Validity and reliability of the Hungarian version of the Pain Self-efficacy Questionnaire among women with endometriosis and chronic pelvic pain

Validity and reliability of the Hungarian version of the Pain Self-efficacy Questionnaire among women with endometriosis and chronic pelvic pain | 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 Article Validity and reliability of the Hungarian version of the Pain Self-efficacy Questionnaire among women with endometriosis and chronic pelvic pain Zsófia Kovács-Szabó, Alexandra Makai, Pongrác Ács, Márta Hock This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4060366/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Our study aimed to perform Hungarian cross-cultural adaptation and assess the reliability and validity of the Pain Self-Efficacy Questionnaire (PSEQ) among women with chronic pelvic pain. The current study was conducted in Hungary among women aged 18–50 (34,39 ± 6,68 years). Besides PSEQ, the 36 Item Short-Form Health Survey (SF36), Visual Analog Scale (VAS), and Perceived Stress Scale (PSS) were used. We examined the reliability of the PSEQ-HU by applying internal consistency and test-retest evaluations. For construct validity of the PSEQ-HU we used confirmatory factor analysis (CFA) and for convergent validity Spearman rank correlation analysis was performed to assess the correlations between PSEQ-HU and SF-36, PCS, PSS and NRS. For discriminant validity two groups were created based on the NRS (0–4, 5–10). The results were analyzed via IBM SPSS version 28.0 software with a significance level of p < 0.05. 262 women took part in the study. Cronbach’s α was 0.966, the intraclass correlation coefficient values showed adequate reliability (ICC = 0.939. 95% CI 0.884–0.968) for the PSEQ-HU. Spearman correlation analysis showed significant correlations between pain-related self-efficacy and health-related quality of life, perceived stress levels and pain catastrophizing. We concluded that PSEQ is a reliable and valid measurement among Hungarian women endometriosis-related pelvic pain. ClinicalTrials.gov registration: https://register.clinicaltrials.gov/prs/app/action/LoginUser?ts=1&cx=-jg9qo4 Unique protocol ID: 9534-PTE2023 NCT05863663 Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Health sciences/Signs and symptoms Figures Figure 1 Figure 2 Introduction Chronic pain is a prevalent and multifactorial problem that has a significant impact on both individuals and society worldwide. Chronic pain affects a significant amount of the population and represents a serious socioeconomic burden 1 . Chronic pelvic pain is a common chronic pain syndrome that affects a significant number of women, especially those suffering from endometriosis. The global prevalence of Chronic Pelvic Pain (CPP) varies from 5–43% for women and 2–17% for men 2 . Chronic pelvic pain involves unique areas of life such as the ability to sit, sexual life and has a significant effect on work productivity. Endometriosis is a chronic, progressive, inflammatory gynecological disease that affects more than 70 million women worldwide. In the United States 11% of women and approximately every 10th woman worldwide and in Hungary suffer from endometriosis 34 . Additionally, it occurs among 40–50% of women with pelvic pain, 20% of women with infertility, 50% and 70% of women suffering from dysmenorrhea and dyspareunia 5 6 . Pelvic pain, lower quality of life, and high levels of fatigue are highly prevalent among women with endometriosis, and according to the literature, up to 50% of them may experience depression and anxiety 7 . Pelvic pain associated with endometriosis is one of the main reasons for the decline in health-related quality of life of women concerned. It also reduces the quality of sleep and the level of physical activity as well as increases the level of perceived stress and influences body image 8 . Psychological factors play an essential role in coping with chronic pain, and self-efficacy 9 has been identified as an important resilience factor to manage pain moreover it has a significant effect on functioning and coping with chronic pain 10 . Self-efficacy has been proven to be an even more important determinant of disability than pain intensity, fear of movement, pain duration, or anxiety 11 12 . A lower self-efficacy level is identified with higher pain intensity 13 while a higher self-efficacy level is associated with greater physical functioning and physical activity participation 14 . Pain-related self-efficacy has been confirmed to be negatively associated with stress and pain catastrophization among patients suffering from chronic pain 14 . There are several other measurement tools for evaluating self-efficacy as the Arthritis Self-Efficacy Scale 15 , the Rheumatoid arthritis Self-Efficacy Scale 16 , the Chronic Pain self-Efficacy Scale 17 , but among these the Pain Self-Efficacy Questionnaire 18 is an extensively researched and reliable tool for evaluating pain-related self-efficacy in subjects with chronic pain (cancer, musculoskeletal chronic pain). According to a 2019 Delphi Study, the Pain Self-Efficacy Questionnaire (PSEQ) is an extensively researched and reliable tool for evaluating pain-related self-efficacy in subjects with chronic pain 19 . The original version of PSEQ was developed and validated in English 18 (Nicholas 2007) and has been tested in samples with chronic pain. Excellent reliability and validity have been demonstrated in different languages such as Japanese 14 , Dutch 20 , Hebrew 21 , Yoruba 21 , Italian 22 , Arabic 23 Catalan 24 , Persian 25 , Canadian-French 26 (Dubé et al., 2022), and Brazilian 27 . As PSEQ is still not available in the Hungarian language, the translation and cultural adaptation of PSEQ is required by the growing number of studies concerning the behavioral and psychological aspects of chronic pain in Hungary. The aims of the present study were to translate the PSEQ into Hungarian language through a process of cross-cultural adaptation and to test its measurement properties on a Hungarian sample of patients presenting with chronic pelvic pain and endometriosis. Methods The current study is a cross-sectional online survey, distributed via social media using endometriosis support groups in Hungary between 2023. January and 2023. April. The sample size to assess internal consistency and construct validity was determined according to the COSMIN guideline, which recommends that the sample size be 10 times larger than the number of items 28 29 . Voluntarily participating women suffering from endometriosis and chronic pelvic pain 30 aged between 18–50, and living in Hungary were recruited for the study. Pregnant women, women not diagnosed with endometriosis, or women under 18 and above 50 were excluded from the study. We asked 39 participants to fill in the questionnaire 2 weeks after the initial testing according to the COSMIN guideline and other relevant studies 31 32 (COSMIN checklist is in the Supplementary data file 1). Original Pain Self-efficacy Questionnaire The self-administered PSEQ is a specific questionnaire developed to assess pain-related self-efficacy covering the previous 4 week period in people with chronic pain, aimed to evaluate how confident the participants are in everyday activities despite the pain. The questionnaire includes 10 questions using a 7-point Likert scale. The score is calculated by summing up the responses, the maximum score is 60 showing excellent pain-related self-efficacy. The original English version of the questionnaire showed excellent internal consistency (Cronbach α: 0.92) and test-retest reliability 18 . Pain Catastrophizing Scale PCS 33 is a validated, self-assessment questionnaire, consisting of 13 statements containing different thoughts and feelings one may experience when enduring pain. The items are divided into the categories of rumination (items 8–11) (Cronbach α: 0.792), magnification (items 6,7 és 13) (Cronbach α: 0.785) and helplessness (items 1–5 and 12) (Cronbach α: 0.883), with each item scored on a 5-point scale. The overall score has a range of 0–52. Higher scores indicate a higher level of pain catastrophizing. The Hungarian version of PCS 34 , has demonstrated good internal consistency. 36 Item Short-Form Health Survey The questionnaire 35 consisting of 8 domains: physical functioning, bodily pain, role limitations due to physical health problems, role limitations due to personal or emotional problems, emotional well-being, social functioning, energy/fatigue, and general health perceptions. Higher scores indicate higher health-related quality of life. The scores were transformed to a 0-100 scale. During the cross-cultural adaptation of the SF-36 the Hungarian version of 36 Item Short-Form Health Survey 36 showed excellent internal consistency, Cronbach 0.93. Perceived Stress Scale- 10 PSS-10 37 is a self-administered questionnaire developed to assess stress levels and “the degree to which individuals appraise situations in their lives as stressful”. The scale includes 10 questions, consisting of 5 answer options related to frequency, varying from 0–4. Higher scores indicate higher stress levels, 40 is the highest possible score. The Hungarian version of PSS-10 38 had good internal consistency (Cronbach α: 0.85). Numeric Pain Rating Scale The scale 38 is a widely used and valid instrument in the literature, aimed to assess the subjective level of pain on a scale of 0–10, where 0 is no pain at all and 10 is the maximum possible pain. In the current study, the participants were asked to rate their average and maximum pain levels in the last 4 weeks and their actual pain intensity. Ethical considerations The study was conducted anonymously and all participants were asked for a written consent after receiving detailed information. Ethical approval for the study was obtained by the Institutional Review Board of the Faculty of Medicine, University of Pécs, in 2023 (no.: 9534-PTE 2023; Clinical trial number: NCT05863663) following the 2008 Helsinki Declaration. Validation process Translation and cultural adaptation process The translation and cross-cultural adaptation were completed through a multistage process 39 . Receiving the consent from the original investigator of the PSEQ to the translation, cross-cultural adaptation, and validation into the Hungarian language, the linguistic validation was carried out according to the relevant guidelines. In phase one of the study, the PSEQ was forward-translated from English to Hungarian by two independent translators. The first translator was aware of the concept of the questionnaire and as a physiotherapist had a clinical background, while the second translator was not informed about the questionnaire, and as an English teacher did not have a clinical perspective. Then a synthesis between translations was made to confirm the equivalence with the original version. The back translation of the PSEQ into the original English language was performed by an independent physiotherapist with high-level English proficiency. We had an committee composed of a medical doctor, an English teacher, a physiotherapist, and a patient suffering from endometriosis, which created the pre-final version of the questionnaire. The pre-final version was piloted to 15 Hungarian women suffering from endometriosis and they were asked to report back on the readability, cultural relevance and comprehensiveness of the translated version. Only minor changes were suggested so the final Hungarian version of the self-administered PSEQ-HU was accepted. Following the creation of the final version of the questionnaire, we evaluated the following psychometric properties of the PSEQ-HU: content validity, structural validity, internal consistency, test-retest reliability, convergent validity, and discriminative validity. Statistical analysis Reliability Internal consistency assesses the degree to which items within an instrument are interconnected, indicating their strength of association (homogeneity). Cronbach’s α was used to verify internal consistency and values between 0.70 and 0.95 are considered adequate 40 . Test-retest reliability was examined with an intraclass correlation coefficient (ICC). ICC values of 0.75–1.00 were interpreted as excellent 41 . Validity Content validity was explored by score distributions and floor/ceiling effects, the latter are considered to be present if more than 15% of the sample achieves the lowest (floor) or highest (ceiling) possible score. Our study aimed to confirm the structural validity of the instrument using confirmatory factor analysis CFA) and reliability statistics such as CFI, TLI, RMSEA, and 90% CI. A ratio of < 3 between the chi-square test and degrees of freedom, CFI and TLI of 0.90 or more, and RMSEA values of 0.08 or less indicated a good model fit. We calculated factor loadings for each item and identified loadings below 0.5 for potential item reduction 42 . Convergent validity of the PSEQ was explored using Spearman’s rank correlation analysis between the total score of the PSEQ and the NRS and SF-36, PCS 22 PSS Correlation was classified as moderate (0.3 0.69) or strong (r > 0.7) 43 . For the examination of discriminant validity, based on the average scores of NRS over the past 4 weeks, we created 2 groups (0–4, no or mild pain 5–10 moderate and severe). Mann-Whitney U-test tested discriminative validity to examine the differences in PSEQ scores between patients having mild or moderate/severe pain 44 . Descriptive statistics were applied to establish sample characteristics, central tendency estimates, and the variability of the data set. These data were presented as means, standard deviations (SD) or percentages (%). Data analysis was performed using IBM SPSS 28.0 software and IBM SPSS AMOS 29.0 (SPSS Inc., Chicago, IL) version. The level of significance was set at p < 0,05. Results Initially, 277 participants were recruited and then 15 were excluded therefore 262 adult women suffering from endometriosis (mean age 34.39 ± 6.68) participated in the study ( Fig. 1 ). A subgroup of 39 participants was asked to fill out the survey twice, 14 days after the initial testing sample-be írni inkább. The sample’s profile and sociodemographic characteristics are shown in Table 1 . Table 1 Sample characteristics Variable Final sample n = 262 (n;%) 1. Marital status living alone 34 (13.1%) living with partner 94 (36.2%) married 127 (48.8%) divorced 5 (1.9%) 2. Educational level elementary school 4 (1.5%) secondary school 106 (40.6%) higher education 151 (57.9%) 3. Work category sedentary 154 (59.7%) light physical 56 (21.7%) heavy physical 7 (2.7%) standing 27 (10.5%) unemployed 14 (5.4%) 4. Residence city 112 (42.9%) village 43 (16.5%) administrational center 41 (15.7%) capital 65 (24.9%) 7. Pelvic pain duration (years) 9.23 ± 7.7 The internal consistency of the PSEQ- HU was excellent with Cronbach’s α = 0.966 (Table 3 ). Test-retest reliability of the PSEQ-HU in a sample of 39 women yielded excellent results (ICC = 0.939. 95% CI 0.884–0.968). Table 2 The descriptive results of the instruments Outcomes Mean (SD) Pain self-efficacy (PSEQ- HU) 36.18 ± 17.04 Current pain intensity. NRS 4.09 ± 3.02 Perceived stress level - PSS 30.92 ± 8.72 Pain catastrophizing - PCS 27.46 ± 14.24 Health-related quality of life - SF-36 Physical functioning 73.38 ± 23.59 Role limitations due to physical health 43.87 ± 41.61 Role limitations due to emotional problems 50.83 ± 44.39 Energy/fatigue 45.06 ± 14.03 Emotional wellbeing 46.16 ± 14.45 Social functioning 62.26 ± 32.35 Pain 46.33 ± 28.11 General health 44.93 ± 23.74 Table 3 Internal consistency of the PSEQ-HU Item Mean (SD) Corrected item-total correlation Cronbach’s α when deleted PSEQ-HU 1 3.60 1.81 0.823 0.964 PSEQ-HU 2 4.11 1.78 0.864 0.962 PSEQ 3 3.76 1.97 0.854 0.962 PSEQ 4 3.87 1.80 0.861 0.962 PSEQ 5 4.01 1.85 0.869 0.962 PSEQ 6 3.57 1.93 0.890 0.961 PSEQ 7 2.73 2.26 0.700 0.969 PSEQ8 3.56 2.01 0.871 0.962 PSEQ9 3.52 2.03 0.892 0.961 PSEQ10 3.44 1.97 0.876 0.962 PSEQ-HU Cronbach’s α = 0.966 Floor and ceiling effects were insignificant, 0.7% and 8.9% of the participants scored the lowest and highest possible scores respectively. Table 2 shows the values of the mean and standard deviation of the different questionnaires. The CFA supported the one-factor structure of the PSEQ-HU questionnaire in the sample we used. (RMSEA = 0.070; TLI (Tucker Lewis) = 0.981; CFI = 0.987; χ²=70.597; df = 31; p < 0.001; χ²/df = 2.277). All items converged meaningfully onto the scale as predicted with significant standardized factor loadings (all p’s < 0.01) ranging from 0.71 to 0.91. Modification indices suggested that the errors between different items presented on Fig. 2 . Table 4 presents the correlations between PSEQ – HU and other measurment tools. We have found weak to moderate correlations between SF-36 subscales and the PSEQ-HU total score and negative significant moderate correlations between PCS. PSS and PSEQ-HU total scores. Table 4 Convergent validity of the PSEQ-HU and the other measurement tools (n = 262). Questionnaire Correlation with total score of PSEQ HU (r. p) (n = 262) SF-36 Physical functioning 0.539** Role Functioning Physical 0.552** Social Functioning 0.560** Bodily pain 0.626** Role functioning emotional 0.427** Emotional Well-Being 0.221** Energy/Vitality 0.520** General Health perception 0.427** PSS -0.404** PCS -0.544** level of significance **=p < 0.001 During the examination of discriminant validity, we applied the Mann-Whitney U test, and the test results indicated a significant difference in the mean scores of the PSEQ-HU between the two groups formed based on the current NRS (p < 0.001). The „no or mild pain” group (45.35 ± 15.19) and the „moderate or severe pain” group (30.41 ± 15.58) showed significant (p < 0.001) differences regarding the PSEQ-HU mean value scores. Discussion Our study aimed to translate and cross-culturally adapt the PSEQ into the Hungarian language and examine its reliability and validity on a sample of women suffering from endometriosis-related chronic pelvic pain. PSEQ itself was used in other studies examining chronic pelvic pain 45 . We examined the psychometric properties of the Hungarian version of PSEQ-HU. Our sample was patients suffering from endometriosis and chronic pelvic pain. According to a 2021 study, PSEQ has been proven to be a reliable, valid and responsive tool, and further studies are required to determine responsiveness in populations with other chronic pain disorders. Dubé’s study examined the psychometric properties of the PSEQ among patients with chronic muscoloskeletal pain. 46 . The mean score of the PSEQ in our study was 36.18 ± 17.04 while the mean score of the original PSEQ was 25.8 ± 12.4 points in a sample of patients with CLBP. Our study was similar to the values in the Persian 36.7 ± 14.3, or Italian study 36.12 ± 12.90. The NRS value of the Hungarian sample (current pain 4.09 ± 3.02) were also similar to the Italian validation study (current pain intensity 4.58 ± 2.0). Similar to other studies, in the current study CFA supported the one-factor structure of the PSEQ. With each item was deleted. Cronbach’s α remained stabil. No significant ceiling and floor effects were found similar to other studies as Italian 22 version. The PSEQ-HU showed good psychometric properties with good indications of reliability and validity. The PSEQ-HU showed excellent internal consistency (Cronbach’s α = 0.966), in congruence with the Hebrew (Cronbach’s α = 0.97) version, Italian 22 (Cronbach’s α = 0.94), Persian 25 (Cronbach’s α: 0.92), Dutch 20 (Cronbach’s α: 0.92) and the original validation 27 (Cronbach’s α: 0.92) studies showed. The PSEQ-HU had excellent test-retest reliability. The PSEQ-HU demonstrated high test-retest reliability (ICC = 0.939. 95% CI 0.884–0.968) congruent with the other validation studies of the PSEQ. We used 2 weeks between initial test and retest suggested by the relevant literature 31 32 . Convergent validity was confirmed in our study. The study showed that PSEQ-HU is significantly and negatively associated with measures of pain catastrophizing, higher stress and pain levels 47 . The correlation between the PSEQ-HU and the PCS was moderate (r=-0.544), similar to the Japanese (r=-0.49), and Italian: (r=-0.418) validational studies. Correlations with NRS: current study (r=-0.479), Italian: (r=-0.399). Our findings that higher Health-related Quality of life is associated with higher self-efficacy is consistent with the results of the other cross-cultural adaptations and validations. Among SF-36 domains we have found a significant moderate positive correlation between physical functioning (r = 0.539) correspondence with similar moderate correlations in other studies Dutch: (r = 0.315), Amharic (r = 0.38) and Persian (r = 0.31). Bodily pain had the strongest correlation with PSEQ-HU in the current study (r = 0.626) in other studies it is a moderate association: Amharic (r = 0.51), Japanese (r = 0.45). We have also found significant moderate correlations between PSEQ-HU and general health domain of the SF-36 (r = 0.427), Amharic (r = 0.40), Persian (r = 0.52), Japanese: (r = 0.31). Vitality was also significantly correlated with PSEQ-HU in our study (r = 0.520), similar to Persian (r = 0.51) and Japanese (r = 0.46) results. Regarding social functioning in our study we have found moderate correlations (r = 0.560), similar tot he Dutch: (r = 0.489), Persian (r = 0.43) and Japanese (r = 0.43) validations. A moderate correlation has been found between PSEQ-HU and the role limitations due to physical health domain of SF-36 (r = 0.552), in accordance with the Amharic (r = 0.32), Persian (r = 0.33), and Japanese (r = 0.41) validation studies of the PSEQ. Role limitations due to mental health showed a moderate significant correlation in our study (r = 0.42), and Japanese (r = 0.41), Persian (r = 0.34) studies showed similar moderate correlations. Only mental health and emotional wellbeing domain showed a weak correlation in the current study (r = 0.221), while in other studies moderate correlations were found (Amharic (r = 0.36), Persian (r = 0.42), Japanese (r = 0.40) 14 25 20 . The results of the current study indicated a significant difference in the mean scores of the PSEQ-HU between the two groups 49 (Breivik et al.. 2008) formed based on the NRS values of the participants (p < 0.001). Although the current article has several strengths, our study has some limitations. First, all patients were recruited from 3 thematic social media groups, the sample was not representative. The number of participants were 262, which is an average number. Also this is the first time this measurement tool has been validated on chronic pelvic pain and endometriosis population. Conclusion The current study indicates that the PSEQ-HU is a valid and reliable instrument for evaluating pain related self-efficacy of individuals with chronic pelvic pain. The translation and cultural adaptation of the PSEQ-HU could contribute to further studies of chronic pain, pain-related self-efficacy and the factors influencing pain-related self-efficacy. The PSEQ-HU may be a useful tool to help determining the effect of different treatment methods on chronic pain and pain-related self-efficacy. Additionally it can be suitable for developing patient-centered care in the Hungarian population with pelvic pain and endometriosis as pain-related self-efficacy is an important predictor of overall health beliefs. Declarations Conflict of interest Authors have no conflict of interest to declare in the current study. Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author Contribution ZSKSZ wrote the main manuscript text, AM helped in preparing statistical analysis, MH helped in writing the main manuscript text and preparing the figures, PÁ prepared the tables. All authors reviewed the manuscript. Data availability: All data generated or analyzed during this study are included in this published article. The data presented in this study are available on request from the corresponding author. The data is not publicly available due to privacy concerns. References Mills SEE, Nicolson KP, Smith BH. 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Obstetrics & Gynecology. 2020;135(3):e98-e109. doi: 10.1097/AOG.0000000000003716 Marx RG, Menezes A, Horovitz L, Jones EC, Warren RF. A comparison of two time intervals for test-retest reliability of health status instruments. Journal of Clinical Epidemiology. 2003;56(8):730–735. doi: 10.1016/S0895-4356(03)00084-2 Wyse AE. How Days Between Tests Impacts Alternate Forms Reliability in Computerized Adaptive Tests. Educational and Psychological Measurement. 2021;81(4):644–667. doi: 10.1177/0013164420979656 Sullivan MJL, Bishop SR, Pivik J. The Pain Catastrophizing Scale: Development and validation. Psychological Assessment. 1995;7(4):524–532. doi: 10.1037/1040-3590.7.4.524 Galambos A, Stoll DP, Bolczár S, Lazáry Á, Urbán R, Kökönyei G. A bifactor structural model of the Hungarian Pain Catastrophizing Scale and latent classes of a clinical sample. Heliyon. 2021;7(9):e08026. doi: 10.1016/j.heliyon.2021.e08026 Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473–483. Czimbalmos Á, Zsolt N, Zoltán V, Husztik P. Páciens megelégedettségi vizsgálat SF-36 kérdőívvel, a magyarországi normálértékek meghatározása. Népegészségügy. 1999;80(1):4–19. Cohen S, Kamarck T, Mermelstein R. Perceived Stress Scale. Published online February 10, 2014. doi: 10.1037/t02889-000 Stauder A, Konkoly Thege B. AZ ÉSZLELT STRESSZ KÉRDŐÍV (PSS) MAGYAR VERZIÓJÁNAK JELLEMZŐI. Mentálhigiéné és Pszichoszomatika. 2006;7(3):203–216. doi: 10.1556/Mental.7.2006.3.4 Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures: Spine. 2000;25(24):3186–3191. doi: 10.1097/00007632-200012150-00014 Terwee CB, Bot SDM, Boer MR de, et al. Quality criteria were proposed for measurement properties of health status questionnaires. Journal of Clinical Epidemiology. 2007;60(1):34–42. doi: 10.1016/j.jclinepi.2006.03.012 Koo TK, Li MY. A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. Journal of chiropractic medicine. 2016;15(2):155–163. doi: 10.1016/j.jcm.2016.02.012 Brown, T. A. (2015). Confirmatory factor analysis for applied research (2nd ed.). The Guilford Press. Carlson KD, Herdman AO. Understanding the Impact of Convergent Validity on Research Results. Organizational Research Methods. 2012;15(1):17–32. doi: 10.1177/1094428110392383 Breivik H, Borchgrevink PC, Allen SM, et al. Assessment of pain. British Journal of Anaesthesia. 2008;101(1):17–24. doi: 10.1093/bja/aen103 Beaumont T, Phillips K, Hull ML, Green R. Does group physiotherapy improve pain scores and reduce the impact of pelvic pain for women referred with persistent pelvic pain? A clinical trial. Journal of Endometriosis and Pelvic Pain Disorders. 2022;14(4):169–177. doi: 10.1177/22840265221141527 Dubé MO, Langevin P, Roy JS. Measurement properties of the Pain Self-Efficacy Questionnaire in populations with musculoskeletal disorders: a systematic review. PR9. 2021;6(4):e972. doi: 10.1097/PR9.0000000000000972 Arnstein P, Caudill M, Mandle CL, Norris A, Beasley R. Self efficacy as a mediator of the relationship between pain intensity, disability and depression in chronic pain patients. Pain. 1999;80(3):483–491. doi: 10.1016/S0304-3959(98)00220-6 Chala MB, Donnelly C, Wondie Y, Ghahari S, Miller J. Cross-cultural translation, adaptation, and validation of the Amharic version pain self-efficacy questionnaire in people with low back pain in Ethiopia. BMC Musculoskeletal Disorders. 2021;22(1):111. doi: 10.1186/s12891-021-03985-4 Breivik H, Borchgrevink PC, Allen SM, et al. Assessment of pain. British Journal of Anaesthesia. 2008;101(1):17–24. doi: 10.1093/bja/aen103 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4060366","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":284090481,"identity":"471b4a01-cfad-45dc-80a3-b4b3758b7128","order_by":0,"name":"Zsófia Kovács-Szabó","email":"","orcid":"","institution":"University of Pécs Institute of Physiotherapy and Sports Science","correspondingAuthor":false,"prefix":"","firstName":"Zsófia","middleName":"","lastName":"Kovács-Szabó","suffix":""},{"id":284090483,"identity":"8a837795-c078-41e8-bb56-93c5b02f91de","order_by":1,"name":"Alexandra Makai","email":"data:image/png;base64,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","orcid":"","institution":"University of Pécs Institute of Physiotherapy and Sports Science","correspondingAuthor":true,"prefix":"","firstName":"Alexandra","middleName":"","lastName":"Makai","suffix":""},{"id":284090485,"identity":"2ca8a2a6-3d21-4622-9efc-856ab91105eb","order_by":2,"name":"Pongrác Ács","email":"","orcid":"","institution":"University of Pécs Institute of Physiotherapy and Sports Science","correspondingAuthor":false,"prefix":"","firstName":"Pongrác","middleName":"","lastName":"Ács","suffix":""},{"id":284090486,"identity":"85de50ef-be17-490b-86c7-a038c4c046cc","order_by":3,"name":"Márta Hock","email":"","orcid":"","institution":"University of Pécs Institute of Physiotherapy and Sports Science","correspondingAuthor":false,"prefix":"","firstName":"Márta","middleName":"","lastName":"Hock","suffix":""}],"badges":[],"createdAt":"2024-03-09 23:00:02","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4060366/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4060366/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":53532872,"identity":"5cb0b763-1843-4421-9821-fb943bbcac67","added_by":"auto","created_at":"2024-03-27 06:51:43","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":64227,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eflow chart of the recruitment process of the sample\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNRS: numerical rating scale\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4060366/v1/bcb3229c113ad15827a185bd.png"},{"id":53532870,"identity":"ec73aec8-064f-4d9f-a347-677a48799cb7","added_by":"auto","created_at":"2024-03-27 06:51:42","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":298370,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eConfirmatory Factor Analysis of PSEQ-HU: Initial Model\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePSEQ-HU: Hungarian version of the Pain Self-efficacy Questionnaire\u003c/em\u003e\u003c/p\u003e","description":"","filename":"figure2PSEQ.png","url":"https://assets-eu.researchsquare.com/files/rs-4060366/v1/502f526488d645e0e33ff9a6.png"},{"id":58776984,"identity":"a45ca260-027f-49f2-ad80-8fbe383ba472","added_by":"auto","created_at":"2024-06-21 03:31:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1048811,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4060366/v1/ff276618-ea29-4183-9545-0721795d11d5.pdf"},{"id":53532871,"identity":"c7024f82-d3bd-4d83-a266-903d542c4094","added_by":"auto","created_at":"2024-03-27 06:51:43","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":1345140,"visible":true,"origin":"","legend":"","description":"","filename":"cosminchecklistPSEQ2.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4060366/v1/5b74c19ea1f1ecfdd7760d7e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Validity and reliability of the Hungarian version of the Pain Self-efficacy Questionnaire among women with endometriosis and chronic pelvic pain","fulltext":[{"header":"Introduction","content":"\u003cp\u003eChronic pain is a prevalent and multifactorial problem that has a significant impact on both individuals and society worldwide. Chronic pain affects a significant amount of the population and represents a serious socioeconomic burden \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eChronic pelvic pain is a common chronic pain syndrome that affects a significant number of women, especially those suffering from endometriosis. The global prevalence of Chronic Pelvic Pain (CPP) varies from 5\u0026ndash;43% for women and 2\u0026ndash;17% for men \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Chronic pelvic pain involves unique areas of life such as the ability to sit, sexual life and has a significant effect on work productivity.\u003c/p\u003e \u003cp\u003eEndometriosis is a chronic, progressive, inflammatory gynecological disease that affects more than 70\u0026nbsp;million women worldwide. In the United States 11% of women and approximately every 10th woman worldwide and in Hungary suffer from endometriosis \u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. Additionally, it occurs among 40\u0026ndash;50% of women with pelvic pain, 20% of women with infertility, 50% and 70% of women suffering from dysmenorrhea and dyspareunia \u003csup\u003e5 6\u003c/sup\u003e. Pelvic pain, lower quality of life, and high levels of fatigue are highly prevalent among women with endometriosis, and according to the literature, up to 50% of them may experience depression and anxiety \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Pelvic pain associated with endometriosis is one of the main reasons for the decline in health-related quality of life of women concerned. It also reduces the quality of sleep and the level of physical activity as well as increases the level of perceived stress and influences body image \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Psychological factors play an essential role in coping with chronic pain, and self-efficacy \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e has been identified as an important resilience factor to manage pain moreover it has a significant effect on functioning and coping with chronic pain \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Self-efficacy has been proven to be an even more important determinant of disability than pain intensity, fear of movement, pain duration, or anxiety \u003csup\u003e11 12\u003c/sup\u003e. A lower self-efficacy level is identified with higher pain intensity \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e while a higher self-efficacy level is associated with greater physical functioning and physical activity participation \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePain-related self-efficacy has been confirmed to be negatively associated with stress and pain catastrophization among patients suffering from chronic pain \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThere are several other measurement tools for evaluating self-efficacy as the Arthritis Self-Efficacy Scale \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e, the Rheumatoid arthritis Self-Efficacy Scale \u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e, the Chronic Pain self-Efficacy Scale \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e, but among these the Pain Self-Efficacy Questionnaire \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e is an extensively researched and reliable tool for evaluating pain-related self-efficacy in subjects with chronic pain (cancer, musculoskeletal chronic pain). According to a 2019 Delphi Study, the Pain Self-Efficacy Questionnaire (PSEQ) is an extensively researched and reliable tool for evaluating pain-related self-efficacy in subjects with chronic pain \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe original version of PSEQ was developed and validated in English \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e (Nicholas 2007) and has been tested in samples with chronic pain.\u003c/p\u003e \u003cp\u003eExcellent reliability and validity have been demonstrated in different languages such as Japanese \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e, Dutch \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e, Hebrew \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e, Yoruba \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e, Italian \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e, Arabic \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e Catalan \u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e, Persian \u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e, Canadian-French \u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e (Dub\u0026eacute; et al., 2022), and Brazilian \u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. As PSEQ is still not available in the Hungarian language, the translation and cultural adaptation of PSEQ is required by the growing number of studies concerning the behavioral and psychological aspects of chronic pain in Hungary.\u003c/p\u003e \u003cp\u003eThe aims of the present study were to translate the PSEQ into Hungarian language through a process of cross-cultural adaptation and to test its measurement properties on a Hungarian sample of patients presenting with chronic pelvic pain and endometriosis.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe current study is a cross-sectional online survey, distributed via social media using endometriosis support groups in Hungary between 2023. January and 2023. April.\u003c/p\u003e \u003cp\u003eThe sample size to assess internal consistency and construct validity was determined according to the COSMIN guideline, which recommends that the sample size be 10 times larger than the number of items \u003csup\u003e28 29\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eVoluntarily participating women suffering from endometriosis and chronic pelvic pain \u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e aged between 18\u0026ndash;50, and living in Hungary were recruited for the study. Pregnant women, women not diagnosed with endometriosis, or women under 18 and above 50 were excluded from the study. We asked 39 participants to fill in the questionnaire 2 weeks after the initial testing according to the COSMIN guideline and other relevant studies \u003csup\u003e31 32\u003c/sup\u003e (COSMIN checklist is in the Supplementary data file 1).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eOriginal Pain Self-efficacy Questionnaire\u003c/h2\u003e \u003cp\u003eThe self-administered PSEQ is a specific questionnaire developed to assess pain-related self-efficacy covering the previous 4 week period in people with chronic pain, aimed to evaluate how confident the participants are in everyday activities despite the pain. The questionnaire includes 10 questions using a 7-point Likert scale. The score is calculated by summing up the responses, the maximum score is 60 showing excellent pain-related self-efficacy. The original English version of the questionnaire showed excellent internal consistency (Cronbach α: 0.92) and test-retest reliability \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003ePain Catastrophizing Scale\u003c/h2\u003e \u003cp\u003ePCS \u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e is a validated, self-assessment questionnaire, consisting of 13 statements containing different thoughts and feelings one may experience when enduring pain. The items are divided into the categories of rumination (items 8\u0026ndash;11) (Cronbach α: 0.792), magnification (items 6,7 \u0026eacute;s 13) (Cronbach α: 0.785) and helplessness (items 1\u0026ndash;5 and 12) (Cronbach α: 0.883), with each item scored on a 5-point scale. The overall score has a range of 0\u0026ndash;52. Higher scores indicate a higher level of pain catastrophizing. The Hungarian version of PCS \u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e, has demonstrated good internal consistency.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e36 Item Short-Form Health Survey\u003c/h2\u003e \u003cp\u003eThe questionnaire \u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e consisting of 8 domains: physical functioning, bodily pain, role limitations due to physical health problems, role limitations due to personal or emotional problems, emotional well-being, social functioning, energy/fatigue, and general health perceptions. Higher scores indicate higher health-related quality of life. The scores were transformed to a 0-100 scale. During the cross-cultural adaptation of the SF-36 the Hungarian version of 36 Item Short-Form Health Survey \u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e showed excellent internal consistency, Cronbach 0.93.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003ePerceived Stress Scale- 10\u003c/h2\u003e \u003cp\u003ePSS-10 \u003csup\u003e37\u003c/sup\u003e is a self-administered questionnaire developed to assess stress levels and \u0026ldquo;the degree to which individuals appraise situations in their lives as stressful\u0026rdquo;. The scale includes 10 questions, consisting of 5 answer options related to frequency, varying from 0\u0026ndash;4. Higher scores indicate higher stress levels, 40 is the highest possible score. The Hungarian version of PSS-10 \u003csup\u003e38\u003c/sup\u003e had good internal consistency (Cronbach α: 0.85).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eNumeric Pain Rating Scale\u003c/h2\u003e \u003cp\u003eThe scale \u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e is a widely used and valid instrument in the literature, aimed to assess the subjective level of pain on a scale of 0\u0026ndash;10, where 0 is no pain at all and 10 is the maximum possible pain. In the current study, the participants were asked to rate their average and maximum pain levels in the last 4 weeks and their actual pain intensity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003eThe study was conducted anonymously and all participants were asked for a written consent after receiving detailed information. Ethical approval for the study was obtained by the Institutional Review Board of the Faculty of Medicine, University of P\u0026eacute;cs, in 2023 (no.: 9534-PTE 2023; Clinical trial number: NCT05863663) following the 2008 Helsinki Declaration.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eValidation process\u003c/h2\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eTranslation and cultural adaptation process\u003c/h2\u003e \u003cp\u003eThe translation and cross-cultural adaptation were completed through a multistage process \u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e. Receiving the consent from the original investigator of the PSEQ to the translation, cross-cultural adaptation, and validation into the Hungarian language, the linguistic validation was carried out according to the relevant guidelines.\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eIn phase one of the study, the PSEQ was forward-translated from English to Hungarian by two independent translators. The first translator was aware of the concept of the questionnaire and as a physiotherapist had a clinical background, while the second translator was not informed about the questionnaire, and as an English teacher did not have a clinical perspective. Then a synthesis between translations was made to confirm the equivalence with the original version.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe back translation of the PSEQ into the original English language was performed by an independent physiotherapist with high-level English proficiency.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWe had an committee composed of a medical doctor, an English teacher, a physiotherapist, and a patient suffering from endometriosis, which created the pre-final version of the questionnaire.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe pre-final version was piloted to 15 Hungarian women suffering from endometriosis and they were asked to report back on the readability, cultural relevance and comprehensiveness of the translated version. Only minor changes were suggested so the final Hungarian version of the self-administered PSEQ-HU was accepted.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eFollowing the creation of the final version of the questionnaire, we evaluated the following psychometric properties of the PSEQ-HU: content validity, structural validity, internal consistency, test-retest reliability, convergent validity, and discriminative validity.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003eReliability\u003c/h2\u003e \u003cp\u003eInternal consistency assesses the degree to which items within an instrument are interconnected, indicating their strength of association (homogeneity). Cronbach\u0026rsquo;s α was used to verify internal consistency and values between 0.70 and 0.95 are considered adequate \u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e. Test-retest reliability was examined with an intraclass correlation coefficient (ICC). ICC values of 0.75\u0026ndash;1.00 were interpreted as excellent \u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eValidity\u003c/h2\u003e \u003cp\u003eContent validity was explored by score distributions and floor/ceiling effects, the latter are considered to be present if more than 15% of the sample achieves the lowest (floor) or highest (ceiling) possible score.\u003c/p\u003e \u003cp\u003eOur study aimed to confirm the structural validity of the instrument using confirmatory factor analysis CFA) and reliability statistics such as CFI, TLI, RMSEA, and 90% CI. A ratio of \u0026lt;\u0026thinsp;3 between the chi-square test and degrees of freedom, CFI and TLI of 0.90 or more, and RMSEA values of 0.08 or less indicated a good model fit. We calculated factor loadings for each item and identified loadings below 0.5 for potential item reduction \u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eConvergent validity of the PSEQ was explored using Spearman\u0026rsquo;s rank correlation analysis between the total score of the PSEQ and the NRS and SF-36, PCS \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e PSS Correlation was classified as moderate (0.3\u0026thinsp;\u0026lt;\u0026thinsp;r\u0026thinsp;\u0026gt;\u0026thinsp;0.69) or strong (r\u0026thinsp;\u0026gt;\u0026thinsp;0.7) \u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFor the examination of discriminant validity, based on the average scores of NRS over the past 4 weeks, we created 2 groups (0\u0026ndash;4, no or mild pain 5\u0026ndash;10 moderate and severe). Mann-Whitney U-test tested discriminative validity to examine the differences in PSEQ scores between patients having mild or moderate/severe pain\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eDescriptive statistics were applied to establish sample characteristics, central tendency estimates, and the variability of the data set. These data were presented as means, standard deviations (SD) or percentages (%).\u003c/p\u003e \u003cp\u003eData analysis was performed using IBM SPSS 28.0 software and IBM SPSS AMOS 29.0 (SPSS Inc., Chicago, IL) version. The level of significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0,05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eInitially, 277 participants were recruited and then 15 were excluded therefore 262 adult women suffering from endometriosis (mean age 34.39\u0026thinsp;\u0026plusmn;\u0026thinsp;6.68) participated in the study \u003cem\u003e(\u003c/em\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). A subgroup of 39 participants was asked to fill out the survey twice, 14 days after the initial testing sample-be \u0026iacute;rni ink\u0026aacute;bb. The sample\u0026rsquo;s profile and sociodemographic characteristics are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSample characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\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 \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\u003eFinal sample n\u0026thinsp;=\u0026thinsp;262 (n;%)\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\u003e1.\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Marital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eliving alone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34 (13.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eliving with partner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e94 (36.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e127 (48.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003edivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2.\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Educational level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eelementary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esecondary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e106 (40.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehigher education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e151 (57.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3.\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Work category\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esedentary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e154 (59.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elight physical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56 (21.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eheavy physical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (2.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003estanding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27 (10.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eunemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (5.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e4.\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Residence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e112 (42.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003evillage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43 (16.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eadministrational center\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41 (15.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecapital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e65\u0026nbsp;(24.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e7. Pelvic pain duration (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9.23\u0026thinsp;\u0026plusmn;\u0026thinsp;7.7\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 internal consistency of the PSEQ- HU was excellent with Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.966 (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Test-retest reliability of the PSEQ-HU in a sample of 39 women yielded excellent results (ICC\u0026thinsp;=\u0026thinsp;0.939. 95% CI 0.884\u0026ndash;0.968).\u003c/p\u003e \n \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe descriptive results of the instruments\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=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eOutcomes\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eMean (SD)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePain self-efficacy (PSEQ- HU)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.18\u0026thinsp;\u0026plusmn;\u0026thinsp;17.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCurrent pain intensity. NRS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.09\u0026thinsp;\u0026plusmn;\u0026thinsp;3.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerceived stress level - PSS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.92\u0026thinsp;\u0026plusmn;\u0026thinsp;8.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePain catastrophizing - PCS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.46\u0026thinsp;\u0026plusmn;\u0026thinsp;14.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003e\u003cb\u003eHealth-related quality of life - SF-36\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysical functioning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e73.38\u0026thinsp;\u0026plusmn;\u0026thinsp;23.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRole limitations due to physical health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e43.87\u0026thinsp;\u0026plusmn;\u0026thinsp;41.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRole limitations due to emotional problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e50.83\u0026thinsp;\u0026plusmn;\u0026thinsp;44.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEnergy/fatigue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e45.06\u0026thinsp;\u0026plusmn;\u0026thinsp;14.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmotional wellbeing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e46.16\u0026thinsp;\u0026plusmn;\u0026thinsp;14.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSocial functioning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e62.26\u0026thinsp;\u0026plusmn;\u0026thinsp;32.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e46.33\u0026thinsp;\u0026plusmn;\u0026thinsp;28.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e44.93\u0026thinsp;\u0026plusmn;\u0026thinsp;23.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \n\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInternal consistency of the PSEQ-HU\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCorrected item-total correlation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCronbach\u0026rsquo;s α when deleted\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\u003ePSEQ-HU 1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.823\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.964\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSEQ-HU 2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.864\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.962\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSEQ 3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.854\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.962\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSEQ 4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.861\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.962\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSEQ 5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.869\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.962\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSEQ 6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.890\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.961\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSEQ 7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.969\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSEQ8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.871\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.962\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSEQ9\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.892\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.961\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSEQ10\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.876\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.962\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSEQ-HU Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.966\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFloor and ceiling effects were insignificant, 0.7% and 8.9% of the participants scored the lowest and highest possible scores respectively. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the values of the mean and standard deviation of the different questionnaires.\u003c/p\u003e\u003cp\u003eThe CFA supported the one-factor structure of the PSEQ-HU questionnaire in the sample we used. (RMSEA\u0026thinsp;=\u0026thinsp;0.070; TLI (Tucker Lewis)\u0026thinsp;=\u0026thinsp;0.981; CFI\u0026thinsp;=\u0026thinsp;0.987; χ\u0026sup2;=70.597; df\u0026thinsp;=\u0026thinsp;31; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; χ\u0026sup2;/df\u0026thinsp;=\u0026thinsp;2.277). All items converged meaningfully onto the scale as predicted with significant standardized factor loadings (all p\u0026rsquo;s\u0026thinsp;\u0026lt;\u0026thinsp;0.01) ranging from 0.71 to 0.91. Modification indices suggested that the errors between different items presented on Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents the correlations between PSEQ \u0026ndash; HU and other measurment tools. We have found weak to moderate correlations between SF-36 subscales and the PSEQ-HU total score and negative significant moderate correlations between PCS. PSS and PSEQ-HU total scores.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eConvergent validity of the PSEQ-HU and the other measurement tools (n\u0026thinsp;=\u0026thinsp;262).\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eQuestionnaire\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eCorrelation with total score of PSEQ HU (r. p) (n\u0026thinsp;=\u0026thinsp;262)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSF-36\u003c/b\u003e\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\u003ePhysical functioning\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.539**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRole Functioning Physical\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.552**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSocial Functioning\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.560**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBodily pain\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.626**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRole functioning emotional\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.427**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmotional Well-Being\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.221**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEnergy/Vitality\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.520**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGeneral Health perception\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.427**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.404**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePCS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.544**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003cem\u003elevel of significance **=p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eDuring the examination of discriminant validity, we applied the Mann-Whitney U test, and the test results indicated a significant difference in the mean scores of the PSEQ-HU between the two groups formed based on the current NRS (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The \u0026bdquo;no or mild pain\u0026rdquo; group (45.35\u0026thinsp;\u0026plusmn;\u0026thinsp;15.19) and the \u0026bdquo;moderate or severe pain\u0026rdquo; group (30.41\u0026thinsp;\u0026plusmn;\u0026thinsp;15.58) showed significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) differences regarding the PSEQ-HU mean value scores.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study aimed to translate and cross-culturally adapt the PSEQ into the Hungarian language and examine its reliability and validity on a sample of women suffering from endometriosis-related chronic pelvic pain. PSEQ itself was used in other studies examining chronic pelvic pain \u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e. We examined the psychometric properties of the Hungarian version of PSEQ-HU.\u003c/p\u003e \u003cp\u003eOur sample was patients suffering from endometriosis and chronic pelvic pain. According to a 2021 study, PSEQ has been proven to be a reliable, valid and responsive tool, and further studies are required to determine responsiveness in populations with other chronic pain disorders. Dub\u0026eacute;\u0026rsquo;s study examined the psychometric properties of the PSEQ among patients with chronic muscoloskeletal pain.\u003csup\u003e\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe mean score of the PSEQ in our study was 36.18\u0026thinsp;\u0026plusmn;\u0026thinsp;17.04 while the mean score of the original PSEQ was 25.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.4 points in a sample of patients with CLBP. Our study was similar to the values in the Persian 36.7\u0026thinsp;\u0026plusmn;\u0026thinsp;14.3, or Italian study 36.12\u0026thinsp;\u0026plusmn;\u0026thinsp;12.90. The NRS value of the Hungarian sample (current pain 4.09\u0026thinsp;\u0026plusmn;\u0026thinsp;3.02) were also similar to the Italian validation study (current pain intensity 4.58\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0).\u003c/p\u003e \u003cp\u003eSimilar to other studies, in the current study CFA supported the one-factor structure of the PSEQ. With each item was deleted. Cronbach\u0026rsquo;s α remained stabil. No significant ceiling and floor effects were found similar to other studies as Italian \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e version.\u003c/p\u003e \u003cp\u003eThe PSEQ-HU showed good psychometric properties with good indications of reliability and validity. The PSEQ-HU showed excellent internal consistency (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.966), in congruence with the Hebrew (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.97) version, Italian \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.94), Persian\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e (Cronbach\u0026rsquo;s α: 0.92), Dutch \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e (Cronbach\u0026rsquo;s α: 0.92) and the original validation \u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e (Cronbach\u0026rsquo;s α: 0.92) studies showed. The PSEQ-HU had excellent test-retest reliability.\u003c/p\u003e \u003cp\u003eThe PSEQ-HU demonstrated high test-retest reliability (ICC\u0026thinsp;=\u0026thinsp;0.939. 95% CI 0.884\u0026ndash;0.968) congruent with the other validation studies of the PSEQ. We used 2 weeks between initial test and retest suggested by the relevant literature \u003csup\u003e31 32\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eConvergent validity was confirmed in our study. The study showed that PSEQ-HU is significantly and negatively associated with measures of pain catastrophizing, higher stress and pain levels \u003csup\u003e\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e. The correlation between the PSEQ-HU and the PCS was moderate (r=-0.544), similar to the Japanese (r=-0.49), and Italian: (r=-0.418) validational studies. Correlations with NRS: current study (r=-0.479), Italian: (r=-0.399).\u003c/p\u003e \u003cp\u003eOur findings that higher Health-related Quality of life is associated with higher self-efficacy is consistent with the results of the other cross-cultural adaptations and validations. Among SF-36 domains we have found a significant moderate positive correlation between physical functioning (r\u0026thinsp;=\u0026thinsp;0.539) correspondence with similar moderate correlations in other studies Dutch: (r\u0026thinsp;=\u0026thinsp;0.315), Amharic (r\u0026thinsp;=\u0026thinsp;0.38) and Persian (r\u0026thinsp;=\u0026thinsp;0.31). Bodily pain had the strongest correlation with PSEQ-HU in the current study (r\u0026thinsp;=\u0026thinsp;0.626) in other studies it is a moderate association: Amharic (r\u0026thinsp;=\u0026thinsp;0.51), Japanese (r\u0026thinsp;=\u0026thinsp;0.45). We have also found significant moderate correlations between PSEQ-HU and general health domain of the SF-36 (r\u0026thinsp;=\u0026thinsp;0.427), Amharic (r\u0026thinsp;=\u0026thinsp;0.40), Persian (r\u0026thinsp;=\u0026thinsp;0.52), Japanese: (r\u0026thinsp;=\u0026thinsp;0.31). Vitality was also significantly correlated with PSEQ-HU in our study (r\u0026thinsp;=\u0026thinsp;0.520), similar to Persian (r\u0026thinsp;=\u0026thinsp;0.51) and Japanese (r\u0026thinsp;=\u0026thinsp;0.46) results. Regarding social functioning in our study we have found moderate correlations (r\u0026thinsp;=\u0026thinsp;0.560), similar tot he Dutch: (r\u0026thinsp;=\u0026thinsp;0.489), Persian (r\u0026thinsp;=\u0026thinsp;0.43) and Japanese (r\u0026thinsp;=\u0026thinsp;0.43) validations. A moderate correlation has been found between PSEQ-HU and the role limitations due to physical health domain of SF-36 (r\u0026thinsp;=\u0026thinsp;0.552), in accordance with the Amharic (r\u0026thinsp;=\u0026thinsp;0.32), Persian (r\u0026thinsp;=\u0026thinsp;0.33), and Japanese (r\u0026thinsp;=\u0026thinsp;0.41) validation studies of the PSEQ. Role limitations due to mental health showed a moderate significant correlation in our study (r\u0026thinsp;=\u0026thinsp;0.42), and Japanese (r\u0026thinsp;=\u0026thinsp;0.41), Persian (r\u0026thinsp;=\u0026thinsp;0.34) studies showed similar moderate correlations. Only mental health and emotional wellbeing domain showed a weak correlation in the current study (r\u0026thinsp;=\u0026thinsp;0.221), while in other studies moderate correlations were found (Amharic (r\u0026thinsp;=\u0026thinsp;0.36), Persian (r\u0026thinsp;=\u0026thinsp;0.42), Japanese (r\u0026thinsp;=\u0026thinsp;0.40) \u003csup\u003e14 25 20\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe results of the current study indicated a significant difference in the mean scores of the PSEQ-HU between the two groups \u003csup\u003e\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u003c/sup\u003e (Breivik et al.. 2008) formed based on the NRS values of the participants (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eAlthough the current article has several strengths, our study has some limitations. First, all patients were recruited from 3 thematic social media groups, the sample was not representative. The number of participants were 262, which is an average number. Also this is the first time this measurement tool has been validated on chronic pelvic pain and endometriosis population.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe current study indicates that the PSEQ-HU is a valid and reliable instrument for evaluating pain related self-efficacy of individuals with chronic pelvic pain. The translation and cultural adaptation of the PSEQ-HU could contribute to further studies of chronic pain, pain-related self-efficacy and the factors influencing pain-related self-efficacy.\u003c/p\u003e \u003cp\u003eThe PSEQ-HU may be a useful tool to help determining the effect of different treatment methods on chronic pain and pain-related self-efficacy. Additionally it can be suitable for developing patient-centered care in the Hungarian population with pelvic pain and endometriosis as pain-related self-efficacy is an important predictor of overall health beliefs.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eConflict of interest\u003c/h2\u003e \u003cp\u003eAuthors have no conflict of interest to declare in the current study.\u003c/p\u003e \u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eZSKSZ wrote the main manuscript text, AM helped in preparing statistical analysis, MH helped in writing the main manuscript text and preparing the figures, P\u0026Aacute; prepared the tables. All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eData availability:\u003c/h2\u003e \u003cp\u003eAll data generated or analyzed during this study are included in this published article. The data presented in this study are available on request from the corresponding author. The data is not publicly available due to privacy concerns.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMills SEE, Nicolson KP, Smith BH. Chronic pain: a review of its epidemiology and associated factors in population-based studies. British Journal of Anaesthesia. 2019;123(2):e273-e283. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.bja.2019.03.023\u003c/span\u003e\u003cspan address=\"10.1016/j.bja.2019.03.023\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhangari A. 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BMC Musculoskeletal Disorders. 2021;22(1):111. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12891-021-03985-4\u003c/span\u003e\u003cspan address=\"10.1186/s12891-021-03985-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBreivik H, Borchgrevink PC, Allen SM, et al. Assessment of pain. British Journal of Anaesthesia. 2008;101(1):17\u0026ndash;24. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/bja/aen103\u003c/span\u003e\u003cspan address=\"10.1093/bja/aen103\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4060366/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4060366/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eOur study aimed to perform Hungarian cross-cultural adaptation and assess the reliability and validity of the Pain Self-Efficacy Questionnaire (PSEQ) among women with chronic pelvic pain. The current study was conducted in Hungary among women aged 18–50 (34,39 ± 6,68 years). Besides PSEQ, the 36 Item Short-Form Health Survey (SF36), Visual Analog Scale (VAS), and Perceived Stress Scale (PSS) were used. We examined the reliability of the PSEQ-HU by applying internal consistency and test-retest evaluations. For construct validity of the PSEQ-HU we used confirmatory factor analysis (CFA) and for convergent validity Spearman rank correlation analysis was performed to assess the correlations between PSEQ-HU and SF-36, PCS, PSS and NRS. For discriminant validity two groups were created based on the NRS (0–4, 5–10). The results were analyzed via IBM SPSS version 28.0 software with a significance level of p \u0026lt; 0.05. 262 women took part in the study. Cronbach’s α was 0.966, the intraclass correlation coefficient values showed adequate reliability (ICC = 0.939. 95% CI 0.884–0.968) for the PSEQ-HU. Spearman correlation analysis showed significant correlations between pain-related self-efficacy and health-related quality of life, perceived stress levels and pain catastrophizing. We concluded that PSEQ is a reliable and valid measurement among Hungarian women endometriosis-related pelvic pain.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinicalTrials.gov registration: \u003c/strong\u003ehttps://register.clinicaltrials.gov/prs/app/action/LoginUser?ts=1\u0026amp;cx=-jg9qo4\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUnique protocol ID: \u003c/strong\u003e9534-PTE2023 NCT05863663\u003c/p\u003e","manuscriptTitle":"Validity and reliability of the Hungarian version of the Pain Self-efficacy Questionnaire among women with endometriosis and chronic pelvic pain","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-27 06:51:36","doi":"10.21203/rs.3.rs-4060366/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"879c112c-6328-4593-a23c-4dfb4b9e89cc","owner":[],"postedDate":"March 27th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":29905943,"name":"Health sciences/Diseases"},{"id":29905944,"name":"Health sciences/Health care"},{"id":29905945,"name":"Health sciences/Medical research"},{"id":29905946,"name":"Health sciences/Signs and symptoms"}],"tags":[],"updatedAt":"2024-06-21T03:23:49+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-27 06:51:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4060366","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4060366","identity":"rs-4060366","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}