The results of the cultural adaptation and psychometric evaluation of the Barkin Index of Maternal Functioning-Persian Version are reported within this manuscript. On the whole, the findings regarding reliability and validity were positive and indicate that the BIMF-Persian version is capable of accurately quantifying the construct of postpartum maternal functioning in Iranian women. These results corroborate the findings of psychometric evaluations (and other validation studies) performed in the United States [2, 22] and Turkey . To date, the body of evidence indicates that the BIMF has global applicability, though it should be tested in additional countries, in different regions of the world.
A 5-factor structure was obtained as a result of the exploratory factor analysis and included: 1) Satisfaction with Maternal Competence (Items 1, 2, 4, 5, 10, 14, 15, 17, 20), 2) Self-care (Items 8, 11, 13, 19), 3) Infant Care (Items 3, 12), 4) Social Support (Items 6, 7, 9), 5) Psychological Wellbeing (Items 16, 18). This result is in line with the Aydin et al. study (2018) in which a 5-factor solution was also obtained . The agreement between this study and the Aydin et.al. study(2018) is intuitive considering the cultural proximity between the two neighboring countries of Iran and Turkey, similarity in both the sample size (250 vs 235) and inclusion criteria. However, these results are not consistent with the Mirghaforvand et al. (2019) and Barkin et al. (2014) studies, in which 2-factor structure was obtained [4, 41]. The difference between the results of our study and Barkin et al. May be due to large cultural differences between two society but the different with Mirghaforvand's study may be related to differences in the study setting and inclusion criteria. Because our study was conducted in Tehran city (the capital of Iran) with a multi-cultural texture from all over the country and Semnan city in the neighboring province of Tehran. While the study of Mirghforvand has been done in the city of Tabriz, Where the dominant culture of its people is Turkish. Also, this study was conducted on mothers with children aged 2–12 months, while their study was performed on mothers with children aged 6–10 weeks Another distinguishing feature is that our study results did not indicate that the removal of items was necessary. In contrast, Mirghaforvand et al.  removed three items (Items 15, 16, and 18), and Aydin et al.  removed four items (Items 15, 16, 18 and 20).
The results of the exploratory factor analysis indicate that the 5-factor model of the Persian version of BIMF accounted for 53.19% of the total variance in the main variables. This same value in the Aydin et al. , Mirghaforvand et al. , and Barkin et al.  studies was 59.9%, 44.2%, 70.72%, respectively. Therefore, our EFA results were adequate considered acceptable  and in line with similar studies.
The Cronbach’s alpha, an indicator of internal consistency, was both adequate and in range with other studies at 0.80. Studies conducted by Barkin et al. (2010; 2014) in the United States indicate a Cronbach’s alpha value between .87 and .88. Mirghafourvand et al.’s (2019) study of 530 postpartum Iranian women also produced a Cronbach’s alpha of .88. In their analysis of 235 Turkish women, Aydin and Kukulu (2018) reported a Cronbach’s alpha of .73, which is also in adequate range [39, 40].
The WHO Process of Translation and Adaptation of Instruments  and the IQOLA (International Quality of Life Assessment) protocol  were used in combination for this project; this method promoted a comprehensive and accurate assessment of the questionnaire items. Expert opinion was obtained and integrated throughout the process and the sample was somewhat diverse in relation to reproductive characteristics; both primiparous and multiparous women were included and both modes of delivery (vaginal and cesarean section) were represented. Including only literate mothers from two urban areas in Iran somewhat limits the generalizability of the findings - although, this measure is performing well in multiple study samples and countries [2, 7, 41].
The strong psychometric properties, ease of administration, and brevity of the BIMF (and, by extension, the Persian version of the BIMF) may implicate this patient-centered measure for widespread use in both medical centers and home visiting programs. Healthcare providers who interact with new mothers such as midwives, obstetrician/gynecologists (OB/GYN) and pediatricians now have a tool at their disposal to evaluate functioning during the postpartum period. While mood disorders such as depression and anxiety should be included as part of routine screening [42, 43], assessment of functioning offers both a different method of evaluation and unique therapeutic option. Providers may decide to address problematic BIMF domains or review the results of all 20 items, once completed. One approach would be to address problematic domains through skill-building exercises. For example, a woman with less than optimal answers on the self-care items might receive targeted, therapeutic support in that specific area.