Title: Validation of the Menopause Representation Questionnaire (MenoSentations- Q) among
Iranian Women and Cross-Cultural Comparison with Portuguese Women
Version: 1 Date: 08 Aug 2024
Reviewer's report:
Review of “Validation of the Menopause Representation Questionnaire (MenoSentations-Q)
among Iranian Women and Cross-Cultural Comparison with Portuguese Women”
Thank you for opportunity to review the paper. This manuscript aims to evaluate the
measurement properties of the MenoSentations-Q in a sample of Iranian women; and compare
its structure with a Portuguese sample. This is an interesting study, but there are some problems.
Major comments
1) Please clearly state the construct of the instrument. It appears that the instruments
assess symptoms. If so, its structure is based on a formative model (see doi: 10.1016/
j.jbusres.2008.01.013; and 10.1016/j.jocm.2023.100412). Because a formative model does not
assume factors, structural validity, internal consistency, and cross-cultural validity cannot be
assessed. Please check the model and describe it in the manuscript.
2) In the rationale for this study, it is not clear why the MenoSentations-Q is better than other
instruments. Validation of an instrument in different countries and populations is not the best
and only justification for evaluating the measurement properties of that instrument in a new
language/population. Failures may continue to be reproduced in multiple studies.
Minor comments
1) In the abstract, clearly state the construct of the MenoSentations-Q. State that you evaluated
its content validity. Change “Construct validity” to “Structural validity”, “Cross-national
invariance” to “Cross-cultural validity”, and “Reliability” to “Internal consistency” (according
to COSMIN recommendations). For cross-cultural validity, did you mean that you assessed this
measurement property with a CFA multigroup? If so, state this in the abstract. Please adjust the
terminology for all measurement properties throughout the manuscript.
2) In introduction section, you stated “(insert reference, as done for the previous instruments)”.
Please revise it.
3) What is the work of Hunter and O'Dea? What is the idea? The same for “on the cognitive
components of the Self-Regulation Model”. Explain it.
4) Please clarify the construct of the instrument.
5) Please use the same terminology throughout the manuscript.
6) In the Methods section, you stated “23 October to 19 February 2023”. Did you mean “23
October 2022 to 19 February 2023”?
7) In the Sampling procedure, you presented the sample size calculation for content validity.
Please also present for each measurement property. Is "Sampling was conducted systematically"
convenience sampling?
8) Add more details about the MenoSentations-Q: well-defined and explicit construct,
conceptual structure (based on reflective or formative model), number of items and subscales
(OK), response options (OK), recall time, range score for each subscale and total score (OK),
interpretation and direction of scores (is the higher, better or worse the measured construct?),
cutoff point (if any).
9) How many items and factors are there in the Portuguese version of the instrument?
10) Please change “retro-translation” to “back-translation”.
11) For content and face validity, how were the interviews conducted? Was there a single
interviewer? Qualified to collect data? Were interviews conducted individually or in groups?
Were they audio and/or video recorded and transcribed verbatim (by whom)? How was the
interview data analyzed?
12) Why did the target population not evaluate the content of the instrument in terms of
relevance, comprehensiveness and comprehensibility of instructions, recall time, items and
response options?
13) How did you divide the sample? What software was used?
14) I would recommend assessing convergent and discriminant validity by comparing
the construct of the instrument under study with the construct of another instrument, or
between subgroups of your sample through the mean difference in scores. (see COSMIN
recommendation)
15) Should "Multigroup Analysis" be "CFA Multigroup"?
16) Was there any missing data, and if so, how did you deal with it? If there was no missing
data, state that there was no missing data.
17) In the results section, please provide the minimum and maximum scores for each subscale
and total scale for the total sample and for the split sample.
18) If 4 factors were found, why is there a total score and not a score for each subscale?
An instrument with a total score and subscales has a bi-factor structure. An instrument with
subscales, but without factorial interactions between them, is not the most appropriate for
presenting a total score.
19) Specify the split sample characteristics as you did for the total sample.
20) Add the factors that have covariance, as shown in Figure 2.
21) Since the instrument has a total score, Cronbach's alpha and McDonald's omega should also
be reported for the total score.
22) Provide the Persian version of the instrument in a supplementary file.
23) In the discussion section, please clarify the clinical significance of this instrument based on
the measurement properties evaluated.
24) What are the strengths of the study?
25) Another limitation/failure: the target population did not evaluate the PROM content during
content validity.