This cross-sectional, descriptive study was conducted on women in Kermanshah and Kurdistan provinces, Iran, from September 2020 to June 2021. The participants of this study were selected based on the multi-stage and network sampling methods. First, a list of cities and towns of Kermanshah and Kurdistan provinces was prepared. Then a quota was allocated to each province according to the number of cities, so three cities from Kurdistan Province and four from Kermanshah Province that had a higher population were selected. Finally, Sanandaj, Marivan, and Saqez from Kurdistan Province and Kermanshah, Islamabad Gharb, Sarpol Zahab, and Javanroud from Kermanshah Province were selected for sampling. Midwives working in urban health centers in each city who were willing to participate in this study were briefed on the questionnaire and how it should be completed. After the online multi-stage sampling, the designed questionnaire's link was then provided to midwives online via WhatsApp. The selected midwives then provided the link to the patients who were eligible to participate in the study, after briefing them on the research objectives and procedures. The inclusion criteria were 18–70 years, no history of ovarian cancer, and willingness to participate in the study. The sampling process continued until the intended sample size was completed. Participants were asked to complete the questionnaire after expressing informed consent. The questionnaire was created in Google Forms and the link was sent to participants via WhatsApp. The first section of the online questionnaire thoroughly briefed participants on the objectives and how to complete it. The participants were also assured that their information would be kept confidential. The sample size was calculated using the formula n = (Z1-α/2 +Zβ)2 p (1 − p)/d2 assuming a type-1 error of 0.05, power of 80%, and proportion of women with the excellent knowledge of ovarian cancer (p) of 25% (13). The calculated sample size was 918 (d: 0.04); considering that about 30% of questionnaires would be incomplete, the sample size was determined to be 1,150. Cancer Awareness Measure (CAM) is a scale developed in the UK to help measure cancer awareness, identify risk factors related to poor awareness, and develop and evaluate interventions to promote cancer awareness. There are different versions of this valid questionnaire for different cancers that are applicable for face-to-face, online, or telephone interviews and self-administration (11, 14). This questionnaire consisted of 35 items in “warning signs” (10 multiple-choice items and one open-ended item), "delay in seeking medical help” (1 open-ended item), “ovarian cancer age” (one multiple-choice item), “risk factors” (12 multiple-choice items and one open-ended item), “NHS screening programs” (8 items), and “confidence in diagnosing the symptoms of ovarian cancer” (one multiple-choice item). The questionnaire was independently translated from English to Persian (translation forward) by two experts in the first step, after obtaining permission from the developer of the Ovarian Cancer Awareness Measure (OCAM). The research team then combined the two translation versions to create a single copy. Two specialists separately translated the final form into English (translation backward), and the research team merged the two English translations into a single copy (15). The tool was then reviewed by 10 experts (all of whom had a Ph.D. in Reproductive Health and Health Education and were knowledgeable and experienced in the measurement of instruments and ovarian cancer) to provide their corrective feedback on the grammar and vocabulary quality of the text, item arrangement, and scoring system. This version of the questionnaire was tested in a pilot study on ten women qualified for the study, and the final changes were made based on participant feedback. The questionnaire items were reviewed and modified for cultural adaptation in order to eliminate any item that was inappropriate for Iranian culture. Open-ended questions were eliminated from the questionnaire due to the lack of appropriate facilities for face-to-face interviews. To facilitate responses, the open-ended item about health-seeking practices was converted into a multiple-choice item. The answer options included instantly, one week, two weeks, as soon as possible, one month, a few months later, and never. In this study, a modified version of the OCAM was used. The questionnaire included two sections.; the first section consisted of items about demographic information such as language, age, marital status, employment status, educational attainment, place of residence, having a relative, friend, or family member with cancer (considering the cancer type). The second part contained items measuring “warning signs” (10 multiple-choice items), "delay in seeking medical help” (one multiple-choice item), “ovarian cancer age” (one multiple-choice item), “risk factors” (12 multiple-choice items), and “confidence in diagnosing the symptoms of ovarian cancer” (one multiple-choice item) as well as four items concerning national awareness screening programs. Each correct response was assigned a score of 2 to determine the level of awareness about the symptoms, risk factors, common ages of developing ovarian cancer, and national screening programs. A score below 16, between 16 and 36, and over 36 was regarded as low, moderate, and suitable knowledge of ovarian cancer, respectively. Ten experts (reproductive health and health education specialist) were asked to evaluate the validity of the questionnaire's qualitative and quantitative content, and the questionnaire was then modified based on their comments on the grammar, vocabulary, necessity, syntax, collocation, scoring system. For each item, the Likert scale was employed to assess relevance, simplicity, clarity, and necessity, and the content validity ratio (CVR) was calculated quantitatively. The mean CVR was equal to 0.88, whereas the content validity index (CVI) was greater than 0.79. Internal correlation and test-retest reliability were used to assess the stability of the questionnaire. The most commonly used method for determining internal correlation is Cronbach's alpha, which ranges from 0 to 1. It is appropriate to have an internal correlation greater than 0.7 (16). Cronbach's alpha for the entire questionnaire was 0.88, indicating the appropriate reliability of this tool for the Iranian population. In the retest technique, 20 qualified participants completed the questionnaire twice with a 2-week interval. The intraclass correlation coefficient (ICC) was used to assess the instrument's test-retest reliability, and it was calculated to be 0.86. An ICC of 0.8 or higher indicates excellent stability (17). The quantitative variables in this study were defined by mean, standard deviation, and interquartile range, whereas the qualitative variables were presented by frequency and percentage. The percentage of awareness was shown using bar charts, and ordinal logistic regression was used to determine the predictors of awareness. The data were statistically analyzed in SPSS-19 at the 0.05 level of significance. The rank logistic regression was used in this study to measure the response variable, i.e. knowledge, (good, moderate, and low). Age, educational attainment, family history of cancer, dialect, and marital status were added separately and then concurrently to the model (ordinal logistic regression) to predict the higher chances of knowing.