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The self-care situation analysis of reproductive-aged women in Tehran: a survey study | BMC Women’s Health

Study design

This was a descriptive cross-sectional study.

The participants

The participants were 1051 reproductive-aged women (including 536 women aged 19-39 and 515 women aged 40-55 years) living in all 22 districts of Tehran in 2021.

The inclusion criteria were: resident of Tehran, having no known medical condition, and having an appropriate mental state and communication to fill out the questionnaire. The exclusion criteria were incorrect completion of the self-report questionnaire.

Sample size

Sampling was performed in all 22 districts of Tehran through the health houses of the Municipality and using a multi-stage sampling method by an online questionnaire (google form). The link to the questionnaire was sent by the head of the health house who had access to the participants’ cellphone numbers. The sample size was obtained by using the following formula to calculate the sample size for each group of 19-39 and 40-55 years-old women.

$$n\ge \frac{z_{1-\alpha /2}^2\left(1-P\right)}{\varepsilon^2P}$$

The minimum sample size was calculated at 385 samples for each group using the formula of descriptive studies and considering the 50% probability of women’s self-care and the Type I error of 0.05 and the absolute error of 0.5.

Sampling method

The sampling method of the study was similar to our previous study to assess postmenopausal women’s self-care needs [16]. A multi-stage sampling method was used to recruit the participants of the study. All 22 districts of the municipality of Tehran were selected as the clusters for sampling. Then, simple random sampling method using Excel software was used to select three or four health houses in each district.

Thereafter, using the quota sampling method and based on the population covered by the center the sample size for each health house was considered 10 to 15 eligible women. Afterward, the link to the online questionnaire was sent to the participants following contacting them and explaining the goals and process of the study and obtaining oral consent. Then electronic written informed consent was also obtained from all participants and completing the forms was only possible after giving the informed consent of the participant. For illiterate women, the questionnaire was filled out by the head of the health center through a telephone interview. The sampling of this study was accomplished during the pandemic of Covid-19.

Instructions for the recruitment of the sample were provided to the heads of the selected municipality health houses. Thereafter, an online workshop was conducted by the main researcher to train head of health houses about the procedure of the sampling. Then the head of each health house selects 10 to 15 eligible reproductive-aged women. The contact number of the main researcher was also provided to the research colleagues to answer the possible questions of the colleagues.

Tools for data collection

This online Google form comprised two questionnaires for data collection, including (1) socio-demographic questionnaires and (2) a questionnaire to assess Reproductive-aged Women’s Health Self Care (RWSCQ) with 36 questions for 19-55 years old women.

  1. (1)

    The socio-demographic questionnaire: This questionnaire contained 15 questions about the personal, social, economic, and anthropometric characteristics of participants including, district, age, weight, height, education, and occupation of women, marital status, employment and education of the spouse if married, adequacy of income, housing status, number of children, medical history and condition.

  2. (2)

    Reproductive-aged Women Health Self Care (RWSCQ): This questionnaire was developed with 36 items in 4 domains including the physical health domain with 14 items, psychosocial health with 6 items, and reproductive-sexual health with 12 items, and periodic tests with 4 items. The questionnaire assessed the self-care of 19-55 years old women.

This questionnaire was developed using a deductive approach and based on a review of the guidelines for women’s health, reproductive health, and self-care which were presented on the site of trustworthy organizations such as the American College of Obstetricians and Gynecologists (ACOG) [17], Royal College of Obstetricians and Gynecologists [18], Medline Plus [19], World Health Organization women’s health [20], Centers for Disease Control and Prevention (CDC) [21]. Finally, the items of the primary questionnaire were generated based on the updated Women’s Preventive Services Initiatives WPSI “2021 recommendations for well-woman care” [22, 23]. This chart is adapted by the members of the advisory panel support for the WPSI including, ACOG, the American Academy of Family Physicians, and the American College of Physicians (ASP). The items were selected and modified to be appropriate for reproductive-aged women and based on the guidelines of the above-mentioned reputable organizations.

To assess the validity and reliability of the questionnaire the method described by Pilot and Beck 2010 was used [24]. RWSCQ was evaluated in two age groups 19 to 39 years and 40 to 55 years. First, face validity (qualitative and quantitative) and then content validity (qualitative and quantitative) were examined.

The face validity

For qualitative face validity assessment, 5 reproductive-aged women were asked about the items’ difficulty, irrelevancy, and ambiguity. Afterward, the impact score of each item was calculated and evaluated by the cut-off point of > 1.5. The Impact Score was calculated by the following formula.

$$\textrm{Impact}\ \textrm{score}=\textrm{frequency}\ \left(\%\right)\times \textrm{importance}$$

All items of the questionnaire had a score of more than 1.5 and so were considered important by the participants. The calculated Impact scores of RWSCQ were 2.47 to 4.86.

The content validity

Content validity of the questionnaire was assessed by 12 experts in midwifery, public health, reproductive health, and nurses. The content Validity of the questionnaire was assessed by calculating Content Validity Ratio (CVR) and Content Validity Index (CVI). The results showed CVR ranged from 0.83 to 1. The modified content validity index of I-CVI for all items ranged from 0.91 to 1, and the S-CVI / Ave score was 0.97. An alpha coefficient above 0.7 is usually acceptable [25].

The reliability

The reliability of the questionnaire was measured by calculating Cronbach’s alpha coefficient for internal consistency assessment and also calculating the Pearson coefficient to measure the stability of the questionnaire by the test-retest method on 15 reproductive-aged women. The results showed the reliability of the questionnaire by a = 0.92, and Intra-class Correlation Coefficient ICC = 0.93. A reliability coefficient higher than 0.7 is acceptable [26].

The scoring

The items were scored 1 to 3 in the responses of “No, I did not”, “Yes, somewhat/ I intend to do” and “Yes I did”, respectively. The score ranges for the different dimensions of the questionnaire including physical-, psychosocial-, and sexual-reproductive health and screening tests were 14 to 42, 6 to 18, 12 to 36, and 4 to 16, respectively, and for the whole questionnaire was 36-108 for RWSCQ-36. The higher scores indicate healthier self-care behaviors of reproductive-aged women. The score of each domain and the total score were calculated and then converted to the standardized 0 to 100 score using the following eq. (X-Min Score / Max-Min Score) × 100. The questionnaire is available in Additional file 1.

Statistical analysis

After filling out the Google forms the participants in the Google platform, the data were generated in the Excel software in two Google Drive for women ages 19-39 and 40-55 years old. Then the data in the Excel file was converted to SPSS. Then, the data were analyzed using SPSS 24 and by Kolmogorov–Smirnov to test the normality of data, ANOVA, Sheffe, Pearson, and Spearman correlation coefficient tests, and linear multiple regression analysis. P values less than 0.05 and a confidence interval of 95% were considered statistically significant.


The study was approved by the ethics committee of Shahid Beheshti University of Medical Sciences, with the code “IR.SBMU.PHARMACY.REC.1398.298”. All methods were performed under the relevant guidelines and regulations as approved by the deputy of research and the ethical committee of Shahid Beheshti University of Medical Sciences. An online written informed consent was obtained from all participants.

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