Validity and Reliability of The Persian Version of Uterine Fibroid Symptom and Health-Related Quality of Life Questionnaire: A Psychometric Study

Document Type : Original Article

Authors

1 Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 1. Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2. Department of Cell & Molecular Biology, Faculty of Biological Sciences, Kharazmi University, Tehran, Iran

3 School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Background: Women with uterine fibroids (UFs) experience many clinical manifestations that affect their quality of
life (QOL). The Uterine Fibroid Symptom and Health-related Quality of Life (UFS-QOL) questionnaire is an English
instrument specifically designed to assess fibroid-related symptoms and their impact on QOL. This study aims to
investigate the reliability and validity of the Persian version of the UFS-QOL questionnaire in Iranian women with UF.
Materials and Methods: In this psychometric study, women with UFs who presented to Imam Hossein Hospital
(Tehran, Iran) between August 2022 and January 2023 were enrolled in this study. A forward-backward approach
was applied to translate the UFS-QOL questionnaire into Persian. The reliability of the UFS-QOL questionnaire was
assessed by internal consistency and test-retest correlation. Confirmatory factor analysis (CFA) was used to assess
convergent validity between items and subscales of the UFS-QOL questionnaire. Pearson’s correlation coefficient was
used to assess convergence validity between subscales of the UFS-QOL and the World Health Organization Quality
of Life Brief Version 26 questionnaire (WHOQOL-BREF-26).
Results: Overall, we assessed 226 women with UFs. All subscales of the UFS-QOL questionnaire had acceptable
internal consistency (Cronbach’s alpha>0.7). Test-retest analysis indicated significant positive correlations between
two measurements of all subscales of the UFS-QOL questionnaire: symptom severity (P<0.001), concern (P<0.001),
activities (P<0.001), energy/mood (P<0.001), control (P<0.001), self-consciousness (P=0.002), and sexual function
(P<0.001). The Kaiser-Meyer-Olkin (KMO) measure value was 0.920, and the result of Bartlett’s test of sphericity
was significant (P<0.001). CFA identified six factors for the health-related QOL (HRQL) questionnaire, which explained
73.827% of the total variation. Most subscales of the UFS-QOL questionnaire correlated with domains of the
WHOQOL-BREF-26 questionnaire (P<0.05).
Conclusion: The Persian version of the UFS-QOL questionnaire is a valid and reliable instrument to evaluate UFrelated
symptoms and QOL among Iranian women.

Keywords

Main Subjects


  1. Luthra J, Halder P, Nahar L, Sultana N, Banerjee A, Kumar A, et al. Evaluation of psychometric properties of the uterine fibroids symptoms and health-related quality of life (ufsqol) questionnaire: The translated Bengali version. Trop J Obstet Gynaecol. 2019; 36(3): 338-347.
  2. Yeung SY, Kwok JWK, Law SM, Chung JPW, Chan SSC. Uterine fibroid symptom and health-related quality of life questionnaire: a chinese translation and validation study. Hong Kong Med J. 2019; 25(6): 453-459.
  3. Stewart EA, Cookson CL, Gandolfo RA, Schulze-Rath R. Epidemiology of uterine fibroids: a systematic review. BJOG. 2017; 124(10): 1501-1512.
  4. Marsh EE, Al-Hendy A, Kappus D, Galitsky A, Stewart EA, Kerolous M. Burden, prevalence, and treatment of uterine fibroids: a survey of U.S. women. J Womens Health (Larchmt). 2018; 27(11): 1359- 1367.
  5. Yang Q, Ciebiera M, Bariani MV, Ali M, Elkafas H, Boyer TG, et al. Comprehensive review of uterine fibroids: developmental origin, pathogenesis, and treatment. Endocr Rev. 2022; 43(4): 678-719.
  6. Al-Hendy A, Myers ER, Stewart E. Uterine fibroids: burden and unmet medical need. Semin Reprod Med. 2017; 35(6): 473-480.
  7. Soliman AM, Yang H, Du EX, Kelkar SS, Winkel C. The direct and indirect costs of uterine fibroid tumors: a systematic review of the literature between 2000 and 2013. Am J Obstet Gynecol. 2015; 213(2): 141-160.
  8. Dolmans MM, Donnez J, Fellah L. Uterine fibroid management: today and tomorrow. J Obstet Gynaecol Res. 2019; 45(7): 1222-1229.
  9. Xu W, Chen W, Chen J, Hu L, Su X, Nie Y, et al. Adaptability and clinical applicability of UFS-QoL in Chinese women with uterine fibroid. BMC Womens Health. 2022; 22(1): 372.
  10. Keizer AL, van Kesteren PJM, Terwee C, de Lange ME, Hehenkamp WJK, Kok HS. Uterine fibroid symptom and quality of life questionnaire (UFS-QOL NL) in the Dutch population: a validation study. BMJ Open. 2021; 11(11): e052664.
  11. Jahanlou AS, Karami NA. WHO quality of life-BREF 26 questionnaire: reliability and validity of the Persian version and compare it with Iranian diabetics quality of life questionnaire in diabetic patients. Prim Care Diabetes. 2011; 5(2): 103-107.
  12. Spies JB, Coyne K, Guaou Guaou N, Boyle D, Skyrnarz-Murphy K, Gonzalves SM. The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata. Obstet Gynecol. 2002; 99(2): 290-300.
  13. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. New York: Routledge; 2013; 20-66.
  14. Coyne KS, Margolis MK, Bradley LD, Guido R, Maxwell GL, Spies JB. Further validation of the uterine fibroid symptom and quality-of-life questionnaire. Value Health. 2012; 15(1): 135-142.
  15. Calaf J, Palacios S, Cristóbal I, Cañete ML, Monleón J, Fernández J, et al. Validation of the Spanish version of the uterine fibroid symptom and quality of life (UFS-QoL) questionnaire in women with uterine myomatosis. Med Clin (Barc). 2020; 154(6): 207-213.
  16. Silva RO, Gomes MT, Castro RA, Bonduki CE, Girão MJ. Uterine fibroid symptom - quality of life questionnaire translation and validation into Brazilian Portuguese. Rev Bras Ginecol Obstet. 2016; 38(10): 518-523.
  17. Karunagoda K, Perera PK, Senanayake H. Uterine fibroid symptoms and quality-of-life questionnaire (UFS-QOL): translation and validation study of the Sinhala version. Ceylon J Sci. 2020; 49(3): 311-315.
  18. Taherdoost H. Validity and reliability of the research instrument; how to test the validation of a questionnaire/survey in a research. IJARM. 2016; 5(3): 28-36.
  19. Hofman CS, Lutomski JE, Boter H, Buurman BM, de Craen AJ, Donders R, et al. Examining the construct and known-group validity of a composite endpoint for The Older Persons and Informal Caregivers Survey Minimum Data Set (TOPICS-MDS); A large-scale data sharing initiative. PLoS One. 2017; 12(3): e0173081.
  20. Oliveira Brito LG, Malzone-Lott DA, Sandoval Fagundes MF, Magnani PS, Fernandes Arouca MA, Poli-Neto OB, et al. Translation and validation of the Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaire for the Brazilian Portuguese language. Sao Paulo Med J. 2017; 135(2): 107-115.