Development and Structural Validation of the Husbands Adaptation of Iranian women with mastectomy scale (HAMS)

Development and Structural Validation of the Husbands Adaptation of Iranian women with mastectomy scale (HAMS) | 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 Development and Structural Validation of the Husbands Adaptation of Iranian women with mastectomy scale (HAMS) Negar Habibi Behrooz, Armin Zareiyan, Marzieh Beigom Bigdeli Shamloo, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7513622/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background Mastectomy significantly impacts the patient's self-image and sexual attractiveness, often disrupting marital relationships. Husbands of these patients require adaptation to support the acceptance of the situation and facilitate the patient's treatment. This study aimed to further validate the HAMS. Method This descriptive-analytical study included 468 husbands of patients undergoing mastectomy who met the inclusion criteria. The HAMS, previously validated for reliability and validity by the researcher, was distributed among participants after providing the necessary information and obtaining written informed consent. Confirmatory factor analysis was performed using IBM SPSS AMOS version 24. Results The confirmatory factor analysis validated the 51-item questionnaire with six dimensions, excluding items 11, 14, 15, 16, 17, 25, 36, and 39. The results indicated that the items of the tool had high intercorrelation within the factors, effectively representing their respective constructs (CR > AVE). Divergent validity analysis demonstrated the uniqueness of the construct (MSV < AVE). Additionally, the HTMT ratio analysis of subscales confirmed the construct's desirable divergence (HTMT 0.05), indicating convergent relationships among related items of each construct. Conclusions The present research introduces a tool that can be utilized for assessing and evaluating adaptation among husbands of Iranian Muslim women undergoing mastectomy. Adaptation Adjustment Breast Cancer Malignancy Partner Figures Figure 1 Introduction Breast cancer is the most prevalent malignancy among women worldwide ( 1 ). The highest incidence rates are observed in Europe and the United States, with the lowest rates seen among Asian and African women ( 2 ). In Iran, breast cancer ranks as the second leading cause of cancer-related mortality( 3 ). The prevalence rate of breast cancer in Iran is 29.88% per 100,000 women annually, with the highest incidence occurring in the 45–65 and 80–85 age groups( 4 ). Treatment options for breast cancer include surgery, chemotherapy, and radiotherapy, chosen based on the severity and stage of diagnosis( 5 ). Among these, mastectomy is the most commonly performed surgical procedure for breast cancer treatment( 6 ). Mastectomy involves the removal of part or all of one or both breasts, leading to asymmetry, large scars, and changes in nipple sensitivity. Given that the breast is an erogenous organ that secretes oxytocin, which induces uterine contractions during sexual activity, its removal results in diminished sexual function ( 7 ), as well as adverse effects on the patient's psychological, sexual, and social well-being ( 8 ). Alterations in a woman’s sexual behavior can influence her husband's sexual functioning, leading to various psychological and emotional consequences( 9 ). In some cases, the psychological toll on husbands has been severe enough to require hospitalization and has been linked to the development of depression( 10 ). Consequently, breast cancer has been referred to as a "relationship cancer." ( 11 , 12 ). Spousal support plays a crucial role in helping women adapt to breast cancer. Such support significantly reduces stress in women, and interventions aimed at reducing spousal stress and promoting their adaptation can ultimately lower patient stress levels and enhance their adjustment( 13 ). Spousal support can also improve the patient’s body image and reduce symptoms of depression, subsequently enhancing the quality of sexual relationships in breast cancer survivors( 14 , 15 ). Conversely, maladaptive responses by either partner to the challenges posed by the disease may lead to major marital difficulties( 12 , 16 ) and pose significant risks to family functioning( 16 ). A key component of spousal support is the husband’s ability to adapt to his wife’s illness( 17 ). Assessing adaptation and its dimensions can play a pivotal role in improving the patient’s treatment process. Furthermore, understanding adaptation and its dimensions can inform counseling sessions, providing education to patients to facilitate acceptance, adopt positive coping strategies, and reintegrate into daily life ( 18 ). It also aids in the timely identification of psychological disorders in husbands ( 19 ). One tool for evaluating adaptation in husbands of women undergoing mastectomy is the HAMS, designed and validated by Bigdeli et al. in 2023. This 51-item questionnaire examines six dimensions: role performance, physical disorders, psychological tensions stemming from financial strain, marital relationships, perceived support, and fear of the future( 20 ). Given that only exploratory factor analysis was performed during the development and validation of this tool, this study aimed to employ confirmatory factor analysis to determine whether the factors proposed by the researcher adequately explain the variance in the observed variables in alignment with the predetermined model. Thus, this research sought to validate the structural integrity of the HAMS for adaptation assessment in husbands of women with breast cancer. Methods This descriptive-analytical study was conducted after obtaining approval from the Ethics Committee of Dezful University of Medical Sciences. A total of 468 participants who met the inclusion criteria were selected through simple random sampling. The study population consisted of husbands of women diagnosed with breast cancer who visited the Imam Hassan Mojtaba Treatment Center in Dezful between April 2024 and December 2024. Inclusion criteria included proficiency in the Persian language, sufficient mental and physical well-being to respond to the questionnaire, and the patient's history of undergoing mastectomy and chemotherapy. The exclusion criterion was the unwillingness to participate. After explaining the study's purpose and ensuring the confidentiality of information, absence of additional costs to the patients and their families, and no deprivation from treatment in case of refusal, written consent was obtained, and the electronic version of the questionnaire was provided to the participants. The study utilized the HAMS tool, a 51-item questionnaire assessing six dimensions: role performance, physical disorders, psychological tensions resulting from financial strain, marital relationships, perceived support, and fear of the future (Table 1 ). The HAMS was developed and validated in Iran in 2023 by Bigdeli et al( 20 ). It should be added that the scale has already been developed by the researcher of the present study and an exploratory factor analysis(EFA) has been conducted, which is sufficient. Table 1 Demographic Characteristics and Background Information Variable Scale Frequency Age (Years) 25–35 80 (17%) 35–45 225 (48%) 45–55 102 (22%) 55–65 61 (13%) Education Level Below Diploma 102 (22%) Diploma 165 (35%) University 201 (43%) Job Self-employed 112 (24%) Retired 80 (17%) Unemployed 138 (20%) Employee 138 (20%) Number of Children 0 9 (2%) 1 61 (13%) 2 102 (22%) 3 or more 296 (63%) Years of Marriage 1–5 23 (5%) 5–10 51 (11%) 10–15 81 (16%) 15–20 23 (5%) More than 20 290 (63%) Years Since Diagnosis Less than 5 98 (21%) 5–10 122 (26%) More than 10 248 (53%) The scoring range for the tool is between 51 and 255. Participants scoring 119 or lower are categorized as having low adaptation, those scoring between 120 and 188 as having moderate adaptation, and those scoring 189 or above as having high adaptation. All items are scored on a 5-point Likert scale, with responses ranging from "very low" to "very high," assigned scores of 1 to 5, respectively. The tool's total and subscale scores were calculated using simple scoring methods. The average completion time for the questionnaire was estimated to be 10 minutes (ranging between 5 to 10 minutes). Based on a previous study, Cronbach's alpha values for dimensions 1, 2, 3, 4, 5, and 6 were 0.931, 0.893, 0.855, 0.745, 0.726, and 0.883, respectively, with an overall value of 0.912 for all dimensions. The split-half reliability coefficients for dimensions 1, 2, 3, 4, 5, and 6 were 0.933, 0.888, 0.834, 0.704, 0.711, and 0.852, respectively, with an overall coefficient of 0.701. Results As shown in Table 1 , the majority of participants were between 35 and 45 years old (48%). Additionally, most participants had a university-level education (43%), were self-employed (24%), and had two or more children (63%). A significant proportion had been married for over 20 years (63%), and more than 10 years had passed since their wives were diagnosed with breast cancer (53%). The final version of the tool, derived from exploratory factor analysis, included the extracted dimensions and the corresponding items for each dimension (subscale). The extracted factors were modeled using AMOS software version 24, and the results of the confirmatory factor analysis indicated that the six-factor model of the Adaptation Scale for Husbands of Women Undergoing Mastectomy demonstrated good model fit. The values for model fit indices, which confirmed the model's adequacy, are provided, all falling within acceptable ranges. Additionally, Diagram 1 illustrates the confirmatory factor analysis model. After evaluating and cleaning the collected data, a total of 468 samples were deemed suitable for confirmatory factor analysis. Following EFA, the HAMS was found to comprise six factors and 51 items, as detailed in the accompanying tables. The labels for the tool’s dimensions were adjusted to align with the items constituting each dimension, and all items were scored in accordance with the concept of the respective dimension. The data were evaluated for skewness, kurtosis, and the absence of missing data. For the first-order confirmatory factor analysis (CFA), data were entered into IBM AMOS version 24. According to the reference by Hair et al. (2020), items with factor loadings below 0.5 in any of the factors were eliminated. Consequently, items 11, 14, 15, 16, and 17 were removed from the first dimension, item 19 from the second dimension, items 25 and 36 from the third, and item 39 from the fourth dimension. The final model was extracted based on Diagram 1. According to Table 2 , the model fit indices (χ²/df = 3.14, RMSEA = 0.068, CFI = 0.911, IFI = 0.912, TLI = 0.903) were all within the acceptable range, indicating a favorable fit of the measurement model to the data. Table 2 Model Fit Indices in Confirmatory Factor Analysis (N = 468) Model Fit Indices Χ 2 df P Value CMIN/DF RMSEA TLI IFI CFI Confirmatory Factor Analysis 2264.49 752 0001≥ 3/14 0.068 0/903 0/912 0/911 Acceptable Fit Range - - 0/05≤ 5≥ 0/08≥ 0/9≤ 0/9≤ 0/9≤ After evaluating the model's fit, three indices—Composite Reliability (CR), Maximum Shared Variance (MSV), and Average Variance Extracted (AVE)—were calculated. The values of these indices demonstrated that the final instrument exhibited convergent validity (as indicated by standardized factor loadings greater than 0.5 and CR values exceeding AVE) across all factors. This indicates a high correlation among the items within each factor, affirming that the items effectively represent their respective constructs (Table 3 ). Table 3 Evaluation indices, composite reliability, H reliability, and measures of convergent and divergent validity. index Factor Alpha CR MSV AVE Effective Role Performance 0.931 0.934 0.194 0.564 Physical Disorders due to Maladaptation 0.893 0.95 0.099 0.759 Psychological Tensions due to Maladaptation 0.855 0.949 0.324 0.657 Marital Relationship Maladaptation 0.745 0.948 0.099 0.752 Perceived Support Strengthening Adaptation 0.726 0.904 0.472 0.704 Fear of the Future Reducing Adaptation 0.883 0.951 0.472 0.828 Additionally, divergent validity analysis revealed that the construct is empirically unique and represents phenomena of interest that are not captured by other metrics within the structural equation model. One of the criteria for this index is that the MSV value must be less than the AVE value (MSV < AVE) (Table 3 ). The Fornell-Larcker criterion indicates the presence of acceptable divergence between constructs. Data analysis confirms the existence of divergence and discriminant validity among the constructs, as evidenced by the larger values along the diagonal of the correlation matrix compared to other numerical values associated with each construct. Also, Heterotrait-Monotrait(HTMT) Ratio and MTMM Multitrait-Multimethod matrix(MTMM) were examined and were less than 0.85. The obtained ratio should be compared against a predetermined threshold when used as a criterion. Some researchers, such as Kline (2011), suggest a threshold of 0.85, which was also considered in this study. The interpretation is as follows: if HTMT values are less than 0.85, it indicates that the actual correlation between two constructs is different, confirming discriminant validity. However, if the HTMT value exceeds this threshold, discriminant validity is called into question. Based on the results of this method, the dimensions of the present tool demonstrated discriminant validity. The findings are presented in Table 4 . Table 4 Results of HTMT Ratio Analysis for Subscales. Subscale Effective Role Performance in Adaptation Physical Disorder Resulting from Inefficiency in Adaptation Maladaptation Causing Psychological Tensions Maladaptation in Marital Relationships Perceived Support Strengthening Adaptation Fear of the Future; Reducing Adaptation Effective Role Performance in Adaptation Physical Disorder Resulting from Inefficiency in Adaptation 0.103 Maladaptation Causing Psychological Tensions 0.420 0.026 Maladaptation in Marital Relationships 0.132 0.321 0.079 Perceived Support Strengthening Adaptation 0.432 0.130 0.553 0.147 Fear of the Future; Reducing Adaptation 0.402 0.190 0.358 0.253 0.671 The standardized regression coefficients between the items and constructs exceeded 0.5, indicating convergent relationships among the items associated with each construct. Discussion The present study aimed to perform confirmatory factor analysis (CFA) on the HAMS questionnaire to assess how well the selected items measure the intended constructs and to examine the relationships between the latent variables (factors) and observed variables (items) ( 21 ). In this study, six dimensions were extracted, including: effective role performance (facilitating adaptation), physical impairment (resulting from inability to adapt), incompatibility (causing psychological tension), marital discord (incompatibility in marital relationships), perceived support (strengthening adaptation), and fear of the future (reducing adaptation). These dimensions differ from the previous version, which included: role performance, physical disorders, psychological tensions related to financial problems, marital relationships, perceived support, and fear of the future ( 20 ). Research has shown that husbands of patients assume additional roles such as caregiving and nursing, which are indicators of better adaptation ( 22 ). They also experience physical problems like hypertension, sleep disturbances, and gastrointestinal issues, which often occur at the time of diagnosis and signify challenges in adaptation ( 23 ). Moreover, husbands face various concerns, including fears about the side effects of the disease, the future, and challenges in securing medication or failed treatments, all of which lead to significant stress ( 23 ). While these husbands demand support, they often receive inadequate or delayed assistance, weakening their foundations for adaptation ( 22 ). In this study, following the evaluation of the model's fit, the convergent and divergent validity, as well as the construct reliability of the HAMS, were assessed. Convergent and divergent validity were evaluated using the Fornell and Larcker (1981) approach based on the following parameters ( 24 ): average variance extracted (AVE), maximum shared variance (MSV), and construct reliability (CR). Confirmatory factor analysis in this study revealed that the items within each factor showed high correlations, effectively representing their respective constructs (CR > AVE). Divergent validity further demonstrated the uniqueness of these constructs (MSV < AVE). The HTMT ratio analysis for subscales confirmed the construct's desirable divergence (HTMT 0.05), indicating convergent relationships among the items associated with each construct. Standardized regression coefficients between the items and constructs exceeded 0.5, further supporting the convergent relationships within each construct. The findings of this study align with previous research on assessing the validity and reliability of psychometric tools. For instance, the Fornell and Larcker approach ( 25 ), applied in this study, is widely used in similar studies to evaluate convergent and divergent validity( 26 , 27 ). The results for CR > AVE and MSV < AVE are consistent with other studies( 28 ), confirming the internal consistency and distinctiveness of the constructs. However, differences in HTMT values (less than 0.85) compared to certain studies ( 18 ) may be attributed to the unique characteristics of the sample (women undergoing mastectomy) or variations in cultural and social contexts. The CFA findings demonstrated that the items were significantly loaded onto their respective constructs, likely due to the careful design of items and their alignment with theoretical components of marital adaptation in this specific population. High values of AVE and CR indicate that the items effectively measure the underlying constructs. Furthermore, the significant differences between MSV and AVE confirm that each construct possesses unique characteristics and does not overlap with the others. These findings align with the adaptation processes observed in husbands of Iranian women undergoing mastectomy( 19 ). Although this study utilized advanced analytical methods, it has limitations. First, sampling from a specific population of women undergoing mastectomy may limit the generalizability of results to other populations. Second, reliance on self-reported data may introduce response bias. Future studies are recommended to adopt mixed-method approaches (qualitative-quantitative) and include more diverse samples. Conclusions The thorough evaluation of the validity and reliability of this questionnaire provides researchers and practitioners with a robust tool for assessing the adaptation of husbands of women undergoing mastectomy. This instrument can be utilized in designing psychological interventions, evaluating the effectiveness of support programs, and improving the quality of life of this patient group and their families. Additionally, methodologies based on HTMT and confirmatory factor analysis offer a framework for future research in developing tools for psychosocial health assessment. Declarations Ethics approval and consent to participate All ethical considerations in human research, including informed consent, data confidentiality, and the right to withdraw from the study were observed in accordance with the Declaration of Helsinki. The authors would like to thank the Student Research Committee of Dezful University of Medical Sciences, Dezful, Iran for their support, cooperation, and assistance throughout the study ( Grant number: IR.DUMS.REC.1402.046). Consent for publication All authors declare their consent to publish the article . Availability of data and materials The dataset presented in the study is available on request from the corresponding author during submission or after its publication Competing interests The author(s) declare no potential conflict of interest with respect to research, authorship and or publication of this article Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Dezdul University of Medical Sciences. Authors' Contributions MBBSH and NHB wrote the main manuscript text. AZ prepared all tables and diagram. All authors reviewed the manuscript. Acknowledgements This article was extracted from a research proposal titled “Structural validation of adaptation questionnaire in husbands of women with Breast cancer”, which was approved by the Vice-chancellor for Research and Technology of Dezdul University of Medical Sciences (ethics code: IR.DUMS.REC.1402.046). Hereby, the authors would like to thank all the participants for their cooperation in the research. Authors' information (optional) NHB: Nursing student, Student Research Committee, School of Nursing, Dezful University of Medical Sciences, Dezful, Iran.AZ: Professor of Nursing Education, School of Nursing, Research Center for Cancer Screening and Epidemiology, AJA University of Medical Sciences, Tehran,Iran, MBBSH: Assistant Professor, Department of Operating room, School of Paramedicine, Dezful University of Medical Sciences, Dezful, Iran.ER:School of Medicine, Iran University of Medical Sciences, Tehran, Iran. References Łukasiewicz S, Czeczelewski M, Forma A, Baj J, Sitarz R, Stanisławek A. Breast cancer—epidemiology, risk factors, classification, prognostic markers, and current treatment strategies—an updated review. Cancers. 2021;13(17):4287. Roheel A, Khan A, Anwar F, Akbar Z, Akhtar MF, Imran Khan M, et al. Global epidemiology of breast cancer based on risk factors: a systematic review. Front Oncol. 2023;13:1240098. Lei S, Zheng R, Zhang S, Wang S, Chen R, Sun K, et al. Global patterns of breast cancer incidence and mortality: A population-based cancer registry data analysis from 2000 to 2020. Cancer Commun. 2021;41(11):1183–94. Saedi S, Saedi A, Ghaemi MM, Milani FM. Epidemiological Study of Breast Cancer in Iran: A Micro Review Study. Eurasian J Sci Technol. 2022;2(3):227–35. Burguin A, Diorio C, Durocher F. Breast cancer treatments: updates and new challenges. J personalized Med. 2021;11(8):808. Saldanha IJ, Broyles JM, Adam GP, Cao W, Bhuma MR, Mehta S, et al. Autologous breast reconstruction after mastectomy for breast cancer: a systematic review. Plast Reconstr Surgery–Global Open. 2022;10(3):e4181. Hanson SE, Lei X, Roubaud MS, DeSnyder SM, Caudle AS, Shaitelman SF, et al. Long-term quality of life in patients with breast cancer after breast conservation vs mastectomy and reconstruction. JAMA Surg. 2022;157(6):e220631–e. Thakur M, Sharma R, Mishra AK, Singh K, Kar SK. Psychological distress and body image disturbances after modified radical mastectomy among breast cancer survivors: A cross-sectional study from a tertiary care centre in North India. Lancet Reg Health-Southeast Asia. 2022;7. Rodrigues CT, Nobre P, Gomes AQ. Breast cancer and sexual dysfunction: Does surgery matter? J Sex Med. 2022;19(5):S224–5. Maleki M, Mardani A, Ghafourifard M, Vaismoradi M. Changes and challenges in sexual life experienced by the husbands of women with breast cancer: a qualitative study. BMC Womens Health. 2022;22(1):326. Fiorillo A, Sampogna G, Del Vecchio V, Luciano M, Monteleone AM, Di Maso V, et al. Development and validation of the family coping questionnaire for eating disorders. Int J Eat Disord. 2015;48(3):298–304. Zangeneh S, Savabi-Esfahani M, Taleghani F, Sharbafchi MR, Salehi M. Men in Marital Relationships with Women Undergoing Breast Cancer Treatment: A Qualitative Study. Int J Sex Health. 2024;36(4):569–83. Ursavaş FE, Karayurt Ö. Effects of a Roy’s adaptation model–guided support group intervention on sexual adjustment, body image, and perceived social support in women with breast cancer. Cancer Nurs. 2021;44(6):E382–94. Shamloo MBB, Elahi N, Shamsi A. Attitudes Toward Patients in Muslim Husbands of Iranian Women with Mastectomy: A Qualitative Study. Trends Med Sci. 2023;3(1). Che Ya SN, Muhamad R, Mohd Zain N, Zakaria R, Ishak A, Hassan II, et al. Coping strategies for sexual problems and sexual dysfunction amongst Malay women with breast cancer. A qualitative study. Sex Med. 2021;9(3):100336. Valente M, Chirico I, Ottoboni G, Chattat R. Relationship dynamics among couples dealing with breast cancer: a systematic review. Int J Environ Res Public Health. 2021;18(14):7288. Kaewkerd O, Chaiyasit Y, Vibulchai S, Kenthongdee W, Sirisawat M, Panput A, et al. Key Factors of Family Adaptation to the Illness of Family Members: An Integrative Review. Bangkok Med J. 2020;16(1):95. Chen H, Abdelrasheed NSG, Mecheser AE, Tayyib NA, Ramaiah P, Prasad K et al. Mediating role of self-compassion in the relationship between psychological flexibility and psychological well-being in women with breast cancer. 2023. Bigdeli Shamloo MB, Ashrafizadeh H. Adaptation Process in Husbands of Iranian Women Undergoing Mastectomy From Diagnosis to Terminal Stages of the Disease: A Grounded Theory Study. Omega. 2024:302228241245238. Bigdeli Shamloo MB, Elahi N, Asadi Zaker M, Zarea K, Zareiyan A. Designing and validating an adaptation questionnaire among the husbands of Iranian Muslim women with breast cancer. Front public health. 2023;11:1073032. Hox JJ. Confirmatory factor analysis. The encyclopedia of research methods in criminology and criminal justice. 2021;2:830-2. Shamloo MBB, Elahi N, Zaker MA, Zarea K, Zareian A. Role playing and interdependence among husbands of Iranian women after a mastectomy. Int J Palliat Nurs. 2023;29(8):360–9. Shamloo MBB, Elahi N, Zaker MA, Zarea K, Zareiyan A. Identification of the Physiological Dimension and SelfConcept among Husbands of Iranian Women with Mastectomy; a Directed Content Analysis. Gulf J Oncol. 2023;1(42):6–13. Fornell C, Larcker DF. Evaluating structural equation models with unobservable variables and measurement error. J Mark Res. 1981;18(1):39–50. Bagozzi RP, Fornell C, Larcker DF. Canonical correlation analysis as a special case of a structural relations model. Multivar Behav Res. 1981;16(4):437–54. Díaz-Periánez C, Camacho-Bejarano R, González-de la Torre H, Cruickshank S, Humphris GM, Bayo-Lozano E, et al. Transcultural Adaptation and Evaluation of the Psychometric Properties of the Spanish Version of the FCR7 Questionnaire for Assessing Fear of Recurrence in Cancer Patients: FCR6/7-SP. Cancers. 2025;17(5):875. Weeratunga E, Senadheera C, Hettiarachchi M, Perera B. Validation of the Sinhalese Version of Brief COPE Scale for patients with cancer in Sri Lanka. BMC Psychol. 2022;10(1):157. Ragala MEA, El Hilaly J, Amaadour L, Omari M, AsriI AE, Atassi M, et al. Validation of Mini-Mental Adjustment to Cancer scale in a Moroccan sample of breast cancer women. BMC Cancer. 2021;21:1–12. Additional Declarations No competing interests reported. Supplementary Files questionaire.pdf Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 16 Oct, 2025 Reviewers invited by journal 06 Oct, 2025 Editor assigned by journal 01 Oct, 2025 Editor invited by journal 11 Sep, 2025 Submission checks completed at journal 09 Sep, 2025 First submitted to journal 09 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-7513622","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":530828828,"identity":"dec8725f-f8f1-4662-9309-886be1ec9dfd","order_by":0,"name":"Negar Habibi Behrooz","email":"","orcid":"","institution":"Dezful University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Negar","middleName":"Habibi","lastName":"Behrooz","suffix":""},{"id":530828829,"identity":"027beef9-2f10-421f-96e1-b402603e4c6d","order_by":1,"name":"Armin Zareiyan","email":"","orcid":"","institution":"AJA University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Armin","middleName":"","lastName":"Zareiyan","suffix":""},{"id":530828830,"identity":"2f35ed08-3d2a-4c32-9799-45502be622b6","order_by":2,"name":"Marzieh Beigom Bigdeli Shamloo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2klEQVRIiWNgGAWjYFACHoYDDGwMMmzsDWxQEcYGorTwsPEcIEELA0gLg0QCGwGVUKDbwHvw4JcyGx4+yefPHt1sY5Dnb2Bu+4BPi9kBvoTDMufSeNikc8yNc9sYDGccYGyegV8Lj8FhybbDIC1s0kAtjBsYGJvxOgyq5T8Pm+TxZyAt9kRpOfix7QAPmwSDGUhLImEth4F+YTiXDAxkoF9yzkkkzzhMSMvx3sMff5TZycm3H3/2OKfMxra/vf0xXi0MzEDEg+BKgEUIAsYfRCgaBaNgFIyCEQwALFxBpoJ7uCYAAAAASUVORK5CYII=","orcid":"","institution":"Dezful University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Marzieh","middleName":"Beigom Bigdeli","lastName":"Shamloo","suffix":""},{"id":530828831,"identity":"69bb9ad7-2c8c-4bbb-ab2a-74df833d742b","order_by":3,"name":"Elham Ramezapour","email":"","orcid":"","institution":"Iran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Elham","middleName":"","lastName":"Ramezapour","suffix":""}],"badges":[],"createdAt":"2025-09-02 05:38:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7513622/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7513622/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":93796131,"identity":"a131f3df-220f-4bb7-ae5c-e0d13176223e","added_by":"auto","created_at":"2025-10-17 15:51:59","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":245877,"visible":true,"origin":"","legend":"","description":"","filename":"editedarticle.docx","url":"https://assets-eu.researchsquare.com/files/rs-7513622/v1/0a06fc0ceecbb98a5fae2043.docx"},{"id":93796129,"identity":"ac3b2b4f-9a50-4314-b3f7-92ae846a8da8","added_by":"auto","created_at":"2025-10-17 15:51:59","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":15808,"visible":true,"origin":"","legend":"","description":"","filename":"table.docx","url":"https://assets-eu.researchsquare.com/files/rs-7513622/v1/5be0e7647d8ceee458f8dfbd.docx"},{"id":93796130,"identity":"e1f92ff5-87c4-40ef-b424-be6176b42871","added_by":"auto","created_at":"2025-10-17 15:51:59","extension":"json","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6277,"visible":true,"origin":"","legend":"","description":"","filename":"36af32083d9c4bfeac75e9e1f2c8bac8.json","url":"https://assets-eu.researchsquare.com/files/rs-7513622/v1/65776a1b5e6670b4a836aa03.json"},{"id":93796136,"identity":"fcee5b9b-0b10-443e-b573-2d8365714c56","added_by":"auto","created_at":"2025-10-17 15:51:59","extension":"pdf","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":385811,"visible":true,"origin":"","legend":"","description":"","filename":"questionaire.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7513622/v1/dc4944fca3684580d7545aaa.pdf"},{"id":93797610,"identity":"796cfb0d-241a-4268-a1b8-0b4b8c9acaaa","added_by":"auto","created_at":"2025-10-17 15:59:59","extension":"xml","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":86092,"visible":true,"origin":"","legend":"","description":"","filename":"36af32083d9c4bfeac75e9e1f2c8bac81enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7513622/v1/52ffaf83fbcca1892f31bb4d.xml"},{"id":93797609,"identity":"2d4fa5aa-b3bd-4d4a-8038-9e50930ca3a9","added_by":"auto","created_at":"2025-10-17 15:59:59","extension":"png","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":41093,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7513622/v1/1bdd1f2148b28156aac73672.png"},{"id":93796137,"identity":"e8d984a6-2405-49b0-8a0b-e7af4d262b1a","added_by":"auto","created_at":"2025-10-17 15:51:59","extension":"xml","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":84051,"visible":true,"origin":"","legend":"","description":"","filename":"36af32083d9c4bfeac75e9e1f2c8bac81structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7513622/v1/086413c62413c00d82692a3d.xml"},{"id":93796139,"identity":"35f00285-67cb-4d5f-b20b-14c6a00d47b0","added_by":"auto","created_at":"2025-10-17 15:51:59","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":92447,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7513622/v1/49032157ba8760690841600a.html"},{"id":93796135,"identity":"b1b29e53-01fa-485b-b184-9a512444c14d","added_by":"auto","created_at":"2025-10-17 15:51:59","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":191167,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDiagram 1: Adaptation model among Iranian Muslim women undergoing mastectomy\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7513622/v1/79f9a37d68f780b6ce55e006.png"},{"id":93797965,"identity":"b2579f3b-652f-40bd-ba1c-533c801ba2d0","added_by":"auto","created_at":"2025-10-17 16:07:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1088314,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7513622/v1/3e581f63-8ca0-41f3-9102-7f48a5056358.pdf"},{"id":93796133,"identity":"832d68d6-82f4-47c1-83b8-5df6523f644f","added_by":"auto","created_at":"2025-10-17 15:51:59","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":385811,"visible":true,"origin":"","legend":"","description":"","filename":"questionaire.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7513622/v1/94a1e4d068f8df67015d36fd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Development and Structural Validation of the Husbands Adaptation of Iranian women with mastectomy scale (HAMS)","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBreast cancer is the most prevalent malignancy among women worldwide (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The highest incidence rates are observed in Europe and the United States, with the lowest rates seen among Asian and African women (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In Iran, breast cancer ranks as the second leading cause of cancer-related mortality(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The prevalence rate of breast cancer in Iran is 29.88% per 100,000 women annually, with the highest incidence occurring in the 45\u0026ndash;65 and 80\u0026ndash;85 age groups(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTreatment options for breast cancer include surgery, chemotherapy, and radiotherapy, chosen based on the severity and stage of diagnosis(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Among these, mastectomy is the most commonly performed surgical procedure for breast cancer treatment(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Mastectomy involves the removal of part or all of one or both breasts, leading to asymmetry, large scars, and changes in nipple sensitivity. Given that the breast is an erogenous organ that secretes oxytocin, which induces uterine contractions during sexual activity, its removal results in diminished sexual function (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), as well as adverse effects on the patient's psychological, sexual, and social well-being (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAlterations in a woman\u0026rsquo;s sexual behavior can influence her husband's sexual functioning, leading to various psychological and emotional consequences(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In some cases, the psychological toll on husbands has been severe enough to require hospitalization and has been linked to the development of depression(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Consequently, breast cancer has been referred to as a \"relationship cancer.\" (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSpousal support plays a crucial role in helping women adapt to breast cancer. Such support significantly reduces stress in women, and interventions aimed at reducing spousal stress and promoting their adaptation can ultimately lower patient stress levels and enhance their adjustment(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Spousal support can also improve the patient\u0026rsquo;s body image and reduce symptoms of depression, subsequently enhancing the quality of sexual relationships in breast cancer survivors(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Conversely, maladaptive responses by either partner to the challenges posed by the disease may lead to major marital difficulties(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) and pose significant risks to family functioning(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eA key component of spousal support is the husband\u0026rsquo;s ability to adapt to his wife\u0026rsquo;s illness(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Assessing adaptation and its dimensions can play a pivotal role in improving the patient\u0026rsquo;s treatment process. Furthermore, understanding adaptation and its dimensions can inform counseling sessions, providing education to patients to facilitate acceptance, adopt positive coping strategies, and reintegrate into daily life (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). It also aids in the timely identification of psychological disorders in husbands (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOne tool for evaluating adaptation in husbands of women undergoing mastectomy is the HAMS, designed and validated by Bigdeli et al. in 2023. This 51-item questionnaire examines six dimensions: role performance, physical disorders, psychological tensions stemming from financial strain, marital relationships, perceived support, and fear of the future(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Given that only exploratory factor analysis was performed during the development and validation of this tool, this study aimed to employ confirmatory factor analysis to determine whether the factors proposed by the researcher adequately explain the variance in the observed variables in alignment with the predetermined model. Thus, this research sought to validate the structural integrity of the HAMS for adaptation assessment in husbands of women with breast cancer.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e This descriptive-analytical study was conducted after obtaining approval from the Ethics Committee of Dezful University of Medical Sciences. A total of 468 participants who met the inclusion criteria were selected through simple random sampling. The study population consisted of husbands of women diagnosed with breast cancer who visited the Imam Hassan Mojtaba Treatment Center in Dezful between April 2024 and December 2024. Inclusion criteria included proficiency in the Persian language, sufficient mental and physical well-being to respond to the questionnaire, and the patient's history of undergoing mastectomy and chemotherapy. The exclusion criterion was the unwillingness to participate. After explaining the study's purpose and ensuring the confidentiality of information, absence of additional costs to the patients and their families, and no deprivation from treatment in case of refusal, written consent was obtained, and the electronic version of the questionnaire was provided to the participants.\u003c/p\u003e\u003cp\u003eThe study utilized the HAMS tool, a 51-item questionnaire assessing six dimensions: role performance, physical disorders, psychological tensions resulting from financial strain, marital relationships, perceived support, and fear of the future (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The HAMS was developed and validated in Iran in 2023 by Bigdeli et al(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). It should be added that the scale has already been developed by the researcher of the present study and an exploratory factor analysis(EFA) has been conducted, which is sufficient.\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\u003eDemographic Characteristics and Background Information\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eScale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (Years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80 (17%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35\u0026ndash;45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e225 (48%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45\u0026ndash;55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e102 (22%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55\u0026ndash;65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61 (13%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation Level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBelow Diploma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e102 (22%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDiploma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e165 (35%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUniversity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e201 (43%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJob\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSelf-employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e112 (24%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRetired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80 (17%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e138 (20%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmployee\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e138 (20%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of Children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61 (13%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e102 (22%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 or more\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e296 (63%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYears of Marriage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u0026ndash;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23 (5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51 (11%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u0026ndash;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e81 (16%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15\u0026ndash;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23 (5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMore than 20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e290 (63%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYears Since Diagnosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLess than 5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e98 (21%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e122 (26%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMore than 10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e248 (53%)\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\u003eThe scoring range for the tool is between 51 and 255. Participants scoring 119 or lower are categorized as having low adaptation, those scoring between 120 and 188 as having moderate adaptation, and those scoring 189 or above as having high adaptation. All items are scored on a 5-point Likert scale, with responses ranging from \"very low\" to \"very high,\" assigned scores of 1 to 5, respectively. The tool's total and subscale scores were calculated using simple scoring methods. The average completion time for the questionnaire was estimated to be 10 minutes (ranging between 5 to 10 minutes).\u003c/p\u003e\u003cp\u003eBased on a previous study, Cronbach's alpha values for dimensions 1, 2, 3, 4, 5, and 6 were 0.931, 0.893, 0.855, 0.745, 0.726, and 0.883, respectively, with an overall value of 0.912 for all dimensions. The split-half reliability coefficients for dimensions 1, 2, 3, 4, 5, and 6 were 0.933, 0.888, 0.834, 0.704, 0.711, and 0.852, respectively, with an overall coefficient of 0.701.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the majority of participants were between 35 and 45 years old (48%). Additionally, most participants had a university-level education (43%), were self-employed (24%), and had two or more children (63%). A significant proportion had been married for over 20 years (63%), and more than 10 years had passed since their wives were diagnosed with breast cancer (53%).\u003c/p\u003e\u003cp\u003eThe final version of the tool, derived from exploratory factor analysis, included the extracted dimensions and the corresponding items for each dimension (subscale). The extracted factors were modeled using AMOS software version 24, and the results of the confirmatory factor analysis indicated that the six-factor model of the Adaptation Scale for Husbands of Women Undergoing Mastectomy demonstrated good model fit. The values for model fit indices, which confirmed the model's adequacy, are provided, all falling within acceptable ranges. Additionally, Diagram 1 illustrates the confirmatory factor analysis model. After evaluating and cleaning the collected data, a total of 468 samples were deemed suitable for confirmatory factor analysis.\u003c/p\u003e\u003cp\u003eFollowing EFA, the HAMS was found to comprise six factors and 51 items, as detailed in the accompanying tables. The labels for the tool\u0026rsquo;s dimensions were adjusted to align with the items constituting each dimension, and all items were scored in accordance with the concept of the respective dimension. The data were evaluated for skewness, kurtosis, and the absence of missing data.\u003c/p\u003e\u003cp\u003eFor the first-order confirmatory factor analysis (CFA), data were entered into IBM AMOS version 24. According to the reference by Hair et al. (2020), items with factor loadings below 0.5 in any of the factors were eliminated. Consequently, items 11, 14, 15, 16, and 17 were removed from the first dimension, item 19 from the second dimension, items 25 and 36 from the third, and item 39 from the fourth dimension. The final model was extracted based on Diagram 1.\u003c/p\u003e\u003cp\u003eAccording to Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, the model fit indices (χ\u0026sup2;/df\u0026thinsp;=\u0026thinsp;3.14, RMSEA\u0026thinsp;=\u0026thinsp;0.068, CFI\u0026thinsp;=\u0026thinsp;0.911, IFI\u0026thinsp;=\u0026thinsp;0.912, TLI\u0026thinsp;=\u0026thinsp;0.903) were all within the acceptable range, indicating a favorable fit of the measurement model to the data.\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\u003eModel Fit Indices in Confirmatory Factor Analysis (N\u0026thinsp;=\u0026thinsp;468)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\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\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModel Fit Indices\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eΧ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003edf\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u003csub\u003eValue\u003c/sub\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCMIN/DF\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRMSEA\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eTLI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eIFI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eCFI\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\u003eConfirmatory Factor Analysis\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2264.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e752\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0001\u0026ge;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3/14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.068\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0/903\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0/912\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0/911\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAcceptable Fit Range\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0/05\u0026le;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u0026ge;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0/08\u0026ge;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0/9\u0026le;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0/9\u0026le;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0/9\u0026le;\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\u003eAfter evaluating the model's fit, three indices\u0026mdash;Composite Reliability (CR), Maximum Shared Variance (MSV), and Average Variance Extracted (AVE)\u0026mdash;were calculated. The values of these indices demonstrated that the final instrument exhibited convergent validity (as indicated by standardized factor loadings greater than 0.5 and CR values exceeding AVE) across all factors. This indicates a high correlation among the items within each factor, affirming that the items effectively represent their respective constructs (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\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\u003eEvaluation indices, composite reliability, H reliability, and measures of convergent and divergent validity.\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=\"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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eindex\u003c/p\u003e\u003cp\u003eFactor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAlpha\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMSV\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAVE\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\u003eEffective Role Performance\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.931\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.934\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.194\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.564\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePhysical Disorders due to Maladaptation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.893\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.099\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.759\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePsychological Tensions due to Maladaptation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.855\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.949\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.324\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.657\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital Relationship Maladaptation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.745\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.948\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.099\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.752\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePerceived Support Strengthening Adaptation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.726\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.904\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.472\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.704\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFear of the Future Reducing Adaptation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.883\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.951\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.472\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.828\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\u003eAdditionally, divergent validity analysis revealed that the construct is empirically unique and represents phenomena of interest that are not captured by other metrics within the structural equation model. One of the criteria for this index is that the MSV value must be less than the AVE value (MSV\u0026thinsp;\u0026lt;\u0026thinsp;AVE) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe Fornell-Larcker criterion indicates the presence of acceptable divergence between constructs. Data analysis confirms the existence of divergence and discriminant validity among the constructs, as evidenced by the larger values along the diagonal of the correlation matrix compared to other numerical values associated with each construct. Also, Heterotrait-Monotrait(HTMT) Ratio and MTMM Multitrait-Multimethod matrix(MTMM) were examined and were less than 0.85.\u003c/p\u003e\u003cp\u003eThe obtained ratio should be compared against a predetermined threshold when used as a criterion. Some researchers, such as Kline (2011), suggest a threshold of 0.85, which was also considered in this study. The interpretation is as follows: if HTMT values are less than 0.85, it indicates that the actual correlation between two constructs is different, confirming discriminant validity. However, if the HTMT value exceeds this threshold, discriminant validity is called into question.\u003c/p\u003e\u003cp\u003eBased on the results of this method, the dimensions of the present tool demonstrated discriminant validity. The findings are presented 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\u003eResults of HTMT Ratio Analysis for Subscales.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubscale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEffective Role Performance in Adaptation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePhysical Disorder Resulting from Inefficiency in Adaptation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMaladaptation Causing Psychological Tensions\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMaladaptation in Marital Relationships\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePerceived Support Strengthening Adaptation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFear of the Future; Reducing Adaptation\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEffective Role Performance in Adaptation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePhysical Disorder Resulting from Inefficiency in Adaptation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.103\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\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMaladaptation Causing Psychological Tensions\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.420\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.026\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\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMaladaptation in Marital Relationships\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.132\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.321\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.079\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\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePerceived Support Strengthening Adaptation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.432\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.553\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.147\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFear of the Future; Reducing Adaptation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.190\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.358\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.253\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.671\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\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 standardized regression coefficients between the items and constructs exceeded 0.5, indicating convergent relationships among the items associated with each construct.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study aimed to perform confirmatory factor analysis (CFA) on the HAMS questionnaire to assess how well the selected items measure the intended constructs and to examine the relationships between the latent variables (factors) and observed variables (items) (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). In this study, six dimensions were extracted, including: \u003cem\u003eeffective role performance\u003c/em\u003e (facilitating adaptation), \u003cem\u003ephysical impairment\u003c/em\u003e (resulting from inability to adapt), \u003cem\u003eincompatibility\u003c/em\u003e (causing psychological tension), \u003cem\u003emarital discord\u003c/em\u003e (incompatibility in marital relationships), \u003cem\u003eperceived support\u003c/em\u003e (strengthening adaptation), and \u003cem\u003efear of the future\u003c/em\u003e (reducing adaptation). These dimensions differ from the previous version, which included: role performance, physical disorders, psychological tensions related to financial problems, marital relationships, perceived support, and fear of the future (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eResearch has shown that husbands of patients assume additional roles such as caregiving and nursing, which are indicators of better adaptation (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). They also experience physical problems like hypertension, sleep disturbances, and gastrointestinal issues, which often occur at the time of diagnosis and signify challenges in adaptation (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Moreover, husbands face various concerns, including fears about the side effects of the disease, the future, and challenges in securing medication or failed treatments, all of which lead to significant stress (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). While these husbands demand support, they often receive inadequate or delayed assistance, weakening their foundations for adaptation (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn this study, following the evaluation of the model's fit, the convergent and divergent validity, as well as the construct reliability of the HAMS, were assessed. Convergent and divergent validity were evaluated using the Fornell and Larcker (1981) approach based on the following parameters (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e): average variance extracted (AVE), maximum shared variance (MSV), and construct reliability (CR).\u003c/p\u003e\u003cp\u003eConfirmatory factor analysis in this study revealed that the items within each factor showed high correlations, effectively representing their respective constructs (CR\u0026thinsp;\u0026gt;\u0026thinsp;AVE). Divergent validity further demonstrated the uniqueness of these constructs (MSV\u0026thinsp;\u0026lt;\u0026thinsp;AVE). The HTMT ratio analysis for subscales confirmed the construct's desirable divergence (HTMT\u0026thinsp;\u0026lt;\u0026thinsp;0.85). Additionally, all path coefficients between the items and constructs were statistically significant (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating convergent relationships among the items associated with each construct. Standardized regression coefficients between the items and constructs exceeded 0.5, further supporting the convergent relationships within each construct.\u003c/p\u003e\u003cp\u003eThe findings of this study align with previous research on assessing the validity and reliability of psychometric tools. For instance, the Fornell and Larcker approach (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), applied in this study, is widely used in similar studies to evaluate convergent and divergent validity(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). The results for CR\u0026thinsp;\u0026gt;\u0026thinsp;AVE and MSV\u0026thinsp;\u0026lt;\u0026thinsp;AVE are consistent with other studies(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), confirming the internal consistency and distinctiveness of the constructs. However, differences in HTMT values (less than 0.85) compared to certain studies (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) may be attributed to the unique characteristics of the sample (women undergoing mastectomy) or variations in cultural and social contexts.\u003c/p\u003e\u003cp\u003eThe CFA findings demonstrated that the items were significantly loaded onto their respective constructs, likely due to the careful design of items and their alignment with theoretical components of marital adaptation in this specific population. High values of AVE and CR indicate that the items effectively measure the underlying constructs. Furthermore, the significant differences between MSV and AVE confirm that each construct possesses unique characteristics and does not overlap with the others. These findings align with the adaptation processes observed in husbands of Iranian women undergoing mastectomy(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAlthough this study utilized advanced analytical methods, it has limitations. First, sampling from a specific population of women undergoing mastectomy may limit the generalizability of results to other populations. Second, reliance on self-reported data may introduce response bias. Future studies are recommended to adopt mixed-method approaches (qualitative-quantitative) and include more diverse samples.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe thorough evaluation of the validity and reliability of this questionnaire provides researchers and practitioners with a robust tool for assessing the adaptation of husbands of women undergoing mastectomy. This instrument can be utilized in designing psychological interventions, evaluating the effectiveness of support programs, and improving the quality of life of this patient group and their families. Additionally, methodologies based on HTMT and confirmatory factor analysis offer a framework for future research in developing tools for psychosocial health assessment.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll ethical considerations in human research, including informed consent, data confidentiality, and the right to withdraw from the study were observed in accordance with the Declaration of Helsinki. The authors would like to thank the Student Research Committee of Dezful University of Medical Sciences, Dezful, Iran for their support, cooperation, and assistance throughout the study ( Grant number: IR.DUMS.REC.1402.046).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare their consent to publish the article\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset presented in the study is available on request from the corresponding author during submission or after its publication\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) declare no potential conflict of interest with respect to research, authorship and or publication of this article\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Dezdul University of Medical Sciences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMBBSH and NHB wrote the main manuscript text. AZ prepared all tables and diagram. All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis article was extracted from a research proposal titled \u0026ldquo;Structural validation of adaptation questionnaire in husbands of women with Breast cancer\u0026rdquo;, which was approved by the Vice-chancellor for Research and Technology of Dezdul University of Medical Sciences (ethics code: IR.DUMS.REC.1402.046). Hereby, the authors would like to thank all the participants \u0026nbsp;for their cooperation in the research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information (optional)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNHB: Nursing student, Student Research Committee, School of Nursing, Dezful University of Medical Sciences, Dezful, Iran.AZ: Professor of Nursing Education, School of Nursing, Research Center for Cancer Screening and Epidemiology, AJA University of Medical Sciences, Tehran,Iran, MBBSH: Assistant Professor, Department of Operating room, School of Paramedicine, Dezful University of Medical Sciences, Dezful, Iran.ER:School of Medicine, Iran University of Medical Sciences, Tehran, Iran.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eŁukasiewicz S, Czeczelewski M, Forma A, Baj J, Sitarz R, Stanisławek A. Breast cancer\u0026mdash;epidemiology, risk factors, classification, prognostic markers, and current treatment strategies\u0026mdash;an updated review. Cancers. 2021;13(17):4287.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRoheel A, Khan A, Anwar F, Akbar Z, Akhtar MF, Imran Khan M, et al. Global epidemiology of breast cancer based on risk factors: a systematic review. Front Oncol. 2023;13:1240098.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLei S, Zheng R, Zhang S, Wang S, Chen R, Sun K, et al. Global patterns of breast cancer incidence and mortality: A population-based cancer registry data analysis from 2000 to 2020. Cancer Commun. 2021;41(11):1183\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSaedi S, Saedi A, Ghaemi MM, Milani FM. Epidemiological Study of Breast Cancer in Iran: A Micro Review Study. Eurasian J Sci Technol. 2022;2(3):227\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBurguin A, Diorio C, Durocher F. Breast cancer treatments: updates and new challenges. J personalized Med. 2021;11(8):808.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSaldanha IJ, Broyles JM, Adam GP, Cao W, Bhuma MR, Mehta S, et al. Autologous breast reconstruction after mastectomy for breast cancer: a systematic review. Plast Reconstr Surgery\u0026ndash;Global Open. 2022;10(3):e4181.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHanson SE, Lei X, Roubaud MS, DeSnyder SM, Caudle AS, Shaitelman SF, et al. Long-term quality of life in patients with breast cancer after breast conservation vs mastectomy and reconstruction. JAMA Surg. 2022;157(6):e220631\u0026ndash;e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThakur M, Sharma R, Mishra AK, Singh K, Kar SK. Psychological distress and body image disturbances after modified radical mastectomy among breast cancer survivors: A cross-sectional study from a tertiary care centre in North India. Lancet Reg Health-Southeast Asia. 2022;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRodrigues CT, Nobre P, Gomes AQ. Breast cancer and sexual dysfunction: Does surgery matter? J Sex Med. 2022;19(5):S224\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMaleki M, Mardani A, Ghafourifard M, Vaismoradi M. Changes and challenges in sexual life experienced by the husbands of women with breast cancer: a qualitative study. BMC Womens Health. 2022;22(1):326.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFiorillo A, Sampogna G, Del Vecchio V, Luciano M, Monteleone AM, Di Maso V, et al. Development and validation of the family coping questionnaire for eating disorders. Int J Eat Disord. 2015;48(3):298\u0026ndash;304.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZangeneh S, Savabi-Esfahani M, Taleghani F, Sharbafchi MR, Salehi M. Men in Marital Relationships with Women Undergoing Breast Cancer Treatment: A Qualitative Study. Int J Sex Health. 2024;36(4):569\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUrsavaş FE, Karayurt \u0026Ouml;. Effects of a Roy\u0026rsquo;s adaptation model\u0026ndash;guided support group intervention on sexual adjustment, body image, and perceived social support in women with breast cancer. Cancer Nurs. 2021;44(6):E382\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShamloo MBB, Elahi N, Shamsi A. Attitudes Toward Patients in Muslim Husbands of Iranian Women with Mastectomy: A Qualitative Study. Trends Med Sci. 2023;3(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChe Ya SN, Muhamad R, Mohd Zain N, Zakaria R, Ishak A, Hassan II, et al. Coping strategies for sexual problems and sexual dysfunction amongst Malay women with breast cancer. A qualitative study. Sex Med. 2021;9(3):100336.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eValente M, Chirico I, Ottoboni G, Chattat R. Relationship dynamics among couples dealing with breast cancer: a systematic review. Int J Environ Res Public Health. 2021;18(14):7288.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKaewkerd O, Chaiyasit Y, Vibulchai S, Kenthongdee W, Sirisawat M, Panput A, et al. Key Factors of Family Adaptation to the Illness of Family Members: An Integrative Review. Bangkok Med J. 2020;16(1):95.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen H, Abdelrasheed NSG, Mecheser AE, Tayyib NA, Ramaiah P, Prasad K et al. Mediating role of self-compassion in the relationship between psychological flexibility and psychological well-being in women with breast cancer. 2023.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBigdeli Shamloo MB, Ashrafizadeh H. Adaptation Process in Husbands of Iranian Women Undergoing Mastectomy From Diagnosis to Terminal Stages of the Disease: A Grounded Theory Study. Omega. 2024:302228241245238.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBigdeli Shamloo MB, Elahi N, Asadi Zaker M, Zarea K, Zareiyan A. Designing and validating an adaptation questionnaire among the husbands of Iranian Muslim women with breast cancer. Front public health. 2023;11:1073032.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHox JJ. Confirmatory factor analysis. The encyclopedia of research methods in criminology and criminal justice. 2021;2:830-2.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShamloo MBB, Elahi N, Zaker MA, Zarea K, Zareian A. Role playing and interdependence among husbands of Iranian women after a mastectomy. Int J Palliat Nurs. 2023;29(8):360\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShamloo MBB, Elahi N, Zaker MA, Zarea K, Zareiyan A. Identification of the Physiological Dimension and SelfConcept among Husbands of Iranian Women with Mastectomy; a Directed Content Analysis. Gulf J Oncol. 2023;1(42):6\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFornell C, Larcker DF. Evaluating structural equation models with unobservable variables and measurement error. J Mark Res. 1981;18(1):39\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBagozzi RP, Fornell C, Larcker DF. Canonical correlation analysis as a special case of a structural relations model. Multivar Behav Res. 1981;16(4):437\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eD\u0026iacute;az-Peri\u0026aacute;nez C, Camacho-Bejarano R, Gonz\u0026aacute;lez-de la Torre H, Cruickshank S, Humphris GM, Bayo-Lozano E, et al. Transcultural Adaptation and Evaluation of the Psychometric Properties of the Spanish Version of the FCR7 Questionnaire for Assessing Fear of Recurrence in Cancer Patients: FCR6/7-SP. Cancers. 2025;17(5):875.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWeeratunga E, Senadheera C, Hettiarachchi M, Perera B. Validation of the Sinhalese Version of Brief COPE Scale for patients with cancer in Sri Lanka. BMC Psychol. 2022;10(1):157.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRagala MEA, El Hilaly J, Amaadour L, Omari M, AsriI AE, Atassi M, et al. Validation of Mini-Mental Adjustment to Cancer scale in a Moroccan sample of breast cancer women. BMC Cancer. 2021;21:1\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Adaptation, Adjustment, Breast Cancer, Malignancy, Partner","lastPublishedDoi":"10.21203/rs.3.rs-7513622/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7513622/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eMastectomy significantly impacts the patient's self-image and sexual attractiveness, often disrupting marital relationships. Husbands of these patients require adaptation to support the acceptance of the situation and facilitate the patient's treatment. This study aimed to further validate the HAMS.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e\u003cp\u003eThis descriptive-analytical study included 468 husbands of patients undergoing mastectomy who met the inclusion criteria. The HAMS, previously validated for reliability and validity by the researcher, was distributed among participants after providing the necessary information and obtaining written informed consent. Confirmatory factor analysis was performed using IBM SPSS AMOS version 24.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe confirmatory factor analysis validated the 51-item questionnaire with six dimensions, excluding items 11, 14, 15, 16, 17, 25, 36, and 39. The results indicated that the items of the tool had high intercorrelation within the factors, effectively representing their respective constructs (CR\u0026thinsp;\u0026gt;\u0026thinsp;AVE). Divergent validity analysis demonstrated the uniqueness of the construct (MSV\u0026thinsp;\u0026lt;\u0026thinsp;AVE). Additionally, the HTMT ratio analysis of subscales confirmed the construct's desirable divergence (HTMT\u0026thinsp;\u0026lt;\u0026thinsp;0.85). Furthermore, all path coefficients between items and constructs were statistically significant (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating convergent relationships among related items of each construct.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe present research introduces a tool that can be utilized for assessing and evaluating adaptation among husbands of Iranian Muslim women undergoing mastectomy.\u003c/p\u003e","manuscriptTitle":"Development and Structural Validation of the Husbands Adaptation of Iranian women with mastectomy scale (HAMS)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-17 15:51:54","doi":"10.21203/rs.3.rs-7513622/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"147396744943475208416883623885734133868","date":"2025-10-16T10:30:09+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-06T19:19:18+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-01T09:53:23+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-11T19:27:39+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-09T06:14:54+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2025-09-09T04:33:39+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"88181081-84af-4038-8d23-0e91d2194329","owner":[],"postedDate":"October 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-17T15:51:54+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-17 15:51:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7513622","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7513622","identity":"rs-7513622","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}