ABSTRACT
Background
Urinary incontinence might have a strong negative influence on quality of life. It can adversely affect physical functioning, social functioning, and emotional well‐being. The Incontinence Impact Questionnaire Short Form (IIQ‐7) is a grade A measure that assesses the impact of urinary incontinence on quality of life in terms of physical activity, travel, social/relationships, and emotional health.
Objectives
The aim of this study was to perform the translation and cultural adaptation of the IIQ‐7 into Hungarian and to assess its psychometric properties, including structural validity, internal consistency, test–retest reliability, convergent validity, and discriminant validity.
Materials and Methods
The cross‐cultural adaptation of the questionnaire followed the COSMIN guideline and Beaton's six‐stage process. The structural validity was evaluated by confirmatory factor analysis. Internal consistency was assessed by Cronbach's alpha value. Test–retest reliability was analyzed using the intraclass correlation coefficient (duration of the test–retest period was 14 days). Convergent validity and discriminant validity were also assessed.
Results
Confirmatory factor analysis showed acceptable model fit indices (χ 2 = 9.331; χ 2/df = 1.333; Comparative Fit Index = 0.996; Tucker‐Lewis Index = 0.998 and root mean‐square error approximation = 0.062). The Cronbach alpha was calculated at 0.931. The intraclass correlation coefficient was 0.901, indicating high test–retest reliability. Regarding discriminant validity, there was a significant difference between IIQ‐7 scores in the three urinary incontinence subgroups (stress, urge, and mixed urinary incontinence; p = 0.027).
Conclusion
The Hungarian IIQ‐7 demonstrates adequate reliability and validity. The results support the use of this instrument for evaluating the influence of urinary incontinence on quality of life among Hungarian women.
Keywords: cross‐cultural adaptation, Hungarian, quality of life, questionnaire, urinary incontinence, validation
1. Introduction
Urinary incontinence (UI) is defined as “the complaint of involuntary loss of urine.” The three main types of UI include: stress urinary incontinence (SUI), urgency urinary incontinence (UUI), and mixed urinary incontinence (MUI) [1]. The prevalence of UI among women is estimated to range from 25% to 45% across most studies [2].
In Hungary, a nationally representative survey was conducted in 2003 to investigate the prevalence of UI in women (N = 35,448). According to the results, 36% of the participants deemed themselves incontinent. Based on data extrapolation, the number of women with UI in Hungary was projected to be near 600,000. The authors considered UI a national health problem [3].
UI has been linked to multiple risk factors, such as obesity, pregnancy, vaginal delivery, multiparity, advanced age, chronic cough, previous surgery, race, and smoking [4, 5, 6].
Even mild UI can significantly reduce quality of life [7]. It often leads to negative self‐perception, embarrassment, and social isolation [5]. According to a cross‐sectional, population‐based study (N = 4208; mean age: 60 years), UI was an independent risk factor for anxiety and depression, and it significantly affected women's work function [8]. UI can have a negative impact on workplace productivity due to more frequent trips to the bathroom and diminished self‐confidence and ability to complete tasks without interruption [9]. Another cross‐sectional study (N = 2907; mean age: 47.4 ± 11.6 years) found that severe UI was associated with nurses' and midwives' intention to leave their current job in the next 12 months (OR: 2.68; 95% CI: 1.18–6.06) [10].
UI might negatively affect sexual function. It has been reported that women with UI had less sexual desire, sexual comfort, and sexual satisfaction compared to controls [11, 12]. Regarding physical burden, UI increases the risk of incontinence‐associated dermatitis, pressure sores [13], falls, fractures [14, 15, 16], and sleep disturbances [17].
In Hungary, the following validated questionnaires are available for assessing perceived bother of symptoms and quality of life related to UI: International Consultation on Incontinence Modular Questionnaire–Urinary incontinence Short Form (ICIQ‐UI SF) [18, 19], International Consultation on Incontinence Questionnaire–Female Lower Urinary Tract Symptoms (ICIQ‐FLUTS) [20, 21, 22], APFQ‐H (Australian Pelvic Floor Questionnaire) [23, 24], and King's Health Questionnaire (KHQ) [25, 26].
The ICIQ‐UI SF assesses the severity of UI. It consists of four questions related to the frequency of UI, leakage amount, overall impact of UI, and type of UI. The ICIQ‐FLUTS consists of 12 questions related to lower urinary tract symptoms (filling: 4 questions; voiding: 3 questions; urinary incontinence: 5 questions) [18]. The ICIQ‐FLUTS has a scale of bother following each item; however, this scale is not included to calculate the overall score [20]. The APFQ‐H assesses bladder, bowel, prolapse, and sexual function. It consists of four separate domains (bladder function, bowel function, prolapse symptoms, and sexual function). At the end of each domain, there is a question that evaluates perceived bother: “How much do your bladder/bowel/prolapse/sexual symptoms bother you?” [23].
Although the ICIQ‐SF, ICIQ‐FLUTS, and APFQ‐H questionnaires contain at least one item that measures the perceived bother, their primary goal is to assess the symptoms and severity of UI and other pelvic floor disorders. They address quality of life/perceived bother only as a secondary outcome and are therefore insufficient for a comprehensive assessment of quality of life. Since UI may affect several quality‐of‐life domains, instruments primarily designed to assess these areas are more appropriate for evaluating quality of life among patients with UI [27].
The primary goal of the KHQ is to evaluate the impact of UI on quality of life. It consists of nine domains and 21 items: general health perception (1 item), incontinence impact (1 item), role limitations (2 items), physical limitations (2 items), social limitations (2 items), personal relationships including family and sexual life (3 items), emotions (3 items), sleep/energy (2 items), and severity (5 items). Each domain is scored separately [25]. The KHQ is a comprehensive instrument with good psychometric properties; however, when respondent burden is an important consideration, the shorter Incontinence Impact Questionnaire Short Form (IIQ‐7) represents a practical and reliable alternative [28].
The IIQ‐7 consists of seven items. It is a grade A measure that evaluates the impact of UI on quality of life in terms of physical activity, travel, social/relationships, and emotional health. It was developed in English [29] and has been translated into several languages, including Turkish [30], Swedish [31], Urdu [32], Dutch [33], Chinese [34, 35, 36], Arabic [37], Polish [38], Bahasa Malaysia [39], Lingala [40], and Spanish [41, 42]. The IIQ‐7 also proved to be an adequate tool for assessing the impact of UI in patients with multiple sclerosis [43]. Due to its brevity, multidimensional quality‐of‐life assessment, and widespread use in both research and clinical practice, the IIQ‐7 represents a valuable instrument for evaluating the impact of UI on quality of life.
To date, the IIQ‐7 has not been validated in Hungarian, and no comparable brief Hungarian questionnaire is currently available for evaluating quality of life among Hungarian women with UI. The aim of this study was to perform the translation and cultural adaptation of the IIQ‐7 into Hungarian and to assess its psychometric properties, including structural validity, internal consistency, test–retest reliability, convergent validity, and discriminant validity.
2. Materials and Methods
2.1. Study Population and Protocol
In this validation study, Hungarian women with UI were enrolled from the Thermal Rehabilitation Centre Harkány, Pécs, Hungary in 2024. Women were also recruited for the study through social media platforms. Inclusion criteria were Hungarian women aged ≥18 years with self‐reported symptoms of UI who were able to read and complete the questionnaire in Hungarian. Exclusion criteria included neurological disorders affecting lower urinary tract function or muscle strength, active urinary tract infection, dementia or cognitive impairment interfering with questionnaire completion, and current malignancy. Inclusion and exclusion criteria were based on self‐reported information provided by the participants.
Data were collected anonymously, and no identifying information was obtained from participants. Participation was voluntary, and written informed consent was obtained from all participants. All data were stored on password‐protected devices, with access restricted to the research team only. The study protocol was approved by the National Scientific and Ethical Committee (ETT TUKEB, lV/1596‐3/2022/EKU). The study was conducted and reported in accordance with the COSMIN guideline [44].
2.2. Translation and Validation Process
At first, the permission to culturally adapt the IIQ‐7 was granted by the MAPI Research Trust. The adaptation and validation of the questionnaire followed the COSMIN guideline and Beaton's six‐stage process: translation, synthesis, back‐translation, expert committee review, pretesting, and assessment of the psychometric properties [45, 46]. Two forward translations of the English IIQ‐7 were performed by two Hungarian physiotherapists, both fluent in English. The research team reviewed and compared the two translations and created a unified version. The research team members were three physiotherapists with experience in working with women who have UI, and a professional translator. A native English speaker who was fluent in Hungarian backward translated the questionnaire from Hungarian to English. The research team compared the back‐translation of the instrument to the original English version.
The questionnaire was pre‐tested for interpretability and usability by conducting cognitive interviews within the target population. Forty‐seven women were contacted in order to determine whether all the words, phrases, and items are easily understandable. A physiotherapist specializing in the management of women with UI conducted the cognitive interviews. Participants were instructed to read each question aloud and describe their interpretation of its meaning [47]. Any remaining issues related to conceptual equivalence identified during the interviews were thoroughly evaluated by the research team, and necessary modifications were implemented accordingly.
2.3. Submission of Documentation to the Developers
The translated and culturally adapted Hungarian version of the IIQ‐7 and documentation from earlier stages were sent to the MAPI Research Trust for appraisal [45].
2.4. Study Instrument
The first part of the self‐administered survey included questions about sociodemographic characteristics, current pregnancy, and obstetric history.
The second part included the IIQ‐7, which is a self‐administered, unidimensional, seven‐item questionnaire that assesses the overall impact of UI on quality of life. It includes four domains that can be affected by UI: physical activity (items 1 and 2), travel (items 3 and 4), social/relationships (item 5), and emotional health (items 6 and 7). Each item is rated on a four‐point response scale: 0 = not at all; 1 = slightly; 2 = moderately; 3 = greatly. The average score of items responded to is calculated. The average, which can range from 0 to 3, is multiplied by 33 1/3 to convert to a scale of 0 to 100. If more than two items are missing, the total score should not be calculated. Higher scores indicate worse health‐related quality of life [29].
Part three included the Hungarian version of the International Consultation on Incontinence Modular Questionnaire–Urinary Incontinence Short Form (ICIQ‐UI SF). The primary goal of the ICIQ‐UI SF is to assess symptom severity by measuring the frequency of UI (possible responses: never/about once a week or less often/two or three times a week/about once a day/several times a day/all the time), leakage amount (possible responses: none/a small amount/a moderate amount/a large amount), overall impact of UI and type of UI. The total score can range from 0 to 21. Higher scores reflect greater symptom severity. Severity is classified as slight (1–5), moderate (6–12), severe (13–18), or very severe (19–21) [18, 19, 48].
2.5. Statistical Analysis
Statistical analysis was conducted using SPSS version 28, SPSS AMOS version 29 and GraphPad Prism version 10.1.1. Cases with incomplete questionnaire data were excluded from the analyzes using listwise deletion. A descriptive analysis was performed to characterize the participants. All statistical tests were two‐sided, and statistical significance was defined as a p‐value less than 0.05.
Confirmatory factor analysis was used to assess structural validity. The predetermined minimum sample size for confirmatory factor analysis was based on the recommendation of at least 10 participants per item [49]. Based on the original validation of the IIQ‐7 [29], we hypothesized a unidimensional structure. The model fit was evaluated using different fit indices: chi‐square (χ 2), degree of freedom (df), chi‐square divided by degree of freedom (χ 2/df ratio), comparative fit index (CFI), Tucker–Lewis index (TLI), root mean square error of approximation (RMSEA), and standardized root mean square residual (SRMR). The χ 2/df ratio was considered adequate below the value of 3.00. Regarding CFI, values greater than 0.90 were considered acceptable. In case of the TLI, values greater than 0.90 were considered acceptable. Regarding RMSEA, values below 0.08 were considered acceptable. In case of the SRMR, values below 0.08 were considered acceptable [50]. Confirmatory factor analysis was performed using the Maximum Likelihood estimation method.
Internal consistency was measured by using Cronbach's alpha. Values below 0.70 indicate low internal consistency, values between 0.7 and 0.8 indicate moderate internal consistency, and values greater than 0.8 indicate high internal consistency [51]. McDonald's ω was also calculated to provide a complementary estimate of internal consistency (adequate reliability if ≥ 0.70) [52].
The test–retest reliability was assessed using the intraclass correlation coefficient (two‐way random effects model). Fifty‐six participants from the main study cohort who agreed to participate in the follow‐up assessment were invited to complete the Hungarian version of the IIQ‐7 again after a 14‐day interval to assess test–retest reliability [53, 54, 55]. Values greater than 0.75 were considered reliable (good reliability) [56].
The IIQ‐7 was developed as a unidimensional questionnaire [29]; however, some authors have reported Cronbach's alpha and intraclass correlation coefficients for different domains (subdomains) [35, 39]. For comparison purposes, these calculations were also performed in the present study.
Standard error of measurement (SEM) and minimum detectable change at the 95% confidence level (MDC95) were also calculated. SEM was calculated as follows: SEM = SD × √(1 − ICC), with SD representing the standard deviation of the sum values obtained in the test and the retest phases, and the ICC is the coefficient of repeatability. MDC95 was calculated through the MDC95 = 1.96 × SEM × √(2) formula. The MDC values were also expressed as a percentage of the total possible score (MDC%). An MDC% value of less than 30% is acceptable, and a value of less than 10% is considered excellent [57].
Convergent validity was assessed by using Spearman's correlation between the IIQ‐7 total score, the ICIQ‐SF total score, and the final item of the ICIQ‐SF. The IIQ‐7 evaluates the impact of UI on quality of life, whereas the primary goal of the ICIQ‐SF is to assess symptom severity. As symptom severity influences quality of life [58], we expected a moderate correlation (0.40–0.69) between the IIQ‐7 total score and the ICIQ‐SF total score. Moreover, we expected a strong correlation (≥0.70) between the IIQ‐7 total score and the ICIQ‐SF final item, which specifically evaluates perceived bother caused by UI [59]. Discriminant validity was assessed by comparing IIQ‐7 total scores among participants with SUI, UUI, and MUI using the Kruskal–Wallis test with post‐hoc tests. Post‐hoc pairwise comparisons were performed using Dunn–Bonferroni tests. Based on previous findings, women with MUI have significantly lower quality of life compared to women with SUI or UUI [60, 61]. Therefore, we anticipated that women with MUI would have significantly higher IIQ‐7 total score.
3. Results
3.1. Translation and Cross‐Cultural Adaptation
During translation, the term “slightly” (enyhén) generated discussion and was translated into “a little” (egy kicsit). “Physical recreation” (fizikai kikapcsolódás) in item 2 (“Has urine leakage affected your physical recreation such as walking, swimming, or other exercise?”) was considered best translated into “active recreation” (aktív kikapcsolódás), because the concept of “physical recreation” is not commonly used in Hungarian. In item 3 (“Has urine leakage affected your entertainment activities (movies, concerts, etc.)?”), the term “your entertainment activities” (szórakozási tevékenységei) was translated into “your entertainment/leisure activities” (szabadidős tevékenységei), for better understanding. The final wording of the questionnaire items was consensus‐based on the professional judgment of the research members.
3.2. Measurement Properties
A total of 106 questionnaires were returned. Seven respondents did not report their gender, and 4 women had an active urinary tract infection. The final study sample consisted of 95 women (Figure 1). In terms of formal education, approximately half of the sample had completed a college/university degree (52.1%, N = 49). More than half of the participants (66.3%, N = 63) were parous. The most common type of UI was SUI (59.1%, N = 55). The mean score ± SD of the ICIQ‐SF scale was 8.6 ± 4.4, whereas the mean score ± SD of the IIQ‐7 was 24.6 ± 26.5. The main characteristics of study participants are detailed in Table 1.
Figure 1.
Flowchart of study participants.
Table 1.
Main characteristics of study participants (N = 95).
| Characteristics | Mean (SD) or N (%) |
|---|---|
| Age, mean (SD), years | 42.4 ± 17.5 |
| BMI, mean (SD), kg/m2 | 25.5 ± 6.4 |
| Place of residence, N (%) | |
| Capital | 29 (30.9%) |
| City | 35 (37.2%) |
| Village | 30 (31.9%) |
| Highest education level, N (%) | |
| Eight grade or less | 5 (5.3%) |
| High school | 40 (42.6%) |
| College/University | 49 (52.1%) |
| Married, N (%) | 44 (46.3%) |
| Constipation, N (%) | 26 (27.4%) |
| Smoking, N (%) | 12 (12.6%) |
| Currently pregnant, N (%) | 4 (4.2%) |
| Parous, N (%) | 63 (66.3%) |
| Vaginal childbirth, N (%) | 53 (57.8%) |
| Cesarean section, N (%) | 13 (14%) |
| Vacuum/Forceps delivery, N (%) | 7 (7.4%) |
| Birth weight greater than 4000 g, N (%) | 11 (12%) |
| Type of urinary incontinence, N (%) | |
| Stress urinary incontinence | 55 (59.1%) |
| Urge urinary incontinence | 17 (18.3%) |
| Mixed urinary incontinence | 21 (22.6%) |
Confirmatory factor analysis showed acceptable model fit indices (χ 2 = 9.331; χ 2/df = 1.333; CFI = 0.996; TLI = 0.998 and RMSEA = 0.062). Detailed results are shown in Table 2.
Table 2.
Model fit statistics of the Hungarian version of IIQ‐7 (N = 95).
| Fit statistics | Hungarian IIQ‐7 |
|---|---|
| χ 2 | 9.331 |
| DF | 7 |
| P | 0.230 |
| χ 2/DF | 1.333 |
| CFI | 0.996 |
| TLI | 0.998 |
| RMSEA | 0.062 |
| SRMR | 0.061 |
Abbreviations: CFI, comparative fit index; DF, degree of freedom; RMSEA, root mean square error of approximation; SRMR, standardized root mean square residual; TLI, Tucker‐Lewis index.
The Hungarian IIQ‐7 had adequate internal consistency. The Cronbach's alpha for the overall score of IIQ‐7 was reported as 0.932 (95% CI: 0.908–0.951), with subdomains ranging from 0.746 to 0.915. McDonald's ω value was 0.940 (95% CI: 0.921–0.959). The test–retest reliability of the total score of IIQ‐7 was 0.901 (95% CI: 0.740–0.959), with subdomains ranging from 0.843 to 0.922. The Cronbach's alpha and the intraclass correlation coefficient values for the total score and subdomains of the Hungarian IIQ‐7 are presented in Table 3.
Table 3.
Internal consistency and test–retest reliability of the Hungarian IIQ‐7 (N = 95).
| Cronbach's alpha | Intraclass correlation | 95% CI | |
|---|---|---|---|
| Hungarian IIQ‐7 (total score) | 0.931 | 0.901 | 0.740–0.959 |
| Physical activity | 0.746 | 0.843 | 0.589–0.936 |
| Travel | 0.840 | 0.852 | 0.693–0.932 |
| Social/relationships | — | 0.922 | 0.831–0.965 |
| Emotional health | 0.915 | 0.894 | 0.778–0.952 |
We determined that the SEM was 6.24 points, the MDC95 was 17.30 points, whereas the percentage of MDC95 was 17.30%.
A significant moderate correlation was found between the total score of IIQ‐7 and ICIQ‐SF (rs (93) = 0.681; p < 0.001). The scatter plot is presented in Figure 2. Additionally, we found a significantly strong correlation between the total score of IIQ‐7 and the final item of the ICIQ‐SF, which assesses the perceived bother due to UI (rs (93) = 0.703; p < 0.001). The scatter plot is shown in Figure 3.
Figure 2.
Convergent validity of the IIQ‐7 scale in comparison with the total ICIQ‐SF score (r = 0.681; p < 0.001).
Figure 3.
Convergent validity of the IIQ‐7 scale in comparison with the ICIQ‐SF item measuring perceived bother due to urinary incontinence (r s(93) = 0.703; p < 0.001).
Regarding discriminant validity, there was a significant difference between IIQ‐7 scores in the three UI subgroups (p = 0.03). IIQ‐7 scores in the MUI group were significantly higher compared to the SUI group (p = 0.02). However, there were no significant differences between the SUI and UUI group and the UUI and MUI group (p > 0.05). Table 4 displays the IIQ‐7 scores by UI type.
Table 4.
IIQ‐7 scores in relation to UI types (N = 95).
| SUI | UUI | MUI | p * | |
|---|---|---|---|---|
| IIQ‐7 scores, mean (SD) | 7.69 ± 4.09 | 7.88 ± 4.45 | 12.14 ± 3.86 | 0.027 |
Kruskal–Wallis.
4. Discussion
The IIQ‐7 is applied worldwide and has been validated in many languages, including Chinese [34, 35, 36], Spanish [41, 42], Turkish [30], and Dutch [33]. Previous psychometric studies using classical test theory methods demonstrated good psychometric properties of the IIQ‐7 in terms of test–retest reliability and internal consistency. The adequate psychometric properties of the questionnaire were also demonstrated by Rasch analysis [62]. The present study aimed to adapt a reliable and valid Hungarian version of the IIQ‐7.
The total score of the Hungarian version of the IIQ‐7 had an excellent internal consistency with a Cronbach's alpha of 0.931. The subdomains of the Hungarian IIQ‐7 also demonstrated an adequate internal consistency (0.746 to 0.915). Based on previous results reported in the literature, the Cronbach's alpha for the total score of IIQ‐7 ranged from 0.87 to 0.99: 0.87 in the Urdu [32], Turkish [30], and Dutch study [33]; 0.89 in the Polish study [38]; 0.90 in the Malaysian study [39]; 0.93 in the Chinese study [35]; 0.98 in the Spanish study [42]; and 0.99 in the Arabic study [37]. In the study of Nusee et al. [39], the Cronbach's alpha for the subdomain of IIQ‐7 ranged from 0.80 to 0.91: 0.80 for the physical activity subdomain, 0.84 for the travel subdomain, and 0.91 for the emotional health subdomain. In the study of Chan et al. [35], the Cronbach's alpha for the subdomains of IIQ‐7 ranged from 0.77 to 0.94: 0.77 for the physical activity subdomain, 0.81 for the travel subdomain, and 0.94 for the emotional health subdomain.
In the present study, intraclass correlation coefficients were excellent for the overall score (0.901) and acceptable for subscales (from 0.843 to 0.922). Prior studies have demonstrated similar results. The intraclass correlation coefficients for the overall score of the IIQ‐7 ranged from 0.75 to 0.98 within studies: 0.75 in the Chinese study [35]; 0.76 in the Turkish study [30]; 0.95 in the Malaysian [39] and Urdu study [32]; and 0.98 in the Spanish [42] and Arabic study [37]. In the study of Nusee et al. [39], the intraclass correlation coefficients for the subdomains of IIQ‐7 ranged from 0.81 to 0.96: 0.93 for the physical activity subdomain; 0.91 for the travel subdomain; 0.81 for the social/relationships subdomain; and 0.96 for the emotional health subdomain. In the study of Chan et al. [35], the intraclass correlation coefficients for the subdomains of IIQ‐7 ranged from 0.63 to 0.72: 0.63 for the physical activity subdomain; 0.69 for the travel subdomain; 0.72 for the social/relationships subdomain; and 0.71 for the emotional health subdomain.
A few limitations should be highlighted. The IIQ‐7 and the Urogenital Distress Inventory (UDI‐6) are commonly used together. However, in the present study, only the Hungarian version of the IIQ‐7 was validated in order to present the validation process and results in detail. The exact distribution of participants according to recruitment source was not recorded separately; therefore, recruitment source‐specific data could not be reported independently. Moreover, only female participants were recruited for this study; we did not validate the Hungarian IIQ‐7 separately for men.
5. Conclusion
The Hungarian IIQ‐7 demonstrates adequate reliability and validity. It is a suitable instrument for assessing the impact of UI on the quality of life among Hungarian women.
Author Contributions
Éva Szatmári: conceptualization, data acquisition, data curation, writing – original draft. Alexandra Makai: conceptualization, methodology, software, data curation, formal analysis. Viktória Prémusz: conceptualization, visualization, resources, writing – review and editing. Pongrác Ács: conceptualization, validation, writing – review and editing. Márta Hock: conceptualization, project administration, supervision, writing – review and editing. All authors read and approved the final manuscript.
Funding
The authors has nothing to report.
Disclosure
All authors have read and approved the final version of the manuscript. Alexandra Makai, the corresponding author, had full access to all of the data in this study and takes complete responsibility for the integrity of the data and the accuracy of the data analysis.
Ethics Statement
This study was performed in line with the principles of the Declaration of Helsinki. The study protocol was approved by the National Scientific and Ethical Committee, ETT TUKEB (lV/1596‐3/2022/EKU).
Consent
Informed consent was obtained from all individual participants included in the study.
Conflicts of Interest
The authors declare no conflicts of interest.
Transparency Statement
The corresponding author, Alexandra Makai, affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.
Acknowledgments
The authors would like to thank all the participants for their contribution to the study. Moreover, the authors acknowledge the use of ChatGPT (OpenAI) to assist with grammar checking and translation of selected text passages.
Szatmári É., Makai A., Prémusz V., Ács P., and Hock M., “Psychometric Properties of the Hungarian Version of Incontinence Impact Questionnaire Short Form (IIQ‐7) Among Hungarian Women: A Validation Study,” Health Science Reports 9 (2026): e72834. 10.1002/hsr2.72834.
Registered by the US National Institute of Health, Identifier NCT NCT05618184
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
References
- 1. Haylen B. T., De Ridder D., Freeman R. M., et al., “An International Urogynecological Association (IUGA)/International Continence Society (ICS) Joint Report on the Terminology for Female Pelvic Floor Dysfunction,” International Urogynecology Journal 21 (2010): 5–26. [DOI] [PubMed] [Google Scholar]
- 2. Milsom I. and Gyhagen M., “The Prevalence of Urinary Incontinence,” Climacteric: The Journal of the International Menopause Society 22 (2019): 217–222. [DOI] [PubMed] [Google Scholar]
- 3. Lipcsey A., Matányi S., Szüle E., Klauber A., Dolinszky G., and Vértes L., “Statistics of Urinary Incontinence of Women in Hungary [in Hungarian],” Orvosi Hetilap 145 (2004): 2237–2240. [PubMed] [Google Scholar]
- 4. Minassian V. A., Bazi T., and Stewart W. F., “Clinical Epidemiological Insights Into Urinary Incontinence,” International Urogynecology Journal 28 (2017): 687–696. [DOI] [PubMed] [Google Scholar]
- 5. Curillo‐Aguirre C. A. and Gea‐Izquierdo E., “Effectiveness of Pelvic Floor Muscle Training on Quality of Life in Women With Urinary Incontinence: A Systematic Review and Meta‐Analysis,” Medicina 59 (2023): 1004. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6. Ambrus E., Makai A., Prémusz V., et al., “Női kismedencei funkciózavarok keresztmetszeti vizsgálata magyarországi populáción,” Orvosi Hetilap 162 (2021): 1724–1731. [DOI] [PubMed] [Google Scholar]
- 7. Krhut J., Gärtner M., Mokris J., et al., “Effect of Severity of Urinary Incontinence on Quality of Life in Women,” Neurourology and Urodynamics 37 (2018): 1925–1930. [DOI] [PubMed] [Google Scholar]
- 8. Chow P. M., Chuang Y. C., Hsu K. C. P., Shen Y. C., and Liu S. P., “Impact of Female Stress Urinary Incontinence on Quality of Life, Mental Health, Work Limitation, and Healthcare Seeking in China, Taiwan, and South Korea (LUTS Asia): Results From a Cross‐Sectional, Population‐Based Study,” International Journal of Women's Health 14 (2022): 1871–1880. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9. Porto M. G., Marôco J., Mascarenhas T., Vergamota P., Queiroz‐Garcia I., and Pimenta F., “Urinary Incontinence Severity: The Impact on Workplace Productivity,” World Journal of Urology 43 (2025): 430. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10. Pierce H., Perry L., Gallagher R., and Chiarelli P., “Urinary Incontinence, Work, and Intention to Leave Current Job: A Cross Sectional Survey of the Australian Nursing and Midwifery Workforce,” Neurourology and Urodynamics 36 (2017): 1876–1883. [DOI] [PubMed] [Google Scholar]
- 11. Felippe M. R., Zambon J. P., Girotti M. E., et al., “What Is the Real Impact of Urinary Incontinence on Female Sexual Dysfunction? A Case Control Study,” Sexual Medicine 5 (2017): e54–e60. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12. Frigerio M., Barba M., Cola A., et al., “Quality of Life, Psychological Wellbeing, and Sexuality in Women With Urinary Incontinence—Where Are We Now: A Narrative Review,” Medicina (Kaunas, Lithuania) 58 (2022): 525. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13. Gray M. and Giuliano K. K., “Incontinence‐Associated Dermatitis, Characteristics and Relationship to Pressure Injury,” Journal of Wound, Ostomy & Continence Nursing 45 (2018): 63–67. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14. Gibson W., Hunter K. F., Camicioli R., et al., “The Association Between Lower Urinary Tract Symptoms and Falls: Forming a Theoretical Model for a Research Agenda,” Neurourology and Urodynamics 37 (2018): 501–509. [DOI] [PubMed] [Google Scholar]
- 15. Kim H. J., Kim J. W., Jang S. N., Kim K. D., Yoo J. I., and Ha Y. C., “Urinary Incontinences Are Related With Fall and Fragility Fractures in Elderly Population: Nationwide Cohort Study,” Journal of Bone Metabolism 25 (2018): 267–274. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16. Tardi P., Szilagyi B., Makai A., et al., “The Development of a Reliable and Valid Instrument to Measure the Osteoporosis‐Related Knowledge: Validation of the Hungarian Version of Osteoporosis Knowledge Assessment Tool (OKAT),” BMC Public Health 21 (2021): 1515. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17. Winkelman W. D., Warsi A., Huang A. J., et al., “Sleep Quality and Daytime Sleepiness Among Women With Urgency Predominant Urinary Incontinence,” Female Pelvic Medicine & Reconstructive Surgery 24 (2018): 76–81. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18. Avery K., Donovan J., Peters T. J., Shaw C., Gotoh M., and Abrams P., “ICIQ: A Brief and Robust Measure for Evaluating the Symptoms and Impact of Urinary Incontinence,” Neurourology and Urodynamics 23 (2004): 322–330. [DOI] [PubMed] [Google Scholar]
- 19. Kenyeres B., Sarlós D. P., Szántó Á., and Pytel Á., “Validation of the Hungarian Version of the International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form (ICIQ‐UI/SF) in Females With Lower Urinary Tract Symptoms,” European Urology Supplements 14 (2015): e1256. [Google Scholar]
- 20. Jackson S., Donovan J., Brookes S., Eckford S., Swithinbank L., and Abrams P., “The Bristol Female Lower Urinary Tract Symptoms Questionnaire: Development and Psychometric Testing,” British Journal of Urology 77 (1996): 805–812. [DOI] [PubMed] [Google Scholar]
- 21. Brookes S. T., Donovan J. L., Wright M., Jackson S., and Abrams P., “A Scored Form of the Bristol Female Lower Urinary Tract Symptoms Questionnaire: Data From a Randomized Controlled Trial of Surgery for Women With Stress Incontinence,” American Journal of Obstetrics and Gynecology 191 (2004): 73–82. [DOI] [PubMed] [Google Scholar]
- 22. Debes W. A., Sadaqa M., Makai A., et al., “Validation of the Hungarian Version of the International Consultation on Incontinence Modular Questionnaire on Female Lower Urinary Tract Symptoms (ICIQ‐FLUTS),” Journal of Clinical Medicine 13 (2024): 7389. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23. Baessler K., O'Neill S. M., Maher C. F., and Battistutta D., “A Validated Self‐Administered Female Pelvic Floor Questionnaire,” International Urogynecology Journal 21 (2010): 163–172. [DOI] [PubMed] [Google Scholar]
- 24. Hock M., Tiringer I., Ambrus E., Németh Z., and Farkas B., “Validation and Translation of the Hungarian Version of the Australian Pelvic Floor Questionnaire (APFQ‐H),” International Urogynecology Journal 34 (2022): 1187–1194. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25. Kelleher C. J., Cardozo L. D., Khullar V., and Salvatore S., “A New Questionnaire to Assess the Quality of Life of Urinary Incontinent Women,” BJOG: An International Journal of Obstetrics & Gynaecology 104 (1997): 1374–1379. [DOI] [PubMed] [Google Scholar]
- 26. Szatmári É., Makai A., Prémusz V., Ács P., and Hock M., “Validation of the Hungarian Version of the King's Health Questionnaire (KHQ) in Women,” Scientific Reports 16 (2026): 19067. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27. Kurzawa Z., Sutherland J. M., Crump T., and Liu G., “Measuring Quality of Life in Patients With Stress Urinary Incontinence: Is the ICIQ‐UI‐SF Adequate?,” Quality of Life Research 27 (2018): 2189–2194. [DOI] [PubMed] [Google Scholar]
- 28. Skorupska K. and Kamińska A., “Advantages and Disadvantages of Commonly Used Urinary Incontinence Questionnaires — How to Correctly Choose Questionnaire in Urinary Incontinence Diagnosis?,” Journal of Clinical Medicine 14 (2025): 8196. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29. Uebersax J. S., Wyman J. F., Shumaker S. A., and McClish D. K., “Short Forms to Assess Life Quality and Symptom Distress for Urinary Incontinence in Women: The Incontinence Impact Questionnaire and the Urogenital Distress Inventory,” Neurourology and Urodynamics 14 (1995): 131–139. [DOI] [PubMed] [Google Scholar]
- 30. Cam C., Sakalli M., Ay P., Cam M., and Karateke A., “Validation of the Short Forms of the Incontinence Impact Questionnaire (IIQ‐7) and the Urogenital Distress Inventory (UDI‐6) in a Turkish Population,” Neurourology and Urodynamics 26 (2007): 129–133. [DOI] [PubMed] [Google Scholar]
- 31. Franzén K., Johansson J. E., Karlsson J., and Nilsson K., “Validation of the Swedish Version of the Incontinence Impact Questionnaire and the Urogenital Distress Inventory,” Acta Obstetricia et Gynecologica Scandinavica 92 (2013): 555–561. [DOI] [PubMed] [Google Scholar]
- 32. Tassawer Q. A., Noor R., Ikram M., and Bashir M. S., “Translation and Validation of Incontinence Impact Questionnaire Short Form in the Urdu Language,” International Urogynecology Journal 34 (2023): 2285–2292. [DOI] [PubMed] [Google Scholar]
- 33. Utomo E., Korfage I. J., Wildhagen M. F., Steensma A. B., Bangma C. H., and Blok B. F. M., “Validation of the Urogenital Distress Inventory (UDI‐6) and Incontinence Impact Questionnaire (IIQ‐7) in a Dutch Population: Validation of the Dutch UDI‐6 and IIQ‐7,” Neurourology and Urodynamics 34 (2015): 24–31. [DOI] [PubMed] [Google Scholar]
- 34. Zhu L., Yu S. jun, Lang J. he, et al., “Validation of Incontinence Impact Questionnaire Short Form in Chinese Population,” Zhonghua fu chan ke za zhi 46 (2011): 505–509. [PubMed] [Google Scholar]
- 35. Chan S. S. C., Choy K. W., Lee B. P. Y., et al., “Chinese Validation of Urogenital Distress Inventory and Incontinence Impact Questionnaire Short Form,” International Urogynecology Journal 21 (2010): 807–812. [DOI] [PubMed] [Google Scholar]
- 36. Choi E. P. H., Lam C. L. K., and Chin W. Y., “The Incontinence Impact Questionnaire‐7 (IIQ‐7) Can Be Applicable to Chinese Males and Females With Lower Urinary Tract Symptoms,” Patient ‐ Patient‐Centered Outcomes Research 7 (2014): 403–411. [DOI] [PubMed] [Google Scholar]
- 37. Ghroubi S., El Fani N., Elarem S., et al., “Arabic (Tunisian) Translation and Validation of the Urogenital Distress Inventory Short Form (UDI‐6) and Incontinence Impact Questionnaire Short Form (IIQ‐7),” Arab Journal of Urology 18 (2020): 27–33. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 38. Skorupska K. A., Miotla P., Kubik‐Komar A., Skorupski P., and Rechberger T., “Development and Validation of the Polish Version of the Urogenital Distress Inventory Short Form and the Incontinence Impact Questionnaire Short Form,” European Journal of Obstetrics & Gynecology and Reproductive Biology 215 (2017): 171–174. [DOI] [PubMed] [Google Scholar]
- 39. Nusee Z., Rusly A., Jamalludin A. R., Abdulwahab D. F., and Ismail R., “Translation and Validation of Bahasa Malaysia Version of Urogenital Distress Inventory (UDI‐6) and Incontinence Impact Quality of Life Questionnaires (IIQ‐7), a Cross Sectional Study,” Malaysian Journal of Medical Sciences 23 (2016): 57–63. [PMC free article] [PubMed] [Google Scholar]
- 40. Loposso M. N., Ndundu J., Mbunzu D., Matala T., Punga A. M., and De Ridder D., “Assessing Quality of Life in Obstetric Fistula Patients: Validation of the Urogenital Distress Inventory (UDI‐6) and Incontinence Impact Questionnaire (IIQ‐7) in Lingala and Kikongo in DR Congo,” Neurourology and Urodynamics 38 (2019): 1994–2000. [DOI] [PubMed] [Google Scholar]
- 41. Ruiz de Viñaspre Hernández R., Tomás Aznar C., and Rubio Aranda E., “Validation of the Spanish Version of the Short Forms of the Urogenital Distress Inventory (UDI‐6) and the Incontinence Impact Questionnaire (IIQ‐7) in Pregnant Women,” Gaceta Sanitaria 25 (2013): 379–384. [DOI] [PubMed] [Google Scholar]
- 42. Bouallalene‐Jaramillo K., Bagur‐Calafat M. C., and Girabent‐Farrés M., “Validation of the Spanish Version of the Urogenital Distress Inventory Short Form and Incontinence Impact Questionnaire Short Form for Women Between the Ages of 18 and 65,” ActaS Urologicas Espanolas 39 (2015): 504–510. [DOI] [PubMed] [Google Scholar]
- 43. Stievano L. P., Olival G. S., Silva R. A. P., et al., “Validation Survey of the Impact of Urinary Incontinence (IIQ‐7) and Inventory of Distress Urogenital (UDI‐6) – The Short Scales – In Patients With Multiple Sclerosis,” Arquivos de Neuro‐psiquiatria 73 (2015): 46–51. [DOI] [PubMed] [Google Scholar]
- 44. Mokkink L. B., Prinsen C. A., Patrick D., et al., COSMIN Study Design Checklist for Patient‐Reported Outcome Measurement Instruments, Version July 2019 (2019), https://www.cosmin.nl/wp-content/uploads/COSMIN-study-designing-checklist_final.pdf.
- 45. Beaton D. E., Bombardier C., Guillemin F., and Ferraz M. B., “Guidelines for the Process of Cross‐Cultural Adaptation of Self‐Report Measures,” Spine 25 (2000): 3186–3191. [DOI] [PubMed] [Google Scholar]
- 46. Prinsen C. A. C., Mokkink L. B., Bouter L. M., et al., “COSMIN Guideline for Systematic Reviews of Patient‐Reported Outcome Measures,” Quality of Life Research 27 (2018): 1147–1157. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 47. Drennan J., “Cognitive Interviewing: Verbal Data in the Design and Pretesting of Questionnaires,” Journal of Advanced Nursing 42 (2003): 57–63. [DOI] [PubMed] [Google Scholar]
- 48. Klovning A., Avery K., Sandvik H., and Hunskaar S., “Comparison of Two Questionnaires for Assessing the Severity of Urinary Incontinence: The ICIQ‐UI SF Versus the Incontinence Severity Index,” Neurourology and Urodynamics 28 (2009): 411–415. [DOI] [PubMed] [Google Scholar]
- 49. MacCallum R. C., Widaman K. F., Zhang S., and Hong S., “Sample Size in Factor Analysis,” Psychological Methods 4 (1999): 84–99. [Google Scholar]
- 50. Hu L. and Bentler P. M., “Fit Indices in Covariance Structure Modeling: Sensitivity to Underparameterized Model Misspecification,” Psychological Methods 3 (1998): 424–453. [Google Scholar]
- 51. Andresen E. M., “Criteria for Assessing the Tools of Disability Outcomes Research,” supplement, Archives of Physical Medicine and Rehabilitation 81, no. 12 Suppl 2 (2000): S15–S20. [DOI] [PubMed] [Google Scholar]
- 52. Dunn T. J., Baguley T., and Brunsden V., “From Alpha to Omega: A Practical Solution to the Pervasive Problem of Internal Consistency Estimation,” British Journal of Psychology 105 (2014): 399–412. [DOI] [PubMed] [Google Scholar]
- 53. Marx R. G., Menezes A., Horovitz L., Jones E. C., and Warren R. F., “A Comparison of Two Time Intervals for Test‐Retest Reliability of Health Status Instruments,” Journal of Clinical Epidemiology 56 (2003): 730–735. [DOI] [PubMed] [Google Scholar]
- 54. Mokkink L. B., Boers M., van der Vleuten C. P. M., et al., “COSMIN Risk of Bias Tool to Assess the Quality of Studies on Reliability or Measurement Error of Outcome Measurement Instruments: A Delphi Study,” BMC Medical Research Methodology 20 (2020): 293. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 55. Wyse A. E., “How Days Between Tests Impacts Alternate Forms Reliability in Computerized Adaptive Tests,” Educational and Psychological Measurement 81 (2021): 644–667. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 56. Koo T. K. and Li M. Y., “A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research,” Journal of Chiropractic Medicine 15 (2016): 155–163. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 57. Wu C., Chuang L., Lin K., Lee S., and Hong W., “Responsiveness, Minimal Detectable Change, and Minimal Clinically Important Difference of the Nottingham Extended Activities of Daily Living Scale in Patients With Improved Performance After Stroke Rehabilitation,” Archives of Physical Medicine and Rehabilitation 92 (2011): 1281–1287. [DOI] [PubMed] [Google Scholar]
- 58. Pizzol D., Demurtas J., Celotto S., et al., “Urinary Incontinence and Quality of Life: A Systematic Review and Meta‐Analysis,” Aging Clinical and Experimental Research 33 (2021): 25–35. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 59. Akoglu H., “User's Guide to Correlation Coefficients,” Turkish Journal of Emergency Medicine 18 (2018): 91–93. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 60. Asoglu M. R., Selcuk S., Cam C., Cogendez E., and Karateke A., “Effects of Urinary Incontinence Subtypes on Women's Quality of Life (Including Sexual Life) and Psychosocial State,” European Journal of Obstetrics & Gynecology and Reproductive Biology 176 (2014): 187–190. [DOI] [PubMed] [Google Scholar]
- 61. Minassian V. A., Devore E., Hagan K., and Grodstein F., “Severity of Urinary Incontinence and Effect on Quality of Life in Women by Incontinence Type,” Obstetrics & Gynecology 121 (2013): 1083–1090. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 62. Monticone M., Ferriero G., Giordano A., Foti C., and Franchignoni F., “Rasch Analysis of the Incontinence Impact Questionnaire Short Version (IIQ‐7) in Women With Urinary Incontinence,” International Journal of Rehabilitation Research 43 (2020): 261–265. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.