Development and psychometric properties of Iranian Women’s Quality of Life Instrument (IWQOLI): Mixed Exploratory Study

doi:10.21203/rs.3.rs-3229203/v1

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Research Article

Development and psychometric properties of Iranian Women’s Quality of Life Instrument (IWQOLI): Mixed Exploratory Study

https://doi.org/10.21203/rs.3.rs-3229203/v1

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published 25 Oct, 2023

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Background: Half of Iran’s population is made up of women and their decisive role in the family is undeniable so their health should be prioritized. In order to determine the health needs and promote women's health, their quality of life should be investigated. For this purpose, a valid tool is needed, which has credible validity and reliability, and its concepts are clearly defined and culturally appropriate.

Methods: This is a sequential exploratory mixed-method research carried out in accordance with the Creswell method in three phases from May 2016 to January 2018 in Tehran. 1- qualitative phase in order to identify the key concept, 2- development of tools with the extraction of items, 3- Determine the psychometric properties of the tool.

Results: Initially, from exploratory analyses (interviewing 40 women), a total of 150 items were extracted. After performing the face and content validity, 32 items were deleted. S-CVI/Ave was obtained for the instrument (0.93). The factor structure of the inventory was identified by undertaking a principal component analysis in a sample of 590 women. Five factors were extracted with a total variance account of 56.24% and 28 items dropped at this point. The Iranian women’s Quality of Life Instrument (IWQOLI) score was significantly correlated with the SF-36 (r = 0.717, p < 0.001). Reliability was demonstrated with Cronbach’s alpha coefficient of 0.919 for the entire scale (90-item). Consistency of the instrument was established with test-retest reliability with an interval of 2 weeks (intra-cluster correlation = 0.889, P < 0.001).

Conclusions: The Iranian women’s Quality of lifeInstrument “IWQOLI”, consisting of 90 items representing 5 domains (sense of peace in life, sense of security, health responsibility, pleasant communication, received comprehensive support), demonstrated excellent psychometric properties, so it may be used for measuring women’s QOL in practical research.

Design

Quality of life

Questionnaire

Women

In recent years, the healthcare system, which is responsible for the health and treatment of all populations, has focused on preliminary health and quality of life (QOL)(1). Since the quality of life, health and disease mutually affect each other, by examining the quality of life, appropriate and related interventions can be made to prevent many health problems and maintain and improve the health of people(2, 3). But the quality of life varies from a person's point of view in different situations, and it relates to the individual's satisfaction from his or her life and is related to factors such as age, culture, gender, education, class status, social environment, and health and illness. Among the factors mentioned, the gender issue plays a key role in determining life quality. In accordance with the World Health Organization, women are considered one of the high-risk groups in the community because of their many roles in the family and society, going through various physiological crises such as puberty, menstruation, pregnancy, labor, and menopause and also a greater risk of suffering from poverty, hunger, and malnutrition, heavy workload and gender discrimination(4, 5). In addition, the participation of women in social and political affairs has also increased significantly. These all situations could have important effects not only on the quality of life but also on the health status of women(6, 7). Several studies have been conducted in this regard in the population of women as a high-risk group, which in general confirms the fact that there are diversities in the quality of life between men and females. To mention as an instance, the results of studies in the general population indicate a weaker quality of life for women in all its dimensions compared with men. The possible causes are stated as the limited physical activity of women outside the home, the greater sensitivity of women in dealing with adverse events, and other sociocultural factors related to gender(8). Since changing the quality of life of women as a subjective understanding of the life situation can have wide consequences not only on their own health but also on society, it should be given special attention(9). According to the literature review, researchers have used general quality of life instruments or general health questionnaires to measure women's quality of life. This is despite the fact that measuring the quality of life with public tools does not provide specific information based on the specific gender characteristics of this society. Since no specific study has been done to design and build a questionnaire to assess the quality of life of women, the researchers in this study decided to take a small step in the development of health services for this group of society by designing a native, valid, and reliable questionnaire.

Design

This is a mixed study that was conducted in accordance with the Creswell method in three phases (1- qualitative phase by content analysis, 2- development of item pools, 3- quantitative phase to determine the psychometric properties of the tool) from May 2016 to January 2018(10).

In the first phase, in order to identify the key concept (women’s QOL), we used a qualitative approach. Purposive sampling was used to select the population. Participant criteria for inclusion in the study were all women and girls of reproductive age (15 to 60 years) with the ability to read and speak Persian, without any disabilities and other physical and psychological ailments, excellent ability of communication and expression, willingness to do an interview )45 to 60 minutes( and talking about their life situation, and their worries and concerns in their daily life (totally 40 women when we reach data saturation).

In the second phase, from all items that were obtained inductively through interviews and terms of the participants, the main themes and pool of items were formed. Then, with the research team's opinion, the concepts that were conceptually similar were removed or merged. In this way, the initial tool for evaluating women's quality of life was designed based on perceived definitions in the form of a methodological process.

In the third phase, in the third phase of the study, the psychometric properties of the primary tool were done in 5 steps.

First, Face validity

Qualitative face validity was determined by asking the points of view of 10 women in the target group. Furthermore, a quantitative assessment of face validity was conducted with the calculation of impact scores (Impact score = frequency(%)🞨 importance) to reduce and remove inappropriate items. The question that received a score of above 1.5, was identified as an important item(11).

Second, content validity

In terms of qualitative content validity, 10 experts in the field of health, quality of life, nursing, and questionnaire designers were asked to write their editorial opinions in writing after carefully studying the instrument (about grammar, Wording, Scaling, and Item Allocation). To assess quantitative content analysis, content validity ratio (CVR).was used as well as the content validity index (CVI). To determine CVR, 10 experts were asked to score each item based on the three-part spectrum (essential, useful but not necessary, and not necessary). According to the Lawshe table, the minimum value was determined as 0/62 (12).Then based on Waltz and Bausell's criteria, CVI (Item content validity index & scale content validity index was calculated. To assess I -CVI, 10 experts scored the relevancy, of each statement in WQOLI using a 4-point rating scale (1 = not relevant, 2 = somewhat relevant, 3 = quite relevant, and 4 = extremely relevant), Then, the score for each item was calculated by dividing the number of specialists agreeing with the phrase having grades 3 and 4 on the total number of specialists. A rate of 0/78 and above is appropriate(11, 13). The Scale Content Validity Index Average method (S-CVI/Ave), was used to determine the average value of I-CVI for the whole scale. A reference value of more than 0.90 is desirable(11). Based on the results of the pilot study and experts’ opinions, necessary changes were made and the WQOLI was modified accordingly and the final instrument was obtained.

Third, Construct validity

We administered an exploratory factor analysis (EFAs) by a principal component extraction method for determining the construct validity of the WQOLI. The number of respondents required for factor analysis was 5 for each statement(14, 15). In this step, 590 women who had the criteria for entering the research were selected through randomized cluster sampling and completed the questionnaires from November 2017 to January 2018.

For indicating the degree of susceptibility of data for factorial analysis and sampling adequacy, the Kaiser-Meyer-Olkin (KMO) and Bartlett Sphericity tests were used. The recommended KMO value was 0.6. To determine the number of questionnaire constructs, eigenvalues greater than 1.0 was considered by the principal component extraction method. The varimax method was used to orthogonally rotation of the acquired constructs. For all 118 items factor-loading > 0.4 were considered(11).

Forth, Criterion validity

In the validity of the criterion, the relationship between the current instrument with the other criterion is tested(11). In this study, a standard instrument (SF36) was used to measure criterion-dependent validity. For this purpose, every 590 participants in this study were asked to complete the WQOLI in addition to SF36 as a completion criterion. Then, using the Pearson correlation test, the scores of the two instruments were compared.

Fifth, reliability

We used internal consistency and test—retest reliability methods with 14-day intervals to assess the reliability of WQOLI. Internal consistency was evaluated using Cronbach's alpha coefficient) 0.70 or more((16). In this research, Cronbach’s alpha of WQOLI was calculated in a sample of 30 women using a convenience sampling method. It was measured for each factor and also for the whole of the questionnaire. Values higher than 0.70 were considered desirable

The stability of a tool shows the reliability of obtained scores following a test-retest administration. In this step, the stability of WQOLI was assessed using the test-retest reliability measurement method. 30 women filled out the questionnaire on two different occasions, at 14-day intervals, and the Persian correlation coefficient was calculated. Values higher than 0.70 were considered desirable(11). Finally, the collected data were imported into version 22.0 for further analysis.

A total of 649 women in this research, signed and returned the informed consent letter; 590 individuals completed and returned the questionnaire packet, and 59 people did not complete it (response rate 91%). The average age of the 590 study participants was 35.08 ± 9.17 (± SD) years (range: 15–49 years). Additional sociodemographic information for the sample, including marital status, educational level, employment status, and income is provided in Table 1.

Table 1. Demographic characteristics of study participants (N590)

Characteristic

Frequency

percentage

Marital status

Single - never married

Married or living as married

Divorced

Widowed

235

315

39.8

53.4

6.4

Education level

Bellow High school

High school graduate

Two-year college

Bachelor

Master

Ph.D.

137

227

4.6

23.2

13.6

38.5

14.9

5.3

Employment status

Working full-time

Working part-time

Housewife

157

191

242

26.6

32.4

41.0

individual income

<10 million rials

10-20 million rials

>20 million rials

278

234

47.1

39.7

13.2

Housing

Personal home

Rental

Governmental

167

397

28.3

67.3

4.4

Analysis of the content of the data from interviews with women led to the explanation of the concept of women's quality of life. Accordingly, the quality of life of women is “a dynamic conception of mental perception of lives, that expressing her experience of having a health responsibility and pleasant communicating, combined with an experience of a sense of security, that has been received in the context of comprehensive support which is in fluctuated in different periods of life.

In the first section and after the interview, 450 items were extracted from the qualitative data, then the extracted items were assessed by the research team in three sessions, and phrases with overlapping concepts were merged and therefore the terms of the original tool were reduced to 150 phrases.

Validity

In qualitative face validity, appropriate comments made by women were subject to necessary changes. Subsequently, the quantitative face validity 6 items were eliminated due to the impact score of less than 1.5. In the qualitative content validity, the items were corrected according to the opinion of the specialists.

In quantitative content validity, by determining the CVR, 26 items were eliminated due to score points less than 0.62. Then, CVI was calculated. At this stage, all questions obtained high scores (0.9) and there was no eliminated question. It should be noted that the S-CVI/Ave was 0.93. Eventually, at the end of the determination of face and content validity, the items were reduced to 118, in four areas of “received comprehensive support (16 items), pleasant communication (42 items), sense of security (23 items), and health responsibility (37 items).

Factor analysis

The KMO value by Exploratory Factor Analysis showed was 0.904; this exceeding the recommended value of 0.6 indicated the sampling adequacy (Table 2). Five components with Eigen values exceeding 1, were indicated by principal components analysis. Orthogonal rotation was used through the Varimax procedure, to facilitate the interpretation of these five components (Table 3). The five factors explained 56.25% of the variance. These five factors are labeled “sense of peace in life, sense of security, health responsibility, pleasant communication, and received comprehensive support"(Table 4–8).

Table 2

KMO and Bartlett's Test
Kaiser-Meyer-Olkin Measure of Sampling Adequacy.		.904
Bartlett's Test of Sphericity	Approx. Chi-Square	9.444E4
	df	6903
	Sig.	.000

Table 3

Total Variance Explained for five factors
Component	Initial Eigenvalues			Extraction Sums of Squared Loadings			Rotation Sums of Squared Loadings
Component	Total	% of Variance	Cumulative %	Total	% of Variance	Cumulative %	Total	% of Variance	Cumulative %
1	18.507	15.684	15.684	18.507	15.684	15.684	17.647	14.955	14.955
2	14.813	12.553	28.237	14.813	12.553	28.237	14.872	12.603	27.558
3	13.374	11.334	39.571	13.374	11.334	39.571	12.542	10.628	38.187
4	11.705	9.919	49.491	11.705	9.919	49.491	12.426	10.531	48.718
5	8.947	7.582	57.073	8.947	7.582	57.073	8.884	7.529	56.247

Table 4

Extracted factors Factor analysis using varimax rotation (the first factor: sense of peace in life)
number	Load factor	Items
Q54	.968	The memory of my relatives makes me relax
Q38	.960	Remembrance of childhood memories and seeing old photos is pleasing to me
Q49	.955	I feel relaxed by going to the shrine and the pilgrimage
Q42	.942	When I do something right, I am pleased
Q48	.940	I believe that the prayer of others helps solve my problems
Q55	.935	After going to the grave of the dead, I find peace
Q53	.929	Thank God for everything
Q51	.923	I feel God helps me
Q43	.918	I feel good about my family being happy
Q44	.915	I am pleased that my life is in line with my goals
Q50	.906	I feel relaxed with prayer
Q41	.899	I'm motivated for the things I want to do
Q52	.893	I feel good about helping people
Q39	.888	There is a clear future for me and my relatives
Q9	.854	I am satisfied with the power of my concentration and learning
Q1	.845	Because physical pain does not prevent me from doing my daily routine, I feel so good
Q7	.820	I am satisfied with my own appearance
Q4	.815	I do my work with joy
Q2	.814	I'm lively and vibrant
Q5	.811	I am pleased to be able to keep my peace in stressful situations
Q3	.787	The more people's attitude is that I have a balanced body
Q11	.536	I am optimistic and I have a positive view of everything
Q12	.521	I have great confidence in doing my job and life responsibilities

Table 5

Extracted factors Factor analysis using varimax rotation (the second factor: sense of security)
number	Load factor	Items
Q92	.935	Mm income is enough for my life
Q84	.928	I am pleased when my opinions are taken into consideration at work
Q98	.892	I feel calm about being in the safe neighborhood
Q88	.883	I'm pleased to do my favorite job
Q93	.882	I feel good about the existence of a law to protect me from harassment
Q95	.882	My legal rights are not violated in society
Q91	.881	I am pleased with having an independent income
Q86	.868	I’m happy due to the proximity of the office to my home,
Q90	.865	I am pleased that my wife has a decent job
Q102	.845	I'm satisfied with the facilities of my home
Q82	.828	I often finish my daily tasks with satisfaction
Q81	.809	I am pleased from working in a safe environment
Q13	.807	I am pleased that I have sufficient independence in my life
Q80	.805	I am satisfied with the benefits of a good employment (such as occupational insurance, pensions, etc.)
Q87	.804	I'm pleased to be successful in my work
Q99	.798	Going home makes me relax
Q97	.787	I am pleased to have no concern for the provision of housing
Q96	.772	I am pleased to receive a fair remuneration
Q85	.747	I am satisfied with the good opportunities for improvement in my work
Q101	.746	I'm pleased with living in this neighborhood because of easy access to amenities like a park, a store, a gym, a bank, a kindergarten ...
Q94	.744	I have no fear in expressing my thoughts

Table 6

Extracted factors Factor analysis using varimax rotation (the third factor: health responsibility)
number	Load factor	Items
Q26	.959	I enjoy eating my favorite foods
Q31	.958	I feel relaxed about being able to talk to my family about my health issues
Q34	.948	By periodic examinations, my mind is at ease about my health
Q22	.945	Despite the obstacles, such as pollution and hot weather, I still exercise to maintain my health
Q16	.921	I am pleased to be able to address my favorite hobbies
Q15	.911	I feel relaxed about having a comfortable sleep
Q37	.894	Always wearing a seat belt in my car
Q21	.890	I am glad to have enough time to exercise
Q29	.880	Benefiting from religiously meals is important to me
Q18	.875	I am glad that I can do my favorite activities on holidays
Q36	.843	I am pleased to be able to change my unhealthy behaviors
Q32	.817	Receive appropriate health information through healthcare workers is more acceptable for me
Q28	.803	I feel well that the food I eat is safe and healthy
Q33	.794	Using medication prescribed by a doctor is more reliable for me
Q35	.782	Using bright and colorful clothes will make me happy

Table 7

Extracted factors Factor analysis using varimax rotation (the forth factor: pleasant communication)
number	Load factor	Items
Q69	.912	I have the best family
Q74	.909	I feel good about being a good model for others
Q78	.906	I am satisfied with myself, because of leaving enough time for my relatives
Q77	.905	I have a satisfying sexual relationship with my partner
Q60	.853	Regardless of the unpleasant behavior of others, I can communicate with them again
Q76	.847	I am pleased to have a good companion in my life
Q67	.841	I'm glad to be able to talk to my family through telephone, Viber and so on
Q70	.836	I established a friendly relationship with others easily
Q72	.835	Relation with relatives creates a feeling of calm in me
Q75	.817	I am satisfied with my marital status
Q57	.805	Presence in areas with flowers and plants make me feel good
Q56	.802	Dealing with flowers and plants makes me calm down.
Q65	.779	I am pleased that others give me opportunity for talking
Q61	.774	I am pleased to be able to communicate with other people from other cities according to their culture
Q59	.753	I am satisfied with the convenient means of transport with easy access for women
Q62	.712	I am pleased to be able to establish a good relationship with the people, despite the difference in age
Q58	.630	Living in a pleasant climate is pleasant to me
Q45	.589	I am satisfied with the situation of my children's life and education

Table 8

Extracted factors Factor analysis using varimax rotation (the first factor: received comprehensive support)
number	Load factor	Items
Q106	.877	The availability of government facilities such as affordable public housing, discounted subway cards, free cinema tickets ... is a great help for me.
Q108	.853	I'm so glad that my closest people motivate me to do my activities
Q115	.841	Access to the right virtual networks to get the right information, lowers my concerns
Q110	.839	I belong to my family and do not feel lonely
Q107	.834	In spite of the great value of the price, I can provide what I need
Q114	.827	consult with others on various issues gives me a good feeling
Q105	.820	I feel calm, because of government assistance to cover my living expenses,
Q112	.810	I am pleased to be able to share my problems with family
Q104	.790	I am pleased that my wife and relatives give me the things I need.
Q117	.789	Relative assistance in my everyday life made me happy
Q116	.785	I have access to the news and information necessary for my daily life
Q103	.755	I am pleased to be financially secured
Q118	.750	I'm glad to see that my wife and relatives are helping me with children's issues

Reliability

After the exclusion of 28 items, the score of WQOLI was remarkably correlated with the SF-36 (r = 0.717, p < 0.001) (Table 9). The Cronbach’s alpha was 0.919 which showed the high reliability and strong internal consistency of this scale (Table 10). The test-re-test reliability resulted in a coefficient of (r = 0.889; P < 0.001) (Table 11).

Table 9

Correlation between mean scores of WQOLI and SF36
WQOL SF36
WQOLI	Pearson Correlation	1	.717^**
	Sig. (2-tailed)		.000
	N	590	590
SF-36	Pearson Correlation	.717^**	1
	Sig. (2-tailed)	.000
	N	590	590
**. Correlation is significant at the 0.01 level (2-tailed).

Table 10

Determine the internal consistency: Cronbach’s alpha of “WQOLI”
Sub-scale	Item number	Cronbach’s alpha, N = 30
First factor: sense of peace in life	23	α = 0/882
second factor: sense of security	21	α = 0.839
third factor: health responsibility	15	α = 0.859
forth factor: pleasant communication	18	α = 0.893
fifth factor: received comprehensive support	13	α = 0.843
Total	90	α = 0.919

Table 11

Determination of stability (test-re-test) of the entire instrument with a two-week interval
		pre	post
pre	Pearson Correlation	1	.889^**
	Sig. (2-tailed)		.000
	N	30	30
post	Pearson Correlation	.889^**	1
	Sig. (2-tailed)	.000
	N	30	30
**. Correlation is significant at the 0.01 level (2-tailed).

How to Calculate the Measurement Score of Women's Quality of Life

The measurement scale in the present questionnaire was considered a Likert scale with a five-part spectrum of negative to positive with the midpoint. According to the experts' opinion, when evaluating the content of the tool, the items were formulated as positive, so the score for the items was done only positively. Scores are considered: I quite agree (5), I agree (4), I neither agree nor disagree (3), I disagree (2), I quite disagree (1). The total score is determined by calculating the average total score of all items. The minimum score of the questionnaire is 90 and the maximum is 450. If the score is between(90–162), the QOL will be very unfavorable. If the score is between(162.1–234), QOL will fit in the relatively unfavorable spectrum. Gaining a score of between (234.1–306) points, QOL is in the middle range. If the score is between(306.1–378), it indicates the desirability of a person's QOL. If the individual score is (378.1–450), the QOL is very favorable.

From a content perspective, we have a variety of quality life tools. In a general classification, they can be divided into 3 categories. A-Tools that are general and measure several aspects of quality of life like SF₃₆ or WHOQOL-BREF(17, 18). B-Tools that are specific to a particular age group and usually measure a specific dimension, for example, KIDSCREEN-52, specific for the age group of 8 to 18 years(19), the Pediatric Quality of Life Inventory (PedsQL) Family Impact Scale(20), and QLI-YES which is specific for aassessing quality of life of young elderly in Sri Lanka(14). C- Tools that relate to a particular group of patients. To mention as an instance, specific quality of life measure for Stroke(21), and the fertility quality of life (FertiQoL) tool(22). Although each of these tools are appropriate and valuable for their particulars, but they do not adequately assess the quality of life of women as one of the most vulnerable groups in society with their own specific features. The “WQOLI” is a new measure of perceived QOL amongst women because items of questionnaire created based on the result of qualitative content analysis.

The WQOLI that was designed and validated in the present research contains 90 items on a 5-point Likert scale. The total number of items in the WQOLI is more longer than in other available (health related quality of life) HRQOL scales such as SF₃₆ (consist of 36 items about general health, physical function, role limitation due to physical problems, physical pain, feeling of vitality, mental health, spiritual and social function) or WHOQOL-BREF (World Health Organization Quality of Life includes 26 items about general quality of life and health status, physical activity, mental health, social relations, life environment(17, 18). Hence, the WQOLI may not be feasible for use in clinical practice as it causes fatigue of the respondents.

In this study, from 590 individuals, no items were left unanswered. So, this mirrors a high degree of acceptance and simplicity that respondents can complete it. The average response time to the questionnaire was 45 minutes. The questionnaire is also designed in such a way that another person can read the items for the original sample and mark the answers. On the other hand, since the questionnaire is tailored to the women's culture in this study and does not invade them, the designed questionnaire is relatively feasible for the general women population. WQOLI is a more comprehensive tool than the ones mentioned above because it covers all aspects of the quality of life. WQOLI incorporates a sense of security, and health responsibility, and received comprehensive support that is not mentioned in the WHOQOL-BREF and SF₃₆. These three aspects of the women's perspective have a special significance in their quality of life and even affect other aspects of their life and health. In the SF₃₆ questionnaire, the general health, physical function, role limitation due to physical problems, physical pain, feeling of excitement, mental health, role limitation due to mental problems, and social function covered only aspects related to health. In the WHOQOL-BREF, two dimensions of physical health and mental health have been raised. In our questionnaire, the sense of peace in life covers almost all aspects of physical, psychological, and spiritual health. In the WHOQOL-BREF, the area of social relations and the context of the living environment have been discussed separately. In WQOLI, the following is a pleasant connection between all the social relationships and even the relationship with his physical environment has encountered. Based on the findings, it is understood that apart from the women's perceptions of their health status paying attention to the status of women in the field of comprehensive support (financial, emotional, and service), security, health responsibility, and communication can bring useful and significant results to improve the quality of women's life.

Limitations

In this study, the psychometric analysis targeted women in a central city in Iran. Consequently, this study may not be generalizable to other women living in rural and urban areas. Hence, further research is needed to increase the efficiency of this questionnaire.

In conclusion, herein we have demonstrated the designing of a scale that is specific for assessing women’s QOL, named the WQOLI, which comprises 90 items, the responses to which are given on a 5- point Likert-type scale. The underlying structure of the WQOLI scale comprises five domains: “sense of peace in life, sense of security, health responsibility, pleasant communication, received comprehensive support". A great effort was made to include women's views and advice. Consistent with the study’s purpose, the WQOLI provides a comprehensive assessment of QOL, which targets themes and areas identified by the health of individuals and their whole life. WQOLI seems a longer questionnaire and might be less feasible in practice, nevertheless, all women had not left any items empty. However, we are currently planning the next iterative phase of tool development, which includes the development shorter version of the WQOLI and field testing. We also offer suggestions about the administration of this instrument by new types, such as a computerized scale instead of the usual paper-and-pencil type.

IWQOLI: Iranian Women’s Quality of Life Instrument

QOL: Quality of Life

Ethics approval and consent to participate

This research was confirmed by the research council and ethics committee of Tarbiat Modares University of Medical Sciences, (With code D52/1918/ Date 5.6.2016). Informed consent was obtained from all subjects. Other esearch ethical principles such as anonymity, and confidentiality were considered. Also, before the interviews women were informed about the purpose of the research. We confirm that the research reported in this manuscript was conducted in accordance with general ethical guidelines in psychology and also the research conforms to the provisions of the Declaration of Helsinki in 1995 (as revised in Brazil 2013). This study is not a clinical trial.

Consent for publication

Not applicable.

Availability of data and materials

The set of data generated during the current study will not be available to the public due to ethical issues and adherence to the principle of confidentiality, but it can be provided upon reasonable request from the corresponding author.

Competing interests

The authors declare that there is no potential conflict of interest about the research, authorship, and/or publication of this paper.

Funding

We have received funding for research from the Research Administration of Tarbiat Modares University, Tehran, Iran but no financial support for the publication of this article.

Author Contribution

FatemehSadat Seyed Nematollah Roshan performed the data collection, Study conception, analysis, drafting of the manuscript, and critical revisions for the important intellectual content.

Fatemah Alhani was responsible for Study conception and design, drafting of the manuscript and critical revisions for important intellectual content, supervising the study & final approval of the version to be submitted.

Armin Zareiyan and Anoshirvan Kazemnejad were responsible for Data analysis; and critical revisions for important intellectual content.

Acknowledgments

The authors would like to thank the deputy of Research Administration of Tarbiat Modares University, Tehran, Iran. or supporting them in this study, and thank all the women who participated in the project.

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No competing interests reported.

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Development and psychometric properties of Iranian Women’s Quality of Life Instrument (IWQOLI): Mixed Exploratory Study

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Abstract

Introduction

Methods

Design

Results

Validity

Factor analysis

Reliability

How to Calculate the Measurement Score of Women's Quality of Life

Discussion

Limitations

Conclusions

Abbreviations

Declarations

References

Additional Declarations

Status:

Journal Publication

Version 1