Gynecological Examination Attitudes Scale: a Methodological Study

Gynecological Examination Attitudes Scale: a Methodological Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Gynecological Examination Attitudes Scale: a Methodological Study Selma SEN, Sezer Er Guneri This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6263180/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective Gynecological examination is very important to protect the reproductive health of women. Women do not want to go to a gynecological examination for reasons such as poor results, embarrassment, privacy, and negative experiences. The objective of this study was to design and develop the Gynecological Examination Attitudes Scale (GEAS) and assess its psychometric properties. Methods Cross sectional, mixed methods design. A STROBE checklist was used. The study was carried out two phases. In phase one, a literature search, cognitive interviews (n:7) and a pilot study were conducted to construct and revise scale indicators. In phase two, a questionnaire-based survey was conducted with three women group (exploratory factor analysis group: 293; confirmatory factor analysis: 225 and test-retest: 28). Results The draft scale consisted of 47 items, and result of the factor analysis applied to test the construct validity. The KMO test for sampling adequacy was 0.86. We conducted exploratory factor analysis to model the interrelationships among items. Results of the analysis the scale was consisted of 32 items and three sub-dimensions as individual response, barriers, individual expectations. Cronbach's alpha coefficient for the total scale was 0.91; Individual Response was 0,94, Barriers was 0,78, Individual Expectations was 0,90. The correlation coefficients between the factors and the correlation coefficient as a result of the test-retest study were found to be significant for the whole scale. Conclusions GEAS is a new tool for determining women's gynecological examination attitudes. The GEAS shows acceptable reliability and evidence of convergent validity among women. Scale development gynecological examination attitudes Figures Figure 1 Figure 2 Introduction Women spend a significant part of their lives in the period known as the “fertile age.” During this reproductive stage, women encounter the most health problems. However, problems also arise at older ages due to menopause and changes during this period [ 1 ]. Thus, regular health checks and screenings are an indispensable part of modern preventive health services and have an important place in human life [ 2 ]. One of the specialists that aim to protect women’s sexual and reproductive health is gynecology [ 3 ]. A vaginal examination is an examination that most women experience several times in their lifetime [ 4 ]. The gynecological examination evaluates and screens for reproductive risks, prevents complications by early diagnosis of gynecological diseases, and protects reproductive health by providing women with education opportunities. The gynecological examination starts with a preliminary case history and may include a pap smear and visual, speculum, bimanual, rectovaginal, abdominal, and breast examinations depending on the examination indication [ 5 , 6 , 7 , 8 ]. Genital examination is often seen as an unpleasant but necessary practice by women [ 4 ]. In the literature, women have expressed concerns over the lack of attention to privacy before and after gynecological examination and a lack of knowledge about the gynecological examination, the instruments used during the examination, and positioning during the examination. Moreover, feelings of embarrassment due to the nakedness of the perineal area during the examination, doubts about personal cleanliness, and health professionals’ lack of knowledge about the examination have been reported. These concerns may also be exacerbated by a provider’s negative attitude during the examination, the fact that the health professional performing the examination might be male, and the woman’s young age [ 3 , 9 , 10 , 11 , 12 , 13 ]. To address the above-mentioned concerns and reduce the negative effects experienced during the gynecological examination, the literature recommends the following practices: establishing positive communication with the woman before the examination, focusing on the woman during the examination, providing information about the procedures applied and her condition, gently applying the tools used, and acting respectfully. On the contrary, harsh, hasty, and insensitive gynecological examinations performed without verbal communication with the patient cause an increase in women's feelings of shame and fear [ 14 ]. Attitude, in the broadest sense, is an individual's mental readiness toward a certain object or person or their attitude in a certain way. Attitudes are seen as an important predictor of human behavior. Since attitudes significantly affect human behavior, measuring attitudes and knowing people’s perspectives toward an object or situation is beneficial for understanding behavior and developing interventions [ 15 ]. Although women acknowledge the benefit of pelvic examinations, they have expressed negative experiences with specific parts of the procedure. Women’s attitudes and experiences toward pelvic examination are interrelated. Moreover, a woman’s first pelvic exam experience often predicts subsequent experiences. For example, an experience of pain during the first pelvic examination is considered a negative experience, and negative experiences are statistically significant for predicting subsequent attitudes toward future pelvic examinations [ 4 ]. Regular check-ups are important in protecting and improving women’s health and preventing diseases. Gynecological examination, which is one of the common health checks, is performed in cases related to reproductive/sexual health, infections, early diagnosis and treatment of reproductive organ cancers, pregnancy, and birth. Examining genital areas during a gynecological examination may lead to negative attitudes toward the examination. Notably, no scale has been developed to determine women’s gynecological examination attitudes. Thus, the objective of this study was to design and develop the Gynecological Examination Attitudes Scale (GEAS) and assess its psychometric properties. Methods The study used a methodological and descriptive scanning model. Descriptive scanning models are useful for describing the events, people, and objects that are the subject of the research as they are without any intervention. This study aimed to produce a valid and reliable measurement tool for determining perceived attitudes toward gynecological examinations among Turkish women. Participants The research was conducted with 293 women selected according to the random sampling method. Before the scale was administered to the full sample, 10 women were interviewed by asking open-ended questions to determine the main concepts regarding gynecological examination attitudes. In line with the data obtained from the literature review and interviews, an item pool of 47 items relevant items was created. The researchers explained the purpose of the study to all participants and assured them that their answers would remain confidential. Last, the interview setting was discussed. Data were collected by online survey method between January 15, 2022 and January 15, 2023. Sample Size To calculate sample size in scale development studies, it is often recommended to include five to ten items per item, depending on the number of items in the draft scale [ 16 ]. For this reason, since the scale consists of 47 items, a total of 293 cases were thought to be sufficient for validity/reliability analysis (47×5 = 235). Procedures for scale development and analyses The scale was developed in four stages. Preparation of item pool (literature review and in-depth interviews to create the item pool), content validity, pilot test implementation and first and second application. Preparation of item pool An item pool for the measurement tool was created by scanning the relevant literature and defining the conceptual structure. Items were created based on studies conducted on the subject, studies conducted abroad on the subject, and interviews with individuals. Some of these works are mentioned in the bibliography section. After reviewing the literature, a pool for the scale items was designed by taking the opinions of health professionals working in the field of reproductive health. As a result of the literature review, the researchers created two separate forms. Form I contained 12 descriptive questions about sociodemographic characteristics and obstetric characteristics. An item pool of 45 questions was then created based on the experts’ opinions and distributed using Form II. The theoretical content of the questions was reduced to 47 items by the researchers after examining the expert opinions. Gynecological Examination Attitudes Scale (GEAS) GEAS was designed as a 5-point Likert-type scale. After reviewing the literature and obtaining expert opinions, a pool of scale items was developed. After the theoretical content of the scale was examined by experts in the field, an item pool of 45 questions was created by the researchers and this pool was increased to 47 items. The scale was pilot-tested with 10 women from the research population who were registered at the family health center and were later excluded from the entire study. A second test was conducted with another sample of 10 women 25 days after the first application. After conducting factor analysis, the scale reached its final form with 47 items (Fig. 1 ). Each of the perceived attitudes was evaluated by the women using a 5-point Likert scale. These statements range from “Strongly Agree (5)” to “Strongly Disagree (1).” Possible scores range from 32 to 160, with a higher score indicating a more positive attitude. The scale was comprised of three subscales and all subscales were summed to produce one combined score: individual response (13 items), barriers (6 items), and individual expectations (13 items). No items were reverse-coded in the scale. Statistical analysis The data collected based on women's opinions through the Gynecological Examination Attitudes Scale draft were analyzed using the computer package program SPSS 22.0 (Statistical Package for Social Sciences). Frequency, percentage and mean tests to define demographic characteristics, Content Validity Index and Lawshe's Content Validity Ratio (CVR) formula, percentage, mean, Cronbach Alpha, Pearson Correlation and factor analysis for validity and reliability studies of the scale (KMO, Bartlett Test, Anti-Image Correlation, Principal Components Analysis, Varimax Rotation Method, Kaiser-Meyer-Olkin, Bartlett’s ) were used. Data collection The necessary permissions were obtained from the Local Ethics Board of the university before data collection. After the researchers formulated the GEAS in accordance with the literature, a pilot test with 20 women was performed, and expert opinions from the 10 experts were analyzed, the GEAS was administered to the rest of the women in the sample. The online survey was shared via social media (i.e., WhatsApp, Instagram, and Facebook), and women were asked to follow a link to complete the survey. Data were collected by an online survey method. The online survey was shared via social media (WhatsApp, Instagram, and Facebook) and women were asked to fill it out. The first application of the scale consisting of 47 items was administered to 293 women. Subsequently, a second application of the scale consisting of 35 items was administered to 225 women. The survey took approximately 10–15 minutes to complete. Kaiser Meier Olkin (KMO) analysis was performed to determine the suitability of the scale for the participant size. Then, validity and reliability analyses of the scale were conducted. Ethical consideration In order to the research to be carried out, the study was granted approval by the Ethical Board of University (Number: 22-2.1T/12). The participants were recruited to study on a voluntary basis. In addition, the participants were informed about the study, and individual informed consent was obtained according to the principles of the Declaration of Helsinki. Results Demographic characteristics of women Concerning the distribution of the participants by age, 17.2% were 25 years old and under, 28.5% were 26–35 years old, 31.1% were 36–45 years old, and 23.2% were 46 years old and over. In terms of educational status, 13.2% of the participants were in primary school/secondary school, 51% were in high school, and 35.8% were university students. Concerning marital status, 39.1% of the participants were married and 60.9% were single. Validity and Reliability Methods Table 1 provides the descriptive statistics for each item of the scale. The means, standard deviations, and peak values of the participants’ responses to the 32 items on the scale were calculated. In these results, the average scores of the scale items range between 2.17 and 4.88 (Table 1 ). Table 1 Items in the Gynecological Examination Attitudes Scale and Descriptive Statistics Gynecological Examination Attitudes Scale N M SD Individual Response(13 Items) 225 35.23 13.60 1. Going for a gynecological examination causes stress for me. 225 2.39 1.31 2. The tools used during gynecological examination frighten me. 225 2.66 1.31 3. I don’t feel discomfort when I go/will go for a gynecological examination. 225 2.48 1.36 4. I cannot feel comfortable on the gynecological examination table. 225 2.17 1.28 5. The procedures performed during gynecological examination frighten me. 225 2.66 1.32 6. I break into a cold sweat during procedures in gynecological examination. 225 3.22 1.38 7. Going for a gynecological examination makes me feel ashamed. 225 3.55 1.49 8. During gynecological examination, I feel that I tense up too much. 225 2.64 1.39 9. I want the gynecological examination to end as soon as possible 225 2.31 1.36 10. I am afraid of experiencing pain during gynecological examination. 225 2.70 1.36 11 The potential problems that may arise from gynecological examination make me uneasy. 225 2.52 1.36 12. I feel uneasy about myself during procedures in gynecological examination 225 2.56 1.42 13. Having an examination on the gynecology table prevents me from going for a check-up 225 3.32 1.49 Barrier (6 Items) 225 26.43 4.26 14. Information given about gynecological examination makes me uneasy. 225 3.64 1.44 15. My financial conditions prevent me from going for a gynecological examination. 225 4.41 1.01 16. Transportation issues prevent me from going for a gynecological examination. 225 4.54 0.94 17. My spouse/family does not want me to go for a gynecological examination. 225 4.82 0.62 18. Potential problems arising from gynecological examination prevent me from going for an examination. 225 4.21 1.25 19. My social environment creates pressure against me not going for a gynecological examination. 225 4.78 0.67 Individual Expectation (13 Items) 225 61.74 4.96 20. It is important for the person conducting the gynecological examination to be experienced. 225 4.75 0.58 21. Explanation of procedures during gynecological examination relaxes me. 225 4.71 0.59 22. During gynecological examination, the approach of the healthcare professional is important in determining my attitude towards the examination. 225 4.70 0.58 23. Maintaining privacy/confidentiality is important during gynecological examination. 225 4.83 0.49 24. There should be a special area for preparation before and after gynecological examination. 225 4.82 0.44 25. Gynecological examination should be done in a separate room. 225 4.79 0.52 26. I expect the environment of gynecological examination to be clean. 225 4.88 0.39 27. My spouse/family supports me in going for a gynecological examination. 225 4.60 0.68 28. My social environment supports me in going for a gynecological examination. 225 4.56 0.71 29. I expect the person conducting the gynecological examination to treat me with kindness and respect 225 4.81 0,48 30. I expect the person conducting the gynecological examination to be cheerful and understanding 225 4.73 0.60 31. I want to ask questions during gynecological examination 225 4.79 0.55 32. The approach of healthcare professionals during gynecological examination is an important determinant for me to go for a check-up again 225 4.71 0.60 TOTAL 225 70.44 20.00 Validity Analyses of Gynecological Examination Attitudes Scale (GEAS) The results indicate the content validity index of the scale was 0.92 and the content validity ratio of the scale was 0.82. The content validity index (considering the value significant at the p < 0.05 significance level; i.e., 0.62 for 10 experts) of the items ranged between 0.74 and 1, and the content validity ratio ranged between 0.34 and 1. Explanatory factor analysis was used to statistically determine the construct validity of the scale. To determine if the scale was suitable for factor analysis, KMO and Bartlett tests were conducted. Based on the results, the KMO value was 0.86 and the number of samples was appropriate for EFA (KMO > 0.500). Additionally, the results of the Bartlett test indicated the X2 value (3544.705) was statistically significant and met the normal distribution condition (p < 0.00). Based on both tests, the researchers determined that the data were homogeneous and suitable for factor analysis. During the examination of the factor structure of the scale, the scale items were released, and principal components analysis produced six factors with eigenvalues above 1. However, when the factor analysis was limited to three, the values shown in Table 2 were obtained. Table 2 Gynecological Examination Attitudes Scale: Factor Analysis ITEMS Factor 1 (Individual Response Domain) Factor 2 (Barrier Domain) Factor 3 (Individual Expectation Domain) Item 1 0.809 Item 2 0.758 Item 3 0.814 Item 4 0.845 Item 5 0.708 Item 6 0.662 Item 7 0.872 Item 8 0.849 Item 9 0.770 Item 10 0.660 Item 11 0.898 Item 12 0.763 Item 13 0.809 Item 14 0.742 Item 15 0.763 Item 16 0.835 Item 17 0.497 Item 18 0.810 Item 19 0.742 Item 20 0.546 Item 21 0.527 Item 22 0.656 Item 23 0.569 Item 24 0.810 Item 25 0.805 Item 26 0.820 Item 27 0.726 Item 28 0.589 Item 29 0.860 Item 30 0.695 Item 31 0.685 Item 32 0.631 EXPLAINED VARIANCE 26.237 10.326 19.780 KMO = 0.865; χ2(496) = 3544.705; Bartlett Test (p) = 0.000 Sub scales’ Cronbach’s alpha coefficients 0.94 0.78 0.90 Scale’s Cronbach’s alpha coefficient 0.90 The largest factor found after varimax rotation was the first factor, individual response, which explained 26.23% of the variance. The second factor, barriers, explained 10.32% of the variance. The third factor, individual expectations, explained 19.78% of the variance. Thus, three factors explained 56.33% of the total variance (Fig. 2 ). The Cronbach alpha coefficient of the factors was determined as follows: 1st factor, individual response: α = 0.94; Factor 2, barriers: α = 0.78; Factor 3, individual expectations: α = 0.900. The Cronbach alpha coefficient of the entire scale was 0.90. Reliability Analyses of Gynecological Examination Attitudes Scale (GEAS) Item analysis to determine the internal consistency of the scale was conducted with 225 women. The analysis showed the item-total score correlation coefficients of the scale items were between 0.45 and 0.90. The Cronbach alpha coefficient calculation was repeated by removing items with low reliability coefficients, and no significant difference was observed. For this reason, no items were removed from the scale. Another method used to evaluate the internal consistency reliability coefficient is to calculate the half-test reliability. For this calculation, the scale items are divided into two parts of equal size and the correlation between the measurement results is calculated. The correlation coefficient between the two halves of the GEAS was determined to be 0.77. According to the half-test reliability results of the scale, the Cronbach alpha coefficient of the first half (16 items) was 0.93, the Cronbach alpha coefficient of the second half was 0.85, the Guttman split-half coefficient was 0.88, and the Spearman-Brown coefficient was 0.88. These results indicate the scale has internal consistency and is reliable. The issue of whether the items in the scale are equal refers to whether the questions were answered with the same approach by the participants and whether the questions have similar difficulty levels. The results indicate the women did not approach or perceive the scale items in the same way and that they answered the items directly by stating their opinions on each item (Hotelling T2 test = 1118.561, F = 28.866, p < 0.001). After evaluating the relationship between the item scores in each subscale and the total score of the subscale by correlation analysis, it was determined that the reliability coefficient for the individual response subscale was between 0.32 and 0.82, which was a highly significant correlation for each item (p < 0.001). The reliability coefficient for the barriers subscale was between 0.34 and 0.66, and a highly significant correlation was found for each item (p < 0.001). The reliability coefficient in the individual expectations subscale was between 0.59 and 0.83, and a highly significant correlation was found for each item (p < 0.001, Table 3 ). The stability over time (test-retest reliability) reliability coefficient of the study, which was conducted with 225 women who volunteered for the second application, was 0.96. Table 3 Gynecological Examination Attitudes Scale: Item-total Score Correlation ITEMS Item-total Score Correlation p The item is deleted (Cronbach’s Alpha) Individual Response Domain Item 1 0.730 0.000 0.902 Item 2 0.682 0.000 0.903 Item 3 0.326 0.000 0.911 Item 4 0.748 0.000 0.901 Item 5 0.773 0.000 0.901 Item 6 0.697 0.000 0.903 Item 7 0.699 0.000 0.903 Item 8 0.807 0.000 0.900 Item 9 0.764 0.000 0.901 Item 10 0.687 0.000 0.903 Item 11 0.644 0.000 0.904 Item 12 0.828 0.000 0.899 Item 13 0.766 0.000 0.901 Barrier Domain Item 14 0.666 0.000 0.903 Item 15 0.343 0.000 0.909 Item 16 0.351 0.000 0.908 Item 17 0.373 0.000 0.908 Item 18 0.498 0.000 0.907 Item 19 0.352 0.000 0.908 Individual Expectation Domain Item 20 0.742 0.000 0.910 Item 21 0.743 0.000 0.909 Item 22 0.679 0.000 0.909 Item 23 0.771 0.000 0.910 Item 24 0.837 0.000 0.909 Item 25 0.814 0.000 0.910 Item 26 0.779 0.000 0.909 Item 27 0.724 0.000 0.908 Item 28 0.756 0.000 0.907 Item 29 0.732 0.000 0.909 Item 30 0.705 0.000 0.910 Item 31 0.591 0.000 0.908 Item 32 0.591 0.000 0.909 N: 225 Cronbach’s Alpha: 0.90 Correlations between the participants’ GEAS scores and subscales are shown in Table 4 . Table 4 Gynecological Examination Attitudes Scale’s First Application Correlations Between Subscales (n = 225) Individual Response Domain Barrier Domain Individual Expectation Domain TOTAL Individual Response Domain r = 1.000 Barrier Domain r = 0.459 p = 0.000 r = 1.000 Individual Expectation Domain r = 0.681 p = 0.000 r = 0.960 p = 0.000 r = 1.000 TOTAL r = 0.926 p = 0.000 r = 0.642 p = 0.000 r = 0.369 p = 0.000 r = 1.000 Discussion Content validity is applied to show how well each item in the scale and the scale overall serves the purpose [ 17 , 18 ]. Content validity is obtained from the opinions of experts in the field to be measured [ 19 ]. The Davis method is used to obtain expert opinions. The results obtained with this method are qualitative results, and to convert these results into quantitative results, content validity ratios and indexes must be calculated [ 19 ]. Although there is no generally accepted criterion in the literature for calculating this technique, the number of experts should not be less than three and, if possible, should be five or more [ 20 ]. It is also argued that in the Davis technique, values greater than 0.80 for content validity are sufficient for the item content validity of the scale [ 19 ]. In this study, the validity rates for all items for 10 expert opinions were calculated to be above 0.62 and the content validity index for 32 items was calculated to be 0.86 (p < 0.05) [ 21 ]. The “least appropriate” items, according to the expert opinions, were reformulated. The scale was organized into 47 items. Following the evaluation of the first application, 12 items were deleted from the scale, and two items were deleted from the scale after the second application. The final version of the scale comprised 32 items. A consensus regarding the minimum sample size required for conducting factor analysis has yet to be reached. However, the most used rule is to include 10 or 15 participants per item in the study [ 22 ]. In this study, 293 participants were used for the statistical analysis for the first application of 47 items. A sample of 225 participants was used for the statistical analysis of the second application of 35 items. Concerning factor analysis in scale development studies, the KMO test is applied to determine the adequacy of the sample size. A scale with a KMO value between 0.70 and 0.79 is considered “good” and a scale with a KMO value between 0.60 and 0.69 is considered “moderate.” In this study, the KMO value of 0.86 and Bartlett’s Test of Sphericity (X2 = 3544.705 p < 0.000) sample size analysis value indicated the sample was sufficient for factor analysis. The factor structure of the scale calculated using principal component analysis was found to have construct-content validity [ 22 , 23 ]. To determine the reliability estimation of Likert-type attitude scales, Cronbach’s alpha coefficient is recommended [ 24 ]. Cronbach’s alpha value is accepted in the literature as an important indicator of internal consistency reliability [ 20 ]. Cronbach's alpha provides information about the extent to which the items included in the scale are consistent with each other and to what extent they represent the hidden, hypothetical variables in the background [ 24 ]. Cronbach's alpha values range from 0.00 to 1.00. High values (values close to 1) indicate high reliability. Although it may vary depending on the measurement purpose, the recommended minimum alpha value is 0.70.24 In this study, three factors explained 56.33% of the total variance. The Cronbach’s alpha coefficient of the scale and subscales was high (α = 0.90) (Tables 2 and 3 ). These results demonstrate that the scale has internal consistency. The items in the scale cohere with each other and assess elements of the same feature, and the homogeneity of the scale is adequate. One of the methods of calculating the internal consistency reliability coefficient is the calculation of half-test reliability [ 23 , 25 , 26 ]. For this test, the items of the scale applied to a group are divided into two halves (either neutrally or even-numbered/odd-numbered items, etc.) and the scores received by the individuals from the two equivalent halves are calculated [ 27 ]. According to the half-test reliability results of the final version of the scale, Cronbach’s alpha coefficient of the first half (16 items) was 0.91, the Cronbach alpha coefficient of the second half (16 items) was 0.92, the Spearman-Brown coefficient of the scale was 0.89 and the Guttman split-half coefficient was 0.89. These results show that the scale has internal consistency and is reliable. When the relationship between the item scores of each subscale and the total score of the subscales was evaluated by correlation analysis, it was found that the reliability coefficient was between 0.32 and 0.82, and a highly significant correlation was found for each of them. substance (p < 0.001, Table 3 ). The test was retested with 225 women who volunteered for the second application, and the stability over time (test-retest reliability) reliability coefficient was found to be 0.96. These results indicate that the tool has adequate consistency over time. Conclusions The factor analysis of the 32-item GEAS indicated the three subscales (individual responses, barriers, and individual expectations) explained 56.33% of the total variance. These subscales measure women’s attitudes toward gynecological examination. As a result of the analyses, the total Cronbach’s alpha coefficient of the 32-item GEAS was 0.90, indicating the scale is valid and reliable for Turkish women. In terms of subscales, the three subscales (individual responses, barriers, and individual expectations) demonstrated Cronbach’s alpha coefficients between 0.78 and 0.94, which indicated the subscales are reliable. The lowest total score obtainable from the PSBCU is 32, whereas the highest score is 160. A higher score indicates a high degree of positive attitude for women regarding gynecological examination and shows that they have positive opinions about gynecological examination. To obtain additional evidence regarding the construct validity of the scale, it would be appropriate to apply the scale to larger sample groups with different characteristics and test it with repeated measurements in terms of variables that may affect the attitude toward gynecological examination (age, gender, educational status, social status, experiences, ethnic group, etc.). The sociodemographic characteristics of the women making up the sample could be regarded as a limitation of the study. Another weakness of the study is that the scale is in Turkish. For other societies, linguistic and cultural validity analysis should be conducted before it is applied to other populations. Nevertheless, the GEAS scale is a simple tool that is suitable for use by all health professionals who provide family planning services. Declarations Data Availability Statement The transcripts from which this manuscript was developed are available on request from the corresponding author. Conflict Of Interest Statement The authors declare no competing interests. Author Contributions SS and SEG planned the study, analysed and wrote the final text. SEG collected data. Funding This study was not supported by any funding sources Acknowledgments We would like to express our gratitude to the practitioners who assisted with the study and the patients who kindly filled out their questionnaires and returned the forms. 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Development of a likert type attitude scale in health sciences. Journal of Hacettepe University Faculty of Nursing . 2018; 5(1): 60-68. Çolakoglu O M, Buyukeksi C. Evaluation of factors effecting exploratory factor analysis process. Karaelmas Journal of Educational Sciences . 2014; 2(1): 58-64. Gözüm S, Aksayan S A. Guide for transcultural adaptation of the scale II: Psychometric characteristic and cross-cultural comparison. Journal Of Research In Nursin g. 2003; 5(1): 3-14. Şeker H, Gençdoğan B. Developing a Measurement Tool in Psychology and Education. Nobel Publisher Press of Ankara; 2014 Erkuş, A. Articles on Psychometrics. Ankara: Turkish Psychologists Association Publisher Press of Ankara; 2003. Hovardaoğlu, S. Research Techniques for Behavioral Sciences. Ve-Ga Publisher Press of Ankara; 2000. Tavşancıl, E. Attitude Measurement and SPSS Advanced Data Analysis. Nobel Publisher Press of Ankara; 2005. Appendix I Appendix 1 is not available with this version. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6263180","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":447443746,"identity":"7102743a-437c-4544-b25f-6e2cff2ec295","order_by":0,"name":"Selma SEN","email":"","orcid":"","institution":"Manisa Celal Bayar University","correspondingAuthor":false,"prefix":"","firstName":"Selma","middleName":"","lastName":"SEN","suffix":""},{"id":447443747,"identity":"634bf150-d48c-4ab2-a220-15b2ebe32b8a","order_by":1,"name":"Sezer Er Guneri","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABD0lEQVRIiWNgGAWjYAgACTkIzUaCFmO4Fh5i9SQ2ENIi397+8HEFg00+A/8aswcf91ik9/MvPsDwoewwg730AaxaDM4cSDY8w5Bm2SDxxtxwxjOJ3JkzniUwzjh3mIGHLwG7FomEY5INDIcNGCTOmEnzHJDI3XDjjAEzbxtQCw6Xyc9/2P6zgeE/RMufAxLp9jfOf2D+i0cLww1mNsYGhgMGDPw9ZtIMByQSDPh7GJgZ8WgxOJPGLNlgkGzAJsFWJtlzQMJwxg02g4M959J5eM7gCrHjDz82VNgZ8PMf3ibx40CdPH//4YcPfpRZy7H34HAYxC5gREjAwgfIOMBAVEzyH0BnjIJRMApGwSiAAADxUlUh4Ro2OAAAAABJRU5ErkJggg==","orcid":"","institution":"Ege University, IZMIR","correspondingAuthor":true,"prefix":"","firstName":"Sezer","middleName":"Er","lastName":"Guneri","suffix":""}],"badges":[],"createdAt":"2025-03-19 15:53:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6263180/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6263180/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":81615218,"identity":"176d5388-11f7-4c3e-b5a4-d2a268667b16","added_by":"auto","created_at":"2025-04-29 08:07:56","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":386846,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of the stage in the development of the Gynecological Examination Attitudes Scale (GEAS)\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6263180/v1/60a3397891c8da997e37d18a.png"},{"id":81614822,"identity":"78fb738a-ca34-46e7-96bf-ac0800a6d968","added_by":"auto","created_at":"2025-04-29 07:59:56","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":81538,"visible":true,"origin":"","legend":"\u003cp\u003eModel for first level multi-factor confirmatory factor analysis of the scale\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-6263180/v1/f5b82f6591ae1194b5575a01.png"},{"id":83902774,"identity":"e5d80ac6-de49-472d-bc27-72e35c57e867","added_by":"auto","created_at":"2025-06-04 09:47:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1861675,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6263180/v1/b1e0d59a-1fef-42e6-8628-b22bdf8f71ca.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eGynecological Examination Attitudes Scale: a Methodological Study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWomen spend a significant part of their lives in the period known as the \u0026ldquo;fertile age.\u0026rdquo; During this reproductive stage, women encounter the most health problems. However, problems also arise at older ages due to menopause and changes during this period [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Thus, regular health checks and screenings are an indispensable part of modern preventive health services and have an important place in human life [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. One of the specialists that aim to protect women\u0026rsquo;s sexual and reproductive health is gynecology [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. A vaginal examination is an examination that most women experience several times in their lifetime [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The gynecological examination evaluates and screens for reproductive risks, prevents complications by early diagnosis of gynecological diseases, and protects reproductive health by providing women with education opportunities. The gynecological examination starts with a preliminary case history and may include a pap smear and visual, speculum, bimanual, rectovaginal, abdominal, and breast examinations depending on the examination indication [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGenital examination is often seen as an unpleasant but necessary practice by women [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In the literature, women have expressed concerns over the lack of attention to privacy before and after gynecological examination and a lack of knowledge about the gynecological examination, the instruments used during the examination, and positioning during the examination. Moreover, feelings of embarrassment due to the nakedness of the perineal area during the examination, doubts about personal cleanliness, and health professionals\u0026rsquo; lack of knowledge about the examination have been reported. These concerns may also be exacerbated by a provider\u0026rsquo;s negative attitude during the examination, the fact that the health professional performing the examination might be male, and the woman\u0026rsquo;s young age [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo address the above-mentioned concerns and reduce the negative effects experienced during the gynecological examination, the literature recommends the following practices: establishing positive communication with the woman before the examination, focusing on the woman during the examination, providing information about the procedures applied and her condition, gently applying the tools used, and acting respectfully. On the contrary, harsh, hasty, and insensitive gynecological examinations performed without verbal communication with the patient cause an increase in women's feelings of shame and fear [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAttitude, in the broadest sense, is an individual's mental readiness toward a certain object or person or their attitude in a certain way. Attitudes are seen as an important predictor of human behavior. Since attitudes significantly affect human behavior, measuring attitudes and knowing people\u0026rsquo;s perspectives toward an object or situation is beneficial for understanding behavior and developing interventions [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Although women acknowledge the benefit of pelvic examinations, they have expressed negative experiences with specific parts of the procedure. Women\u0026rsquo;s attitudes and experiences toward pelvic examination are interrelated. Moreover, a woman\u0026rsquo;s first pelvic exam experience often predicts subsequent experiences. For example, an experience of pain during the first pelvic examination is considered a negative experience, and negative experiences are statistically significant for predicting subsequent attitudes toward future pelvic examinations [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRegular check-ups are important in protecting and improving women\u0026rsquo;s health and preventing diseases. Gynecological examination, which is one of the common health checks, is performed in cases related to reproductive/sexual health, infections, early diagnosis and treatment of reproductive organ cancers, pregnancy, and birth. Examining genital areas during a gynecological examination may lead to negative attitudes toward the examination. Notably, no scale has been developed to determine women\u0026rsquo;s gynecological examination attitudes. Thus, the objective of this study was to design and develop the Gynecological Examination Attitudes Scale (GEAS) and assess its psychometric properties.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe study used a methodological and descriptive scanning model. Descriptive scanning models are useful for describing the events, people, and objects that are the subject of the research as they are without any intervention. This study aimed to produce a valid and reliable measurement tool for determining perceived attitudes toward gynecological examinations among Turkish women.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThe research was conducted with 293 women selected according to the random sampling method. Before the scale was administered to the full sample, 10 women were interviewed by asking open-ended questions to determine the main concepts regarding gynecological examination attitudes. In line with the data obtained from the literature review and interviews, an item pool of 47 items relevant items was created. The researchers explained the purpose of the study to all participants and assured them that their answers would remain confidential. Last, the interview setting was discussed. Data were collected by online survey method between January 15, 2022 and January 15, 2023.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSample Size\u003c/h3\u003e\n\u003cp\u003eTo calculate sample size in scale development studies, it is often recommended to include five to ten items per item, depending on the number of items in the draft scale [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. For this reason, since the scale consists of 47 items, a total of 293 cases were thought to be sufficient for validity/reliability analysis (47\u0026times;5\u0026thinsp;=\u0026thinsp;235).\u003c/p\u003e\n\u003ch3\u003eProcedures for scale development and analyses\u003c/h3\u003e\n\u003cp\u003eThe scale was developed in four stages. Preparation of item pool (literature review and in-depth interviews to create the item pool), content validity, pilot test implementation and first and second application.\u003c/p\u003e\n\u003ch3\u003ePreparation of item pool\u003c/h3\u003e\n\u003cp\u003eAn item pool for the measurement tool was created by scanning the relevant literature and defining the conceptual structure. Items were created based on studies conducted on the subject, studies conducted abroad on the subject, and interviews with individuals. Some of these works are mentioned in the bibliography section. After reviewing the literature, a pool for the scale items was designed by taking the opinions of health professionals working in the field of reproductive health. As a result of the literature review, the researchers created two separate forms. Form I contained 12 descriptive questions about sociodemographic characteristics and obstetric characteristics. An item pool of 45 questions was then created based on the experts\u0026rsquo; opinions and distributed using Form II. The theoretical content of the questions was reduced to 47 items by the researchers after examining the expert opinions.\u003c/p\u003e\n\u003ch3\u003eGynecological Examination Attitudes Scale (GEAS)\u003c/h3\u003e\n\u003cp\u003eGEAS was designed as a 5-point Likert-type scale. After reviewing the literature and obtaining expert opinions, a pool of scale items was developed. After the theoretical content of the scale was examined by experts in the field, an item pool of 45 questions was created by the researchers and this pool was increased to 47 items. The scale was pilot-tested with 10 women from the research population who were registered at the family health center and were later excluded from the entire study. A second test was conducted with another sample of 10 women 25 days after the first application. After conducting factor analysis, the scale reached its final form with 47 items (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEach of the perceived attitudes was evaluated by the women using a 5-point Likert scale. These statements range from \u0026ldquo;Strongly Agree (5)\u0026rdquo; to \u0026ldquo;Strongly Disagree (1).\u0026rdquo; Possible scores range from 32 to 160, with a higher score indicating a more positive attitude. The scale was comprised of three subscales and all subscales were summed to produce one combined score: individual response (13 items), barriers (6 items), and individual expectations (13 items). No items were reverse-coded in the scale.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe data collected based on women's opinions through the Gynecological Examination Attitudes Scale draft were analyzed using the computer package program SPSS 22.0 (Statistical Package for Social Sciences).\u003c/p\u003e \u003cp\u003eFrequency, percentage and mean tests to define demographic characteristics, Content Validity Index and Lawshe's Content Validity Ratio (CVR) formula, percentage, mean, Cronbach Alpha, Pearson Correlation and factor analysis for validity and reliability studies of the scale (KMO, Bartlett Test, Anti-Image Correlation, Principal Components Analysis, Varimax Rotation Method, Kaiser-Meyer-Olkin, Bartlett\u0026rsquo;s ) were used.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eThe necessary permissions were obtained from the Local Ethics Board of the university before data collection. After the researchers formulated the GEAS in accordance with the literature, a pilot test with 20 women was performed, and expert opinions from the 10 experts were analyzed, the GEAS was administered to the rest of the women in the sample. The online survey was shared via social media (i.e., WhatsApp, Instagram, and Facebook), and women were asked to follow a link to complete the survey. Data were collected by an online survey method. The online survey was shared via social media (WhatsApp, Instagram, and Facebook) and women were asked to fill it out.\u003c/p\u003e \u003cp\u003eThe first application of the scale consisting of 47 items was administered to 293 women. Subsequently, a second application of the scale consisting of 35 items was administered to 225 women. The survey took approximately 10\u0026ndash;15 minutes to complete. Kaiser Meier Olkin (KMO) analysis was performed to determine the suitability of the scale for the participant size. Then, validity and reliability analyses of the scale were conducted.\u003c/p\u003e\n\u003ch3\u003eEthical consideration\u003c/h3\u003e\n\u003cp\u003eIn order to the research to be carried out, the study was granted approval by the Ethical Board of University (Number: 22-2.1T/12). The participants were recruited to study on a voluntary basis. In addition, the participants were informed about the study, and individual informed consent was obtained according to the principles of the Declaration of Helsinki.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eDemographic characteristics of women\u003c/h2\u003e \u003cp\u003eConcerning the distribution of the participants by age, 17.2% were 25 years old and under, 28.5% were 26\u0026ndash;35 years old, 31.1% were 36\u0026ndash;45 years old, and 23.2% were 46 years old and over. In terms of educational status, 13.2% of the participants were in primary school/secondary school, 51% were in high school, and 35.8% were university students. Concerning marital status, 39.1% of the participants were married and 60.9% were single.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eValidity and Reliability Methods\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e provides the descriptive statistics for each item of the scale. The means, standard deviations, and peak values of the participants\u0026rsquo; responses to the 32 items on the scale were calculated. In these results, the average scores of the scale items range between 2.17 and 4.88 (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eItems in the Gynecological Examination Attitudes Scale and Descriptive Statistics\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGynecological Examination Attitudes Scale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndividual Response(13 Items)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.23\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.60\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Going for a gynecological examination causes stress for me.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. The tools used during gynecological examination frighten me.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. I don\u0026rsquo;t feel discomfort when I go/will go for a gynecological examination.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. I cannot feel comfortable on the gynecological examination table.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. The procedures performed during gynecological examination frighten me.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. I break into a cold sweat during procedures in gynecological examination.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. Going for a gynecological examination makes me feel ashamed.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8. During gynecological examination, I feel that I tense up too much.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9. I want the gynecological examination to end as soon as possible\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10. I am afraid of experiencing pain during gynecological examination.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11 The potential problems that may arise from gynecological examination make me uneasy.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12. I feel uneasy about myself during procedures in gynecological examination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13. Having an examination on the gynecology table prevents me from going for a check-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBarrier (6 Items)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e225\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e26.43\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e4.26\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14. Information given about gynecological examination makes me uneasy.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15. My financial conditions prevent me from going for a gynecological examination.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16. Transportation issues prevent me from going for a gynecological examination.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17. My spouse/family does not want me to go for a gynecological examination.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18. Potential problems arising from gynecological examination prevent me from going for an examination.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19. My social environment creates pressure against me not going for a gynecological examination.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndividual Expectation (13 Items)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e225\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e61.74\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e4.96\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20. It is important for the person conducting the gynecological examination to be experienced.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21. Explanation of procedures during gynecological examination relaxes me.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22. During gynecological examination, the approach of the healthcare professional is important in determining my attitude towards the examination.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23. Maintaining privacy/confidentiality is important during gynecological examination.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24. There should be a special area for preparation before and after gynecological examination.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25. Gynecological examination should be done in a separate room.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26. I expect the environment of gynecological examination to be clean.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e27. My spouse/family supports me in going for a gynecological examination.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e28. My social environment supports me in going for a gynecological examination.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e29. I expect the person conducting the gynecological examination to treat me with kindness and respect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30. I expect the person conducting the gynecological examination to be cheerful and understanding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31. I want to ask questions during gynecological examination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e32. The approach of healthcare professionals during gynecological examination is an important determinant for me to go for a check-up again\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTOTAL\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e225\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e70.44\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e20.00\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eValidity Analyses of Gynecological Examination Attitudes Scale (GEAS)\u003c/h2\u003e \u003cp\u003eThe results indicate the content validity index of the scale was 0.92 and the content validity ratio of the scale was 0.82. The content validity index (considering the value significant at the p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 significance level; i.e., 0.62 for 10 experts) of the items ranged between 0.74 and 1, and the content validity ratio ranged between 0.34 and 1.\u003c/p\u003e \u003cp\u003eExplanatory factor analysis was used to statistically determine the construct validity of the scale. To determine if the scale was suitable for factor analysis, KMO and Bartlett tests were conducted. Based on the results, the KMO value was 0.86 and the number of samples was appropriate for EFA (KMO\u0026thinsp;\u0026gt;\u0026thinsp;0.500). Additionally, the results of the Bartlett test indicated the X2 value (3544.705) was statistically significant and met the normal distribution condition (p\u0026thinsp;\u0026lt;\u0026thinsp;0.00). Based on both tests, the researchers determined that the data were homogeneous and suitable for factor analysis.\u003c/p\u003e \u003cp\u003eDuring the examination of the factor structure of the scale, the scale items were released, and principal components analysis produced six factors with eigenvalues above 1. However, when the factor analysis was limited to three, the values shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e were obtained.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGynecological Examination Attitudes Scale: Factor Analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eITEMS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFactor 1\u003c/p\u003e \u003cp\u003e(Individual Response Domain)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFactor 2\u003c/p\u003e \u003cp\u003e(Barrier Domain)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFactor 3\u003c/p\u003e \u003cp\u003e(Individual Expectation Domain)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.809\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.758\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.814\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.845\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.708\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.662\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.872\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.849\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 9\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.770\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 10\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.660\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 11\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.898\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 12\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.763\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 13\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.809\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 14\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.742\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 15\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.763\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 16\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.835\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 17\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.497\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 18\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.810\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 19\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.742\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 20\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.546\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 21\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.527\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 22\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.656\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 23\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.569\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 24\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.810\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 25\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.805\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 26\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.820\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 27\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.726\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 28\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.589\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 29\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.860\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 30\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.695\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 31\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.685\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem 32\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.631\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEXPLAINED VARIANCE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.326\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.780\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKMO\u0026thinsp;=\u0026thinsp;0.865; χ2(496)\u0026thinsp;=\u0026thinsp;3544.705; Bartlett Test (p)\u0026thinsp;=\u0026thinsp;0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSub scales\u0026rsquo;\u003c/b\u003e \u003cb\u003eCronbach\u0026rsquo;s alpha coefficients\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eScale\u0026rsquo;s Cronbach\u0026rsquo;s alpha coefficient\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe largest factor found after varimax rotation was the first factor, individual response, which explained 26.23% of the variance. The second factor, barriers, explained 10.32% of the variance. The third factor, individual expectations, explained 19.78% of the variance. Thus, three factors explained 56.33% of the total variance (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The Cronbach alpha coefficient of the factors was determined as follows: 1st factor, individual response: α\u0026thinsp;=\u0026thinsp;0.94; Factor 2, barriers: α\u0026thinsp;=\u0026thinsp;0.78; Factor 3, individual expectations: α\u0026thinsp;=\u0026thinsp;0.900. The Cronbach alpha coefficient of the entire scale was 0.90.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eReliability Analyses of Gynecological Examination Attitudes Scale (GEAS)\u003c/h2\u003e \u003cp\u003eItem analysis to determine the internal consistency of the scale was conducted with 225 women. The analysis showed the item-total score correlation coefficients of the scale items were between 0.45 and 0.90. The Cronbach alpha coefficient calculation was repeated by removing items with low reliability coefficients, and no significant difference was observed. For this reason, no items were removed from the scale.\u003c/p\u003e \u003cp\u003eAnother method used to evaluate the internal consistency reliability coefficient is to calculate the half-test reliability. For this calculation, the scale items are divided into two parts of equal size and the correlation between the measurement results is calculated. The correlation coefficient between the two halves of the GEAS was determined to be 0.77. According to the half-test reliability results of the scale, the Cronbach alpha coefficient of the first half (16 items) was 0.93, the Cronbach alpha coefficient of the second half was 0.85, the Guttman split-half coefficient was 0.88, and the Spearman-Brown coefficient was 0.88. These results indicate the scale has internal consistency and is reliable. The issue of whether the items in the scale are equal refers to whether the questions were answered with the same approach by the participants and whether the questions have similar difficulty levels. The results indicate the women did not approach or perceive the scale items in the same way and that they answered the items directly by stating their opinions on each item (Hotelling T2 test\u0026thinsp;=\u0026thinsp;1118.561, F\u0026thinsp;=\u0026thinsp;28.866, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eAfter evaluating the relationship between the item scores in each subscale and the total score of the subscale by correlation analysis, it was determined that the reliability coefficient for the individual response subscale was between 0.32 and 0.82, which was a highly significant correlation for each item (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The reliability coefficient for the barriers subscale was between 0.34 and 0.66, and a highly significant correlation was found for each item (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The reliability coefficient in the individual expectations subscale was between 0.59 and 0.83, and a highly significant correlation was found for each item (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The stability over time (test-retest reliability) reliability coefficient of the study, which was conducted with 225 women who volunteered for the second application, was 0.96.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eGynecological Examination Attitudes Scale: Item-total Score Correlation\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eITEMS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eItem-total Score Correlation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThe item is deleted\u003c/p\u003e \u003cp\u003e(Cronbach\u0026rsquo;s Alpha)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"12\" rowspan=\"13\"\u003e \u003cp\u003e\u003cb\u003eIndividual Response Domain\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.730\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.902\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.682\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.903\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.326\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.911\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.748\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.901\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.773\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.901\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.697\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.903\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.699\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.903\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.807\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.900\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.764\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.901\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.687\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.903\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.644\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.904\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.828\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.899\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.766\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.901\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eBarrier Domain\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.666\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.903\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.343\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.909\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.908\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.373\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.908\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.498\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.907\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.352\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.908\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"12\" rowspan=\"13\"\u003e \u003cp\u003e\u003cb\u003eIndividual Expectation Domain\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.742\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.910\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.743\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.909\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.679\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.909\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.771\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.910\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.837\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.909\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.814\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.910\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.779\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.909\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.724\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.908\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.756\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.907\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.732\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.909\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.705\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.910\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.591\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.908\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem 32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.591\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.909\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eN: 225 Cronbach\u0026rsquo;s Alpha: 0.90\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eCorrelations between the participants\u0026rsquo; GEAS scores and subscales are shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eGynecological Examination Attitudes Scale\u0026rsquo;s First Application Correlations Between Subscales (n\u0026thinsp;=\u0026thinsp;225)\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndividual Response Domain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBarrier Domain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIndividual Expectation Domain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTOTAL\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndividual Response Domain\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBarrier Domain\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.459\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndividual Expectation Domain\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.681\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.960\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTOTAL\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.926\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.642\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.369\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eContent validity is applied to show how well each item in the scale and the scale overall serves the purpose [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Content validity is obtained from the opinions of experts in the field to be measured [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The Davis method is used to obtain expert opinions. The results obtained with this method are qualitative results, and to convert these results into quantitative results, content validity ratios and indexes must be calculated [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Although there is no generally accepted criterion in the literature for calculating this technique, the number of experts should not be less than three and, if possible, should be five or more [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. It is also argued that in the Davis technique, values greater than 0.80 for content validity are sufficient for the item content validity of the scale [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In this study, the validity rates for all items for 10 expert opinions were calculated to be above 0.62 and the content validity index for 32 items was calculated to be 0.86 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The \u0026ldquo;least appropriate\u0026rdquo; items, according to the expert opinions, were reformulated. The scale was organized into 47 items. Following the evaluation of the first application, 12 items were deleted from the scale, and two items were deleted from the scale after the second application. The final version of the scale comprised 32 items.\u003c/p\u003e \u003cp\u003eA consensus regarding the minimum sample size required for conducting factor analysis has yet to be reached. However, the most used rule is to include 10 or 15 participants per item in the study [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In this study, 293 participants were used for the statistical analysis for the first application of 47 items. A sample of 225 participants was used for the statistical analysis of the second application of 35 items.\u003c/p\u003e \u003cp\u003eConcerning factor analysis in scale development studies, the KMO test is applied to determine the adequacy of the sample size. A scale with a KMO value between 0.70 and 0.79 is considered \u0026ldquo;good\u0026rdquo; and a scale with a KMO value between 0.60 and 0.69 is considered \u0026ldquo;moderate.\u0026rdquo; In this study, the KMO value of 0.86 and Bartlett\u0026rsquo;s Test of Sphericity (X2\u0026thinsp;=\u0026thinsp;3544.705 p\u0026thinsp;\u0026lt;\u0026thinsp;0.000) sample size analysis value indicated the sample was sufficient for factor analysis. The factor structure of the scale calculated using principal component analysis was found to have construct-content validity [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo determine the reliability estimation of Likert-type attitude scales, Cronbach\u0026rsquo;s alpha coefficient is recommended [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Cronbach\u0026rsquo;s alpha value is accepted in the literature as an important indicator of internal consistency reliability [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Cronbach's alpha provides information about the extent to which the items included in the scale are consistent with each other and to what extent they represent the hidden, hypothetical variables in the background [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Cronbach's alpha values range from 0.00 to 1.00. High values (values close to 1) indicate high reliability. Although it may vary depending on the measurement purpose, the recommended minimum alpha value is 0.70.24 In this study, three factors explained 56.33% of the total variance. The Cronbach\u0026rsquo;s alpha coefficient of the scale and subscales was high (α\u0026thinsp;=\u0026thinsp;0.90) (Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). These results demonstrate that the scale has internal consistency. The items in the scale cohere with each other and assess elements of the same feature, and the homogeneity of the scale is adequate.\u003c/p\u003e \u003cp\u003eOne of the methods of calculating the internal consistency reliability coefficient is the calculation of half-test reliability [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. For this test, the items of the scale applied to a group are divided into two halves (either neutrally or even-numbered/odd-numbered items, etc.) and the scores received by the individuals from the two equivalent halves are calculated [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. According to the half-test reliability results of the final version of the scale, Cronbach\u0026rsquo;s alpha coefficient of the first half (16 items) was 0.91, the Cronbach alpha coefficient of the second half (16 items) was 0.92, the Spearman-Brown coefficient of the scale was 0.89 and the Guttman split-half coefficient was 0.89. These results show that the scale has internal consistency and is reliable.\u003c/p\u003e \u003cp\u003eWhen the relationship between the item scores of each subscale and the total score of the subscales was evaluated by correlation analysis, it was found that the reliability coefficient was between 0.32 and 0.82, and a highly significant correlation was found for each of them. substance (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The test was retested with 225 women who volunteered for the second application, and the stability over time (test-retest reliability) reliability coefficient was found to be 0.96. These results indicate that the tool has adequate consistency over time.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe factor analysis of the 32-item GEAS indicated the three subscales (individual responses, barriers, and individual expectations) explained 56.33% of the total variance. These subscales measure women\u0026rsquo;s attitudes toward gynecological examination.\u003c/p\u003e \u003cp\u003eAs a result of the analyses, the total Cronbach\u0026rsquo;s alpha coefficient of the 32-item GEAS was 0.90, indicating the scale is valid and reliable for Turkish women. In terms of subscales, the three subscales (individual responses, barriers, and individual expectations) demonstrated Cronbach\u0026rsquo;s alpha coefficients between 0.78 and 0.94, which indicated the subscales are reliable. The lowest total score obtainable from the PSBCU is 32, whereas the highest score is 160. A higher score indicates a high degree of positive attitude for women regarding gynecological examination and shows that they have positive opinions about gynecological examination.\u003c/p\u003e \u003cp\u003eTo obtain additional evidence regarding the construct validity of the scale, it would be appropriate to apply the scale to larger sample groups with different characteristics and test it with repeated measurements in terms of variables that may affect the attitude toward gynecological examination (age, gender, educational status, social status, experiences, ethnic group, etc.). The sociodemographic characteristics of the women making up the sample could be regarded as a limitation of the study. Another weakness of the study is that the scale is in Turkish. For other societies, linguistic and cultural validity analysis should be conducted before it is applied to other populations. Nevertheless, the GEAS scale is a simple tool that is suitable for use by all health professionals who provide family planning services.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe transcripts from which this manuscript was developed are available on request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict Of Interest Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSS and SEG planned the study, analysed and wrote the final text. SEG collected data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was not supported by any funding sources\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;We would like to express our gratitude to the practitioners who assisted with the study and the patients who kindly filled out their questionnaires and returned the forms. For their expert opinions, we would like to thank instructors (professor, associate professor et al.)\u003c/p\u003e "},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBeji N K, Kaya G, Savaşer S. The priority problems of women\u0026apos;s health in Turkey. \u003cem\u003eOrdu University Journal of Nursing Studies\u003c/em\u003e. 20214; (1): 105-112.\u003c/li\u003e\n\u003cli\u003eYurdakul M. Women\u0026apos;s Health Diagnosis and Evaluation. In: Şirin A, Kavlak O, eds. Women\u0026apos;s Health. Bedray Publisher Press of İstanbul; 2008: 32-46.\u003c/li\u003e\n\u003cli\u003eDaşıkan Z, Sevil \u0026Uuml;. Psychosocial factors restraining gynecological examinations in women. \u003cem\u003eSted\u003c/em\u003e. 2014; 26(2): 72-83.\u003c/li\u003e\n\u003cli\u003eWijma B, Gullberg M, Kjessler B. Attitudes towards pelvic examination in a random sample of Swedish women.\u003cem\u003eActa Obstet Gynecol Scand\u003c/em\u003e. 1998; 77(4): 422-8.\u003c/li\u003e\n\u003cli\u003eEvans D, Goldstein S, Loewy A, Altman A D. No. 385-indications for pelvic examination. \u003cem\u003eJournal of Obstetrics and Gynaecology Canada\u003c/em\u003e. 2019; 41(8): 1221\u0026ndash;1234. https://doi.org/10.1016/j.jogc.2018.12.007\u003c/li\u003e\n\u003cli\u003eQaseem A, Linda LH, Harris R, Starkey M, Denberg T D. Screening pelvic examination in adult women: a clinical practice guideline from the American college of physicians. \u003cem\u003eAnnal of Internal Medicine\u003c/em\u003e. 2014; 161(1): 46-53. https://doi.org/10.7326/M14-0701\u003c/li\u003e\n\u003cli\u003eSoraes E A M G, Moraes R. Fusion of online assessment methods for gynecological examination training: A feasibility study. \u003cem\u003eTEMA (S\u0026atilde;o Carlos)\u003c/em\u003e. 2018; 19(3): 423-436. https://doi.org/10.5540/tema.2018.019.03.0423\u003c/li\u003e\n\u003cli\u003eStormo A R, Cooper C P, Hawkins N A, Saraiya M. (). Physician characteristics and beliefs associated with use of pelvic examinations in asymptomatic women. \u003cem\u003ePreventive Medicine\u003c/em\u003e. 2012; 54(6): 415-421. https://doi.org/10.1016/j.ypmed.2012.03.012\u003c/li\u003e\n\u003cli\u003eAbraham S, Chapman M, Taylor A, Bcbride A, Boyd C. Anxiety and feelings of medical students conducting their first gynecological examination. \u003cem\u003eJournal of Psychosomatic Obstetrics Gynecology. \u003c/em\u003e2009; 24(1): 39-44. https://doi.org/10.3109/01674820309042799\u003c/li\u003e\n\u003cli\u003eAltay B, Kefeli B. Anxiety level of women coming for gynecological examination and some affecting factors. \u003cem\u003eE-Journal of Dokuz Eylul University Nursing Faculty\u003c/em\u003e. 2012; 5 (4): 134-141.\u003c/li\u003e\n\u003cli\u003eDemir S, Oskay \u0026Uuml; Y. Women\u0026rsquo;s experiences of gynecological examinations and their expectations from healthcare professionals. \u003cem\u003eJournal of Women\u0026apos;s Health Nursing Jowhen\u003c/em\u003e. 2014; 1(1): 68-79.\u003c/li\u003e\n\u003cli\u003eHassan S, Aboud S A H H, Elkayal M M. Investigate young female reaction concerning their gynecological examination. \u003cem\u003eAmerican Journal of Nursing Research\u003c/em\u003e. 2018; 6(5): 282-290. Doi:10.12691/ajnr-6-5-9\u003c/li\u003e\n\u003cli\u003e\u0026Uuml;lker K, Kıvrak Y. The effect of information about gynecological examination on the anxiety level of women applying to gynecology clinics: A prospective, randomized, controlled study. \u003cem\u003eIranian Red Crescent Medical Journal\u003c/em\u003e. 2016; 18(6): 23864. Doi: 10.5812/ircmj.23864.\u003c/li\u003e\n\u003cli\u003eLai C, Levy V. Hong Kong Chinese women\u0026rsquo;s experiences of vaginal examinations in labour. \u003cem\u003eMidwifery\u003c/em\u003e. 2002; 18(4): 296-303. https://doi.org/10.1054/midw.2002.0326\u003c/li\u003e\n\u003cli\u003eKan A, Akbaş A. Affective factors that influence chemistry achievement (attitude and self efficacy) and the power of these factors to predict chemistry achievement-I. \u003cem\u003eJournal of Turkish Science Education\u003c/em\u003e. 2006; 3(1): 76-85.\u003c/li\u003e\n\u003cli\u003e\u0026Ouml;zdamar K. Statistical Data Analyses with Computer Programs. Kaan Publisher Press of İstanbul; 2010.\u003c/li\u003e\n\u003cli\u003eErcan İ, Kan İ. Reliability and validity in the scales. \u003cem\u003eJournal of Uludag University Medical Faculty\u003c/em\u003e. 2004; 30(3): 211-216.\u003c/li\u003e\n\u003cli\u003eYeşilyurt S, \u0026Ccedil;apraz C A. Road map for the content validity used in scale development studies. \u003cem\u003eErzincan University Journal of Education Faculty\u003c/em\u003e. 2018; 20(1): 251-264.\u003c/li\u003e\n\u003cli\u003eYurdag\u0026uuml;l H, Bayrak F. Content validity measuresin scale development studies: comparison of content validity index and kappa statics. \u003cem\u003eHacettepe University Journal of Education\u003c/em\u003e. 2012; 2: 264-271.\u003c/li\u003e\n\u003cli\u003eKartal M, Bardak\u0026ccedil;ı, S. Validity and Reliability Analyzes with SPSS and AMOS Applied Examples. Akademisyen Publisher Press of Ankara; 2018.\u003c/li\u003e\n\u003cli\u003e\u0026Ouml;zdemir Z. Development of a likert type attitude scale in health sciences. \u003cem\u003eJournal of Hacettepe University Faculty of Nursing\u003c/em\u003e. 2018; 5(1): 60-68.\u003c/li\u003e\n\u003cli\u003e\u0026Ccedil;olakoglu O M, Buyukeksi C. Evaluation of factors effecting exploratory factor analysis process. \u003cem\u003eKaraelmas Journal of Educational Sciences\u003c/em\u003e. 2014; 2(1): 58-64.\u003c/li\u003e\n\u003cli\u003eG\u0026ouml;z\u0026uuml;m S, Aksayan S A. Guide for transcultural adaptation of the scale II: Psychometric characteristic and cross-cultural comparison. \u003cem\u003eJournal Of Research In Nursin\u003c/em\u003eg. 2003; 5(1): 3-14.\u003c/li\u003e\n\u003cli\u003eŞeker H, Gen\u0026ccedil;doğan B. Developing a Measurement Tool in Psychology and Education. Nobel Publisher Press of Ankara; 2014\u003c/li\u003e\n\u003cli\u003eErkuş, A. Articles on Psychometrics. Ankara: Turkish Psychologists Association Publisher Press of Ankara; 2003.\u003c/li\u003e\n\u003cli\u003eHovardaoğlu, S. Research Techniques for Behavioral Sciences. Ve-Ga Publisher Press of Ankara; 2000.\u003c/li\u003e\n\u003cli\u003eTavşancıl, E. Attitude Measurement and SPSS Advanced Data Analysis. Nobel Publisher Press of Ankara; 2005.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Appendix I","content":"\u003cp\u003eAppendix 1 is not available with this version.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Scale development, gynecological examination, attitudes","lastPublishedDoi":"10.21203/rs.3.rs-6263180/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6263180/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eGynecological examination is very important to protect the reproductive health of women. Women do not want to go to a gynecological examination for reasons such as poor results, embarrassment, privacy, and negative experiences. The objective of this study was to design and develop the Gynecological Examination Attitudes Scale (GEAS) and assess its psychometric properties.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eCross sectional, mixed methods design. A STROBE checklist was used. The study was carried out two phases. In phase one, a literature search, cognitive interviews (n:7) and a pilot study were conducted to construct and revise scale indicators. In phase two, a questionnaire-based survey was conducted with three women group (exploratory factor analysis group: 293; confirmatory factor analysis: 225 and test-retest: 28).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe draft scale consisted of 47 items, and result of the factor analysis applied to test the construct validity. The KMO test for sampling adequacy was 0.86. We conducted exploratory factor analysis to model the interrelationships among items. Results of the analysis the scale was consisted of 32 items and three sub-dimensions as individual response, barriers, individual expectations. Cronbach's alpha coefficient for the total scale was 0.91; Individual Response was 0,94, Barriers was 0,78, Individual Expectations was 0,90. The correlation coefficients between the factors and the correlation coefficient as a result of the test-retest study were found to be significant for the whole scale.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eGEAS is a new tool for determining women's gynecological examination attitudes. The GEAS shows acceptable reliability and evidence of convergent validity among women.\u003c/p\u003e","manuscriptTitle":"Gynecological Examination Attitudes Scale: a Methodological Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-29 07:59:51","doi":"10.21203/rs.3.rs-6263180/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"af9f9654-a699-46ef-bfbb-56986e56e6d1","owner":[],"postedDate":"April 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-04T09:38:55+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-29 07:59:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6263180","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6263180","identity":"rs-6263180","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}