Background
Wife abuse is one of the most important types of domestic violence, through which men exercise their social or physical power on women. This type of violence is divided into three general categories including physical abuse, emotional abuse, and sexual abuse [
1]. Violence against women as one of the major public health concerns in today’s world has turned into a pervasive phenomenon in recent decades [
2]. According to the reports by the United Nations, the prevalence of wife abuse is 25% in Belgium, 28% in the United States, 25% in Norway, 17% in New Zealand, 38% in Korea, 20% in Colombia, and 58–67% in New Guinea [
3]. The prevalence of wife abuse in Iran is in the range of 30 to 80%. The most accurate rate of wife abuse in the country was provided by the National Survey, which estimated it as 66% [
4].
Studies conducted in this area showed the high rate of wife abuse. Ahmadi et al. [
5] indicated that 35% of married women were subjected to various forms of domestic violence, of which 30% were subjected to physical violence, 29% to psychological violence, and 10% to sexual violence. Violence may have non-fatal physical consequences from cuts to fractures and damage to internal organs, unwanted pregnancy, sexually transmitted diseases, unintended abortion, pelvic inflammatory disease, chronic pelvic pain, headache, irritable bowel syndrome, smoking, addiction, alcoholism, nutritional problems, and sexual disorders; fatal consequences such as suicide and murder, and psychological consequences such as depression, fear, anxiety, and obsession [
6].
Most researches have focused on preventing problems caused by wife abuse. Early psychotherapy interventions in the event of domestic violence reduce women’s psychological problems [
7]. Psychotherapy interventions include a range of interventions that target cognition, motivation, and behavior. These include (1) formal cognitive behavioral therapy (CBT) and trauma-focused CBT, and CBT‐based techniques; (2) integrative therapies including motivational interviewing; and (3) behavior therapies e.g. relaxation techniques; (4) humanistic therapies e.g. supportive and non‐directive therapies; (5) and other psychologically‐orientated interventions e.g. art therapy, meditation, and narrative therapy [
8]. Therefore, due to the importance of identifying, diagnosing, preventing, and performing therapeutic interventions, a tool for measuring and evaluating wife abuse is needed [
9].
In foreign research to measure and evaluate wife abuse, different measures such as the Conflict Tactics Scale-Revised (CTS-R), Abuse Assessment Screen, Violent Behavior Inventory, Emotional Violence Scale, and Violence against Women Questionnaire (Haj Yahya, 1999) are used. The psychometric properties of these tools have not been studied except for Conflict Tactics Scale-Revised (CTS-R) in Iran [
9‐
15].
In Iran, in addition to the Conflict Resolution Tactics Questionnaire, Spouse Abuse Questionnaire (Ghahari et al.,2006), and the translated version of Questionnaire by Moffitt et al. (Shams Esfandabad and Emamipour, 2003) are commonly used to evaluate wife abuse [
16‐
18]. However, reviewing these tools clarify limitations and shortcomings such as large number of questions, not covering all types of wife abuse, and the incompatibility of some questions of the questionnaire with the cultural and social environment. Also, some of these tools, including the Conflict Resolution Tactics questionnaire, do not specifically and comprehensively examine wife abuse.
Haj-Yahia’s questionnaire of Violence Against Women (1999) is adapted from the other five questionnaires, including the Conflict Tactics Scales (Straus, 1980), the Psychological Maltreatment of Women Inventory (Tolman, 1990), the Measure of Wife Abuse (Rodenberg & Fantuzzo, 1995), the Index of Spouse Abuse (Hudson & McIntosh, 1981), and the Abusive Behavior Inventory (Shepard & Campbell, 1992) [
15]. This questionnaire is a combination of existing questionnaires and measures all aspects of wife abuse. Due to the importance and necessity of this tool to be used in various researches, the present study was conducted to the psychometric evaluation of the Persian version of Haj-Yahia’s questionnaire of Violence against Women in a sample of married women in Tehran, Iran.
Haj-Yahia’s questionnaire of violence against women
The Haj-Yahia’s questionnaire of Violence against Women consisted of 32 items and 4 factors: the first factor, which included items 1–16, measures psychological abuse; the second factor, which includes items 17–27, assesses physical abuse; the third factor, which includes items 28–30, evaluates sexual abuse, and the fourth factor, which includes items 31 and 32, measures economic abuse. The questionnaire is designed as a dichotomous scale (0 = never and 1 = at least once). Then cumulative scores were calculated for each pattern of abuse. Psychological abuse was assessed as follows: “never” (the wife had never been subjected to any of these acts), “mild” (the wife had been subjected to 1–5 acts), “moderate” (the wife had been subjected to 6–10 acts), and “severe” (the wife had been subjected to 11 or more acts). Physical violence was assessed according to two levels: “never” (the wife had never been subjected to any of these acts) and “at least once” (the wife had been subjected to at least one of these acts). Sexual abuse and economic abuse were measured according to the same approach (i.e., “never” and “at least once”). Cronbach’s alpha coefficients for the four factors of the Haj-Yahia’s questionnaire were 0.92, 0.93, 0.86, and 0.71, respectively [
15].
Statistical analyses
A quantitative method was used to evaluate face validity. To determine the face validity, the impact score of each question was calculated. To assess the impact scores, the questionnaire was completed by 20 married women, to determine the importance of each of the 32 questions based on a five-point Likert scale (absolutely important (score 5), important (score 4), moderately important (score 3), slightly important (score 2) and not important at all (score 1)). The impact score was calculated according to the following formula:
$$\mathrm{Impact}\;\mathrm{score}\:=\:\mathrm{Frequency}\;(\%)\;\times\;\mathrm{Importance}.$$
Frequency is the ratio of people who gave the questions a score of 4 and 5, and the importance is the average score of the respondents based on the desired Likert scale. Only questions with a score equal to or greater than 1.5 are acceptable [
21].
Content validity was also quantitatively evaluated using content validity ratio (CVR) and content validity index (CVI). In determining the content validity ratio, a group of experts, which consisted of 8 psychiatrists, evaluated each item with three options (necessary, useful but unnecessary, and unnecessary). Responses were calculated based on the CVR formula, adapted to the Lawshe Table [
22] and finally, numbers equal to and above 0.75 were accepted. After determining and calculating the CVR, the CVI was measured based on Waltz and Basel’s method [
23]. To do so, the questionnaire was given again to the eight psychiatrists to calculate CVI and they were asked to comment on the relevancy, clarity, and simplicity of each of the 32 questions based on a four-part Likert scale (1: unrelated, 2: slightly related, 3: related, and 4: completely related). For this purpose, CVI was computed as the number of experts giving the rating 3 and 4 to each item, divided by the total number of experts [
24]. Hyrkas et al. (2003) recommended a score of 0.79 and above for accepting items based on a CVI score [
25]. In the next step, based on the average of CVI scores of all the items, the average content validity index (S-CVI / Ave) was calculated. Polit and Beck (2006) recommended a score of 0.90 or higher as acceptable S-CVI/ Ave [
24].
Interclass correlations (ICC) were calculated in a sample of 40 married women after 21 days to examine the temporal stability. If ICC is higher than 0.80, the rate of stability is desirable [
26]. Cronbach’s alpha coefficient and McDonalds’ Omega were used to examine internal consistency.
In confirmatory factor analysis, according to the Rule of 10, ten respondents were required for each latent variable [
27]. Considering the number of factors (latent variables) of the questionnaire in the present study, the sample size was sufficient to perform factor analysis. Since all variables were categorical, the weighted least square mean and variance adjusted (WLSMV) was used. Several model fit indices and their criteria were used to examine the goodness-of-fit of the Haj-Yahia’s four-factor model: Tucker-Lewis Index (TLI), comparative fit index (CFI), root mean square error of approximation (RMSEA), and Standardized Root Mean Squared Residual (SRMR).
We performed confirmatory factor analysis using Mplus version 8 software and for other calculations, we used STATA V14.
Reliability
To determine the internal consistency, Cronbach’s alpha coefficient and McDonalds’ Omega were calculated in a sample of 471 married women, which was 0.95 for the total questionnaire according to Table
3. Using Cronbach’s alpha coefficient, the internal consistency of psychological abuse, physical abuse, sexual abuse, and economic abuse was found to be 0.90, 0.93, 0.79, and 0.78 respectively. In addition, using McDonalds’ Omega, internal consistency estimates of 0.90, 0.94, 0.84, and 0.76 were found for the four factors respectively. The ICC rate for the total questionnaire was 0.98 and for different dimensions of the questionnaire ranged from 0.93 to 0.99, which was in the acceptable range.
Table 3
Cronbach’s alpha coefficient and intra-cluster correlation, confidence interval, and significant probability
Psychological | 0.90 | 0.90 | 0.97 | 0.72 0.99 | 0.0001 |
Physical | 0.93 | 0.94 | 0.99 | 0.96 0.99 | 0.0001 |
Sexual | 0.79 | 0.84 | 0.93 | 0.83 0.97 | 0.0001 |
Economic | 0.78 | 0.76 | 0.94 | 0.89 0.97 | 0.0001 |
Wife abuse (total) | 0.95 | 0.95 | 0.98 | 0.69 0.99 | 0.0001 |
Discussion
Domestic violence is a chronic life-threatening disease that, if left untreated, increases in severity and frequency and leads to serious adverse effects to health in women. Studies have shown that identifying victims of violence through screening and providing counseling and support services to them can improve the quality of life and reduce violence-related injuries in married women who suffer from violence [
28,
29]. Therefore, this study aimed to examine the psychometric properties and factor structure of the Persian version of the Haj-Yahia’s questionnaire in a large sample of married Iranian women. The findings suggest that the Persian version of the Haj-Yahia questionnaire showed good psychometric properties. This tool will help assess violence among married women.
The main methods used for determining the content validity in the studies of instruments’ psychometric properties have been CVI and CVR which had desirable values in the present study and were consistent with the previous studies [
30,
31].
In this study, we examined whether a new dataset of married women is appropriate for the 4-factor model devised in a previous study [
15]. For that, CFA was performed and model fits were examined. To examine the model fit of CFA, we have to consider the different fit indices of the model. It has been suggested that for the RMSEA index, values less than 0.05 have a good fit, and values between 0.05 and 0.08 have an acceptable fit [
32]. Therefore, a value of 0.039 in our sample shows a good fit. Also, the CFI and TLI values were 0.99, which indicates a good fit [
33]. The values of CFI ≥ 0.95, TLI ≥ 0.95, and RMSEA ≤ 0.10 were recommended by Meyers et al.[
34]. As a result, based on the values of the desired indices, this sample has a good and acceptable fit with Haj-Yahia’s four-factor model.
Haj-Yahia’s questionnaire included four factors of psychological violence, physical violence, sexual violence, and economic violence. Psychological violence has manifested itself in insults, threats, humiliation, and verbal abuse. Physical violence is when a person hurts or tries to hurt a partner by slapping, pushing, squeezing a person’s throat, hitting, or using another type of physical force, and sexual violence is any sexual act or attempts to obtain a sexual act by violence or coercion [
35,
36]. Economic violence is any act or behavior which causes economic harm to an individual. Economic violence can take the form of, for example, property damage, restricting access to financial resources, or not complying with economic responsibilities [
37]. Economic violence is an important aspect of violence against women that has been ignored in many studies. for example, the oldest Iranian scale in this field focused on assessing physical, mental, and sexual abuse using 44 items [
17]. In addition, the Violence Against Women Instrument (VAWI), often used to assess domestic violence, assesses three dimensions of violence, including psychological, physical, and sexual [
38].
The results indicated a strong Cronbach’s alpha value for the four subscales (psychological, physical, sexual, and economic), which shows that these four subscales and the total scale are reliable enough for a Tehran or Iran sample. The results are consistent with the results of Indo et al. [
39]. The intra cluster correlation coefficient in this study was 0.98 for all the items and was in the range of 0.93 to 0.99 for the dimensions of the questionnaire. This result shows that the reliability coefficient of this tool is excellent in this method as Croon has introduced the inter-cluster correlation coefficient of 0.75-1 as the excellent level [
40].
The results obtained from this study were similar to those reported in the Palestinian study [
15], which showed that Haj-Yahia’s questionnaire has good cross-cultural construct validity and good internal reliability. However, more studies are needed in different populations and cultures to examine these and other psychometric properties.
We can point out the diversity of the dimensions of the present questionnaire as well as its short form compared with other tools such as the Conflict Resolution Tactics Questionnaire (Panaghi et al.), and Spouse Abuse Questionnaire (Ghahari et al.,2006). In addition, Panaghi et al.‘s questionnaire is mainly suggested for clinical settings and the Conflict Resolution Tactics questionnaire has not specifically addressed the types of wife abuse.
This study had several limitations. The research sample has been selected by convenience sampling, so its generalization to the whole community should be done carefully. The content of the questionnaire’s items also evaluates the personal and confidential information related to the respondents. Therefore, subjects may be cautious in completing the questionnaire, which causes damages to the validity of the questionnaire.
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