Introduction

Menopause is a physiological process (1) that is accompanied by problems that affect the quality of life of women (2). How women perceive menopause affects their adaptation to these problems (3). About 51 to 41 percent of women experience various symptoms during menopause (4). Although menopause symptoms are not life-threatening, they can affect work and social activity, enjoyment of life and its quality (5-6). Adapting to menopause is particularly important due to the many and different perceived feelings of postmenopausal women (7-8).

In general, adaptation can be considered as a spectrum, at one end is adaptation with a positive concept that expresses a positive reaction to stressful factors, and at the other end is conformity in a negative form, which means surrendering (9).

 We can learn the way to deal with changes and react appropriately to that event, although cannot change certain events in life (6).

Identifying the factors affecting women's adaptation to menopause can have a significant impact on fully understanding and fully accepting the passage of the youth phase and entering a new phase of life, reducing complications and annoying problems, and improving the quality of life (6).

Based on the literature review, various questionnaires about menopause have been designed and implemented.  In other countries and Iran, there was not any tool, that menopausal adopting examines all aspects of adopting. The available questionnaires examined some aspects of menopause such as, quality of life, emotional and social disorders, and experiences of menopause (3-10). In past researches, the quality of life of menopause was measured by MENQOL questionnaire(3). Health improvement during menopause was measured by HPELP questionnaire (10). However, menopausal adopting doesn’t assess in Iran.The designed tool puts questions in front of the participants and in return they hand over numbers to the researcher and the researcher compares the data according to his initial hypotheses and achieves results. Standardized tools are very important in obtaining correct, accurate and generalizable information.

Therefore, this study aimed to design and evaluate psychometrically measure of the tool to measure adaptation to menopause.

Methods

This methodology study was conducted among 540 females in Mashhad, Iran in 2022.

Sample size

Based on a confidence level of 0.95 and a sample loss of 25%, the sample size was estimated to be 450 participants. Inclusion criteria: declaration of consent to enter the study, women aged 45-65 with menopause experience, literacy, Iranian nationality, and Farsi speaking. Exclusion criteria: unwillingness to continue participating in the intervention. The questionnaire used was the researcher-made questionnaire on menopause adaptation. Question bank was based on content analysis. Demographic variables included age, education, being rich or poor, social status, occupation, and membership in social groups.

Results

The characteristics of the participants   had included, the age (mean ± standard deviation) was 52±2.1. 11% of the participants’ had no children, 36% had one child, and others had two or more children. 9% person was illiterate, 21% were at the elementary level, 35% had a diploma, 6% had a post-graduate degree, 24% had a bachelor's degree, and 4%had a master's degree. 48% were homemakers, 17%were employees, 23% were self-employed, such as tailors and sellers, and 12%were retired.

The qualitative phase was based on the content analysis method and in-depth unstructured interviews. Four main themes were detected evaluation and understanding of the menopause period, encountering to signs and symptoms of menopause, seeking support, and self-care.

Factors influencing was approved 4 subscales of the Evaluation and understanding menopause, encountering sign and symptoms of menopause, seeking support and self-care. In this phase, 102 questions were designed based on the qualitative phase and review of the literature (Fig. 1).

In this phase, the questionnaire was examined in terms of face validity, content validity, and construct validity.,

Face validity

Based on the opinion of experts in qualitative face validity, 7 questions were deleted and 12 questions were corrected. 10 questions were merged. Finally, in this section, 64 questions   remained and entered the content validity stage.

Content validity

Based on the opinion of experts in qualitative face validity, 4 questions were deleted and 10 questions were corrected. Finally, in this section, 60 questions remained and entered the construct validity stage The CVR for all questions were 0.81 and S-CVI/UA 0.95 and s-cvi/ave /0/99.

Construct validity

The goodness of fit the model for five subscales was acceptable( X²/df=2.94, RMR=0.48, GFI=0.96, AGFI=0.92, NFI=0.90, NNFI=0.97, CFI=0.91, RMSEA=0.78 )

Reliability

Based on the results of Impact factorfor   4 subscales the Evaluation and understanding menopause, encountering sign and symptoms of menopause, seeking support and self-care were 0.19, 0.21, 0.38, 0.17.  According to the results, the reliability of   all 4 subscales and the entire questionnaire was acceptable.

Abbreviation	Index	Normal	Reported value
X2/df	Root Mean Square Error of Approximation(RMSEA)	3 <	94/2
RMR	Chi-degree freedom	0.050<	48/0
GFI	incremental fit index	0.9 >	96/0
AGFI	Normed Fit Index	0.9 >	92/0
NFI	Goodness of fit	0.9 >	90/0
NNFI	Adjusted Goodness of Fit	0.9 >	97/0
CFI	Comparative Fit Index	0.9 >	0.91
RMSEA	Root Mean Square Error of Approximation (RMSEA)	0.80<	0.78

Discussion

The purpose of this study was to design and evaluate the psychometric properties of the menopausal adopting questionnaire for menopausal women. According to many studies, menopause is considered an important stage in every woman's life. This stage is accompanied by many complaints and side effects. In many cases, women feel the loss of an ability. According to the mentioned cases, tolerance and compatibility with this step is very important. This questionnaire can be useful in the assessment of needs for adaptation to menopause.

The results of this study showed that the instrument had acceptable validity and reliability. The validity of the questionnaire was evaluated using face validity, content validity, and construct validity. The CVR and CVI and ICC for all questions were 0.81 and 0.95, and 0.89, respectively. To perform the reliability of the instrument, The Cronbach’s alpha and KAPA coefficients for all questions were 0.869 and 0.99, respectively.

Finally, a questionnaire with 46 questions and 4 subscales of the evaluation and comprehension of the menopause phase (8 item) experiencing menopausal warning symptoms (15 item) and seeking support (10 item) and self-care (13 item) was approved. Based on the results, it is acceptable for CVR and CVI to be greater than 0.6 and 0.78 respectively (14). HPLP-II was also used in the article by Nazari (15) and Shabani (16). In Rabiei's article (17) The following questionnaires were used: lifestyle questionnaire (LSQ), Keys and Gyarmo well-being scale, and Hayman's MRS menopause In Niga's article (18), shortened version of the COPE Inventory, Menopause Rating Scale, the Sense of Coherence Scale, the Brief COPE Inventory, and the medical outcomes. According to the questionnaires used in various articles, the design of the menopause adaptation questionnaire is a new work that can be useful in examining the educational needs of postmenopausal women in adapting with this new situation. It examines the period of menopause and facing the warning signs of menopause and seeking for support and self-care. These questions are based on a 5-point Likert scale (I completely agree (5), I agree (4), I have no opinion (3), I disagree (2), I completely disagree (1) is measured. Questions 1, 2, 5, 6, 7, 9, 10, 11, 12, 29, and 30 are scored in reverse. The full score is 230, the cutoff points are 76 and 152.

 
Figure 1: 4 subscales, Factors influencing on menopausal adopting

Conclusion    

Considering the trend of population increase and the increase of elderly and middle-aged people and the inevitable existence of menopause as a period of life and it many consequences, it is very important to adapt to these changes. The results of this study showed that the menopausal adapting questionnaire can be used as a valid tool to assess the current situation and evaluate programs related to menopausal adopting. The strength of this study is that the equations derived may use to predict the outcome of future educational activities. This endeavor helps women adjust to this period of life and live more comfortably and worry-free.

Acknowledgments

The researchers thank all of the instructors at Mashhad University's Health and the participants for their assistance in conducting this study.

Data availability statement

All data generated or analyzed during this study is included in this published article

Ethics approval and consent to participate

All procedures performed in studies were in accordance with the ethical standards of the institutional research committee with the 1964 Helsinki declaration. This proposal has been approved by the Ethics Committee of Mashhad University of Medical Sciences; the ethics code IR.MUMS.FHMPM.REC.1400.076. Address: https://ethics.research.ac.ir/ IR.MUMS.FHMPM.REC.1400.076).

Consent for publication: Applicable.

Competing interests: There is no potential conflict of interest between the authors.

Funding: no funding

Author contribution:

Author contribution are concluded, Conceptualization byM.KH, and Methodology by M. S, Software by SH.M, M.KH, Data curation and Investigation by M.KH, N. P, Validation by M. S, Supervision by M.KH, N. P, M. S, M.M, Writing - original draft by M.KH, Writing - review & editing by M.KH, N.P, M. S,M.M.