Journal of Education and Health Promotion

Abstract BACKGROUND: Assessment of circulating and scrub skills is an important issue in operating
room (OR) programs. However, there is a lack of well‑designed tools that are specifically developed
for this purpose. Hence, this study aimed to develop and determine the validity and reliability of a
checklist to measure the circulating and scrub skills of OR novices.
MATERIALS AND METHODS: This cross‑sectional methodological study was conducted among 124
OR technology students who were selected during three consecutive academic years (2019–2020 to
2021–2022). The developed checklist was evaluated with face validity, content validity (quantitative
and qualitative), construct validity  (known‑groups validity), criterion‑related validity  (concurrent
and predictive validities), internal consistency  (Kuder–Richardson 20, KR‑20), and inter‑rater
reliability (intra‑class correlation coefficient, ICC). Known‑groups validity was evaluated by comparing
the difference between the checklist scores of first‑semester and third‑semester students using
independent samples t‑test. Additionally, concurrent and predictive validities were evaluated by ICC
through measuring the correlation between the total score of checklist and grades of a multiple‑choice
test and two clinical apprenticeship courses, respectively. Data were analyzed in the Statistical
Package for Social Sciences software.
RESULTS: After reconciling the preliminary checklist in terms of face and content validities, a
checklist with 17 sub‑scales and 340 items called “Circulating and Scrub Skills of Operating Room
Novices (CSSORN)” was developed. Regarding the known‑groups validity, the third‑semester
students had higher scores compared to the first‑semester students (p < 0.001 in most sub‑scales).
Besides, the total score of checklist showed a significant correlation with the criteria of concurrent
and predictive validities (ICC = 0.64, ICC = 0.72; P < 0.001). The KR‑20 for the entire checklist was
0.90 (range: 0.60–0.93). The ICC for inter‑rater reliability was also 0.96 for the entire checklist (range:
0.76–0.99, P < 0.001 in all sub‑scales).
CONCLUSION: The CSSORN had appropriate validity and reliability to be used for measuring the
circulating and scrub skills of OR novices. To shed light on the findings, further testing of this checklist
on larger populations and in different contexts is suggested.

Abstract BACKGROUND: Patients with heart failure experience severe and chronic physical and psychological
manifestations while the disease progresses. Assessing the degree of distress caused by
manifestations of the disease in patients is the first step in designing and evaluating intervention
programs to improve patients’ symptoms. The aim of this study was to investigate the psychometric
properties of the Persian version of the Symptom Distress Scale in HF patients.
MATERIALS AND METHODS: This study was conducted via methodological research design from
March to November 2019. The translation process and cross‑cultural adaptation were performed
using a process recommended by the World Health Organization. The face and content validity and
internal consistency were used to evaluate the validity and reliability of the instrument. The scale
was evaluated by exploratory and confirmatory factor analysis in 300 patients with heart failure, and
the obtained data were analyzed using SPSS‑22 and AMOS‑22 software.
RESULTS: The content validity of the scale was approved based on the results of the study. One‑factor
scale with 13 items was used in the confirmatory factor analysis, and the results showed that the
instrument had high goodness‑of‑fit indices. Spearman correlation test for convergent validity showed
a correlation between the score obtained by the Scale of Symptoms of Disease and the scores of
The European Heart Failure Self‑care Behavior scale (9 items) (P < 0.0001).
CONCLUSION: The Persian version of the Symptom Distress Scale can be used as a valid instrument
for people with heart failure due to its desirable psychometric properties.

Abstract BACKGROUND: Facilitating the healing process of patients with psychiatric disorders depends on
high‑quality mental health care and expert psychiatric nurses. A valid tool is required to objectively
evaluate the quality of performance and competency of psychiatric nurses. This systematic review
aimed to investigate and critique the psychometric properties of some psychiatric nursing clinical
competency assessment instruments with Consensus‑based standards for the selection of health
status measurement instruments (COSMIN) checklist and according to Preferred Reporting Items
for Systematic Reviews and Meta‑analyses (PRISMA).
MATERIALS AND METHODS: To retrieve published articles using Persian and English keywords
“psychiatric nursing,” “competence,” “competency,” “tool,” “checklist,” “scale,” “questionnaire,”
“psychiatric mental health nurse,” were searched in databases without time limitation. Then,
psychometric properties of selected instruments were evaluated using the COSMIN checklist and
reported according to the PRISMA statement.
RESULTS: Most of these tools did not entirely and desirably report psychometric properties. It is not
designed as a special tool for postgraduate psychiatric nursing.
CONCLUSION: The methodology of existing instruments does not meet the COSMIN checklist criteria;
therefore it needs to develop. To assess the competency of psychiatric nursing postgraduate, a tool
tailored to the cultural and social context and with acceptable psychometric properties is necessary.

Abstract 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.

Abstract BACKGROUND: COVID‑19 pandemic poses unique physical and emotional challenges in providing
clinical education. Failure to identify the challenges and problems that students face in the clinical
learning environment hinders their effective learning and growth. Consequently, the progress of
their skills is affected. The aim of this study was to develop a challenge in the clinical education
environment of medical students during the outbreak of COVID‑19 questionnaire and to test its
psychometric properties.
MATERIALS AND METHODS: This study is part of a larger study that was conducted using a
combined consecutive method in Qazvin. In the first stage, a phenomenological study was performed
with van Manen’s method by interviewing 12 students at Qazvin University. To extract the items of
the tool in the second stage, the concept was defined. Ultimately, the psychometric properties of
the questionnaire were evaluated with face validity, content validity (quantitative and qualitative),
construct validity (exploratory factor analysis), internal consistency (Cronbach’s alpha), and test–retest
reliability (intraclass correlation coefficient).
RESULTS: The initial tool had 70 questions. After validation, 53 items remained in the final
questionnaire. Four extracted dimensions were as follows: “Inadequate professional competency,”
“Inefficient clinical planning” and “outcomes of learning‑teaching activities,” and “the challenges
related to the stigma of medical staff.” Cronbach’s alpha for the whole questionnaire was
0.98 (range: 0.87–0.98). The test–retest (intraclass correlation coefficient) reliability was
0.98 (P < 0.001).
CONCLUSIONS: According to the obtained results, if the items of “Inadequate professional
competency,” “Inefficient clinical planning” and “outcomes of learning‑teaching activities,” and “the
challenges related to the stigma of medical staff,” the challenges of students’ clinical education can
be reduced during the COVID‑19 outbreak.

Abstract BACKGROUND : The complex, multifaceted care environment and the threatening situation of caring
for hemodialysis patients cause tension in their family caregivers. Due to the severe tension, family
caregivers are likely to ignore their basic needs and only pay attention to the patient’s needs and
related issues. This study was conducted with the aim of designing and evaluating the Perceived
Care tension Questionnaire for Caregivers of Hemodialysis Patients (PCTQHFC).
MATERIALS AND METHODS: The present study was a sequential exploratory mixed methods
study of scale development variant conducted in two phases: qualitative and quantitative. This study
was conducted in 2019 in Shahrekord. The qualitative phase included item development and scale
development. In the quantitative phase (Item Analysis), the validation characteristics of the tool were
examined using face, content and construct validity, and its reliability by internal consistency and
stability. Findings were performed using software SPSS 18.
RESULTS: Principal components analysis with orthogonal rotation to generate factors, showed that
five factors, namely emotional exhaustion, inadequate social support, care burden, confusion and
ambiguity and lack of adaptability skills had an eigenvalue of higher than 1, so that they explained,
respectively, 75.98%, 61.36%, 72.49%, 76.33%, and 70.31% of the total variance. The internal
consistency was obtained 0.811 and the inter‑class correlation coefficient for the whole instrument
0.832.
CONCLUSION: PCTQHFC is a culturally appropriate measure with strong psychometric properties.
The instrument designed in this study measures the care tension of hemodialysis patients. Therefore,
researchers, health‑care providers, and community health policymakers can plan and implement
interventions to reduce the tension of caregivers of hemodialysis patients by analyzing and identifying
the tensions of caregivers.

Abstract INTRODUCTION: Understanding adaptation is strongly influenced by the culture and beliefs of every
society. By increasing knowledge about the different dimensions which require the adaptation in
different aspects requiring the nurse adaptation in oncology, a clear definition of the problem can be
stated. Because of the lack of a standard and appropriate tool for the culture of the Iranian society,
this aimed at developing and validating the nurse adaptation tool in the oncology departments.
METHODS: This research is a methodological study and an exploratory mixed method being
conducted in three main steps of conceptualization, production of items, and field test. Inductive
conceptualization was performed through qualitative methodology and conventional content analysis
approach; in the second step, developed instrument was evaluated in terms of face validity, content
validity, and construct validity. In the third step, sampling of oncology nurses was done and exploratory
factor analysis was performed for evaluating the construct validity, adequacy of sampling, and
dimensioning. Cronbach’s alpha was calculated for checking the reliability of the instrument.
RESULTS: The oncology nurse adaptation questionnaire was formed with twenty items in four main
dimensions, including “emotional factors,” “supportive factors,” “work‑related factors in the ward,”
and “factors related to job conditions.” The reliability of the tool was confirmed by evaluating the
internal consistency with Cronbach’s alpha, which was above 0.7 for each dimension and 0.82 for
the whole instrument.
CONCLUSION: This instrument can be used as a practical tool for determining the adaptation of
oncology nurses for providing evidence to improve the work conditions of nurses by improving the
working conditions in the workplace and providing facilities with individual intervention, and the
outcome will be care of patients with high quality.

Abstract BACKGROUND: Disordered eating attitude may lead to full‑blown eating disorders. Recent
longitudinal studies show that disordered eating attitudes either remain stable or even increase from
childhood to adulthood. The current study was done to determine the psychometric properties of the
Eating Attitudes Test‑8 (EAT‑8) and introduce the suitable measure for researchers and therapist in
the field of clinical psychology and psychiatrist.
MATERIALS AND METHODS: The Persian version of the EAT‑8 was produced through forward
translation, reconciliation, and back translation. A sample of 302 students were selected through
convenience sampling method and completed a set of questionnaires, including the EAT‑8,
Eating Attitudes Test‑16 (EAT‑16), Eating Beliefs Questionnaire‑18 (EBQ‑18), self‑esteem scale,
and self‑compassion scale short‑form. The construct validity of the EAT‑8 was assessed using
confirmatory factor analysis and divergent and convergent validity. Internal consistency and test–retest
reliability (2 weeks’ interval) were conducted to evaluate the reliability. Data analysis was conducted
using SPSS (version 22) software and LISREL (version 8.8).
RESULTS: EAT‑8 was found to be valid and reliable measures, with good internal consistency and
good test–retest reliability among students. In terms of convergent validity, EAT‑8 showed a significant
positive correlation with self‑report measures of EAT‑16 and EBQ‑18. EAT‑8 showed a negative
correlation with self‑compassion and self‑esteem, thus demonstrated a good divergent validity. The
results of this study also provide support for the one‑factor model of the EAT‑8.
CONCLUSION: The EAT‑8 showed good validity and reliability and could be useful in assessing
disordered eating in Iranian population. The EAT‑8 shows notable promise as a measure for use in
disordered eating research and clinical settings.

Abstract BACKGROUND AND AIM: Measuring child abuse and adverse experiences is a critical task with
regard to its long‑term impact on the health of individuals and communities. The purpose of this
study was to validate the Persian version of the International Adverse Childhood Experiences Abuse
Short Form (ACE‑ASF) in Iranian society.
MATERIALS AND METHODS: This cross‑sectional study was conducted in Kerman, southeast of
Iran, in 2019, on 494 students from Kerman University of Medical Sciences, selected by convenience
sampling method. Psychometric properties of the questionnaire were examined after the forward
and backward translation processes. The factor structure of the questionnaire was evaluated using
exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The concurrent validity of
the questionnaire was assessed using the childhood trauma questionnaire (CTQ). Cronbach’s alpha
and corrected item‑total correlation were used to measure reliability.
RESULTS: The mean age of participants was 24.3 ± 5.3 years. Based on EFA, two physical–emotional
abuse and sexual abuse factors were obtained. The CFA fit indices well supported two extracted
factors. The CFA showed acceptable factor loadings. The internal consistency coefficient of
Cronbach’s alpha was 0.75 for the physical–emotional abuse factor and 0.77 for the sexual abuse
factor. The correlation coefficient of ACE‑ASF and CTQ was r = 0.56. The reliability index of intraclass
correlation coefficient was 0.73 (95% confidence interval: 0.60–0.84).
CONCLUSION: The Persian version of the ACE‑ASF questionnaire has acceptable psychometric
properties.

Abstract INTRODUCTION: Assessment interprofessional collaboration (IPC), in community health‑care
setting usually has been neglected due to the lack of standard tools and assessors. In the present
study, the IPC checklist extracted from CANMEDS collaborator toolkit for teaching and assessing
the collaborator role is contextualized in Iranian community healthcare.
MATERIALS AND METHODS: According to CANMEDS Toolkit, an instrument extracted for IPC
assessment. Using Chavez’ toolkit, face and content validity were studied through two rounds of
Delphi by 12 experts of TUMS. Qualitative content validity including content validity index (CVI),
and content validity ratio (CVR) were assessed following watching a standard video about IPC by
them. Construct validity was studied by confirmatory factor analysis through LISREL software. To
check reliability, Cronbach’s alpha was calculated, and the other 12 experts completed checklists in
test–retest process with a 2‑week interval.
RESULTS: Face and qualitative content validity were confirmed using the Delphi method. CVI and
CVR were calculated as 0.61 and 0.86. In factor analysis, x2/df and RMSEA were calculated as
1.363 and 0.036; CFI, IFI, GFI, and AGFI were >0.7, and hence, the construct validity was confirmed.
Cronbach’s alpha was 0.953 for internal consistency. Test–retest was also calculated as 0.918
indicated to confirm reliability.
CONCLUSION: CANMEDS framework as an assessment tool for evaluating IPC in community health
setting is not only valid and reliable in the Iranian context but also it is easy to use for respondents
resulted from the rational number of items in community.

Abstract BACKGROUND AND AIM: Some people exposed to disasters will suffer from acute stress
disorder (ASD) due to the negative consequences of these disasters. Evaluating this disorder at a
large scale requires a credible and standardized tool. Therefore, the current study aims to investigate
the psychometric properties of the ASD questionnaire for people exposed to Kerman earthquake.
METHODS: This is a descriptive‑tooling study, conducted on 435 men and women older than 18 years
living in earthquake‑affected areas of Kerman Province (Kouh‑e‑Banan). The study was carried out
using the Persian translating of the English version of the Diagnostic and Statistical Manual of Mental
Disorders, Fifth Edition ASD questionnaire on accessible individuals living in temporary residence
tents in two initial and final stages and different stages of validity and reliability evaluation was carried
out. The findings were analyzed using descriptive statistics and Pearson’s correlation coefficient.
RESULTS: During the evaluation of content validity, no questions were eliminated. To carry out
factor analysis, sampling competence, and suitability of sample size were confirmed through
Kaiser–Meyer–Olkin and Bartlett’s tests. In the factor analysis stage, 14 items in three factors were
defined. The factors were included reexperiencing and analysis, arousal (continuous irritability), and
avoidance factors which together explained 59.43% of percentage distribution. In the next stage
of evaluating divergent validity, the results indicated a significant and inverse correlation between
ASD score and quality of life score (r = −0.43, P = 0.002) of the participants, while there was also
a positive and significant correlation between ASD score and general health disorder score of
the participants (r = 0.47, P < 0.0001). The reliability of the questionnaire was investigated using
Cronbach’s alpha, and inner class correlation coefficient was calculated to be 0.9.
CONCLUSIONS: The tool investigated in this study has suitable validity and reliability and is effective
for use by psychologists and relief workers for necessary interventions and prevention of ASD in
disasters.

Abstract BACKGROUND: A proper measurement instrument is selected based on the suggested use of
the instrument, the target concept of measurement, and features of measurement (e.g. internal
consistency, reproducibility, content and construct validity, responsiveness, and interpretability).
Concerning the design and features of measurement, there are not any adequately specific standards
for instrumentation to measure oral health literacy (OHL). The present study proposes a protocol
that attempts to fill this gap by introducing the psychometrics of a standard questionnaire which
measures OHL.
MATERIALS AND METHODS: The present research employs a methodological design and is carried
out in Tehran, with data collected through interviews that are held face to face. The data collection
procedure involves a review of the related literature, cognitive interviews, fuzzy Delphi Method, and
focal groups with participants with OHL work experience for item generation. The target participants
of this research are the Iranian adult population and experts working professionally in different
health domains. For qualitative data analysis, the content analysis strategy and in the instrument
Psychometrics COSMIN checklist will use.
CONCLUSIONS: Achievement of the present research  will be used to evaluate the capability of
the Iranian adult population in searching, processing, and deciding on healthcare services. This
instrument will focus on evaluating both clinical and nonclinical settings. The present research can
vastly improve our knowledge of the state of OHL in the Iranian adult population.

Abstract BACKGROUND: Structural empowerment (SE) is an effective method of advancing work
environments and has previously been widely discussed in Western countries. Due to the lack of
culturally and academically accepted scales in Iran for measuring SE, localization of a foreign scale
in this field is necessary.
OBJECTIVES: This study aimed at investigating the validity and reliability of the Persian Version of
the Conditions of Work Effectiveness Questionnaire‑II (CWEQ‑II‑PV) among Iranian nurses.
METHODS: The present cross‑sectional methodological research was conducted during 2017–2018.
Participants were 230 nurses working in four teaching hospitals affiliated to Kashan University of
Medical Sciences in Kashan, Iran, who were selected using quota sampling. A standard forward–
backward translation procedure according to Wild et al. (2005) was used to translate the English
Version of the CWEQ‑II to Persian. The psychometric evaluation processes were achieved by face,
content, and construct validity (confirmatory factor analysis [CFA]). Reliability was examined using
test–retest and Cronbach’s alpha for internal consistency reliability.
RESULTS: The CWEQ‑II‑PV showed good content validity (the mean content validity scores for
relevancy, clarity, and simplicity were 94%, 96%, and 94%, respectively). In the CFA, the original
six‑factor version with 19 items was confirmed. The original model was presented and incorporated in
the CFA, indicating an acceptable fit for the model (root mean square error of approximation = 0.06,
comparative fit index = 0.92, goodness of fit index (GFI) = 0.94, and adjusted GFI = 0.91). Cronbach’s
alpha coefficient for the total scale was 0.84 and for each component ranged from 0.71 to 0.87,
indicating good internal consistency, and the test–retest Spearman and intraclass correlation
coefficients were 0.93 and 0.87, respectively, showing good test–retest reliability.
CONCLUSIONS: Evidence was found to support the reliability and validity of the CWEQ‑II‑PV scale
that measures the quality of the work environment for nurses from a SE perspective.

Abstract INTRODUCTION: The importance of life skills and their application in promoting personal, family,
and occupational health in military personnel is well recognized. It is, therefore, important to identify
and assess life skills in military personnel with a valid and reliable tool. The present study aims to
develop such a tool and evaluate its psychometric features in military personnel.
MATERIALS AND METHODS: As part of a mixed study, a qualitative concept analysis study was
conducted using hybrid approach to redefine life skills in military personnel, and results obtained
were used to form a pool of items. Next, in a methodological study, psychometric evaluation,
qualitative and quantitative face validity, qualitative and quantitative content validity, and construct
validity (exploratory factor analysis), and reliability (using test‑retest and internal consistency) were
performed on the inventory.
RESULTS: Initial pool of items was designed with 156 items, which were reduced to 93, following
qualitative face validity, and further reduced to 80 after quantitative face validity (item impact score).
No further reduction was implemented after qualitative and quantitative content validity (content validity
ratio and content validity index ratio). Following construct validity (factor analysis), the remaining 80
items were summarized in 5 factors. Cronbach’s alpha for the 5 factors was found 0.7, and correlation
coefficient of test‑retest results exceeded 0.9 and was significant at 0.01.
CONCLUSION: Given the acceptable results of psychometric features, this tool can be used as a
valid and reliable tool for assessing life skills in military personnel.