What if a questionnaire could turn a broad idea like menopausal self-care into just thirteen measurable items? This study tests whether that short tool is valid, reliable, and useful for Iranian menopausal women. Menopause is a normal stage in a woman’s life, marked by the cessation of menstruation after twelve months of amenorrhea, and its symptoms affect women’s health and quality of life.

Menopausal women should learn self-care practices to enjoy a healthy lifestyle, positive health behaviors, and health status. Despite that importance, studies have reported limited knowledge and activities about self-care among menopausal women. The scale of the problem is striking: in one study, only zero point eight percent of Iranian menopausal women performed appropriate self-care activities.

Further research is needed to assess the quality of tools that help researchers, policymakers, and clinicians assess self-care concepts and promote tailored care for groups with different care needs. Long questionnaires have a main limitation: the vagueness of their validity and reliability.

By contrast, questionnaire brevity is highlighted as beneficial for research because it can ensure quicker and more precise completion. The relationship between self-care knowledge, attitude, and health is apparent, but studies examining women’s self-care knowledge and attitude specifically for menopausal women appear to be lacking.

The main objective was to develop and evaluate the validation properties of the Women’s Self-care Knowledge and Attitude Questionnaire, or WSKAQ, in Iranian menopausal women. The questionnaire was intended to be short, suitable for the menopause community, based on objective questions, and covering different self-care knowledge and attitudes.

This cross-sectional study was conducted from October to November twenty twenty-three on two hundred forty-nine menopausal women. The women were selected through convenience sampling from two urban health service centers in Shiraz, Iran, and randomly chosen using PASS software version fifteen.

The initial questionnaire was developed from an extensive literature review and experts’ opinions. The literature search covered Scopus, PubMed, Web of Science, and Google Scholar, using keywords including self-care knowledge, self-care attitude, women’s health, menopause, and post menopause.

The research team extracted and assessed items used in different studies to evaluate self-care knowledge and attitudes among women. The self-care definition used for developing WSKAQ items emphasized water and fruit or vegetable consumption, regular physical activity, stopping smoking or tobacco use and alcohol intake, regular preventive care such as screenings, and controlling stress.

Reading down the figure, the questionnaire passes through two evaluation stages before reaching the final version. The first stage branches into four checks—face, content, construct, and discriminative validity—while the second consolidates reliability assessment using several complementary statistics.

A Kolmogorov-Smirnov test assessed data normality among two hundred forty-nine participants, and exploratory factor analysis identified the WSKAQ factor structure using SPSS software version twenty-seven. The Kaiser-Meyer-Olkin and Bartlett’s tests for sphericity assessed sampling adequacy and the suitability of factor analysis.

Principal component analysis with varimax rotation was conducted to extract latent factors and their appropriate items. Items were allocated to a factor when their commonalities exceeded zero point three. The Kolmogorov-Smirnov test indicated a lack of item normality, with p less than zero point zero zero one, but Bartlett’s test and the KMO test demonstrated sampling adequacy for factor analysis.

For the self-care knowledge subscale, exploratory factor analysis identified two factors accounting for forty-seven point twenty-nine percent of total data variance. Health promotion experts named those factors screenings, with three items, and lifestyle, with three items; item one was not allocated to a factor because its commonalities were below zero point three.

For the seven-item self-care attitude subscale, the KMO test was zero point eight seven eight, and exploratory factor analysis identified one factor accounting for fifty-five point fifty percent of total data variance. In the knowledge-loading columns, the strongest visible associations are item three with lifestyle at zero point seventy-eight, and item five with screenings at zero point seventy-eight; item one remains below the bolding threshold in both columns.

In the attitude column, loadings range from zero point fifty for item six to zero point eighty-nine for item three. For the final questionnaire, Cronbach’s alpha was zero point seventy-seven and McDonald’s Omega was zero point seventy-eight. The self-care knowledge subscale had a Kuder-Richardson coefficient of zero point seventy-nine, while Cronbach’s alpha for self-care attitude was zero point eighty-one.

Spearman’s rho showed correlations of zero point fifty-four for self-care knowledge and zero point ninety-five for attitude scores with the total questionnaire score, both with p less than zero point zero zero one. The correlation between the subscales was medium, at zero point thirty, with p less than zero point zero zero one.

Look down the item-to-subscale column: knowledge-item correlations range from zero point nineteen to zero point thirty, while attitude-item correlations range from zero point forty-two to zero point seventy-six. The reliability rows also show confidence intervals of zero point seventy-three to zero point eighty-eight for knowledge and zero point seventy-seven to zero point eighty-four for attitude.

The study had limitations, including its focus on urban health centers and urban women, which suggests the need for future research in rural health centers and with rural women. Only women with at least primary education were included, limiting generalizability to illiterate women.

Reliance on self-reported data introduced potential biases, because self-report studies are susceptible to errors and can be affected by participants’ emotional states when completing questionnaires. In the Iranian context, the thirteen-item version of the WSKAQ showed acceptable validation properties and reliability, making it practical for measuring self-care knowledge and attitude in menopausal women.

The importance of self-care knowledge and attitude in women’s health underscores the need for an accurate evaluation tool. The paper aimed to facilitate more comprehensive and insightful cross-cultural studies of self-care knowledge and attitude. The thirteen-item WSKAQ showed acceptable validation properties and reliability in the Iranian context, offering a practical way to measure self-care knowledge and attitude while highlighting limits on wider generalization.