The short form endometriosis health profile questionnaire (EHP-5): psychometric validity assessment of a Croatian version

Purpose To translate, adapt and validate the Endometriosis Health Profile-5 (EHP-5) in Croatian population.

This validation study is a part of a prospective, observational study (EHP-5 CRO) with aim of implementation of EHP-5 and to provide better insight in quality of life consideration of women with endometriosis in Croatian clinical practice. A 150 consecutive patients with surgically proven endometriosis were enrolled. The translation to Croatian followed standardized procedure. Cronbach's Alpha was calculated to calculate internal consistency reliability of EHP-5. The test–retest reliability was calculated using intraclass correlation coefficient (ICC). The t test for independent samples was used to assess known-groups validity.

Both EHP-5 core and EHP-5 modular parts of the questionnaire had good internal consistency, assessed by the Cronbach’s Alpha coefficient (α = 0.793 and α = 0.842, respectively). Obtained results indicate very good reliability for core as well as for modular part of EHP-5 questionnaire (ICC = 0.896 and 0.936, respectively). The independent t test showed that women who reported their pain with VAS scale 7 or more had significantly higher results (p < 0.001) on EHP-5 (M = 50.63) compared with women who reported their pain 6 or less (M = 26.91). Furthermore, we found statistically significant difference between women who are infertile with women who are fertile (p < 0.001), whereby infertile women had higher average result on EHP-5 (M = 49.55) compared with fertile women (M = 34.36).

The Croatian version of the EHP-5 have very good psychometric characteristics and can be used as a reliable tool for assessing patients with endometriosis in everyday clinical practice. Similar content being viewed by others

Kennedy S, Bergqvist A, Chapron C, D’Hooghe T, Dunselman G, Greb R, Saridogan E (2005) ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 20(10):2698–2704. https://doi.org/10.1093/humrep/dei135 Schliep KC, Mumford SL, Peterson CM, Chen Z, Johnstone EB, Sharp HT, Buck Louis GM (2015) Pain typology and incident endometriosis. Hum Reprod 30(10):2427–2438. https://doi.org/10.1093/humrep/dev147 Shafrir AL, Farland LV, Shah DK, Harris HR, Kvaskoff M, Zondervan K, Missmer SA (2018) Risk for and consequences of endometriosis: a critical epidemiologic review. Best Pract Res Clin Obstet Gynaecol 51:1–15. https://doi.org/10.1016/j.bpobgyn.2018.06.001 Seear K (2009) The etiquette of endometriosis: Stigmatisation, menstrual concealment and the diagnostic delay. Soc Sci Med 69(8):1220–1227. https://doi.org/10.1016/j.socscimed.2009.07.023 De Graaff AA, D’Hooghe TM, Dunselman GAJ, Dirksen CD, Hummelshoj L, Wullschleger M, WERF EndoCost Consortium (2013) The significant effect of endometriosis on physical, mental and social wellbeing: results from an international cross-sectional survey. Human Reprod 28(10):2677–2685. https://doi.org/10.1093/humrep/det284 Fourquet J, Báez L, Figueroa M, Iriarte RI, Flores I (2011) Quantification of the impact of endometriosis symptoms on health-related quality of life and work productivity. Fertil Steril 96(1):107–112. https://doi.org/10.1016/j.fertnstert.2011.04.095 Bourdel N, Chauvet P, Billone V, Douridas G, Fauconnier A, Gerbaud L, Canis M (2019) Systematic review of quality of life measures in patients with endometriosis. PLoS ONE 14(1):e0208464. https://doi.org/10.1371/journal.pone.0208464 Jones G (2001) Development of an endometriosis quality-of-life instrument: the endometriosis health profile-30. Obstet Gynecol 98(2):258–264. https://doi.org/10.1016/S0029-7844(01)01433-8 Rizwana R, Ashraf K (2018) The construction and validation of the stellenbosch endometriosis quality of life measure (SEQOL). Health Care Women Int 39(10):1123–1139. https://doi.org/10.1080/07399332.2018.1455684 Jones G, Jenkinson C, Kennedy S (2004) Development of the short form endometriosis health profile questionnaire: The EHP-5. Qual Life Res 13(3):695–704. https://doi.org/10.1023/B:QURE.0000021321.48041.0e Selcuk S, Sahin S, Demirci O, Aksoy B, Eroglu M, Ay P, Cam C (2015) Translation and validation of the endometriosis health profile (ehp-5) in patients with laparoscopically diagnosed endometriosis. Eur J Obstet Gynecol Reprod Biol 185:41–44. https://doi.org/10.1016/j.ejogrb.2014.11.039 Minas V, Dada T (2014) Laparoscopic treatment of endometriosis and effects on quality of life: a retrospective study using the short form EHP-5 endometriosis specific questionnaire. J Obstet Gynaecol 34(4):336–340. https://doi.org/10.3109/01443615.2013.874409 Aubry G, Panel P, Thiollier G, Huchon C, Fauconnier A (2017) Measuring health-related quality of life in women with endometriosis: comparing the clinimetric properties of the endometriosis health profile-5 (EHP-5) and the EuroQol-5D (EQ-5D). Hum Reprod 32(6):1258–1269. https://doi.org/10.1093/humrep/dex057 Goshtasebi A, Nematollahzadeh M, Hariri FZ, Montazeri A (2011) The short form endometriosis health profile (EHP-5): translation and validation study of the Iranian version. J Ovarian Res 4(1):11. https://doi.org/10.1186/1757-2215-4-11 Lovibond PF, Lovibond SH (1995) The structure of negative emotional states: comparison of the depression anxiety stress scales (Dass) with the beck depression and anxiety inventories. Behav Res Ther 33(3):335–343. https://doi.org/10.1016/0005-7967(94)00075-U González-Rivera JA, Pagán-Torres OM, Pérez-Torres EM (2020) Depression, anxiety and stress scales (DASS-21): construct validity problem in hispanics. Eur J Investig Health Psychol Educ 10(1):375–389. https://doi.org/10.3390/ejihpe10010028 Toth M, Jokić-Begić N (2020) Psychological contribution to understanding the nature of dry eye disease: a cross-sectional study of anxiety sensitivity and dry eyes. Health Psychol Behav Med 8(1):202–219. https://doi.org/10.1080/21642850.2020.1770093 Takaesu Y, Nishi H, Kojima J, Sasaki T, Nagamitsu Y, Kato R, Isaka K (2016) Dienogest compared with gonadotropin-releasing hormone agonist after conservative surgery for endometriosis: comparison between dienogest and GnRHa. J Obstet Gynaecol Res 42(9):1152–1158. https://doi.org/10.1111/jog.13023 Cozzolino M, Coccia M, Lazzeri G, Basile F, Troiano G (2019) Variables associated with endometriosis-related pain: a pilot study using a visual analogue scale. Revis Brasileira de Ginecologia e Obstetrícia / RBGO Gynecol Obstet 41(03):170–175. https://doi.org/10.1055/s-0039-1679879 Fauconnier A, Huchon C, Chaillou L, Aubry G, Renouvel F, Panel P (2017) Development of a French version of the endometriosis health profile 5 (EHP-5): cross-cultural adaptation and psychometric evaluation. Qual Life Res 26(1):213–220. https://doi.org/10.1007/s11136-016-1346-y Mokkink LB, Terwee CB, Stratford PW, Alonso J, Patrick DL, Riphagen I, de Vet HCW (2009) Evaluation of the methodological quality of systematic reviews of health status measurement instruments. Qual Life Res 18(3):313–333. https://doi.org/10.1007/s11136-009-9451-9 Tsang S, Royse CF, Terkawi AS (2017) Guidelines for developing, translating, and validating a questionnaire in perioperative and pain medicine. Saudi J Anaesth 11(Suppl 1):S80–S89. https://doi.org/10.4103/sja.SJA_203_17 Funding The authors have no relevant financial or non-financial interests to disclose. Author information Authors and Affiliations Contributions All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by MM, LM, GV, BŠ and IŠ. The first draft of the manuscript was written by MM and MĆ and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Corresponding author Ethics declarations Conflict of interest The authors have no affiliation with any organization with a direct or indirect financial interest in the subject matter discussed in the manuscript. The following authors have affiliations with organizations with direct or indirect financial interest in the subject matter discussed in the manuscript Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Appendix Appendix Upitnik–EHP-5 Prvi dio Tijekom zadnja 4 tjedna koliko često ste zbog endometrioze… - 1. Otežano hodali zbog bolova? (Nikad/Rijetko/Ponekad/Često/Uvijek). - 2. Osjećali da vaši simptomi utječu na vaš život? (Nikad/Rijetko/Ponekad/Često/Uvijek) - 3. Imali promjene raspoloženja? (Nikad/Rijetko/Ponekad/Često/Uvijek). - 4. Imali osjećaj da drugi ne shvaćaju kroz što prolazite? (Nikad/Rijetko/Ponekad/Često/Uvijek). - 5. Imali osjećaj da vaša bolest utječe na vašu pojavu u društvu? (Nikad/Rijetko/Ponekad/Često/Uvijek). Potrebno je zaokružiti odgovor na svako pitanje koji vas najbolje opisuje. Drugi dio Tijekom zadnja 4 tjedna koliko često ste zbog endometrioze… - A. Bili spriječeni u obavljanju dužnosti na vašem radnom mjestu? (Nikad/Rijetko/Ponekad/Često/Uvijek). - B. Imali poteškoća kod bavljenja vlastitom djecom? (Nikad/Rijetko/Ponekad/Često/Uvijek). - C. Izbjegavali seksualne odnose zbog boli? (Nikad/Rijetko/Ponekad/Često/Uvijek). - D. Pomislili da vaš doktor misli da je vaša bol samo stvar vašeg psihičkog stanja? (Nikad/Rijetko/Ponekad/Često/Uvijek). - E. Bili frustrirani neuspješnim liječenjem? (Nikad/Rijetko/Ponekad/Često/Uvijek). - F. Osjećali depresiju zbog toga što ne možete imati djecu ili više djece? (Nikad/Rijetko/Ponekad/Često/Uvijek). Napomena: Molimo odgovorite samo na pitanja koja se odnose na vas. Rights and permissions About this article Cite this article Mikuš, M., Matak, L., Vujić, G. et al. The short form endometriosis health profile questionnaire (EHP-5): psychometric validity assessment of a Croatian version. Arch Gynecol Obstet 307, 87–92 (2023). https://doi.org/10.1007/s00404-022-06691-1 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00404-022-06691-1