competency is necessary for the growth of nursing and safe care profession as well as evaluation of the nurses' educational needs. The present study was conducted to determine psychometric properties of the Persian version of the patient safety competency self-evaluation (PSCSE) tool in Iranian psychiatric wards.MATERIALS AND METHODS:All nurses (n = 209) working in two psychiatric hospitals of Kerman, Iran, were included in the present cross-sectional study using census method. This tool contains 41 items: six items are related to knowledge, 14 items deal with attitude, and 21 items are about skill dimension. Psychometric properties of the questionnaire including its content and face validity were also examined. The factor structure of the questionnaire was evaluated using exploratory factor analysis. The internal consistency and reliability were assessed by test–retest method with an interval of 14 days. Cronbach's alpha and corrected item-total correlation were used to measure reliability.RESULTS:The content validity index was 0.65 and the content validity ratio was 0.89. Item 14 was removed from the skill domain because it was not related to the psychiatric ward. According to the results of factor analysis, there was a significant relationship between the questions and the relevant factors. The correlation coefficient for test–retest with 14 days interval was intraclass correlation coefficient = 0.92 for the whole instrument and 0.89, 0.89, and 0.92 for the domains of knowledge, attitude, and skill, respectively. The internal consistency coefficient (Cronbach's alpha) of the whole tool was 0.95 and 0.95, 0.79, and 0.95 for the domains of knowledge, attitude, and skill, respectively. Finally, PSCSE Questionnaire was obtained with 40 items in dimensions of knowledge (6 items), attitude (14 items), and skills (20 items).CONCLUSION:Persian version of the nurses' competency tool in ensuring patient safety in psychiatric wards has acceptable psychometric characteristics.

The purpose of this study was to develop and evaluate the validity and reliability of a healthy diet and physical activity assessment tool among patients one year after bariatric surgery based on Health Action Process Approach. We compiled 53 items based on healthy diet and physical activity behaviors among patients undergone bariatric surgery through reviewing the literature. Using quantitative and qualitative methods, and a panel of experts, we evaluated the face and content validities of the tool. The reliability was evaluated by Intra-class correlation coefficient and Cronbach's alpha. The content validity ratio and the content validity index were 0.62 and 0.79, respectively. Exploratory factor analysis showed seven factors, including risk perception, outcome expectations, task self-efficacy, coping, recovery self-efficacy, action planning, coping planning, and behavioral intentions. The Intra-class correlation coefficient was between 0.8 and 0.91; and Cronbach's alpha for different constructs was between 0.8 and 0.95. The findings showed that the constructs of the Health Action Process Approach tool regarding healthy diet and physical activity had adequate validity and reliability in bariatric surgery patients.

Background and Aim: Spiritual care is an essential part of holistic nursing care. It refers to a set of nursing care practices which help patients adapt better to the crises. Spiritual care can also lead to patient’s comfort, reduction of physical and emotional pain, reduction of anxiety, a deeper communication between the patient and the nurse, and a sense of relief in the patient’s family. In fact, the overall welfare condition of the patient and his/her family is a product of comprehensive care, an important aspect of which is the spiritual care, as the spiritual dimension encompasses other human dimensions and is a complement to individual’s health. Although most nurses recognize spiritual care as an important part of the holistic care, only about one third of them consistently provide this type of care and it is ignored in most cases. The present study, therefore, aimed to determine the barriers to provide patients admitted to hospitals in Kashan with spiritual care from the viewpoint of the nurses. Materials and Methods: This cross-sectional study was carried out on 306 nurses working at hospital affiliated with Kashan University of Medical Sciences in 2015. Quota sampling was chosen to select the participants. To begin, in collaboration with the nursing offices in the hospitals affiliated with Kashan University of Medical Sciences, a list of all nurses in each hospital was prepared and used as the sampling frame. Then, according to the number of nurses in each hospital, the appropriate sample size for each hospital was calculated. To collect the data, the researcher attended the clinical sections of the hospitals at different working shifts for two months collecting the samples from among those available. Explaining the study objectives and the approximate time to respond to the questionnaire (about 30 minutes) to the nurses, the researcher handed the questionnaire out to them if they were willing to participate in the study. About half an hour or an hour later, the researcher referred to the nurses to collect the completed questionnaires. In case the participants had not been able to complete the questionnaires during the allotted time, they were asked to set a time on the same day to hand the completed questionnaires back, or to submit the completed questionnaires to the section’s secretary later. Then, the researcher collected the questionnaires at as soon as possible. In a few cases where data collection was at the same time as the hospital training classes, the researcher referred to some of the nurses at the end of the classes, and- if they were willing to participate, she asked them to complete the questionnaires and to set a time and place to hand the completed questionnaires back. The data collection instrument were a researcher-made questionnaire designed through library research and reviewing various articles. For the validity of the questionnaire, qualitative and quantitative content validity were used to calculate its Content Validity Ratio (CVR) and Content Validity Index (CVI) of the instrument. Using Cronbach's alpha coefficient and through measures of internal consistency, the reliability of the instrument was also calculated. Alpha value was 0.78 for the entire instrument, 0.91 for the spiritual and religious support section, and 0.86 for the barriers to spiritual care section. Running descriptive and inferential statistics in SPSS 16 statistical software, the data were analyzed using t-test, one-way ANOVA, and Tukey’s post hoc test. Ethical Considerations: The present study was approved by both Research Council and Ethics Committee of Kashan University of Medical Sciences’. All ethical considerations in research were observed. Having obtained the permission from the university and hospital officials, the data were collected. Participation in the study was voluntary. After explaining the purpose and the nature of the research to all the participants, their informed consent to participate in the research was obtained. The questionnaires were anonymous and the participants were assured that their personal information will remain confidential. Results: The mean and standard deviation for the age of the nurses were 31.94 ± 6.53 years old. Most of the participants (78.3%) were females, and 93.8% of them had a bachelor's degree. The mean and standard deviation for their work experience was 8.66 ± 6.27 years. 68.2% of the nurses mentioned that they had not received any training concerning the concept of spiritual care. However, 72.5% of the nurses expressed their interest in acquiring spiritual care. In the nurses’ point of view, the major barriers to spiritual care were reported to be the lack of a sufficient number of staff to provide comprehensive care (78.1%), lack of private space for having a dialogue with the patient (70.3%), heavy workload and its related fatigue (67.4%), inadequate training (66.3%), dedication of more attention to the physical needs (66.3%), lack of organizational support (62.8%), insufficient time (62.7%), inability to communicate (56.9%), nurses and patients’ sexual differences (56.2%), and the belief in a better spiritual care by clergymen and psychologists (54.3%). t-test did not show a significant difference between the scores for the barriers to provide spiritual care in the two genders and the scores for the willingness to learn spirituality. In addition, the analysis of variance did not indicate a significant difference between the scores for the barriers to provide spiritual care and different ages and work histories. There was also no significant difference between the individual’s spirituality and religiosity and the impact of religious and spiritual beliefs on work. However, the analysis of variance revealed a significant difference between the scores for the barriers to provide spiritual care in different sections and different levels of education. Tukey’s post hoc test indicated that oncology nurses’ and surgical nurses' scores were significantly different (P=0.03) so that oncology nurses’ scores were lower than those of the other sections. Tukey’s post hoc test also showed that there was a significant difference between the scores of nurses with the bachelor’s degree and those with the associate's degree (P=0.03) in such a way that the scores of nurses with the bachelor’s degree were higher than those of the nurses with the associate's degrees. Conclusion: The results of the study pointed to the lack of a sufficient number of staff to provide comprehensive care and the lack of private space for having a dialogue with the patient as the most important barriers to provide spiritual care. Meanwhile, most nurses were not trained on how to provide spiritual care. In addition, oncology nurses and nurses with associate degrees received lower scores in providing spiritual care. It is recommended that health planners take the barriers into account to provide the patients with spiritual care, adopt appropriate measures to address them in order to improve the quality of holistic nursing care, and increase the patient and nurse satisfaction. Please cite this article as: Adib-Hajbaghery M, Saeadnejad Z. Barriers to Provide Patients Admitted to Hospitals in Kashan with Spiritual Care: Nurses’ Viewpoints. Med Ethics J 2016; 10(37): 49-59.

IntroductionMultiple sclerosis (MS) is a central nervous system disorder and is frequently associated with fatigue. The Fatigue Scale for Motor and Cognitive Functions (FSMC) is an instrument to assess both motor and cognitive dimensions of fatigue in MS.MethodsThe study included 60 MS patients who completed the Persian version of the Modified Fatigue Impact Scale (MFIS) and a translated version of FSMC questionnaire. The FSMC was translated using standardized forward–backward translation, expert review, and patient feedback to ensure linguistic and conceptual validity. To evaluate test–retest reliability, participants completed the translated version of FSMC again after two weeks. Content validity was examined by a panel of eight experts.ResultsSixty individuals with a mean age of 36.36 ± 9.7 years and an Expanded Disability Status Scale score of 3.00 ± 2.0 were enrolled in this study. Fifty-one (85%) of the participants were female. The Persian FSMC demonstrated strong content validity (Content Validity Index: 0.875–1.00; content validity ratio: 0.75–1.00). Internal consistency was excellent (Cronbach's alpha = 0.964). Test–retest reliability was strong for average scores (intraclass correlation coefficient (intraclass correlation coefficient (ICC) = 0.979), though fair to good for single measures (ICC = 0.540). Convergent validity was supported by strong correlations with MFIS scores (FSMC-total: r = 0.88; motor: r = 0.87; cognitive: r = 0.85; all p < .001). No floor/ceiling effects were observed.ConclusionsThe Persian version of the FSMC is a valid and reliable instrument for assessing fatigue in Iranian patients with MS. With strong psychometric properties, it is well-suited for clinical and research use in Persian-speaking populations.

Background: A few studies have been done regarding the validity and reliability of the Mini-Peer Assessment Tool across various specialties. This study was conducted to determine the reliability, content and construct validity of Mini-Peer Assessment Tool to assess the competency of emergency medicine residents. Methods: This study was carried out to investigate the psychometric properties of the mini-PAT tool to evaluate the professional competencies of emergency medicine residents in educational hospitals affiliated to Tehran University of Medical Sciences. The initial Mini-Peer Assessment Tool was translated into Persian. After that, the content validity index and content validity ratio determined by consulting 12 professors of emergency medicine. The construct validity was determined with exploratory factor analysis and investigation of the correlation coefficient on 31 self and 248 peer assessment cases. The reliability of the mini peer assessment tool was determined by internal consistency and item deletion by using Cronbach's alpha coefficient. Reliability was also assessed by determining the agreement between the two tools of self-assessment and peer assessment by using the diagram Bland and Altman. Results: The results showed content validity ratio (CVR) of the items ranged from 0.56 to 0.83, and the content validity index (CVI) of the items ranged from 0.72 to 0.90. The reliability of the self-assessment and peer-assessment tools were 0.83 and 0.95 respectively and there was a relative agreement between the self-assessment method and the peer assessment method. Finally, the tool underwent exploratory factor analysis resulting extraction into two factors namely 'clinical competencies' and 'human interactions' in the peer assessment tool. In the self-assessment tool, the factors of 'good practice' and 'technical competence' were extracted. Conclusion: The results of the present study provided evidence of the adequacy of content validity, reliability of the contextually customized mini-peer assessment tool in assessing the competencies of emergency medicine residents.

Patients with multiple sclerosis (MS) should have magnetic resonance imaging evaluation regularly. They will experience anxiety before this examination. We conducted this study to evaluate the validity and reliability of emotions and attitudes towards MRI" (MRI-EMA). One hundred-nine patients with MS were asked to fill the valid and reliable Persian version of Beck Anxiety Inventory (BAI), and MRI-EMA, questionnaires. Two weeks later, twenty cases were asked to fill the questionnaire again to assess reliability. The intra-class correlation coefficient (ICC) and Cronbach's alpha analysis were used. The correlation coefficient between BAI and MRI-EMA was calculated. Five neurologists assessed content validity by content validity ratio (CVR) and content validity index (CVI). The mean age was 37.2±1.2 years and 77% were females. CVI and CVR for all questions were 100%. The correlation coefficient between BAI and MRI-EMA was r=0.1, P=0.1 and only fear of MRI subscale was significantly correlated with BAI. The ICC of all questions was between 0.79 and 0.98. Patients with MS have to be routinely screened with MRI which provides anxiety for them. Considering MRI related anxiety is crucial for these cases. The Persian version of the MRI-EMA questionnaire is a valid and reliable instrument for measuring MRI related anxiety in patients with multiple sclerosis.

Background:Reliability and validity are the key concepts in measurement processes. Young internet addiction test (YIAT) is regarded as a valid and reliable questionnaire in English speaking countries for diagnosis of Internet-related behavior disorders.Objectives:This study aimed at validating the Persian version of YIAT in the Iranian society.Patients and Methods:A pilot and a cross-sectional study were conducted on 28 and 254 students of Qom University of Medical Sciences, respectively, in order to validate the Persian version of YIAT. Forward and backward translations were conducted to develop a Persian version of the scale. Reliability was measured by test-retest, Cronbach’s alpha and interclass correlation coefficient (ICC). Face, content and construct validity were approved by the importance score index, content validity ratio (CVR), content validity index (CVI), correlation matrix and factor analysis. The SPSS software was used for data analysis.Results:The Cronbach’s alpha was 0.917 (CI 95%; 0.901 - 0.931). The average of scale-level CVI was calculated to be 0.74; the CVI index for each item was higher than 0.83 and the average of CVI index was equal to 0.89. Factor analysis extracted three factors including personal activities disorder (PAD), emotional and mood disorder (EMD) and social activities disorder (SAD), with more than 55.8% of total variances. The ICC for different factors of Persian version of Young Questionnaire including PAD, EMD and for SAD was r = 0.884; CI 95%; 0.861 - 0.904, r = 0.766; CI 95%; 0.718 - 0.808 and r = 0.745; CI 95%; 0.686 - 0.795, respectively.Conclusions:Our study showed that the Persian version of YIAT is good and usable on Iranian people. The reliability of the instrument was very good. Moreover, the validity of the Persian translated version of the scale was sufficient. In addition, the reliability and validity of the three extracted factors of YIAT were evaluated and were acceptable.

Escala de Calidad de vida Osteoporosis (ECOS-16) was originally developed in Spanish to evaluate the quality of life (QoL) in post-menopausal women (PMW) with osteoporosis or osteopenia based on the osteoporosis-specific QoL instruments. ECOS-16 has been translated into several languages, but the Urdu version is not yet available. To translate the ECOS-16 Questionnaire into Urdu and determine its validity and reliability in PMW with osteopenia. This was a linguistic validity and reliability study. ECOS-16 was translated into Urdu using Beaton's guidelines. Content validity was examined using Waltz's four-point ordinal scale. Twenty osteopenia-afflicted PMW aged 48-70 underwent pilot testing for face validity. Discriminant validity was determined by an independent T-test between PMW women with and without osteopenia. Convergent validity was assessed using Spearman's correlation coefficient. Cronbach's alpha and Intraclass correlation coefficient (ICC2,1) assessed internal consistency and test-retest reliability. The factor analysis was used to describe the factors. Each question's content validity ratio (CVR) was 0.83-1.00, while the scale's S-CVR was 0.96. Each question's Likert scale content validity index (CVI) was 0.91-0.93, while the scale's S-CVI was 0.91. Significant discriminant validity was found between groups in weeks I and II (p-value < 0.001). A correlation coefficient of 0.89 and 0.96 (p-value < 0.001) between Urdu ECOS-16 total score and SF-36 and EQ-5D scores suggests convergent validity. One component explained 83.86% of Urdu ECOS-16's variance in factor analysis. Excellent test-retest reliability (ICC2,1 = 0.990, 95% CI, 0.985-0.994, p-value < 0.001). Cronbach's alpha for standardized items was 0.995. ECOS-16 translated in Urdu is a valid and reliable questionnaire to assess QoL in PMW with osteopenia. It has a simple and easy language that can be understood easily by the Urdu-speaking population.

Introduction: Prevalence of depression in patients with diabetes is 2-3 times more than patients without diabetes. Hence, the aim of the current study was to evaluate the reliability and validity of Persian version of the 10-item Kessler Scale (K10) in assessment of mental health status among patients with type 2 diabetes in Ardabil, Northwest of Iran. Methods: This cross-sectional methodological study was conducted in Ardabil on a total of 70 patients with type 2 diabetes. K10 was translated into Persian by backward-forward method, and content validity was evaluated by a panel of experts in the field of psychiatry, psychology and epidemiology. Concurrent validity examined by the correlation between K10 and general health questionnaire-12 (GHQ-12). The reliability and stability evaluated by Cronbach¢s alpha and intraclass correlation coefficient (ICC) (test-retest method). The total score was computed from 10-items, which were classified into four categories (well, mild, moderate and severe). The analysis was performed using SPSS the level of significance was set at 0.05. Results: The total average content validity ratio (CVR) and content validity index (CVI) were 0.88 and 0.95; correlation between K10 and GHQ-12 was significant (r = 0.63, P < 0.001), hence, the content and concurrent validity of K10 Persian version was confirmed. Reliability was tested by Cronbach¢s alpha = 0.84 and ICC = 0.77, respectively. Conclusion: The Persian version of K10 is valid and reliable for evaluation of mental health status among patients with type 2 diabetes.

The attitudes toward older patients are considered the main factor in providing health services. There is a lack of proper short scale to measure attitudes toward older patients among healthcare professionals. The present study was to assess the psychometric properties of the UCLA Geriatric Attitude scale (UCLA-GAS) among a sample of Iranian healthcare professionals. The method of this study was cross-sectional for psychometric evaluation. The sample included 232 healthcare professionals in Mazandaran city. Study participants were selected by cluster random sampling technique. Psychometric evaluation of the UCLA-GAS assessed through content and construct validity. Content validity was evaluated based on the content validity index (CVI) and construct validity was investigated using exploratory and confirmatory factor analysis. Also, convergent validity was assessed using the Kogan's Attitudes Toward Older People Scale (KAOPS) questionnaire. Cronbach's alpha was used to evaluate internal consistency reliability and stability was assessed using test-retest. Regarding the content validity, CVI and modified Kappa statistic for all items were >0.79 and showed all items relevant to the UCLA-GAS in the Iranian context. The three dimensions of the UCLA-GAS extracted from factor analysis were labeled: 1- medical/economic burden (6 items) 2- appreciate attitude (5 items), 3- resource allocation (3 items). CFA revealed that the UCLA-GAS structure model was a validated model (CMIN = 2.312, GFI = 0.913, CFI = 0.902, RMSEA = 0.075). The scale had a significant and positive correlation with KAOPS questionnaire. Also, The Cronbach's alpha of the scale was 0.78 and intra-class correlation coefficient (ICC) for total instrument was reported as 0.93 (95% CI: 0.87-0.98) and demonstrated good reliability of the instrument. The result shows the UCLA-GAS is a valid and reliable scale for measuring attitudes toward older patients among healthcare professionals. This study recommends using Iranian UCLA-GAS in future research and policy-making.

Introduction: Social media usage, knowledge, and risk perception factors may play pivotal roles in shaping HPV vaccination acceptance. However, limited research has systematically evaluated the validation of questionnaire on these factors. Objective: This study aimed to assess the validity and reliability of a questionnaire designed to measure the impact of social media use, knowledge, and risk perception towards HPV vaccination acceptance in China. Materials and methods: To ensure rigorous validity and reliability analysis, the questionnaire underwent assessment using the Face Validity, Content Validity Index (CVI), Content Validity Ratio (CVR), and Cronbach's Alpha coefficient to evaluate validity and reliability as well as mitigate potential misinterpretation of results. Results: The final version of questionnaire comprised 78 items across five sections and underwent a rigorous evaluation to ensure both validity and reliability. The CVI, and CVR indicating that all items meet the minimum standards for content validity. Furthermore, in comparison to the initial version of the questionnaire, the Cronbach's Alpha values for each domain in the final version have shown improvement: HPV-related social media usage behavior [Cronbach's Alpha: 0.851 (item numbers: 10)], HPV knowledge [0.818 (25)], risk perception [0.888 (17)], and HPV vaccine acceptance [0.772 (7)]. These values surpass the minimum requirements of the inclusion criteria, signifying enhanced reliability of the revised questionnaire. Conclusion: The final version of questionnaire exhibited robust validity and reliability. This validated questionnaire serves as a valuable tool for future research endeavors, emphasizing the significance of meticulous instrument development and validation in yielding high-quality research outcomes in the domain of HPV-related factors.

BackgroundDespite the critical role of health literacy in emergency management, no specific questionnaire exists to measure first aid health literacy in the older population. To address this gap, the present study aimed to develop and psychometrically evaluate a first aid health literacy assessment questionnaire for older adults in 2024–2025.MethodsThis methodological study focused on questionnaire development and psychometric evaluation based on the framework proposed by Boateng et al. Initial questionnaire items were generated through an extensive literature review. Content validity and face validity were assessed using quantitative and qualitative methods. A multi-stage random sampling method was employed to recruit 400 eligible older adults who were covered by comprehensive health centers affiliated with Kashan University of Medical Sciences. All participants completed a background information questionnaire, the Persian version of the Abbreviated Mental Test (AMT), and the Health Literacy Instrument for Adults-Short Form (HELIA-SF). Construct validity was evaluated using Principal Component Analysis (PCA) and convergent validity. Internal consistency was assessed using the Kuder-Richardson Formula 21 (KR-21), test-retest reliability was measured via the intra-class correlation coefficient (ICC), and stability was determined using the standard error of measurement (SEM) and the minimal detectable change (MDC). Ceiling and floor effects were also examined. Data analysis was performed using JASP version 0.19.3.ResultsThe content validity ratio (CVR) and content validity index (CVI) for all items exceeded 0.8 and 0.9, respectively, and the modified kappa coefficient was greater than 0.89. Item impacts were all above 4.5. PCA extracted three components, collectively accounting for 58.2% of the variance in the total score. Results revealed a significant positive correlation between the first aid health literacy assessment questionnaire for older adults and the HELIA-SF (p < 0.001). Reliability indices were as follows: KR-21 = 0.704, ICC = 0.955, SEM = 0.707, and MDC = 2.331. No ceiling or floor effects were observed.ConclusionThe first aid health literacy assessment questionnaire for older adults demonstrates good validity and reliability. This questionnaire can effectively measure first aid health literacy levels in the older population and can design targeted educational interventions to improve their health outcomes.Clinical trial numberNot applicable.