Translation and Validation of the Persian Version of Sexual Function: Vaginal Changes Questionnaire (SVQ) for Women with Gynecological Cancers | BMC Women’s Health
Type of study and participants
This methodological study with a psychometric design was conducted on women with gynecological cancers using convenience sampling from April 2019 to May 2020. The research setting was 4 medical centers in Tehran (Be ‘sat and Loghman as public centers and Roshana and Kimia oncology clinics as a private center). Convenience sampling was used to select medical centers in different districts of Tehran.
Inclusion criteria were literacy in reading and writing, being married and sexually active (having any type of sexual relationship, including a range of activities such as foreplay, penetration and after -game) in the last 6 months. All of these criteria were provided using self-assessment. Other inclusion criteria were definite diagnosis of endometrial, cervical, or ovarian cancer and convalescing based on medical records. The exclusion criteria were suffering or a history of known mental illness affecting sexual function, having experienced an unfortunate event in the last 3 months before the start of the study (death of a loved one, etc. .) and to have had extramarital affairs from each couple. All exclusion criteria were provided using self-report. It is necessary to explain that the data was collected using closed questions when the physical and mental conditions of the women were stable. In order to estimate the sample size in this study, the sample size must be 10 times the number of items in the instrument . Thus, a sample of 240 was obtained and taking into account a sample loss of 10%, a total sample size of 250 was calculated.
After receiving the Code of Ethics from Joint Organizational Ethics Committee of School of Nursing and Midwifery and School of Rehabilitation of Tehran University of Medical Sciences (Code: IR.TUMS. FNM.REC.1397.208) and presented a letter of introduction to the authorities of the medical centers concerned, the corresponding permit was obtained for the collection. All eligible women with endometrial, cervical and ovarian cancers who were willing to participate participated in the study and the objectives were explained to them. Before starting the study, the participants received the necessary explanations on the objectives and method of the study, voluntary participation, respect for privacy, confidentiality and the right to abstain from any stage of collection. of data. As compensation, the samples informed that those who wanted to receive sex education or counseling about their GC-related sexual concerns or problems, they could be contacted by the research team after participating in the study. They were assured that it was not necessary to write down their first and last name and that all their information would remain confidential with the researcher. Informed written consent was obtained from the participants. This study was conducted in two phases. First, the Persian version of SVQ was developed, and then it was psychometrically tested.
Data collection tools
Three inventories, including the demographic profile scale, the SVQ and the FSFI were used to collect the data.
Persian Version of Sexual Function – Vaginal Changes Questionnaire (SVQ)
Jensen et al. (2004) first developed and conducted psychometric tests on SVQ in Denmark  to study post-GC treatment sexual function. This questionnaire consists of 27 items and 5 subscales, including intimacy (IN), overall sexual satisfaction (GS) and sexual interest (SI). All participants responded to the scale regardless of spousal availability or sexual function. Vaginal changes (VC) and sexual function (SF) were only answered by sexually active patients. Then, Chow et al. (2010) conducted psychometric tests of this scale in China . The psychometric tests of the instrument in this study were based on the translation and adaptation process provided by the World Health Organization .
After obtaining permission from the original designer of the questionnaire, the questionnaire was translated into Persian in four stages. First, the questionnaire was Forward Translation by two Persian-speaking English translators. Then the translated versions were compared by the panel of experts in the presence of two translators and a common translation was agreed. In the third stage (reverse translation), two English-speaking translators who were fluent in Persian and had never seen the English version of the questionnaire were asked to translate the Persian version of the questionnaire back into English. In the last phase, pre-tests and cognitive interviews were conducted to measure the clarity of the translated version and incomprehensible elements were noted and revised. The translated version was given to 10 candidates meeting the inclusion criteria. Their opinions on each element were polled in personal interviews, and elements that were not understood were identified and necessary changes made. Finally, the final version in Persian was approved.
Content validity, face validity, construct validity and criterion validity were used to validate SVQ.
Content validity was tested using a qualitative method. In the qualitative content analysis, the author gave the questionnaire to 10 specialists in oncology, sexual and reproductive health, health promotion, health psychology and social medicine and the need, clarity and simplicity of the instrument were examined.
To perform a face validity analysis, it was tried to adopt a fluent writing style with appropriate wording. To this end, the translated questionnaire was presented to 15 eligible women and they were asked about the simplicity, comprehensibility and clarity of the items to assess qualitative face validity. To test quantitative face validity, a 5-point Likert scale was used (Very important = 5, Important = 4, Moderately important = 3, Slightly important = 2, Not important = 1) and the impact score was demand. Impact score of 1.5 or greater, quantitative face validity approved.
Construct validity determines whether a questionnaire can achieve the objectives of the study. , and exploratory factor analysis indicates whether the elements of the instrument are correctly arranged. To measure construct validity, the correlation of items before factor analysis should be examined using the Bartlett test and the KMO index and this index should not be less than 0.5. . To examine construct validity, an exploratory factor analysis with orthogonal varimax rotation was used by the maximum likelihood method in SPSS 22 with a factor load greater than 1 and a load factor greater than 0.4.
The validity of the criteria
The Persian version of the FSFI was used in this study to test the validity of the SVQ criteria. For this purpose, the two scales were given to the participants and the data were collected simultaneously. The Persian version of the standard FSFI developed by Rosen et al.  has 19 items in 6 dimensions, including sexual desire (2 items), arousal (4 items), lubrication (4 items), orgasm (3 items), sexual satisfaction (3 items), and pain ( 3 items).
To determine reliability, Cronbach’s alpha was measured for the entire questionnaire and its subscales.