Participants and Study Design
We conducted a cross-sectional study on infertile couples using the convenience sampling method. The inclusion criteria were as follows: 1) couples diagnosed with infertility, 2) those with primary or secondary infertility and without children, 3) those aged >18 years, and 4) those willing to voluntarily complete a multi-item questionnaire. In contrast, the exclusion criteria were as follows: 1) couples with a history of psychiatric problem and 2) those with other major diseases during the study period. The participants were recruited from August 2018 to October 2018, and the target sample size was 150. The sample size in this study was determined using Song and Kim method, according to which, the appropriate sample size was assumed to be 150–400 [13].
Data Collection
Data were collected from Haeundae Community Health Center in Busan, South Korea, and an online infertility website. The owner of this website is an obstetrics and gynecology specialist, and medical information about infertility treatment is shared in this internet portal community.
Prior to collection, we obtained approval for this study from the director of Haeundae Community Health Center. The researcher approached infertile couples who were visiting the community health center to enroll in the national support program for infertile couples and explained the purpose of the study. The questionnaire was administered to those who agreed to participate in the study. If both spouses were present, they were asked to fill the form separately, and the questionnaires were collected on the spot. If only one spouse was present, he/she was given an envelope containing the study description and questionnaire for the couple to complete at home and bring it on a scheduled date. In total, 97 couples participated in the study and 92 couples provided complete answers to the questionnaires.
A study recruitment notice was posted along with the researcher’s telephone number on the site’s bulletin board of the online infertility website. We explained the purpose of the study over the phone to those who contacted us and wished to participate in the study. The couples were instructed to send a proof of infertility, such as a medical report and doctor’s note, via text message. An envelope including the purpose of the study and a consent form was mailed to those who agreed to participate, and signed consent forms were mailed back to us. After collecting the informed consent forms, an online link for the questionnaire was sent to the couples individually via a text message. The response rates were immediately confirmed on the site in which the survey results were tallied. In total, 60 couples completed the survey and two did not.
The infertile couples were instructed to fill out the questionnaire without discussing the answers with each other. Of the 157 eligible couples, seven declined to participate. Finally, 150 couples completed the survey in the current study (response rate: 95.5%).
The questionnaire took approximately 10–15 minutes to be completed. After the questionnaire was completed, the subjects were remunerated for their participation in the study.
Instruments
Consent for the use of tools in this study was obtained from the authors of previous studies.
Resilience
We used the translated version of the Resilience Scale developed by Wagnild and Young [7, 14]. The scale comprises 25 questions—17 questions on personal competence and 8 on acceptance of self and life. Each item was scored on a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). Higher scores represented a greater resilience. The reliability coefficient Cronbach’s α values were 0.85 for the scale originally developed, 0.88 for that used in Song Yang-sook’s study, and 0.80 for that used in the current study [14].
FertiQoL questionnaire
FertiQoL is a self-administered questionnaire used to assess QoL among infertile individuals [15]. The FertiQoL, translated by Kim Joo-hee, was utilized [16]. This scale comprises two modules—the Core FertiQoL and Treatment FertiQoL. The optional Treatment module was not used in the current study. The Core FertiQoL module yields four subscales, which are as follows: emotional, mind–body, relational, and social. Each subscale comprises six items, and the respondents answered each item using a 5-point Likert scale. The raw total scores and the subscales scores were scaled, ranging from 0 to 100. A higher score represents a better QoL.
The reliability coefficient Cronbach’s α values were 0.92 (approximately 0.75–0.90) for the scale originally developed, 0.92 (approximately 0.72–0.89) for that used in Kim Joo-hee’s study [16], 0.91 for that used in Maroufizadeh’s study [11], 0.93 for that used in Li’s study [8], and 0.88 (approximately 0.68–0.71) for that used in the current study.
Demographic Characteristics of the Couples
Data on the demographic characteristics of the couples, such as age, length of marriage, duration of infertility, national financial support, cause of infertility, and psychiatric treatment, were collected using a questionnaire.
Statistical Analysis
The data collected were analyzed using Statistical Package for the Social Sciences (SPSS) Version 22.0 and Analysis of Moment Structures (AMOS) Version 22.0. Descriptive statistics on the demographic characteristics of the participants and measurement variables of the couples were presented using SPSS descriptive statistics, and the skewness and kurtosis of the measurement variables were examined to test the normality of the data.
In addition, Pearson’s correlation coefficients were used to check the correlation and multicollinearity of each factor and the measurement variables. To identify the actor and partner effects of infertile couples’ resilience on their QoL, we used the AMOS structural equation model. We chose the structural equation model because it has the advantage of statistically comparing and evaluating the magnitudes of the estimates obtained through model verification.
Confirmatory factor analysis was conducted to investigate the validity of the latent variables for the model. The fit of the model was evaluated using absolute goodness-of-fit indices and incremental fit indices. Absolute goodness-of-fit indices included chi-square test (χ2), χ2/df, root-mean-square error of approximation (RMSEA), standard root-mean-square residual (SRMR), goodness-of-fit index (GFI), and adjusted goodness-of-fit (AGFI). Incremental fit indices included an incremental fit index, comparative fit index (CFI), normed fit index (NFI), incremental fit index (IFI), and Tucker–Lewis index (TLI). Finally, bootstrapping in AMOS was used to verify the statistical significance of the paths in the structural equation model.
Participants and Study Design
We conducted a cross-sectional study on infertile couples using the convenience sampling method. The inclusion criteria were as follows: 1) couples diagnosed with infertility, 2) those with primary or secondary infertility and without children, 3) those aged >18 years, and 4) those willing to voluntarily complete a multi-item questionnaire. In contrast, the exclusion criteria were as follows: 1) couples with a history of psychiatric problem and 2) those with other major diseases during the study period. The participants were recruited from August 2018 to October 2018, and the target sample size was 150. The sample size in this study was determined using Song and Kim method, according to which, the appropriate sample size was assumed to be 150–400 [13].
Data Collection
Data were collected from Haeundae Community Health Center in Busan, South Korea, and an online infertility website. The owner of this website is an obstetrics and gynecology specialist, and medical information about infertility treatment is shared in this internet portal community.
Prior to collection, we obtained approval for this study from the director of Haeundae Community Health Center. The researcher approached infertile couples who were visiting the community health center to enroll in the national support program for infertile couples and explained the purpose of the study. The questionnaire was administered to those who agreed to participate in the study. If both spouses were present, they were asked to fill the form separately, and the questionnaires were collected on the spot. If only one spouse was present, he/she was given an envelope containing the study description and questionnaire for the couple to complete at home and bring it on a scheduled date. In total, 97 couples participated in the study and 92 couples provided complete answers to the questionnaires.
A study recruitment notice was posted along with the researcher’s telephone number on the site’s bulletin board of the online infertility website. We explained the purpose of the study over the phone to those who contacted us and wished to participate in the study. The couples were instructed to send a proof of infertility, such as a medical report and doctor’s note, via text message. An envelope including the purpose of the study and a consent form was mailed to those who agreed to participate, and signed consent forms were mailed back to us. After collecting the informed consent forms, an online link for the questionnaire was sent to the couples individually via a text message. The response rates were immediately confirmed on the site in which the survey results were tallied. In total, 60 couples completed the survey and two did not.
The infertile couples were instructed to fill out the questionnaire without discussing the answers with each other. Of the 157 eligible couples, seven declined to participate. Finally, 150 couples completed the survey in the current study (response rate: 95.5%).
The questionnaire took approximately 10–15 minutes to be completed. After the questionnaire was completed, the subjects were remunerated for their participation in the study.
Instruments
Consent for the use of tools in this study was obtained from the authors of previous studies.
Resilience
We used the translated version of the Resilience Scale developed by Wagnild and Young [7, 14]. The scale comprises 25 questions—17 questions on personal competence and 8 on acceptance of self and life. Each item was scored on a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). Higher scores represented a greater resilience. The reliability coefficient Cronbach’s α values were 0.85 for the scale originally developed, 0.88 for that used in Song Yang-sook’s study, and 0.80 for that used in the current study [14].
FertiQoL questionnaire
FertiQoL is a self-administered questionnaire used to assess QoL among infertile individuals [15]. The FertiQoL, translated by Kim Joo-hee, was utilized [16]. This scale comprises two modules—the Core FertiQoL and Treatment FertiQoL. The optional Treatment module was not used in the current study. The Core FertiQoL module yields four subscales, which are as follows: emotional, mind–body, relational, and social. Each subscale comprises six items, and the respondents answered each item using a 5-point Likert scale. The raw total scores and the subscales scores were scaled, ranging from 0 to 100. A higher score represents a better QoL.
The reliability coefficient Cronbach’s α values were 0.92 (approximately 0.75–0.90) for the scale originally developed, 0.92 (approximately 0.72–0.89) for that used in Kim Joo-hee’s study [16], 0.91 for that used in Maroufizadeh’s study [11], 0.93 for that used in Li’s study [8], and 0.88 (approximately 0.68–0.71) for that used in the current study.
Demographic Characteristics of the Couples
Data on the demographic characteristics of the couples, such as age, length of marriage, duration of infertility, national financial support, cause of infertility, and psychiatric treatment, were collected using a questionnaire.
Statistical Analysis
The data collected were analyzed using Statistical Package for the Social Sciences (SPSS) Version 22.0 and Analysis of Moment Structures (AMOS) Version 22.0. Descriptive statistics on the demographic characteristics of the participants and measurement variables of the couples were presented using SPSS descriptive statistics, and the skewness and kurtosis of the measurement variables were examined to test the normality of the data.
In addition, Pearson’s correlation coefficients were used to check the correlation and multicollinearity of each factor and the measurement variables. To identify the actor and partner effects of infertile couples’ resilience on their QoL, we used the AMOS structural equation model. We chose the structural equation model because it has the advantage of statistically comparing and evaluating the magnitudes of the estimates obtained through model verification.
Confirmatory factor analysis was conducted to investigate the validity of the latent variables for the model. The fit of the model was evaluated using absolute goodness-of-fit indices and incremental fit indices. Absolute goodness-of-fit indices included chi-square test (χ2), χ2/df, root-mean-square error of approximation (RMSEA), standard root-mean-square residual (SRMR), goodness-of-fit index (GFI), and adjusted goodness-of-fit (AGFI). Incremental fit indices included an incremental fit index, comparative fit index (CFI), normed fit index (NFI), incremental fit index (IFI), and Tucker–Lewis index (TLI). Finally, bootstrapping in AMOS was used to verify the statistical significance of the paths in the structural equation model.