Scholarly article on topic 'Psychometric properties of the Chinese version of the Infertility Self-Efficacy Scale'

Psychometric properties of the Chinese version of the Infertility Self-Efficacy Scale Academic research paper on "Economics and business"

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Abstract of research paper on Economics and business, author of scientific article — Bing Fu, Pingping Yan, Hang Yin, Shujuan Zhu, Qing Liu, et al.

Abstract Objective To translate the English version of Infertility Self-Efficacy Scale into Chinese and to validate the psychometric properties of the Chinese version of the Infertility Self-Efficacy Scale (CISE). Method(s) Participants were recruited from the Gynecology Department of two city hospitals. Five main processes were involved in the formation of CISE [1]: scale translation based on expert consultation [2]; pre-test questionnaire development with infertile women's feedback (N = 20) [3]; factor structure assessed by exploratory and confirmatory factor analysis (N = 177) [4]; assessment of reliability by internal consistency (N = 177) and test-retest reliability (N = 21); and [5] assessment of convergent validity with Self-rating Anxiety Scale, Self-rating Depression Scale, and Simplified Coping Style Questionnaire (N = 177). Results This study established a 16-item CISE. Factor analyses confirmed a one-component solution, which explained 54.59% of total variances and showed an acceptable model fit. Cronbach's α and test-retest correlation coefficients for the scale were 0.94 and 0.84, respectively. The CISE score was significantly correlated with anxiety (r = −0.47), depression (r = −0.60), positive coping style (r = 0.37), and certain negative coping style items. Conclusion This 16-item CISE is a reliable and valid measure to evaluate perceived self-efficacy among a sample of Chinese women who underwent infertility treatment.

Academic research paper on topic "Psychometric properties of the Chinese version of the Infertility Self-Efficacy Scale"

INTERNATIONAL JOURNAL OF NURSING SCIENCES XXX (2016) 1 —9

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ORIGINAL ARTICLE

Psychometric properties of the Chinese version of the Infertility Self-Efficacy Scale

Bing Fu a,1} Pingping Yan a,1} Hang Yin b, Shujuan Zhu a, Qing Liu a, Yulan Liu a, Chanyuan Dai a, Guanxiu Tang a, Chunli Yan a, Jun Lei a

a The Third Xiangya Hospital of Centra! South University, PR China b Xiang Ya Nursing Schoo! of Centra! South University, PR China

ARTICLE INFO

ABSTRACT

Article history: Received 16 July 2015 Received in revised form 21 April 2016 Accepted 26 July 2016 Available online xxx

Keywords:

Confirmatory factor analysis

Infertility

Self-efficacy Women

Objectiue: To translate the English version of Infertility Self-Efficacy Scale into Chinese and to validate the psychometric properties of the Chinese version of the Infertility Self-Efficacy Scale (CISE).

Method(s): Participants were recruited from the Gynecology Department of two city hospitals. Five main processes were involved in the formation of CISE [1]: scale translation based on expert consultation [2]; pre-test questionnaire development with infertile women's feedback (N = 20) [3]; factor structure assessed by exploratory and confirmatory factor analysis (N = 177) [4]; assessment of reliability by internal consistency (N = 177) and test-retest reliability (N = 21); and [5] assessment of convergent validity with Self-rating Anxiety Scale, Self-rating Depression Scale, and Simplified Coping Style Questionnaire (N = 177).

Results: This study established a 16-item CISE. Factor analyses confirmed a one-component solution, which explained 54.59% of total variances and showed an acceptable model fit. Cronbach's a and test-retest correlation coefficients for the scale were 0.94 and 0.84, respectively. The CISE score was significantly correlated with anxiety (r = -0.47), depression (r = -0.60), positive coping style (r = 0.37), and certain negative coping style items.

Conclusion: This 16-item CISE is a reliable and valid measure to evaluate perceived self-efficacy among a sample of Chinese women who underwent infertility treatment.

Copyright © 2016, Chinese Nursing Association. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.

org/licenses/by-nc-nd/4.0/).

* Corresponding author.

E-mail address: leijunbao@126.com (J. Lei). Peer review under responsibility of Chinese Nursing Association.

1 Bing Fu and Pingping Yan contributed equally to this work. http://dx.doi.org/10.1016/jijnss.2016.07.008

2352-0132/Copyright © 2016, Chinese Nursing Association. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

1. Introduction

The incidence of infertility has increased. Infertility affects 8%—12% of the child-bearing population worldwide [1—4]. In China, infertility influences approximately 15% of the child—bearing population, and over 50 million patients are infertile according to a national conference on infertility in 2014. Infertility is considered a stressful life event that causes social and marital pressures among affected individuals [5]. Infertility diagnosis and corresponding medical treatments may trigger a number of negative consequences, such as anxiety, depression, stigma, and low self-esteem [6—8]. These psychological distresses also negatively affect infertility treatment and patients' pregnancy outcomes. For instance, depression or anxiety is a risk factor of low pregnancy rates [6,9]. Emotional distress is also an important factor considered by participants to discontinue fertility treatment; this factor is also accounted for 34% of dropout couples in a previous study [10]. Fertility and childbearing ability are of great value among women because of Chinese traditional concepts, such as "There are three forms of unfilial conduct, of which the worst is to have no descendants." Infertile Chinese women usually experience high stress levels. Therefore, infertile women should be provided with adequate support to help them overcome infertility and actively treat diseases.

Bandura [11] defined perceived self-efficacy as an individual's beliefs about his or her capabilities to achieve goals in specific tasks. Self-efficacy is determined by mastery experiences, vicarious experiences, social persuasions, and emotional and physical states. Successful mastery or vicarious experiences, positive verbal persuasions (e.g., encouragement), and good emotional and physical states strengthen people's beliefs to succeed. In addition, self-efficacy beliefs affect an individual's feelings, thinking, and behavior via four major mechanisms: cognitive, motivational, affective, and decisional processes. Self-efficacy theory [12] suggests that individuals with high self-efficacy are certain of mastering their environment, which exposes them to difficult tasks and challenging goals. These individuals persevere and find solutions when they encounter difficulties. By contrast, individuals with low self-efficacy concentrate on obstacles rather than opportunities, underestimate their power, show weak commitment to achieve goals, and exhibit negative emotional status (e.g., anxiety and panic).

Bandura's study clarifies the interrelationship between self-efficacy and emotions, and this finding is consistent with that observed in other studies. Self-efficacy is significantly associated with anxiety and depression [13—15]. Anxiety and depression may affect one's self-efficacy. Anxiety and depression are considered a significant negative predictor of efficacy strength [16,17]. People with high anxiety and depression levels exhibit low self-efficacy. Self-efficacy can also influence individuals' emotions related to anxiety and depression. People with high self-efficacy are less vulnerable to stress, anxiety, and depression. Self-efficacy plays a positive role in alleviating anxiety and depressive symptoms [18,19] because a strong sense of self-efficacy enhances personal accomplishments and encourages people to have high aspirations and strong commitment to achieve their goals

[20]. Self-efficacy beliefs can also reduce the influence of stressful working conditions and can function as a mediator between stressors and negative emotions [21].

Self-efficacy is related to healthy behaviors and thus plays an essential role in lifestyle intervention programs. People with high self-efficacy more likely exhibit healthy behaviors. For example, exercise and diet management for people with or at a high risk of metabolic syndrome is effective by changing self-efficacy beliefs [22]. The effect of cognitive behavioral therapy on panic disorder is also attributed to self-efficacy to a certain extent [23]. Furthermore, self-efficacy promotes smoking cessation intervention among people living with HIV [24]. Turner et al. [25] explored the self-efficacy of 44 infertile women undergoing in vitro fertilization and found that the pregnancy rate of women with high self-efficacy is higher than that of women with low self-efficacy. This finding is observed possibly because people with high self-efficacy manifest a more positive emotional state and healthy behavior than individuals with low self-efficacy do [26].

Studies on infertility self-efficacy are limited in China. The associations between self-efficacy and negative emotions or healthy behavior in Chinese infertile patients remain unclear. A valid instrument has yet to be developed to assess infertility self-efficacy. Current measures that evaluate the perceived infertility self-efficacy are generic. An example of this type of instrument is the Chinese version of the General Self-efficacy scale (GSES), which was developed by Zhang and Schwarzer in 1995 and was originally used in college freshmen in Hong Kong [27]. GSES lacks sensitivity in screening the levels of self-efficacy for an infertile population. Therefore, a valid instrument should be established to assess infertility self-efficacy.

A few validated instruments have been developed to examine infertility self-efficacy. For instance, Infertility Self-Efficacy Scale (ISE) is a frequently used instrument. Developed by Cousineau [28] in 2006, ISE is a reliable and valid instrument specific to infertile patients. The detailed information about ISE was provided in the methodology section. ISE was translated to various languages, including the Portuguese Version of the Infertility Self-Efficacy Scale [29] and Turkish Version of the Infertility Self-Efficacy Scale-Short Form [30]. These two versions of ISE are applicable and feasible for the corresponding populations. Thus, these instruments are used to identify patients who perceive themselves as less competent to cope with infertility. ISE could also be a valuable tool for Chinese infertile population if cross-culture adaptation can be achieved. Therefore, this study aimed to translate ISE into Chinese and examine the psychometric properties of the Chinese version of the Infertility Self-Efficacy Scale (CISE) in a sample of Chinese infertile women.

2. Methods

2.1. Materials and measures

2.1.1. Participants

Infertile women (Inpatients) who were treated in two hospitals from April 2014 to July 2014 participated in this study. The respondents were requested to sign a consent form after the

purpose and content of the study were explained in detail by one of the research team members. The inclusion criteria were (a) aged 18 years or older; (b) clinical diagnosis of infertility; (c) no major comorbidities (e.g. cancer, mental illness, or severe chronic diseases); (d) able to read and fill in the questionnaire. All the participants needed to respond to the self-report questionnaires in paper version, which were provided by the research team. This study was approved by the ethical committees of the aforementioned hospitals.

2.1.2. Questionnaires

Basic information included demographic information (e.g. age, ethnicity, marital status, education level, and household income) and disease information (e.g. type and duration of infertility, and cause of infertility), which was designed by the research team.

Developed by Cousineau [28] in 2006, ISE is a 16-item instrument designed to assess infertile patients' perception of the capability to cope with infertility and the concurrent medical treatment. All of the items were rated on a nine-point Likert scale (e.g. 1 = "not at all confident" to 9 = "very confident"). The total score of the ISE (ranging from 9 to 144) was the cumulative score of the 16 items. High scores indicate high perceived infertility self-efficacy. The internal consistency a coefficient was 0.94. The item-total correlation coefficient ranged from 0.59 to 0.86. The test-retest reliability correlation coefficient was 0.91. Correlations with conceptually similar constructions (Fertility Problem Inventory, Perceived Stress Scale, and Ways of Coping subscales) suggest that ISE achieved convergent validity.

Self-rating Anxiety Scale (SAS) is a 20-item instrument developed by Zung [31] in 1971, which was designed to assess individuals' level of anxiety. Each item is scored from one (a little of the time) to four (most of the time). The sum of all the item scores is the raw score. The raw score multiplied by 1.25 was the index score. According to the Chinese norm, an index score below 50 was considered normal, 50 and 59, mild anxiety, 60 and 69, moderate anxiety, and above 70, severe anxiety. The Chinese version of SAS was widely used and exhibited good reliability and validity. Cronbach's a for SAS was 0.72 in this study.

Self-rating Depression Scale (SDS) is a 20-item instrument developed by Zung [32] in 1965, which was designed to assess individuals' level of depression based on a four-point rating scale that as the same as that of SAS. The raw score multiplied by 1.25 was the index score. According to the Chinese norm, an index score below 53 was considered normal, 53 and 62, mild depression, 63 and 72, moderate depression, and above 72, severe depression. Cronbach's a for SDS was 0.76 in this study.

Simplified Coping Style Questionnaire (SCSQ) is a 20-item measure in Chinese culture, which was developed by Jie [33] in 1998 based on the Ways of Coping Questionnaire [34]. SCSQ was designed to assess the attitudes and actions individuals would take in the face of the life events. Items are grouped into two subscales (PC: Positive Coping style and NC: Negative Coping style) and rated on a four-point Likert scale (e.g., 0 = "not take" to 3 = "usually take"). The PC subscale describes the efforts to cope with and resolve problems pro-actively, which contains 12 items. The NC subscale describes

the efforts to escape or avoid problems, which includes eight items. The subscale score was the cumulative score of the contained items. Previous studies demonstrated adequate reliability and validity for SCSQ. Cronbach's a for SCSQ was 0.84 in this study. The Cronbach's a for PC subscale was 0.85 and that for NC subscale was 0.71.

2.2. Procedure

2.2.1. Phase I: translation

This phase aimed to obtain permission from the original authors and form the initial version of CISE through a forward-backward translation and a cross-cultural adaptation. Permission was first secured to translate and validate the CISE from the original author, Dr. Cousineau, and Inflexxion, Inc. and obtain the electronic version of the original ISE scale. Two researchers who were fluent in English independently developed the forward translation into Chinese. The translated scale was finalized after a consensus was reached between the two versions of the translation. A native English nursing researcher who had no specific knowledge regarding the instrument, performed backward translations. Few inconsistencies between the translations were identified and changes were made by mutual agreement to improve consistency with the original scale. Two bilingual (Chinese and

Table 1 — Characteristics of Participant (N = 177).

Group N (%)

Age (y)

<32 130 (73)

>33 47 (27)

Ethnicity

Ethnic Han 155 (88)

Minority 22 (12)

Marital status

Married 159 (90)

Others 18 (10)

Education level

College or above 60 (34)

Secondary school/High school 108 (61)

Primary school or below 9(5)

Household income (RMB/month)

<2000 54 (31)

2000-4000 69 (39)

4000-6000 29 (16)

>6000 25 (14)

Living area

Village 80 (45)

Township 49 (28)

City 48 (27)

Infertility type

Secondary 129 (73)

Primary 48 (27)

Duration of infertility (years)

<3 156 (88)

3-6 17 (10)

>6 4(2)

Cause of infertility

Uterine/cervix factor 107 (61)

Fallopian tube factor 71 (40)

Ovary factor 10 (6)

Other factors 20 (11)

4 international journal of nursing sciences xxx (2016) 1—9

English) linguistic experts evaluated whether the statements of the translated version are clear, concise, and reasonable and to examine the equivalence between the original English and translated Chinese version. Minor inconsistencies about the last item were settled properly after consulting the original author.

2.2.2. Phase II: pre-test study

This task examines item readability and comprehensibility. In this phase, a sample of 20 Chinese infertile women was asked to complete the translated version of ISE. After finishing the questionnaire, our research members would ask the participants, "Is there any difficulty in understanding the item statements?". No difficulty was reported by the respondents.

2.2.3. Phase III: validation

This task assesses the reliability and validity of CISE. The recruited infertile women were asked to complete a set of self-report questionnaires, including the translated CISE, SAS, SDS, SCSQ, and a demographic data sheet. Critical ration (CR) value and an item-total correlation were calculated to determine the item level. The calculation of CR is as follows [35]: The total CISE scores of all the participants were arranged from high to low. A high-score group and a low-score group were set with 27% for the boundary. T-test was used to test whether a difference exists in each item score of CISE between the two groups. No statistically significant items were detected in CR or statistically significant items with a CR value below 3.50. Items with an item-total correlation below 0.40 were detected and deleted. A principle component analysis (PCA) of exploratory factor analysis and a confirmatory factor analysis were performed to examine the factor structure. Internal consistency, which was determined by Cronbach's a and the test-retest correlation coefficient in a sample of 21 participants for a one-week interval, was computed to determine the reliability of CISE. Convergent

validity, which was examined by calculating the correlations of CISE with SAS, SDS, and SCSQ on the basis of Pearson's/ Spearman's correlation coefficient, was performed to determine the validity of CISE.

2.3. Data analyses

All analyses were conducted using SPSS 17.0 and AMOS 18.0 for Windows. Descriptive statistics, PCA, confirmatory factor analysis, reliability analysis, and Pearson correlation test were used in this study. All P values were based on a two-tailed test. Statistical significance was indicated by P < 0.05.

3. Results

3.1. Sample characteristics

A sample of 186 infertile women was recruited in this study. Nine patients discontinued because of time constraints and physical discomfort. A total of 177 (95%) valid questionnaires were included in the final analysis.

The characteristics of the study sample are summarized in Table 1. The age of the participants ranged from 20 to 43 years (Mean = 30 and SD = 5). Most of the patients (90%) were married. The patients suffered from infertility for an average of 15 months (range: 1-184 months), and 73% of the participants were diagnosed with secondary infertility. Two causes (uterine/cervix factor and fallopian tube factor) coexist for about 10% of the 177 infertile women.

3.2. Item analysis

None of the 16 items was reduced in the item-level analysis (Table 2). All of the items were statistically significant items with a CR value above 3.50 (P < 0.01). The item-total correlations ranged from 0.65 to 0.82, and the corrected

Table 2 — Results of item analysis (N = 177).

CISE CR Item-total Corrected item-total

correlation correlation

1. Ignore or push away unpleasant thoughts that can upset me during medical 10.05a 0.72a 0.68

procedures.

2. Keep a sense of humor. 10.31a 0.72a 0.67

3. Make meaning out of my infertility experience. 10.94a 0.74a 0.70

4. Handle mood swings caused by hormonal treatments 8.67a 0.66a 0.61

5. Keep from getting discouraged when nothing I do seems to make a difference. 10.21a 0.71a 0.66

6. Accept that my best efforts may not change my/our infertility. 9.39a 0.67a 0.61

7. Control negative feelings about infertility. 10.16a 0.73a 0.68

8. Cope with pregnant friends and family members. 9.51a 0.71a 0.66

9. Handle personal feelings of anger or hostility. 9.31a 0.71a 0.66

10. Keep a positive attitude. 12.46a 0.78a 0.75

11. Lessen feelings of self-blame, shame, or defectiveness. 11.80a 0.78a 0.74

12. Stay relaxed while waiting for appointments or test results. 12.64a 0.80a 0.77

13. Do something to make myself feel better if I am sad or discouraged. 12.49a 0.79a 0.76

14. Feel good about my body and myself. 12.80a 0.81a 0.78

15. Keep active with my usual life routine. 13.03a 0.82a 0.79

16. Feel like a sexual individual. 9.28a 0.65a 0.60

Note: a P < 0.01 (2-tailed).

item-total correlations ranged from 0.60 to 0.79, which is above the 0.40 criterion of adequate correlation with the total scale.

3.3. Exploratory factor analysis

Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy was 0.94, which indicated satisfactory factorability of the data file. The statistical significance of Bartlett's Test of Sphericity high (c2 = 1783, P < 0.001), indicating that the data were suitable for PCA. A PCA with varimax rotation was performed, and one component with an eigenvalue greater than one (8.73) was extracted, which accounted for 54.59% of the total variance.

Component loadings ranged from 0.65 to 0.83, and commu-nalities ranged from 0.42 to 0.68 (Table 3). The scree plot also indicated that a single component solution may be adequate

(Fig. 1).

3.4. Confirmatory factor analysis

The goodness-of-fit indices for the original model were not ideal. After covariance between the error terms for some items was added, the adjusted single component model fit the data well (Table 4). Therefore, the result was stable. The path diagram for the single-component model is presented in Fig. 2.

Table 3 — Results of PCA and Cronbach's a if item deleted (N = 177).

CISE Mean (SD) Component Communality Cronbach's a if

loading estimate item deleted

1. Ignore or push away unpleasant thoughts that can upset me during 6.06 (2.40) 0.72 0.52 0.94

medical procedures.

2. Keep a sense of humor. 5.62 (2.35) 0.72 0.52 0.94

3. Make meaning out of my infertility experience. 5.99 (2.04) 0.74 0.55 0.94

4. Handle mood swings caused by hormonal treatments 5.63 (2.03) 0.66 0.43 0.94

5. Keep from getting discouraged when nothing I do seems to make a 5.49 (2.37) 0.70 0.50 0.94

difference.

6. Accept that my best efforts may not change my/our infertility. 5.23 (2.60) 0.65 0.43 0.94

7. Control negative feelings about infertility. 5.38 (2.25) 0.73 0.53 0.94

8. Cope with pregnant friends and family members. 5.88 (2.42) 0.70 0.49 0.94

9. Handle personal feelings of anger or hostility. 5.78 (2.16) 0.70 0.50 0.94

10. Keep a positive attitude. 6.66 (2.03) 0.79 0.62 0.94

11. Lessen feelings of self-blame, shame, or defectiveness. 6.21 (2.29) 0.78 0.61 0.94

12. Stay relaxed while waiting for appointments or test results. 6.11 (2.28) 0.81 0.65 0.94

13. Do something to make myself feel better if I am sad or discouraged. 6.40 (2.07) 0.80 0.65 0.94

14. Feel good about my body and myself. 6.16 (2.37) 0.81 0.66 0.94

15. Keep active with my usual life routine. 6.73 (2.16) 0.83 0.68 0.94

16. Feel like a sexual individual. 6.08 (2.03) 0.65 0.42 0.94

Fig. 1 — Scree Plot.

Table 4 — Summary of fit indices of the single component model of CISE (N = 177).

c2 df c2/df CFI IFI TLI GFI RMSEA

Before modification 279.266 104 2.685 0.899 0.900 0.884 0.838 0.098

After modification 111.851 86 1.301 0.985 0.985 0.979 0.930 0.041

3.5. Internal consistency and test-retest reliability

Cronbach's a estimate for the 16 items was 0.94 (P < 0.01). This value indicated a high degree of internal consistency. Cron-bach's a estimate would not improve if any of the items deleted (Table 3). The test-retest correlation coefficient of the scale for a one-week interval was 0.84 (P < 0.01).

3.6. Convergent validity

Correlation analysis was conducted to assess the associates between CISE and other measures. A Kolmogorov-Smirnov Test (K-S Test) was performed, and bivariate normal distribution data were differentiated from those that did not fit the normality. Pearson correlation was employed for bivariate normal distribution data, and Spearman correlation was used for those that did not fit the normality. The findings are summarized in Table 5. Both the total SAS score and SDS score

were inversely and significantly correlated with the total CISE score (SAS: r = -0.47, P < 0.01; SDS: r = -0.60, P < 0.01). The score of the PC subscale of SCSQ was significantly and positively correlated with the total CISE score (r = 0.37, P < 0.01). No statistical significance was observed in the relationship of the total CISE score with the score of the NC subscale of SCSQ. Certain items of CISE were correlated with the NC subscale. The total CISE score was also correlated with two items in the NC subscale ("try to rest or vacation and put aside the trouble tentatively" and "imagine some miracle would happen to improve the situation").

4. Discussion

Our study examined the component structure of the translated CISE and evaluated its psychometric properties with a

Fig. 2 — Path diagram for the single-component model with standardized parameter estimates.

Table 5 — Correlations of CISE to SAS, SDS and SCSQ (N = 117).

SAS# SDS SCSQ SCSQ-NC-Item 19# SCSQ-NC-Item 13#

CISE -0.47a -0.60a 0.37a -0.13 -0.20a 0.19b

Item 1# -0.35a -0.54a 0.20a -0.18b -0.21a 0.09

Item 2# -0.33a -0.48a 0.29a -0.11 -0.22a 0.19b

Item 3# -0.34a -0.46a 0.26a -0.13 -0.17b 0.19b

Item 4# -0.23a -0.39a 0.21a -0.22b -0.22a 0.03

Item 5# -0.36a -0.39a 0.25a -0.17b -0.19a 0.15

Item 6# -0.31a -0.34a 0.29a -0.12 -0.11 0.16b

Item 7# -0.27a -0.40a 0.27a -0.10 -0.12 0.08

Item 8# -0.45a -0.44a 0.26a -0.23a -0.24a 0.13

Item 9# -0.36a -0.38a 0.25a -0.11 -0.10 0.12

Item 10# -0.30a -0.47a 0.37a -0.04 -0.15 0.24b

Item 11# -0.41a -0.47a 0.33a -0.06 -0.05 0.15b

Item 12# -0.32a -0.49a 0.26a -0.07 -0.17b 0.14

Item 13# -0.31a -0.45a 0.33a -0.07 -0.14 0.19b

Item 14# -0.44a -0.46a 0.33a -0.12 -0.18b 0.18b

Item 15# -0.37a -0.46a 0.34a -0.08 -0.14 0.27a

Item 16# -0.34a -0.37a 0.23a -0.15b -0.08 0.04

Note: # K-S Test P < 0.05: the data was not fit the normality and analyzed by Spearman correlation; a P < 0.01 (2-tailed);b P < 0.05 (2-tailed); SCSQ-NC-Item 19: "imagine some miracle would happen to improve the situation"; SCSQ-NC-Item 13: "try to rest or vacation and put aside the trouble tentatively".

sample of 177 Chinese women who underwent infertility treatment. Item analysis showed a satisfactory CR value and item-total correlation. The PCA with varimax rotation revealed one component construct of CISE, which was similar to that of the original English scale. Confirmatory factor analysis indicated an acceptable model fit. Furthermore, the 16-item CISE demonstrated good internal consistency, adequate test-retest reliability, and strong correlations with three theoretically relevant variables. CISE also yielded satisfactory psychometric properties considered as a measure of perceived self-efficacy in Chinese infertile women who undergo medical treatment.

As expected, CISE is strongly related to SAS, SDS, and the PC subscale of CSCQ which suggests that CISE achieved good convergent validity. Although the total CISE score was not clearly related to the NC of CSCQ, an inverse relationship was observed in certain items of CISE (e.g. items 1,4, 5,8, and 16). A significantly inverse relationship existed between the total CISE score and one negative coping item ("imagine some miracle would happen to improve the situation"). A specific negative coping item ("try to rest or vacation and put aside the trouble tentatively") exhibited positive correlations with the total CISE score. Thus, for this population, the perceived attempt to avoid conflict is a harmful factor of perceived self-efficacy. Avoidance of conflict by resting or taking a vacation may be a helpful factor of perceived self-efficacy because this aspect may distract patients' attention and alleviate the injury caused by infertility. However, these assumptions should be validated in further studies.

A few limitations were noted in this study. First, the study subjects were recruited in two teaching hospitals in the same city. The generalizability of the results in other parts of China requires further investigation. Second, this study focused on infertile women who were actively seeking medical care. The suitability of CISE for infertile men was not assessed. Although previous studies determined that infertile women

perceive themselves as less confident to cope with infertility than men [28,36], a comparison cannot be established between male and female patients. No significant difference was observed in the mean self-efficacy score (Current study: 5.96 versus Cousineau's study: 5.80, P > 0.05) among female patients between the current study and the one conducted by Cousineau et al. [28], which included both male and female patients. The mean self-efficacy score of men in Cousineau's study was significantly higher than that obtained in our study (Current study: 5.96 versus Cousineau's study: 6.70, P < 0.01).

In conclusion, the 16-item CISE is a reliable and valid instrument that can be used to quantify infertile women's perception of their capability to cope with infertility and the concurrent medical treatment in Chinese infertile population. The capacity of CISE to determine the specific infertility self-efficacy could contribute to future intervention studies. Further evaluation of CISE with diverse samples in other regions in China and in male infertile patients should help demonstrate the robustness of CISE.

Financial support

This work was supported by (1) China Hunan Provincial Science and Technology Department, the Hunan Provincial Natural Science Foundation (10JJ3074) and (2) Health Department of Hunan Province, High-level Medical Talents "225" Project of Hunan Province (Xiangwei [2013]13).

Conflict of interest

We wish to confirm that there are no known conflicts of interest associated with this publication, and no significant financial support for this work could have influenced its outcome.

international journal of nursing sciences xxx (2016) 1-9

Acknowledgments

We are grateful to the following experts for their generous input to the scale translation or the study design: Honghong Wang, Ph.D., Xianhong Li, Ph.D., Jingping Zhang, Ph.D., Xiang Ya Nursing School of Central South Universty; Shiwu Wen, Ph.D., Xin Huang, Ph.D., Jingcheng Shi, Ph.D., School of Public Health of Central South University, Hui Li, M.S., Shaoxing University. We also would like to acknowledge the contributions of the data collection group: Qin Wang, RN, The Second Xiangya Hospital of Central South University; Xin Dai, RN, The Third Xiangya Hospital of Central South University; Jie He, M.S, Zhihong Chen, B.M., Xiang Ya Nursing School of Central South University.

Appendix A. Supplementary data

Supplementary data related to this article can be found at http://dx.doi.org/10.1016/j.ijnss.2016.07.008.

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