Developing and Psychometric Evaluation of a Reproductive Health Assessment Scale for Married Adolescent Women: An Exploratory Mixed-Method Study

Afrouz Mardi, Abbas Ebadi, Zahra Behboodi , Moghadam, Malek Abazari, Nazila Nezhad-Dadgar, Atefeh Shadman


Background: Adolescent women’s reproductive health is often neglected despite the high prevalence of early marriage. Since no appropriate scales were found to assess the health status of adolescent women, this study aimed to develop a reproductive health scale in married adolescent women in Iran and investigate its psychometric properties.

Materials and Methods: An exploratory mixed‑methods study was conducted in Ardabil healthcare centers (Ardabil City, Iran) between May 2017 and December 2018. In the qualitative phase, 14 semi‑structured in‑depth interviews were conducted with married adolescent women, and two focus group discussions were held with 12 key informants. In the quantitative phase, the initial scales were validated using face, content, and construct validities. In a cross‑sectional study among 300 women, Exploratory Factor Analysis (EFA) was used to assess the construct validity. Internal consistency and test‑retest methods were used to review. The initial scale was designed with 45 items, but only 30 items reached the construct validity stage. EFA revealed five factors that explained 50.96% of the variance. Cronbach’s alpha coefficient of 0.75 estimates the reliability of the scale.

Results: The qualitative study identified 76 items that reached 88 items through literature confirmed its reliability, and test‑retest with a two‑week interval confirmed its consistency (ICC = 0.99, p < 0.001). Finally, the scale was approved with 27 items and four domains: sexual, pregnancy and childbirth, psychosocial, and family planning.

Conclusions: This valid and reliable scale with cultural sensitivity can be used to help health professionals to improve the reproductive health of married adolescent women.


Adolescent, Iran, psychometrics, reproductive health, scale, women

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