Testing Psychometrics of Healthcare Empowerment Questionnaires (HCEQ) among Iranian Reproductive Age Women: Persian Version

Development of mobile application for cervical cancer screening in women: Protocol of a multi-phase study

BACKGROUND

Cervical cancer is one of the most common cancers in women. It is considered preventable due to the possibility of screening. The common barriers to cervical cancer screening include lack of knowledge, lack of time, and wrong beliefs. The use of e-Health technologies is one of the approaches for health promotion. The present study is aimed to the development of a mobile application for cervical cancer screening in women.

MATERIALS AND METHOD

This is a multi-phase study. In the first step, a literature review will be conducted to examine factors related to cervical cancer screening and existing applications related to cervical cancer and its screening. Then, in the second step, a cross-sectional study will be conducted to investigate the factors related to cervical cancer screening in 246 women referred to comprehensive health centers and women's clinics in teaching hospitals in Isfahan, Iran. The comprehensive health centers and women's clinics in teaching hospitals will be randomly selected using a lottery method. Using convenience sampling, women who meet the inclusion criteria will be included in the study, provided they provide informed consent. The data will be collected using a questionnaire, and then the descriptive and inferential statistical tests and SPSS18 software will be used to analyze the data. In the third step, specialists (gynecologists, reproductive health specialists, and midwives) will prioritize the application content by filling out a questionnaire. Then, the research team will compile the application content draft, and this draft will be reviewed and approved by experts on the expert panel. The prototype of the application will be prepared, and experts will evaluate it in the fifth step.

DISCUSSION

The results of this study will result in the development of applications for cervical cancer screening. The use of mobile applications can be useful in lifting some of the barriers to screening. Therefore, developing such applications may help improve cervical cancer screening.

Measures of women's empowerment based on individual-level data: a literature review with a focus on the methodological approaches

Background

Quantifying women's empowerment has become the focus of attention of many international organizations and scholars. We aimed to describe quantitative indicators of women's empowerment that are based on individual-level data.

Methods

In this scoping review, we searched PubMed, Scopus, Web of Science, Science Direct, Google, and Google Scholar for publications describing the operationalization of measures of women's empowerment.

Results

We identified 36 studies published since 2004, half of them since 2019, and most from low- and middle-income countries. Twelve studies were based on data from the Demographic and Health Surveys and used 56 different variables from the questionnaires (ranging from one to 25 per study) to measure the overall empowerment of women 15-49 years. One study focused on rural women, two included married and unmarried women, and one analyzed the couple's responses. Factor analysis and principal component analysis were the most common approaches used. Among the 24 studies based on other surveys, ten analyzed overall empowerment, while the others addressed sexual and reproductive health (4 studies), agriculture (3) and livestock (1), water and sanitation (2), nutrition (2), agency (1), and psychological empowerment (1). These measures were mainly based on data from single countries and factor analysis was the most frequently analytical method used. We observed a diversity of indicator definitions and domains and a lack of consensus in terms of what the proposed indicators measure.

Conclusion

The proposed women's empowerment indicators represent an advance in the field of gender and development monitoring. However, the empowerment definitions used vary widely in concept and in the domains/dimensions considered, which, in turn influence or are influenced by the adopted methodologies. It remains a challenge to find a balance between the need for a measure suitable for comparisons across populations and over time and the incorporation of country-specific elements.

Women's decision to adopt or not adopt cervical cancer screening: Application of precaution adoption process model as the theoretical framework

BACKGROUND

The cancer is uncontrolled growth and spread of cells that affect almost all parts of the body. One of the most prevalent cancers in the female genital system is cervical cancer. The aim of present study was to determine the effect of educational intervention using the Precaution Adoption Process Model (PAPM) on cervical cancer screening behavior (Pap smear test) among women.

MATERIALS AND METHODS

In this interventional study that was done in Karaj health centers (2016), women (aged 15-49 years) were in the third stage of behavior change process based on PAPM randomly assigned to experimental and control groups. The data collection tool was a PAPM-based questionnaire whose validity and reliability were confirmed. Gathered data were analyzed using statistical software SPSS 16 and statistical tests (t-test, repeated measures analysis of variance, and Wilcoxon, Chi-squared, Fisher's exact, and Mann-Whitney tests).

RESULTS

The result showed that the stages of the decision-making process between the two groups were significantly different at the time immediately and 2 months after the intervention (P > 0.001). Also the results of the intervention based on the health belief model health belief model (HBM) components, regarding variables of knowledge, perceived susceptibility, perceived benefits, perceived barriers, and subjective norms, the mean scores in the experimental group were significantly different between the three sections before, immediately, and 2 months after the intervention (P > 0.001).

CONCLUSIONS

This study provides hints how persons could be influenced to move from the "Deciding about action" positions into to the stages of decided to act, adoption, and maintenance for promoting cervical cancer screening behavior.

Psychometric analysis of Persian version of patient safety competency self-evaluation in psychiatric wards

BACKGROUND

Assessment of the patient safety competency is necessary for the growth of nursing and safe care profession as well as evaluation of the nurses' educational needs. The present study was conducted to determine psychometric properties of the Persian version of the patient safety competency self-evaluation (PSCSE) tool in Iranian psychiatric wards.

MATERIALS AND METHODS

All nurses (n = 209) working in two psychiatric hospitals of Kerman, Iran, were included in the present cross-sectional study using census method. This tool contains 41 items: six items are related to knowledge, 14 items deal with attitude, and 21 items are about skill dimension. Psychometric properties of the questionnaire including its content and face validity were also examined. The factor structure of the questionnaire was evaluated using exploratory factor analysis. The internal consistency and reliability were assessed by test-retest method with an interval of 14 days. Cronbach's alpha and corrected item-total correlation were used to measure reliability.

RESULTS

The content validity index was 0.65 and the content validity ratio was 0.89. Item 14 was removed from the skill domain because it was not related to the psychiatric ward. According to the results of factor analysis, there was a significant relationship between the questions and the relevant factors. The correlation coefficient for test-retest with 14 days interval was intraclass correlation coefficient = 0.92 for the whole instrument and 0.89, 0.89, and 0.92 for the domains of knowledge, attitude, and skill, respectively. The internal consistency coefficient (Cronbach's alpha) of the whole tool was 0.95 and 0.95, 0.79, and 0.95 for the domains of knowledge, attitude, and skill, respectively. Finally, PSCSE Questionnaire was obtained with 40 items in dimensions of knowledge (6 items), attitude (14 items), and skills (20 items).

CONCLUSION

Persian version of the nurses' competency tool in ensuring patient safety in psychiatric wards has acceptable psychometric characteristics.

Testing adaptation and psychometric properties of survey instrument for students' perspectives on e-professionalism and social media in Iranian students: Corona crisis and medical education

BACKGROUND

The use of social networks in the field of education has also accelerated and has become a powerful source of learning for transformation and empowerment in various fields. This study aimed to test the adaptation and psychometric properties of an instrument for students' prospective on e-professionalism in the use of social media in Iranian medical science students.

MATERIALS AND METHODS

In this questionnaire, with the aim of psychometric properties of the perception toward social media in Iranian students, this survey instrument developed by (Ness et al.) in five fields in 2^nd-year pharmacology students in Purdue University The fields include accountability, hiring decisions, profile editing, professionalism, and privacy settings. In this study, first, a cultural adaptation was done by an expert panel. Then, psychometric properties of an instrument by content validity and construct validity using explanatory factor analysis were performed. Reliability was assessed by test-retest and internal consistency of items. The reliability of the survey instrument with three factors was 0.82 using the test-retest, and the internal consistency was good (r = 0.94).

RESULTS

The result of psychometric properties using the principal component method extracted three factors (accountability, hiring decision, and professionalism) to assessment of students' attitude to professionalism using social media in Iranian students.

CONCLUSION

The adapted and psychometric properties of the instrument developed by Ness et al., 2013, with three dimensions and ten items proved to be a valid, reliable instrument for use for assessing perspectives on e-professionalism and social media in Iranian medical students. This questioner may be suitable for Iranian researches in medical education.

Multicultural Psychological Empowerment Scale for Saudi Women

The current study aimed to construct a multicultural psychological empowerment scale for Saudi women depending on the four dimensions of psychological empowerment, namely, meaningfulness, impact, self-efficacy, and self-determination. It was applied to a sample (N = 1,080) of Saudi women from various age categories, different social, educational, and employment status, and geographical regions. Pooled confirmatory factor analysis was using to determine the reliability and validity of the scale. As a result, the reliability and validity of the entire model were satisfied. Specifically, the composite reliability values fell in the range between 0.804 and 0.883. Meanwhile, the convergent validity was achieved as these values produced from each construct were higher than the acceptable limit of 0.50. Also, the construct validity of fitness indexes (e.g., comparative fit index, incremental fit index, Tucker-Lewis Index, root mean square error of approximation, and chi-square over degree of freedom) was achieved. In its final form, multicultural psychological empowerment scale for Saudi Women included (26) phrases distributed over its four dimensions. The study suggested systematic measurements of psychological empowerment for Saudi women from different categories, targeted with therapeutic, preventative and developmental visions, plans, and programs to determine the extent of their psychological empowerment.

Reliability and validity of a satisfaction questionnaire on virtual education in the coronavirus disease 2019 pandemic era aimed at cardiology faculty members

BACKGROUND

In the coronavirus disease 2019 pandemic era, clinical programs and mandatory hands-on activities have been supplanted by remote teaching to maintain the fundamental capabilities of medical training and to furnish medical students with quality education. Nonetheless, the satisfaction of faculty members with this training method in the current pandemic has yet to be assessed. The aim of this study was to design a Persian questionnaire with appropriate validity and reliability on cardiology professors' satisfaction level with virtual education.

MATERIALS AND METHODS

In this cross-sectional study, a questionnaire was devised drawing upon scientific sources and Iranian medical educators' expertise. Seventeen faculty members in various specialties evaluated the questionnaire concerning face and content validity. Content validity was assessed through the calculation of the content validity ratio (CVR) (values >0.62 were considered acceptable) and the content validity index (CVI) (values >0.79 were considered acceptable), construct validity was evaluated through principal component factor analysis by the Kaiser-Meyer-Olkin (KMO) statistic and Bartlett's sphericity test, internal reliability was measured through the calculation of Cronbach's alpha coefficient, and consistency was appraised through the use of test-retest reliability at two different time points.

RESULTS

The questionnaire had a reliability rate of 95%, indicating high internal validity. Concerning test-retest reliability, the intraclass correlation coefficient was 0.96 (P < 0.001), demonstrating relatively good stability. The CVI was 0.81, and the CVR was 0.85. The KMO measure of sampling adequacy was 0.954, indicating the acceptability of the degree of common variance among the all items.

CONCLUSIONS

This Persian questionnaire on virtual education aimed at cardiology faculty members in the current pandemic with its low question count and appropriate domains had high reliability and validity. By knowing the level of professors' satisfaction with the new method of education, it is possible to take steps to better provide specialized medical education to cardiology residents.

Development and psychometric evaluation of the perceived care tension questionnaire for caregivers of hemodialysis patients: A mixed method study

BACKGROUND

The complex, multifaceted care environment and the threatening situation of caring for hemodialysis patients cause tension in their family caregivers. Due to the severe tension, family caregivers are likely to ignore their basic needs and only pay attention to the patient's needs and related issues. This study was conducted with the aim of designing and evaluating the Perceived Care tension Questionnaire for Caregivers of Hemodialysis Patients (PCTQHFC).

MATERIALS AND METHODS

The present study was a sequential exploratory mixed methods study of scale development variant conducted in two phases: qualitative and quantitative. This study was conducted in 2019 in Shahrekord. The qualitative phase included item development and scale development. In the quantitative phase (Item Analysis), the validation characteristics of the tool were examined using face, content and construct validity, and its reliability by internal consistency and stability. Findings were performed using software SPSS 18.

RESULTS

Principal components analysis with orthogonal rotation to generate factors, showed that five factors, namely emotional exhaustion, inadequate social support, care burden, confusion and ambiguity and lack of adaptability skills had an eigenvalue of higher than 1, so that they explained, respectively, 75.98%, 61.36%, 72.49%, 76.33%, and 70.31% of the total variance. The internal consistency was obtained 0.811 and the inter-class correlation coefficient for the whole instrument 0.832.

CONCLUSION

PCTQHFC is a culturally appropriate measure with strong psychometric properties. The instrument designed in this study measures the care tension of hemodialysis patients. Therefore, researchers, health-care providers, and community health policymakers can plan and implement interventions to reduce the tension of caregivers of hemodialysis patients by analyzing and identifying the tensions of caregivers.

Validation of academic motivation scale among medical students using factor analysis and structural equation modeling: Middle Eastern perspective

BACKGROUND

Demanding careers like medicine requires a lot of motivation and the Academic Motivation Scale (AMS) developed by Vallerand et al. (1992) is an instrument to measure motivation. This study evaluated the validity and reliability of AMS among medical students in the Middle East.

MATERIALS AND METHODS

This was a methodological research utilizing a convenient sampling technique. AMS scale comprising 28 items subdivided into seven subscales was administered to 900 students (281 students returned the filled AMS). Data were analyzed using the descriptive statistics, one-way ANOVA, and t-tests. Exploratory factor analysis and Cronbach's alpha were used to evaluate the validity and reliability of the scale, respectively.

RESULTS

There was a statistically significant difference between both genders in overall scores (P = 0.015*), two subscales, namely "Identified Regulation" (P =0.017*) and "Stimulating Experience" (P = 0.015*), with females showing higher value. Second-year students (n = 91) had significantly higher score (10.9 ± 4.1) for "Amotivation" (P =.001*) and first-year students (n = 48) had significantly higher score (16.2 ± 3.0) for "Achievement" subscale (P =.014*). P < 0.05 was considered statistically significant with 95% confidence interval. No statistically significant difference was observed between the groups based on nationality or age. Bartlett's test of sphericity was significant (Chi-square: 2988.010; df = 278; P < 0.001). Kaiser-Meyer-Olkin was 0.890. Principal component analysis with varimax rotation extracted seven factors corresponding to the original items of AMS questionnaire. All subscales correlated positively except "amotivation." Structural equation modeling revealed the relation between observed and unobserved variables.

DISCUSSION

This study demonstrated that AMS is valid and reliable for application among Middle East medical students, without needing any modification. AMS has widespread application in medical education as it impacts learning outcomes.

CONCLUSION

This study demonstrated that AMS is valid and reliable for application among the Middle East students without needing any modification.

Virtual learning during the COVID-19 pandemic: What are the barriers and how to overcome them?

CONTEXT

Virtual learning is not without challenges. It can cause stress, lack of motivation, and social isolation. Due to COVID-19 pandemic, our college shifted from face-to-face to virtual teaching-learning style. the aim was to find out the barriers in virtual learning among medical students and provide solutions to overcome them.

MATERIALS AND METHODS

This cross-sectional study was conducted among 3^rd- and 4^th-year Bachelor of Medicine and Bachelor of Surgery students in 2020. Prevalidated electronic survey forms on institutional barrier, technical barrier, and individual barrier were sent to students, 160 students responded. SPSS version 12 was used to calculate descriptive statistics and independent t-test.

RESULTS

The students had the highest mean score in individual barrier (mean: 2.82 [standard deviation (SD): 0.72]) followed by institutional barrier (mean: 2.79 [SD: 0.74]) and technological barrier (mean: 2.72 [SD: 0.75]). Regarding technological barriers, 38.6% of the students agreed difficulty in procurement of the laptop and 66.4% faced slow Internet connection. Regarding institutional barriers, 75.9% were stressed to join one lecture to another lecture as the lectures were continuous, 69.6% had limited opportunity to interact with lecturers, and 62.7% had poor communication between lecturers and students. Regarding individual barriers, 74.1% of the students were not motivated for online learning, 71.5% of the students could not learn as well as they were in the classroom, and 58.2% disagreed taking online courses in future.

CONCLUSION

Low motivation, communication, Internet connectivity, and technical problems were the main barriers. Smaller size class, highly motivated and well-trained lecturers, and interactive lectures may help in breaking the barriers of virtual learning.

Validity and reliability of a virtual education satisfaction questionnaire from the perspective of cardiology residents during the COVID-19 pandemic

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has prompted the further virtualization of medical education. The satisfaction level of specific users such as cardiology residents with virtual education can augment its quality; hence, the significance of a valid and reliable questionnaire to obtain feedback is needed. This study aimed to design and measure validity and reliability of a satisfaction questionnaire for virtual education of cardiology residents during COVID-19 pandemic.

MATERIALS AND METHODS

In this cross-sectional study, a self-administered questionnaire was developed by the faculty members of Rajaie Cardiovascular Medical and Research Center. Reliability was tested utilizing Cronbach's alpha and intercorrelation which was tested using Pearson's correlation coefficient test (ICC). Factor analysis was done by the Kaiser-Meyer-Olkin measure of sampling adequacy and Bartlett's sphericity test. The statistical analyses were performed with the SPSS software version 22.

RESULTS

The face validity index was determined via an assessment of the relevance, clarity, and simplicity of each item, and values >0.79 were accepted. The total Cronbach's alpha coefficient was calculated 0.93. Concerning test-retest reliability, the correlation between two rounds of evaluation was >80 (P > 0.001) and ICC was 0.99 (P = 0.001). The content validity evaluation yielded an index of 0.95 and a ratio of 0.91. The principal component factor analysis, conducted to investigate construct validity, generated four domains.

CONCLUSIONS

The study results confirmed the validity and reliability of the designed questionnaire to evaluate the level of satisfaction of cardiology residents with virtual learning in COVID-19 pandemic.

New psychometric evidences on the Dental Environment Stress questionnaire among Romanian students

BACKGROUND

The academic environment is a challenge for dental students due to the multiple sources of stress they face. For this reason, the present study analyzes the psychometric properties of the Dental Environment Stress (DES) questionnaire. The secondary objective was to identify the specific sources of stress perceived by dental students related to gender and years of study.

MATERIALS AND METHODS

A cross-sectional study was conducted among dental students (n = 340; M_age= 22.45) from the Romanian University of Medicine and Pharmacy in October- December 2019. The factorial structure of the questionnaire was performed by means of the confirmatory factor analysis (CFA) and the multi group-CFA. The convergent and divergent validities were measured by associating DES with scales that measure depression, anxiety, and tension/stress (Depression Anxiety Stress Scale-21-R), perceived stress (Perceived Stress Scale-14), and life satisfaction (Satisfaction with Life Scale).

RESULTS

New measure obtained supported a five-factor and thirty-item structure, which is gender invariant. All the factors within DES have a significant positive correlation with depression, anxiety, tension/stress, and perceived stress and a negative correlation with life satisfaction. The Cronbach's α coefficients are acceptable (range: 0.67-0.89). The female students perceive aspects related to performance, the relations with the faculty, clinical responsibilities, and personal life to be more stressful than males. Senior students perceive more stressed aspects related to personal life, while freshmen have higher scores on stress associated with clinical responsibilities.

CONCLUSIONS

The present results show that DES has psychometric properties which are adequate for the assessment of dental stress in the case of Romanian students; nevertheless, it is necessary to extend the use of DES to students attending other universities and to dental practitioners.

Psychometric characteristics of the health care empowerment questionnaire in a sample of patients with arthritis and rheumatic conditions

Background

Patient empowerment can improve health‐related outcomes and is important in chronic conditions, such as arthritis. This study aimed to validate the Health Care Empowerment Questionnaire (HCEQ), a patient‐reported experience measure of empowerment, for use with patients with arthritis and other rheumatic diseases.

Methods

The HCEQ measures Patient Information Seeking (or Involvement in Decisions) and Healthcare Interaction Results (or Involvement in Interactions) and asks respondents to answer questions in two ways: whether they feel something happened and its importance to them. Face validity was assessed through qualitative data (n = 8, nominal group technique; n = 55, focus groups). Measure structure was assessed through confirmatory factor analysis (CFA); internal consistency was also assessed (n = 9226). Test‐retest reliability was assessed with sub‐sample of participants (n = 182).

Results

We found adequate face validity of the HCEQ for patients with arthritis. The CFA indicated good fit to the data for the two‐factor structure of the HCEQ (RMSEA = 0.075; CFI = 0.987; TLI = 0.978; SRMR = 0.026). Internal consistency was strong (α=0.94 for both subscales). Test‐retest reliability was moderate for Patient Information Seeking (ICC=0.67) and good for Healthcare Interaction Results (ICC=0.77).

Conclusions

The HCEQ, with modifications, demonstrated promising psychometric properties within this sample, laying the foundation for further assessment. This work supports the HCEQ as an appropriate instrument for examining experiences with and perceived importance of empowerment in individuals with arthritis and other rheumatic conditions.

Patient Contribution

Patients contributed to the assessment of face validity. As a measure of patient empowerment, the HCEQ’s use can enable further participation of patients in health care.

Establishing criterion validity for the Revised Critical Nutrition Literacy Tool in U.S. college students

BACKGROUND

Critical nutrition literacy (CNL) plays an important role in how college students make everyday decisions about nutrition choices. Increasing CNL is an aim of many introductory nutrition courses, but there are limited instruments measuring this construct. This study aimed to assess the changeability of CNL and the relationship between CNL and markers of diet quality in young adults.

DESIGN

This was a two-phase research project consisting of a nonexperimental, pre-post study and a cross-sectional assessment from 2018 to 2019. Participants were U.S. college students, 18-24 years old, recruited from introductory-level courses from three participating universities, located in Rhode Island, West Virginia, and New Jersey.

SUBJECTS AND METHODS

Interventions consisted of (1) a 4-credit, 13-week nutrition course and (2) a cross-sectional, online behavior, environment, and perception survey. CNL was measured using the Revised CNL Tool (CNLT-R) instrument across both phases. Measures for phases include: (1) the changeability of CNL and (2) the relationship between CNL and markers of diet quality.

ANALYSIS

Paired t-tests and multivariate analysis of variance were utilized through SPSS version 25.0.

RESULTS

CNL score significantly increased from baseline to postintervention from 3.38 ± 0.48 to 3.61 ± 0.55 (P = 0.014). There was an overall significant effect of CNL on markers of diet quality, such as cups of fruits and vegetables (F/V) and teaspoons of added sugar (F [2,1321] = 3.12, P < 0.05; Wilks' Λ = 0.99).

CONCLUSIONS

This research found that an introduction to nutrition course was associated with an increase in CNL and that CNL is related to diet quality. The instrument could be used by nutrition educators as an outcome assessment. Future research should investigate other components of the CNL construct as well as predictive validity.

Systematic review of psychometric properties of instruments measuring patient preferences for engagement in health care

AIM

To identify, critically appraise, and summarize instruments that measure patients' preferences for engagement in health care.

DESIGN

Psychometric systematic literature review.

DATA SOURCES

PubMed, Embase, CINAHL, and PsycINFO were searched from inception to March 2019.

REVIEW METHODS

Three reviewers independently evaluated the 'methodological quality' and the 'measurement properties' of the included instruments using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist and Terwee's quality criteria. Each instrument was given a Grading of Recommendations Assessment, Development and Evaluation (GRADE) score. The review was registered at PROSPERO (registry number CRD42018109253).

RESULTS

A total of 16 studies evaluating 8 instruments measuring patients' preferences for engagement in health care were included. All instruments were downgraded for their 'methodological quality' or 'measurement properties', or a combination of both. Common concerns were lack of theoretical basis, absence of patient input during development, incorrect usage and reporting of validity measures and absence of a priori hypotheses to test validity.

CONCLUSIONS

There were no identified instruments that demonstrated adequate evidence for all measurement properties. The Patient Preferences for Patient Participation Scale (4Ps) and 10-item Decisional Engagement Scale (DES-10) had the highest overall GRADE scores; however, each had some underlying developmental or methodological issues.

IMPACT

Assessing how patients prefer to engage in their care is a critical first step to truly individualize engagement interventions to meet patient expectations. Systematic reviews of measures of patient experience with engagement in health care have been undertaken but none are available on measures of patient preferences for engagement. The results highlight the need to further develop and test instruments that measure patients' preferences for engagement in health care within a framework for consumerism. Involving the consumer in the instrument development process will ensure that engagement strategies used by healthcare providers are relevant and individualized to consumer preferences.

Effectiveness of an educational intervention using theory of planned behavior on health care empowerment among married reproductive-age women: A randomized controlled trial

BACKGROUND

Empowerment is an essential issue in women's lives. Powerful women can act successfully in health-related issues more than others. This study aimed to determine the effectiveness of an educational intervention designed based on theory of planned behavior (TPB) on health care empowerment among married women in reproductive age.

METHODS

This randomized controlled trial was carried out among 488 reproductive-age women between 2018 and 2019 in Tehran, Iran. Participants were recruited using randomized cluster sampling and divided into intervention (n = 243) and control (n = 245) groups by random allocation. Data were collected using a self-administered researcher-made questionnaire based on TPB and Health Care Empowerment Questionnaire. Validity (content validity index = 0.87; content validity ratio = 0.89) and reliability of the questionnaires were confirmed (α = 0.96). Intervention was implemented within four sessions (lasting 60 min) using eight health related scenarios based on TPB constructs. Baseline and post intervention data (6 months after the intervention) were analyzed by SPSS₂₅ (Inc., Chicago, IL, USA) using independent t-test, Chi-squared test, Fisher's Exact test, Mann-Whitney, path analysis, and regression of generalized estimating equation model. P < 0.05 was considered statistically significant.

RESULTS

Results showed the mean ± standard deviation age of the participants was 33.6 ± 7.1. Six months after the intervention, a significant difference was highlighted in health care empowerment domains as well as behavioral intention, attitude toward behavior, subjective norms, and perceived behavioral control (P < 0.001) between intervention and control groups.

CONCLUSION

TPB-based educational intervention can significantly improve women's perception about health care empowerment. Tailoring and implementation of TPB-based intervention by health policy makers and health care providers is suggested to achieve better perception of empowerment toward receiving health care among women.