Validity and reliability of parent assessments of pubertal maturation among adolescent girls in Isfahan, Iran

Nafiseh Mozafarian; Mahin Hashemipour; Mohammad Reza Maracy; Seyed Ali Madineh; Raheleh Farahi; Roya Kelishadi

doi:10.1515/jpem-2023-0409

Validity and reliability of parent assessments of pubertal maturation among adolescent girls in Isfahan, Iran

J Pediatr Endocrinol Metab. 2024 Jan 11;37(2):156-162. doi: 10.1515/jpem-2023-0409. Print 2024 Feb 26.

Authors

Nafiseh Mozafarian¹, Mahin Hashemipour^{1

2}, Mohammad Reza Maracy^{3

4}, Seyed Ali Madineh⁵, Raheleh Farahi⁶, Roya Kelishadi¹

Affiliations

¹ Child Growth and Development Research Center, Research Institute for Primordial Prevention of Noncommunicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
² Metabolic Liver Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
³ Department of Biostatistics and Epidemiology, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran.
⁴ Environment Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
⁵ Isfahan Provincial Education and Training Organization, Isfahan, Iran.
⁶ Health Center of Isfahan Province, Isfahan University of Medical Sciences, Isfahan, Iran.

PMID: 38197810
DOI: 10.1515/jpem-2023-0409

Abstract

Objectives: The current paper presents the steps considered for validation of a questionnaire for assessment of sexual maturity among Iranian adolescent girls.

Methods: This cross-sectional study was performed in 2022 in Isfahan, Iran. Based on the Growth and Development Questionnaire that included both the Pubertal Development Scale (PDS) and Sexual Maturation Scale (SMS), two Persian questionnaires were prepared. The face validity, content validity, criterion validity, and reliability of the questionnaire were assessed. We compared agreement of two parent-reported measures of puberty, SMS and PDS, with clinical Tanner stages (TSs) as the gold standard. Percent agreement, Cohen's kappa coefficient, and Kendall's τ b were used to assess the agreement between maternal assessments with clinical TS. The intraclass correlation coefficient (ICC) and the Cronbach's α coefficient were also calculated to evaluate the reliability of the questionnaire.

Results: A total of 150 students aged 6-17 years with mean (SD) age of 10 (2.04) completed this study. The percentages of agreement for the mother-reported SMS in relation to clinical TS for breast stage and pubic hair stage were 60 % and 53.8 %, respectively. The percentages of agreement of the mother-reported PDS in relation to clinical TS for breast stage and pubic hair stage were 55.8 and 66 %, respectively. The weighted kappa coefficients showed moderate agreement, with weighted kappa ranging from 0.52 to 0.61. The mother-reported SMS and PDS showed high reliability. The Cronbach's alpha of the PDS and the SMS was 0.88 and 0.83, respectively. The ICC of the mother-reported SMS and the mother-reported PDS was 0.95 (0.92-0.98) and 0.97 (0.94-0.98), respectively.

Conclusions: This study indicated that a maternal assessment of sexual maturity using the PDS or SMS can reliably estimate pubertal development in adolescent girls in an Iranian population.

Keywords: girls; pubertal development scale; puberty; sexual maturation scale; validity.

MeSH terms

Adolescent
Cross-Sectional Studies
Female
Humans
Iran / epidemiology
Mothers
Puberty*
Reproducibility of Results
Sexual Maturation*
Surveys and Questionnaires