Despite that hysterectomy is the second gynecological surgery and providing the necessary information about this surgery will help women's positive perceptions of health care experiences, there is no comprehensive tool for examining the educational needs of women with hysterectomy. Therefore, the present study was conducted with the aim of designing and psychometric evaluation of the women's educational needs questionnaire after hysterectomy.

 

The initial version of the questionnaire of this methodological study was compiled analogously with a comprehensive review of studies related to the subject of research and the questionnaires used in these studies and with the opinion of a group of experts and hysterectomized women [19-19, 16, 14, 3]. First, all research-related studies were searched busing the electronic databases Pubmed, SID, Science Direct, GoogleScholar, Scopus, Chochraine Library, Magiran by the keywords hysterectomy, hysterectomy women and educational needs, during the years 1982-2015. Articles were selected based on thematic relevance of titles, abstract relevance and full text of the article. The search for articles was limited to Persian and English articles and the articles included both quantitative and qualitative articles. In the first stage the search resulted in the selection of 84 articles. After deleting unrelated articles, the findings of 14 articles were used to form a pool of items. The sum of these searches was used to design the initial version of the questionnaire in the form of 45 phrases with yes-no answers.
At first, face validity was examined by two methods, quantitative and qualitative. Because if sentences and phrases needed to be changed, the validity of the whole tool might change [18].
In order to determine the qualitative face validity of the questionnaire, 20 hysterectomized women in the teaching hospitals of Mazandaran University of Medical Sciences were asked about the level of difficulty, the degree of appropriateness and ambiguity about the expressions of the instrument.

After correcting the cases based on the opinions of the participants, in the next stage, face validity was evaluated quantitatively by determining the impact score and by interviewing 20 hysterectomized women. At this point, they were asked to rate the initial statements in terms of the degree of importance in the 5-point Likert scale from not at all (score 1) to very important (score 5). By calculating the product of the importance of the expression in the frequency, the effect score of each expression was determined. Frequency in terms of percentage was the number of people who scored 4 and 5 on each phrase, and the significance of the mean significance score based on the Likert scale was mentioned. If the impact score of each phrase was equal to or greater than 1.5, the item would be identified and retained as appropriate for later review [18].
The validity of qualitative content was evaluated using the opinions of 12 experts and experienced people in the field of obstetrics, reproductive health, midwifery and psychiatry at Mazandaran University of Medical Sciences and based on Persian grammar criteria, the use of appropriate words for writing tools and appropriate scoring.
At this stage, by measuring the content validity ratio and content validity index and during a survey of 12 content validity expert, the questionnaire was evaluated quantitatively; based on the 3 Likert scale (necessary, useful but not necessary and not necessary). After calculating the content validity ratio as a product of the fraction whose difference is the number of participants from half of the people who found the phrase necessary, the denominator was half the total number of participants, and the result was compared with the criteria in the "Minimum Value Determination" table compiled by Lawshe [24]. Dividing the number of specialists agreeing with the expressions ranked 3rd and 4th by the total number of specialists, expressions that scored 0.79 or higher were retained [25].
The reliability of the instrument was assessed at two-week intervals by surveying 20 women who underwent hysterectomy in the teaching hospitals of Mazandaran University of Medical Sciences.
Cronbach's alpha coefficient was used to evaluate the reliability of the instrument in terms of internal coherence. Cronbach's alpha represents the degree of fit of a group of expressions that make up a structure. Cronbach's alpha greater than 0.7 was described as good internal cohesion [18].
In order to determine the reliability of the questionnaire in the repeatability dimension, the test-retest method was used calculating the correlation coefficient within the cluster. Qualitative scales for ICC were determined based on the following criteria: less than 0.4 (poor reliability), 0.4-0.6 (moderate reliability), 0.6-0.8 (good reliability) and 0.8-1 (Excellent reliability) [26].

Developing the questionnaire for women's educational needs after hysterectomy and psychometrics led to the formation of a questionnaire for women's educational needs after hysterectomy with 44 questions and in 5 dimensions: physical, mental, sexual, care and other needs.
The CVR index for all items in the questionnaire except for one item was above the Lawshe table criterion, which indicated the importance and necessity of each item. The CVI for each item was above 0.79 and was therefore considered appropriate. Also, the reliability of the instrument in terms of internal coherence by examining the Cronbach's alpha coefficient for the whole instrument was 0.90. Measurement of the repeatability index at two-week intervals showed that the instrument was stable (ICC= 0.97, P<0.001).

 

The findings showed that the dimensions of educational needs of womenwho underwent hysterectomy focus on five dimensions: physical, psychological, emotional, sexual, care and other needs. Graff's 1995 study studied at 56 women who experienced hysterectomy and assessed their educational needs after a hysterectomy; this study was qualitatively designed in the form of 85 questions and 14 main areas including surgical incision, physical activity, miscellaneous, gastrointestinal status, urinary status, study, menopause, vaginal concerns, non-incision and gastrointestinal disorders, psychological issues, nutrition, anatomy. sexual desire and maintaining health [16]. However, in Graff's study, less attention was paid to the sexual dimensions, care and costs of surgery and hospitalization, as well as the follow-up of routine midwifery care after surgery (Pap smear and mammography). Also in a 2000 study by Wade et al. on 102 women who underwent a hysterectomy two years prior to the study, the designed tool included three open-ended questions: 1) How would you describe your hysterectomy experience in general? 2) What fears, concerns, and questions do you still have about your surgery? 3) How can your training needs related to hysterectomy be better addressed? [3].
 

The Hysterectomy Women's Educational Needs Questionnaire is valid and reliable. It can be used by public health researchers and health system policy makers to provide patient-centered health services based on the needs and priorities of patients.

 

This article is a part of the thesis of Master of Science (MSc) in Midwifery Counseling and is the result of a research project approved by Mazandaran University of Medical Sciences and Health Services (IR.MAZUMS.Rec.94-1685). We would like to thank this university and all the people involved in the research and all those who contributed to this important work.

 

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.