Development and validation of an Infertility Stigma Scale for Chinese women

Development and psychometric evaluation of the female infertility stigma instrument (ISI-F): protocol for a mixed method study

Background

Infertility stigma is one of the greatest challenges in most societies for reproduction and sexual health of infertile women. Since no specific tool exists for assessing the infertility stigma in women, this study would be conducted to develop and evaluate the psychometric properties of Female Infertility Stigma Instrument (ISI-F).

Methods

This is a mixed method study with sequential exploratory design (qualitative and quantitative phase). In the first qualitative phase, semi-structured interviews would be performed with infertile female who had experienced infertility whithout any psychological disorder. Women who are eligible for participating in the study will be selected using purposeful sampling method with maximum variation in terms of age, education, occupation and infertility duration. Data would be analyzed using conventional content analysis and in this phase the primary item pool will be developed for the Female Infertility Stigma Instrument (ISI-F). In the quantitative phase, the psychometric properties of the Instrument would be evaluated, including the content, face and construct validity as well as reliability via the internal consistency and stability. The psychometric properties described in the COSMIN checklist will be utilized for designing the instrument.

Discussion

Developing a valid and reliable scale for Female Infertility Stigma Instrument (ISI-F) would be helpful for future studies to assess the status of this situation. It also helps planning interventional studies for improvement of the reproductive health of infertile women.

Preferred problem solving and decision-making role in fertility treatment among women following an unsuccessful in vitro fertilization cycle

Background

While the literature on healthcare decision-making has long focused on doctor-patient interaction, fertility treatment is an exception, characterized by a triangular interplay between the doctor, the woman and her partner. This study examined treatment decision-making preferences of women undergoing in vitro fertilization (IVF) treatment, following an unsuccessful IVF cycle, especially their preferred level of doctor and spousal involvement.

Methods

A cross-sectional survey was conducted with 246 Chinese women undergoing IVF recruited from an assisted reproduction clinic of a university-affiliated hospital in Hong Kong. Data collection was conducted between January 2014 and August 2015.

Results

Most participants preferred sharing the decision-making tasks with their doctors (92%). In the doctor-patient relationship, passive roles were associated with higher marital satisfaction, presence of religious affiliation and secondary infertility, while autonomous roles were related to female-factor infertility. Fifty-two percent of participants anticipated sharing decision-making, while 46% preferred handing over the decision to their husbands. Preference for a passive rather than a shared role in the spousal relationship was related to a higher husband’s age, greater marital satisfaction and higher anxiety.

Conclusions

In brief, women tended to prefer sharing decision-making tasks with their doctor as well as actively engaging their partner in making decisions about fertility treatment. This study adds to our understanding of women’s role preference and level of involvement in infertility treatment decision-making by providing quantitative evidence from women’s experience. It highlights the importance of healthcare professionals in facilitating shared decision-making among couples.

Gender differences in factors associated with depression in infertility patients

AIMS

To clarify gender differences in the demographic variables and infertility problems associated with depression among men and women undergoing infertility treatment.

DESIGN

A cross-sectional study.

METHODS

We surveyed 380 women and 360 men undergoing infertility treatment at the reproductive medicine center of a hospital in China's Ningxia Province from March - September 2016.

RESULTS

For women, ethnicity, the number of clinic visits, social concern, and sexual concern were factors linked with depression symptoms. For men, treatment cost pressure and social concern were significantly associated with depression symptoms.

CONCLUSION

Psychological counseling and intervention programs should be integrated into in-vitro fertilization treatments and interventions should be targeted based on gender differences.

IMPACT

The provision of treatment-related sexual knowledge by nurses is indispensable for infertile participants. Mental health policies should be developed to facilitate the implementation of psychological services. Psychological counseling and intervention programs should be integrated into in vitro fertilization treatment to help men and women with infertility cope with psychological distress.

Anxiety, depression and social support in pregnant women with a history of recurrent miscarriage: a cross-sectional study

Objective: This study aims to investigate the prevalence of anxiety and depressive symptoms and the associations between social support and anxiety/depressive symptoms amongst Chinese pregnant women with a history of recurrent miscarriage. Methods: A cross-sectional study was conducted in Guangzhou, China, between September 2016 and May 2017 with 278 Chinese pregnant women with a history of recurrent miscarriage. Measures included the Self-rating Anxiety Scale (SAS), the Edinburgh Postnatal Depression Scale (EPDS) and the Perceived Social Support Scale (PSSS). Results: The occurrence of anxiety (SAS ≥ 50) and depressive symptoms (EPDS ≥ 13) were 45.0% and 37.0%, respectively. The women reported moderate level of social support. The low and moderate level of social support and education of high school or below were the predictors for anxiety and depressive symptoms. The other predictors for anxiety symptoms were having been married for ≥5 years and no child. Another predictor for depressive symptoms was aged ≥35 years. Anxiety predicted depressive symptoms. Conclusion: The results suggest early routine screening for anxiety and depressive symptoms amongst the Chinese pregnant women with a history of recurrent miscarriage. Health-care professionals should give more effort to enhance these women's social support to decrease their anxiety and depressive symptoms.

The effect of stigma on depression levels of Turkish women with infertility

PURPOSE

This study was conducted to determine the effect of stigma on depression levels of women with infertility in Turkey.

DESIGN AND METHODS

It was completed in the Infertility Polyclinic of the Health Research and Application Center in Eastern Turkey between 1 November 2017 and 31 January 2018. The population of the study consisted of all women who applied to the relevant unit between these dates and received infertility treatment. This study was completed with 121 infertile women. To gather data, the researchers used personal information questionnaires, Infertility Stigma Scale, and the Beck Depression Inventory.

FINDINGS

The mean score for the stigma level was 60.79 ± 2.03 and for depression, it was 28 ± 1.08. A positive significant relationship was found among the scales (P < 0.05). The levels of depression and stigma were moderate, and the stigma had a negative impact on depression.

PRACTICE IMPLICATIONS

Based on these results, nurses with counseling and trainer roles should be aware of the psychological issues faced by infertile individuals and psychiatric counseling should become a part of the diagnostic process for infertility treatment.

Infertility Stigma Scale: A psychometric study in a Turkish sample

PURPOSE

The purpose of the present study is to conduct the Turkish validity and reliability study of the Infertility Stigma Scale (ISS).

DESIGN AND METHODS

This methodological study was conducted in an infertility polyclinic in Turkey. The sample consisted of 178 infertile women.

FINDINGS

The validity of the four-factor structure of the scale and the appropriateness of its fit indices were confirmed. The analyses of internal consistency indicated that the total score correlations of items were sufficient; test-retest, r = 0.948;P < 0.001; Cronbach's α = 0.93.

PRACTICE IMPLICATIONS

ISS could be used as a useful assessment instrument in investigating the stigma concerning infertility and making efficient related interventions.

Resilience acts as a moderator in the relationship between infertility-related stress and fertility quality of life among women with infertility: a cross-sectional study

BACKGROUND

Infertility-related stress can seriously impact the fertility quality of life (QoL) of infertile women. Resilience, as a coping resource, can effectively combat psychological stress. This study aimed to evaluate the fertility QoL of infertile women and to examine whether resilience moderates the association of infertility-related stress with fertility QoL.

METHODS

This cross-sectional study was conducted in northeast of China from December 2017 to February 2018. Out of 559 women outpatients with infertility, 498 (89.1%) completed self-reported questionnaires including the FertiQoL Scale, Fertility Problem Inventory (FPI) and Connor-Davidson Resilience Scale (CD-RISC). Hierarchical multiple regression analysis and simple slope analysis were applied to explore the influencing factors related to fertility QoL as well as to examine the moderating effect of resilience on the association of infertility-related stress with fertility QoL.

RESULTS

The mean FertiQoL score was 64.54 ± 16.90 among the participants. Household monthly income and causes of infertility were significantly related to fertility QoL. In addition, infertility-related stress was negatively related to fertility QoL, and resilience was positively associated with fertility QoL, explaining 36.3% of the variance. Resilience moderated the association of infertility-related stress with fertility QoL. Specifically, the effect of infertility-related stress on fertility QoL varied by low(1 SD below the mean, B = - 0.496, β = - 0.714, P < 0.001), mean (B = - 0.293, β = - 0.422, P < 0.001) and high (1 SD above the mean, B = - 0.090, β = - 0.130, P < 0.001) levels of resilience. The higher resilience was, the weaker the effect of infertility-related stress on fertility QoL was.

CONCLUSIONS

Overall, women with infertility in China had relatively low FertiQoL scores. Resilience influenced the association of infertility-related stress with fertility QoL. Infertile patients' psychological status must be addressed and adequate resilience-based interventions such as mindfulness-based skills should be provided to improve fertility QoL of women with infertility.

A study of sociocultural factors on depression in Chinese infertile women from Hunan Province

OBJECTIVE

To explore the sociocultural factors influencing depression in Chinese infertile women in Hunan Province.

METHODS

A cross-sectional study was carried out. A total of 211 Chinese infertile women completed demographic details, a disease-related information questionnaire, a self-rating depression scale (SDS) and a social support rating scale (SSRS).

RESULTS

One hundred and seven (50.71%) of the participants were classified as depressed according to the self-rating depression scale. The average SDS index score was 50.06 ± 10.59. Using analysis of variance (ANOVA), Pearson correlation and a multivariable regression analysis, the results showed family type, feelings of discrimination, social support, feelings of shame and reproductive pressures were influential factors in depression among Chinese infertile women.

CONCLUSION

Sociocultural factors influence depression levels in Chinese female infertile patients. The unique aspects of Chinese culture may have a negative mental impact on the patients, and cultural factors should be taken into consideration in the development of coping strategies for Chinese infertile women.

Psychometric properties of the Chinese version of the Reproductive Concerns After Cancer Scale (RCAC) for young female cancer survivors

PURPOSE

This study aimed to translate, culturally adapt, and test the psychometric properties of the Reproductive Concerns After Cancer scale (RCAC) in young Chinese female cancer survivors.

METHODS

The Chinese version of the RCAC was developed using the standard Functional Assessment of Chronic Illness Therapy (FACIT) translation methodology, and then 800 young Chinese female cancer survivors were recruited to complete the scale. The validation of the RCAC is as follows: (1) content validity was evaluated by a group of experts; (2) factor structure was assessed using confirmatory factor analysis and factorial invariance analysis; (3) convergent validity was determined by correlations with the Patient Health Questionnaire 9 (PHQ-9) and Functional Assessment of Cancer Therapy-General (FACT-G) scale; (4) internal consistency reliability was assessed using Cronbach's α coefficient; and (5) test-retest reliability was assessed using intra-class correlations.

RESULTS

Internal consistency (Cronbach's alpha coefficients ranged from 0.71 to 0.81) and test-retest reliability (intra-class correlation coefficients ranged from 0.82 to 0.95) of the Chinese version of the RCAC were satisfactory. Results also indicated that the content validity index of the RCAC (Chinese version) was good. The Chinese version of the RCAC score was correlated with the PHQ-9 (r = 0.568, p < 0.01) and FACT-G (r = -0.524, p < 0.01) scores, which indicated acceptable convergent validity. Confirmatory factor analysis supported a six-factor structure of the Chinese version of the RCAC with a good model fit. Moreover, multi-group confirmatory factor analysis indicated factorial invariance (configural, metric, scalar, and strict invariance) of the RCAC across cancer types.

CONCLUSIONS

The translation and cross-cultural adaption of the RCAC into Chinese was successful. The Chinese version of the RCAC has suitable factor structure and psychometric properties for reproductive concerns evaluation in young female cancer patients and is appropriate to use in clinical trials of Chinese patients.

Development and validation of the Humanitarian Aid Difficulty Scale for Japanese healthcare workers

Few studies have investigated deployment-related experiences of healthcare workers dispatched for medical humanitarian aid or attempted to assess their difficult living and working environments. This is the first study to develop and validate a scale to measure these kinds of difficulties, in 264 Japanese healthcare workers. The Humanitarian Aid Difficulty Scale was developed in three stages. First, an item pool was generated based on literature and expert reviews. The scale was then tested in a pilot study. Reliability and validity were identified through exploratory and confirmatory factor analysis and Cronbach's alpha. The scale consisted of 23 items across five factors based on exploratory factor analysis (cooperation, health status, infrastructure, culture and customs, and supplies and equipment). The total variance explained was 60.7%. Reliability of the five factors was acceptable and validity was supported by confirmatory factor analysis. Cronbach's alpha for the scale was 0.87. The scale may enable evaluation of the level of difficulty of the living and working environments of Japanese healthcare workers in medical humanitarian aid who are at a greater risk of distress.