Development and Psychometric Properties of the Sexual Health Scale for Middle-Aged Married Women (SHIMA): a Mixed Methods Study

Purpose: This study aimed to develop and psychometrically validate the Sexual Health Scale for Middle-Aged sexually active women (SHIMA). Methods: This study was a sequential exploratory study consisting of two phases. In phase one, we interviewed 19 middle-aged women and reviewed the existing instruments to generate an item pool. Then, a panel of experts (n = 16) examined the items. In the second phase, the psychometric properties of the scale were assessed. For content and face validity, a panel of experts (n = 8) and a group of middle-aged women (n = 10) reviewed the items. For construct validity, a cross-sectional study was carried out on a sample of 427 married women. Finally, SHIMA’s reliability was assessed. Results: In the first phase, the sexual health concept was explored, and a provisional scale including 60 items was generated. Next, 21 items were removed based on content and face validity. Accordingly, the results obtained from the exploratory factor analysis (EFA) indicated acceptable loading for 34 items tapping into six factors that jointly explained 48.67% of the total variance observed. The internal consistency evaluation revealed that Cronbach’s alpha and McDonald’s omega were greater than 0.7, and the average inter-item correlation was greater than 0.4, except for one factor that showed borderline results. Test-retest reliability over a 2-weeks interval was 0.90, indicating its high stability. Conclusion: The SHIMA is a reliable and valid scale for measuring sexual health in middle-aged married women. It can be used as a sexual health screening scale by healthcare professionals and for research purposes.