Epidemiology and Public Health Sciences

Department of Public Health and Clinical Medicine

Umeå University, SE-901 87 Umeå, Sweden, 2009

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Author: Mojgan Padyab Supervisor: Mehdi Ghazinour

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ABSTRACT

Background Stress as a negative emotional and psychological process, happens when individuals try to adjust to circumstances that disrupt their daily functioning. One of the influential factors on the interaction between people and stress is their ways of coping. One of the most widely used self-assessment inventories of coping is “Ways of Coping”. Two categories of coping, problem-focused and emotion-focused, can be derived from this questionnaire through eight scales. The reliability and factor structure of the Farsi version of this questionnaire is to be evaluated.

Methods Translation from English to Farsi, back translation, cultural adaptation for idioms was performed. A total of 100 Farsi-speaking samples from Tehran were selected by non-probability sampling technique. Face validity was checked by giving the pre-final version of the questionnaire to 20 native Farsi speaking individuals. Internal consistency, floor and ceiling effect and factor structure of the items in the questionnaire were assessed. Mean scores and relative scores calculated and was compared by demographical characteristics of the sample population.

Results Most respondents found the Farsi version of Ways of Coping questionnaire convenient to complete and relevant to their experiences regarding coping strategies. Floor and ceiling effects were observed for some items. Eight factors were extracted, i.e., Planful Problem Solving, Distancing, Escape Avoidance, Self Control, Seeking Social Support, Positive Reappraisal, Positive Thinking and Accepting Responsibility. The eight factors jointly accounted for 61% of the total variance. Cronbach-alpha for the total score was 0.88. Mean score differences of coping scales were not statistically significant between men and women, marital status and age groups. No difference was found for relative scores by demographic characteristics. Positive reappraisal constitutes the highest mean score and relative score, compared to other coping strategies.

Conclusions Regarding psychometric properties of the Farsi-version of the Ways of Coping questionnaire, internal consistency was acceptable for the total score, but not acceptable for some of the sub-scales. The scale items differ between Farsi and English versions, due to the cultural and perceptional differences between two populations. Iranians tend to use Positive Reappraisal as the most frequent coping strategy which is justified by religious norms, cultural traits and beliefs.

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ACKNOWLEDGMENTS

I am grateful to all the personnel in the department of Public Health, Umeå University for facilitating such an appropriate study and learning environment.

My unceasing gratitude to my mentor and supervisor, Mehdi Ghazinour, Department of Social Work, who has taught me so much. I appreciate his guidance and thought-provoking interactions and whenever I needed guidance his door was always open.

For his useful comments, my thanks to Miguel San Sebastian at the department of Public Health.

Special thanks to Habib Emami whom I have had the pleasure of working with. His expertise and good humour is appreciated.

I am grateful to Birgitta Åstrom for her wonderful support and making me feel so welcome in Umeå.

I would like to thank everyone who made data collection possible. I am very grateful to the 100 Iranian participants for the time they devoted to filling out the questionnaires.

Last but definitely not least, I am and will eternally be grateful and indebted to my parents for their encouragement and support of every step I take in life.

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ABBREVIATIONS

CC Confrontive Coping

D Distancing

EA Escape Avoidance

KMO Kaiser-Meyer-Olkin

PCA Principal Component Analysis

PPS Planful Problem Solving

PR Positive Reappraisal

PT Positive Thinking

SC Self controlling

SID Scientific information Database

SSS Seeking Social Support

WHO World Health Organization

WOC Ways of Coping

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TABLE OF CONTENTS

ABSTRACT ............................................................................................................................... ii Background ............................................................................................................................ ii Methods .................................................................................................................................. ii Results .................................................................................................................................... ii Conclusions ............................................................................................................................ ii

ACKNOWLEDGMENTS.......................................................................................................... 3 INTRODUCTION...................................................................................................................... 6 AIM ............................................................................................................................................ 7

Research questions ................................................................................................................. 7 THEORETICAL FRAMEWORK ............................................................................................. 7

Definitions .............................................................................................................................. 7 Stress .................................................................................................................................. 7 Stress mediators: interactions between people and stressors ............................................. 8

Coping theory ......................................................................................................................... 9 Ways of Coping questionnaire: Development and scales ...................................................... 9 The psychometric approach.................................................................................................. 11 The importance of psychometrics in Social Sciences .......................................................... 13 Psychometrics properties of Ways of Coping ...................................................................... 13

MATERIALS AND METHODS ............................................................................................. 14 Samples ................................................................................................................................ 14 Data collection...................................................................................................................... 14 Main outcome measures....................................................................................................... 14

Face validity ..................................................................................................................... 14 Content validity ................................................................................................................ 14 Reliability ......................................................................................................................... 15 Mean scores and relative scores ....................................................................................... 15

Statistical analysis ................................................................................................................ 15 Factor analysis.................................................................................................................. 15

Translation and cultural adaptation ...................................................................................... 16 Ethical considerations........................................................................................................... 16

RESULTS................................................................................................................................. 16 Content validity .................................................................................................................... 17 Factor analysis...................................................................................................................... 18 Internal consistency.............................................................................................................. 23 Mean scores and relative scores ........................................................................................... 24

DISCUSSION .......................................................................................................................... 27 CONCLUSION ........................................................................................................................ 29 LIMITATIONS ........................................................................................................................ 30 REFERENCES......................................................................................................................... 31

Web reference....................................................................................................................... 33

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INTRODUCTION

During my studies at the department of Statistics, we had some practical projects, where we were assigned to interpret estimates calculated using statistical packages into words and give meaning to them. For every day that passed by, this process seemed reasonable, meaningful and interesting and stimulated me to start a professional career as statistical consultant in medical research. My experience was improving more and more and I got familiar with different research projects specially those at international levels. Gradually, I got to know that research is integrated with different social, behavioral, cultural and psychological factors. Different contexts demand different approaches and the results could differ accordingly. The difference is more apparent in studies that are related to the social and cultural background of the participants, i.e., social science studies. One methodological problem is the difference in the construct of the instruments among different populations. Many of those instruments were developed in Western countries and the scales are applied only to western individuals with their own context, social and cultural situations.

The lack of enough instruments in Eastern countries might be one of the reasons of fewer studies in such fields. Iran is one of those countries that is lagged behind the global publication flow. The Scientific Information Database (SID) was developed in 2004 to provide information on Iranian publications. The results from this website shows between 1974 and 2004 Iranian scientists published only 49 papers in international journals that are related to social sciences, e.g., “Genetic Social and General Psychology Monographs”, “International Social Science Journal”, “International Sociology”, “Journal of Social Psychology”, “Social Compass”, “Social Psychiatry and Psychiatric Epidemiology” and “Social Science and Medicine”. www.sid.ir

The comparable few publications might be due to the lack of enough tools and instruments in the Iranian scientific area. Research in Iran demands more construct validity and reliability of Western instruments, to make sure that the translated instrument is still valid and applicable in another language and context. Thus, there is a need to develop valid and culturally adapted scales for Iranian population. It is also possible to develop a new instrument, in which, different aspects of the phenomena which is supposed to be measured must be considered.

One study area with inadequate attention in Iran is stress and I realized that few studies are done about coping strategies in stressful situations. The results of my search using different data bases showed that only one study had been done in Farsi version of an instrument called “Coping Response Inventory” by Aguilar-Vafaie and Abiari (2007). By using this questionnaire, different coping strategies were discovered among Iranians.

In the current study, the aim is to present the psychometric properties of another instrument, named Ways of Coping, which is basically designed to evaluate different coping strategies.

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I start with aim, theoretical framework and the importance of psychometrics in social sciences; followed by methodological aspects of the study. The results and discussion will come afterwards and I will mention some limitations of the study in the end.

AIM

The aim of this thesis is to assess the following statements regarding Farsi version of the Ways of coping questionnaire:

• to estimate the internal consistency

• to derive the factor structure of the items

Research questions - Is the content validity of the Farsi version of the questionnaire approved?

- What are the coping scales in Iranian population?

- Do the coping strategies differ by demographic characteristics?

- Is the instrument internally consistent?

THEORETICAL FRAMEWORK

In order to be able to explain the coping strategies among Iranian population, I start with some definitions of several constructs which the readers need to be familiar with, before getting to the main theories. In the following thesis I used two main theories. One of which is the theory of coping which was initially introduced by Folkman and Lazarus. The second theory is about knowledge and importance of the psychometric properties of the instruments in use.

Definitions

Stress Stress is a part of life and happens to everybody regardless of their wealth, happiness, health and power. It is defined as the negative emotional and psychological process that occurs as individuals try to adjust to circumstances that disrupt or threaten to disrupt a person’s daily functioning and their equilibrium (Bernstein, Penner, Clarke-Stewart & Roy, 2006). It could be stimulated by different events or situations which are academically called stressors.

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Traumatic accident, life difficulties and strains, serious illnesses and catastrophic events are examples of stressors. Stress is a transaction between people and their environment, in a way that they confront stressors and then respond physically e.g., nervousness, nausea and fatigue, as well as, psychologically, e.g., emotional, cognitive or behavioral (Bernstein et al., 2006). The transaction between people and their environment is influenced by many factors which Bernstein et al., (2006) call them stress mediators. Cognitive appraisal, predictability, control over stress, social support and coping resources and coping methods are examples of stress mediators (Bernstein et al., 2006). All the above mentioned variables can curtail or magnify the response to stress. A brief explanation of different stress mediators is given in the next section.

Stress mediators: interactions between people and stressors We listed some important stress mediators in the previous section and the definition of them is as follows:

Cognitive appraisal is the extent to which people perceive, interpret and appraise stressors. Lazarus’s theory was among the first studies on psychological stress reaction to stressors which identifies how cognitive appraisal and the way people think can influence the stressor’s impact (Bernstein et al., 2006).

Predictability and control can also mediate the effect of stressors; in other words predictable stressors tend to have less impact and according to Thompson, Sobolow-Shubin, Galbraith, Schwankovsky and Cruzen (1993), if someone believes that the stressor is controllable, even if it isn’t, the impact is definitely reduced and that person experiences less harm from the stressor.

Coping resources and coping methods are referred to available and potential resources and also various coping methods that people use in stressful situations. Money and time are examples of resources and people usually suffer less from a stressor if they have adequate coping resources (Benight, Swift, Sanger, Smith & Zeppelin, 1999). The effective coping strategy is an important factor to reduce the impact of stressors. An increasing trend of literatures indicates that coping is a major mediator between stressful event and psychological/somatic health outcomes. Different coping strategies are considered to be effective for different outcomes. The results of the study on HIV-positive adult men revealed that strengthening their cognitive coping skills to assist them in regulating emotional responses reduced their anxiety (Côté & Pepler, 2002).

Coping self-efficacy which is another coping strategy, is defined as the perception of one’s capability for managing stressful situations, is shown to be an important strategy to cope with natural disaster stressors (Benight et al., 1999). The findings of this study suggest that those people with higher levels of self-efficacy should be able to manage existing internal resources (optimism in which an individual believes that future environmental outcomes will be positive) and external resources (social support) more effectively which may result in a better recovery from initial resource losses and lower psychological distress. Coping procedure is an important factor in relation between stressful episodes and depression (Coyne, Aldwin & Lazarus, 1981). The assessment of coping in stressful situations in Coyne et al. (1981) study

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revealed meaningful differences between depressed and non-depressed persons. Depressed persons tend to seek more emotional and informational support from others and they believe their lack of ability to take action is more related to their feeling of uncertain and their requirement to more information than of feeling that they are inept to change the situation. Most of the methods we mentioned are classified as focusing either on problems or on emotions.

Coping theory The effect of stressor is reduced by the use of effective coping strategy. Most of these methods are categorized in either problem-focused or emotion focused.

Problem-focused coping involves efforts to change or eliminate the source of stress, whereas emotion-focused coping strategies tend to regulate the negative emotional consequences of the stressors (Folkman, Lazarus, Dunkel-Schetter, DeLongis & Gruen, 1986). People can experience both forms of coping procedures during a stressful situation, for example Folkman and Moskowitz (2000 a) in a study about stress and positive emotion, pointed on the nature of the coping processes more as a challenge than as a threat which is associated with positive emotions. In the study of caregivers by Folkman (1997), which is premised on this evidence, she describes three coping mechanisms that can explain how people can experience positive emotions during long period of severe stress; these mechanisms are positive reappraisal, problem-focused coping and the creation of positive events.

The two forms of coping, i.e., problem-focused and emotion-focused, can be measured by the Ways of Coping questionnaire and the first research using the revised version was reported in Folkman and Lazarus (1985).

Ways of Coping questionnaire: Development and scales The questionnaire was developed to assess the specific ways in which people cope with stressors. The Ways of Coping questionnaire is based on a definition of coping as cognitive and behavioral strategies people use to manage internal and/or external demands in stressful encounters (Folkman et al., 1986). This definition has four key elements (Folkman & Lazarus, 1985; 1988):

1- Coping is process oriented approach not static.

2- More related to management rather than mastery, as some coping processes that are used to tolerate such problems, or to minimize, accept or ignore them are just as important as problem-solving strategies that aim to master the environment (Lazarus & Folkman, 1984).

3- It makes no a priori judgment about the quality of coping processes.

4- It makes a distinction between coping and automatic behavior. It does not refer to all the things we do in relating to the environment.

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The first version of Ways of Coping (Folkman & Lazarus, 1980) contained 68 items that were derived from theoretical framework outlined by Lazarus and his colleagues (Lazarus & Launier, 1978). The revised 66-item version differs from the original in that redundant and unclear items were deleted and several items were added (e.g., “I prayed”, “I jogged or exercised”, “I reminded myself how much worse things could be”) (Folkman & Lazarus, 1988). Further, the response format was changed from Yes-No to a 4-point Likert scale, so that respondents could indicate the frequency with which they use each strategy (0=does not apply and/or not used, 1=used somewhat, 2=used quite a bit, 3=used a great deal).

The Ways of Coping questionnaire is designed to measure coping processes, not coping dispositions or styles. A process-oriented approach to coping refers to express what an individual thinks and does within the context of a specific encounter and how these thoughts and actions differ as the encounter unfolds (Lazarus & Folkman, 1984, p.4).

Two categories of coping were derived from factor analysis in the ways of coping questionnaire.

a) Wide range of stressful encounters reported by a community sample of middle-aged married couples (Folkman et al., 1986)

b) The ways students cope with a college examination (Folkman & Lazarus, 1985).

In general, it is suggested to the investigators to use the scales from the study of middle-aged married couples, since it covers a broader sampling of subjects and stressful encounters (Folkman & Lazarus, 1988). However, in a situation of college examinations or students, the scales from the second study might be more appropriate. Therefore, we briefly name the scales derived from the middle-aged couples study. These 8 categories are: Confrontive coping, distancing, self-controlling, seeking social support, accepting responsibility and escape avoidance, plan full problem solving and positive reappraisal.

A brief description of these eight categories is given by Folkman and Lazarus (1988)1 in the following section:

Confrontive Coping: This scale describes aggressive efforts to change the situation (e.g., “Stood my ground and fought for I wanted” or “tried the person responsible to change his or her mind”). It also suggests some degree of hostility (e.g., “I expressed anger to the person(s) who caused the problem”) and risk-taking (e.g., “took a big chance or did something very risky” or “I did something which I didn’t think would work, but at least I was doing something”)

Distancing: This scale describes cognitive efforts to detach oneself (e.g., “Went on as if nothing had happened” or “Tried to forget the whole thing”). Another code related to this

1 . All the scale definitions are from Folkman and Lazarus according to the reference. Dr Folkman gave the copy right of the instrument to the Mind Garden Company. The definitions of the scales according to the Folkman comes from the Mind Garden Company who has published the manual of the WOC.

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scale concerns with minimizing the significance of the situation and create a positive outlook (e.g., “Looked for the silver lining, so to speak; tried to look on the bright side of things”)

Self-Control: This scale describes efforts to regulate one’s feelings (e.g., “I tried to keep my feelings to myself” or “Kept others from knowing how bad things were”) and actions (e.g., “I tried not to act too hastily or follow my first hunch” or “Tried not to burn my bridges, but leave things open somewhat”).

Seeking Social Support: It describes efforts to seek informational support (e.g., Talked to someone to find out more about the situation” or “I asked a relative or friend I respected for advice”), tangible support (e.g., “Talked to someone who could do something concrete about the problem”) and emotional support (e.g., “Accepted sympathy and understanding from someone”).

Accepting Responsibility: This scale acknowledges one’s own role in the problem (e.g., “Realized I brought the problem on myself”) with a concomitant theme of trying to put things right (e.g., “I apologized or did something to make up”).

Escape Avoidance: This scale describes wishful thinking (e.g., “Wished that the situation would go away or somehow be over with” and behavioral effort to escape or avoid the problem (e.g., “Tried to make myself feel better by eating, drinking, smoking, using drugs or medication, etc” or ” Slept more than usual”). The items of this scale contrast with those on the distancing scale, which involves detachment.

Planful Problem Solving: This scale describes deliberate problem-focused efforts to alter the situation (e.g., “I knew what had to be done, so I doubled my efforts to make things work”) coupled with an analytic approach to solving the problem (e.g., “Came up wit a couple of different solutions to the problem” or “I made a plan of action and followed it”).

Positive Reappraisal: This scale describes efforts to create positive meaning by focusing on personal growth (e.g., “Changed or grew as a person in a good way” or “I was inspired to do something creative”). It also has a religious dimension (e.g., “I prayed” or “Found new faith”)

The development of the questionnaire follows the coping theoretical framework and is based on the psychometric approach.

The psychometric approach The term “psychometrics” is defined as the statistical study of psychological tests (Passer & Smith, 2008) the first psychometric instrument was developed to measure intelligence. The psychometric approach to intelligence tries to measure differences among individuals in terms of their performance. In other words, as Passer and Smith (2008) state in the book, psychometric approach to intelligence tries to provide a measurement-base map of mind.

Psychometrics started to develop when the need to have an instrument to measure different phenomena lacked in studies. The studies include psychology, psychophysics, social sciences, medicine, nutritional studies and so on. The need to measure mental health, personality testing

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and intelligence was a need to develop psychometrics in psychology. The need to assign numbers to objects and events based on certain rules, according to Stevens (1946) was the basic idea for developing psychometrics in social sciences.

There is also a considerable use of different instruments being used in medicine, helping physicians to come up to a cut-off point in diagnosis of different diseases, the extent of the patients’ physical activity or to score the level of pain. A simple example includes the Rose questionnaire (1962) in cardiovascular field survey which is designed to measure the angina pectoris (pressure-like pain in the chest). There are a huge number of such instruments in the field of medicine but there is no enough space in this manuscript to point on them.

Although psychometrics has different applications in different fields, the assessment of psychometric instruments usually follow a certain way in that they have the intention to reflect differences of the scores among the population. In other words, they attempt to quantify and measure a certain phenomena and doing so the researcher ia able to assess the distribution and differences of the phenomena among the study population. The psychometric assessment procedure is based on the self report questionnaires, including questions about the research main question and a number of response categories (intensity or amount) that is related to the question. The individuals who are responding the questions in the instrument are needed to position themselves to each item and mention the response category that fits those best.

After we get the scores of all items, we need to define an index or overall score from them, but there is one important key element before going to that step and it is making sure that the instrument is valid and reliable. A reliable measurement measures the phenomena consistently but a valid test measures something that it was supposed to. An instrument can be reliable and consistent but not necessarily valid. It can always quantify the amount the same at any time (consistency) but the resulting measure is wrong. Cronbach (1951) emphasizes on reliability when he argues no validity can be interpreted without some appropriate measurement of error or reliability.

After checking for reliability and validity, the scores are aggregated and analyzed according to the purpose of the study. Sometimes some factors or themes are extracted using a statistical technique called Factor Analysis (reduces a large number of items to a smaller clusters, factors or scales to characterize certain phenomena in each factor) and sometimes the aggregated measure is enough for further statistical inferences. In some instruments the aggregated score will be used to ascertain a cut-off for further diagnosis and in some other instruments different outcomes are obtained based on the logical conditions and the relations between items, e.g., the Angina questionnaire we mentioned earlier, we categorize Rose angina in 3 levels based on the certain combinations of responses to the items of the Rose questionnaire. Following these combinations the researcher will categorize the respondent into these groups: definite angina grade 2 (severe), definite angina grade 1 (moderate), and possible angina (mild).

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The importance of psychometrics in Social Sciences Nowadays the development of instruments in social sciences has found the same importance as in medicine and there is a considerable growth in literatures in psychometric properties of such instruments. Many studies in medicine and natural sciences are mainly focused on physical conditions of health and the social conditions rank second in importance. In addition to subjective physical conditions, social and environmental background variables account for the overall well-being, happiness and satisfaction. What all studies are trying to reach is improving peoples’ life conditions, goodness of life, life satisfaction or as Bowling (2001) calls quality of life.

Shaw (1977) has defined quality of life (QL) as a product of ones natural endowment (NE) and the effort made on one’s behalf by the family (H) and society (S), such that QL=NE × H × S. This definition highlights the importance of social indicators on quality of life which automatically reflects the importance of social indicators on people’s health. What we mean by health is not just absence of disease, but feelings of mental and physical well-being, full functioning, physical fitness, ability to cope with stresses, social support which is defined in its best way by WHO. If we have a short look in the definition of health by WHO (www.who.int), “A state of complete physical, mental and social well-being, and not merely the absence of disease”, we realize that social well-being and mental health are as important as physical health to the overall well-being of individuals, societies and countries. Indeed, health is more than just a biomedical condition; it involves social human being functioning and incorporates with the environment.

Psychometrics properties of Ways of Coping The first psychometric self-report instrument on Ways of Coping was developed in 1976 based on different strategies suggested in the literatures on coping (Sidle, Moos, Adams & Cady, 1969). The Ways of coping checklist (1976) was carefully constructed instruments and was able to screen and identify different coping strategies among individuals. A revised version of Ways of Coping was developed in 1985 with almost the same concept and range of strategies from Ways of Coping checklist but some changes on unclear items and redundant items. The psychometric perspective on coping has been very much dominated by the theoretical models by Lazarus and Launier (1978).

The ways of coping model of Coping is one of the most frequently used in psychometric studies. It is one of the widely used measures of self-report coping strategies and there has been an enormous volume of coping research that use this instrument in different settings and cultures. Translations have been done in the Dutch (Bramsen, Bleiker, Mattanja Triemstra, Van Rossum & Van Der Ploeg, 1995), Spanish (Munet-Vilaro, Gregorich & Folkman, 2002) Swedish (Ahlström & Wenneberg, 2002) languages and based on the report by Mapi Research Institute, translations of WOC questionnaire are done in Finland, France, Germany, Italy, Israel (Hebrew), Korea, The Netherlands, Portugal, Slovenia, Spain, Taiwan (Mandarin Chinese), Turkey (www.mapi-research).

The widely used WOC questionnaire has not been translated and validated for Farsi-speaking people. Iranian researchers have realized the need for a reliable and valid instrument to assess

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the coping processes for Farsi speaking and this study presents the results of this process in Iran.

MATERIALS AND METHODS

In the following part of my thesis, study population is described and I proceed with different methodological aspects of this study. Since this investigation is about a specific instrument, I will introduce the instrument in the theoretical part of the thesis. My choice is based on the fact that this instrument has a good theoretical approach and giving a picture of the instrument in the method section would be somehow irrelevant. However, I tried to find relevant books and papers published in different journals which are related to my investigation. The databases such as Pub Med and Psychinfo have been used. Several key words were applied (e.g. reliability, validity, coping, psychometric studies, stress, etc). In the end of the thesis some limitation of the investigation will be presented.

Samples A total of 100 native Farsi-speaking samples aged 20 years and over from Tehran, Iran were selected by non-probability sampling technique. The samples are representative of Iranian population according to age and sex distribution based on the last population census (Iran statistical yearbook 13852, statistical center of Iran (www.SCI.org.ir).

Data collection The sampling started in one household in different areas and was continued with the next household who agreed to participate. A verbal consent was given beforehand and the individuals had autonomy to not participate. It takes about 10 minutes to answer the questions. The instruction about how to complete the questionnaire was given by the author in advance. In the first contact, the purpose and the instruction of the questionnaire was presented.

Main outcome measures Face validity is concerned with whether a measurement, at face value, appears to be measuring what it is intended to measure or whether it is unambiguous and appropriate (Bowling, 2001). In the presence of the author the pre-final Iranian version of the WOC were completed by 20 samples to make sure if the Iranian version can be understood correctly and the questions measure what they were intended to measure. Content validity is considered whether the scales tap all relevant concepts of the attribute to be measured (Bowling, 2001). In this step we also check the distribution of the scores and the percentage of respondents scoring at the lowest level (i.e., floor effect) and the percentage of respondents scoring the highest level (i.e., ceiling effect). The presence of ceiling effect or 2 . 1385 is based on Jalalian calendar which is the officially calendar used in Iran, it is 2006 according to Christian calendar.

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floor effects indicates that the items are unlikely to vary across subjects and will reduce the sensitivity (Fayers & Machin, 2000). The less sensitivity implies the lower variability among the population and therefore it becomes impossible to differentiate people according the scores, because almost all have the same score for that specific item.

Reliability refers to the ability to produce consistent results. In this study, the reliability of WOC questionnaire has been tested using the internal consistency method, Cronbach coefficient alpha. Cronbach-alpha ranges from zero to one and values equal or greater than 0.7 indicate adequate internal consistency for a scale (Cronbach, 1951). Since this questionnaire measures coping processes, which by definition, are variable, traditional test-retest estimates of reliability are inappropriate (Folkman & Lazarus, 1988).

Mean scores and relative scores aims to calculate the mean score for each scale. As I mentioned earlier, there are four possible responses 0, 1, 2 and 3. in order to calculate the mean scores, add the response for the items in that scale and divide the total score by the number of items in that scale. The high mean score indicate that the person often used the behaviors described by that scale in coping with the stressful event.

Relative scores describe the proportion of the effort for each type of coping strategy and are presented as a percentage that range from 0 to 100. A high relative score for a scale means that the person used that coping behavior more than the other behaviors (Folkman & Lazarus, 1988)

To calculate the relative scores, first the average response for each scale was calculated by dividing the total score by the number of items in the scale.

Then sum of the average responses per scale calculated across all the scales. That means take the eight averages from each scale and sum them.

Finally the average score for each scale is divided by the sum of the averages for all 8 scales. This is the value for relative score for each scale.

Statistical analysis Factor analysis is applied to identify the separate factors within the scales. It defines the dimensions of items of a questionnaire. In the present study, factor structure of the WOC was analyzed using principal component factor analysis with oblique rotation. Oblique rotation was selected because from theoretical point of view, individuals are expected to choose from a vast array of coping strategies rather than to use one set of strategies to the exclusion of others (Folkman & Lazarus, 1988).

I the present investigation, Cronbach-alpha was used to assess internal consistency of the items and One-way analysis of variance and Independent samples T-test were used to compare mean and relative scores of different coping strategies by demographic characteristics of the study population.

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Since the number of subjects in different levels of education is extremely different, pair wise comparisons were performed using Wilcoxon rank sum T-tests (equivalent to Mann-Whitney) and Bonferroni-corrected alphas were considered as significance level (Marascuilo & McSweeney, 1977). In our case with four educational levels, six pair wise comparisons are needed and the significance level would be 0.05/6=0.008.

Translation and cultural adaptation The official permission to translate and adapt the Iranian version of WOC questionnaire was obtained from Susan Folkman by the department of Social Work, Umeå University.

The author translated the English version of WOC (Folkman & Lazarus, 1988) into Farsi. The translation of English idioms was made so as to capture the meaning of the concept rather than literal translation. The Farsi translation was translated back into the original English language by a bilingual (Farsi and English). Each item of the English back translated was checked with the original English version. Consensus in terms of semantic, idiomatic and conceptual equivalence was reached and pre-final version of the questionnaire was obtained. This version was pilot tested with the first 20 native Persian speaking samples to make sure about the face validity.

Ethical considerations This investigation was originally discussed by scientific committee which was consisted of several researchers from Umeå University department of social work, department of clinical science division of psychiatry and Iran Medical University in Tehran. Since the main question of the thesis was about psychometric properties of the WOC instrument and the participants consisted of healthy people, the scientific committee did not advice to approve this investigation to any general ethical review.

Despite the fact that there was no need to present the investigation to the regional ethical committee, I took the general guidelines of ethical issues into consideration. All the participants were ensured their anonymities. Availability to me was guaranteed during data collection. I was available if the participants had question. During data collection none of the participants had any unpleasant thoughts or reaction due to the items of the instrument. They were informed that they can reach me anytime just in case of coming up any question or trouble regarding data collection. No one has contacted me so far.

RESULTS

Table 1 summarizes demographic characteristics of the study population. The mean age (SD) of the participants was 38.5 (15). Minimum age was 20 and maximum was 80 years. Mean age did not statistically differ between men and women (38.4±15.3 vs. 38.6±14.9, respectively).

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Table 1: Demographic characteristics of the study population (n=100)

Characteristic Number

Sex Men

50*

Age groups (year)

20-29 30-39 40-49 50 and more

36 24 18 22

Education

Less than 12 years 12 years (Diploma) Advanced diploma Bachelor of science (BSc) Master of science (MSc) PhD and higher

6 25 9 33 11 16

Marital status

Single Married

41 59

* values represent percentage (%)

Content validity Most participants found the Iranian version of WOC questionnaire easy to complete and relevant to their experiences regarding coping strategies. All the questions were filled in and there were no missing values for all 66 items. Mean response to every item for the WOC questionnaire ranged from 0.43 to 2.54 (possible range: 0-3).

The percentage of respondents scoring at the lowest level (i.e., floor effect) ranged from 0 to 71, while the percentage of respondents scoring at the highest level (i.e., ceiling effect) ranged from 2 to 61 (Table 2). It is noteworthy that these variables had KMO (will be discussed later in factor analysis section) less than the threshold of 0.5 and therefore omitted from further analysis.

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Table 2: Response pattern for each item of the WOC questionnaire (n=100)

Item # Floor

(%)

Ceiling

(%)

Item # Floor

(%)

Ceiling

(%)

Item # Floor

(%)

Ceiling

(%)

1 2 57 23 5 44 45 16 39

2 0 61 24 14 23 46 8 37

3 20 20 25 30 20 47 66 2

4 16 41 26 8 31 48 25 27

5 15 26 27 16 25 49 14 34

6 27 21 28 20 21 50 29 21

7 26 24 29 12 36 51 13 31

8 9 53 30 1 60 52 6 38

9 25 15 31 15 45 53 21 21

10 5 57 32 33 11 54 6 23

11 37 21 33 71 6 55 8 55

12 35 20 34 67 8 56 20 21

13 42 11 35 8 37 57 20 27

14 13 25 36 17 23 58 8 39

15 13 32 37 9 27 59 13 25

16 62 9 38 4 35 60 17 46

17 52 6 39 9 31 61 11 24

18 14 31 40 49 5 62 6 44

19 4 45 41 13 18 63 21 23

20 33 24 42 17 35 64 30 16

21 45 13 43 14 35 65 12 28

22 39 17 44 47 4 66 44 15

Factor analysis 66 items from WOC questionnaire were analyzed by means of Principal Component Analysis (PCA) as the extraction technique. Nonrotated PCA was run to check the correlation matrix, adequacy of sampling measure and factorability. Correlation matrix (not shown) reveals many correlations among the 66 items are in excess of 0.3 (the lower cut-off), indicating that the variables have factorability and patterns in variables are predicted (Tabachnick & Fidell, 2007). Bartlett’s test of sphericity is another indicator for factorability of the data. P-value obtained from this test is less than 0.001, showing that the data is factorable (Brace, Kemp & Snelgar, 2003).

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Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy (the on-diagonal values in the anti-image correlation matrix) for each variable were calculated. The variables with KMO less than 0.5 should be dropped from further analysis (Brace, Kemp & Snelgar, 2003). In our data set, half of the variables (33 items) had KMO less than 0.5.

We also checked the negative partial correlations (Not shown) and most of them were small, which is another requirement for existence of factor structure underlying the variables (Tabachnick & Fidell, 2007).

Principal factor analysis was run to estimate the probable number of factors from eigenvalues. The first 10 unrotated factors have eigenvalues larger than one. Eigenvalues were 7.459 for the first factor and 1.081 for the 10th factor. The changes in successive eigenvalues are quite small after the 8th factor. Furthermore, selecting eight factors let us compare factors from our data with those obtained in the Folkman et al. (1986) community sample study. Principal factor extraction with oblique rotation for eight factors was used in the next step to estimate the pattern matrix which includes factor loadings of retained 33 items of the original 66 items (Table 3). Loadings less than 0.4 on their factors were dropped.

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Table 3: Factor loadings of 33 items following oblique rotation and Cronbach-alpha for each factor

Item

No.

Item label label

Folkman

Factor

loading

Cronbach-alpha=0.79

18 Accepted sympathy and understanding from someone SSS 0.47

46 Stood my ground and fought for what I wanted CC 0.75

48 Drew on my past experiences; I was in a similar situation before PPS 0.63

49 I knew what had to be done, so I doubled my efforts to make things work PPS 0.66

52 Came up wit a couple of different solutions to the problem

PPS

PPS 0.55

Cronbach-alpha=0.53

3 Turned to work or substitute activity to take my mind off things NA 0.76

13 Went on as if nothing had happened D 0.79

21 Tried to forget the whole thing D 0.64

44 Made light of the situation; refused to get too serious about it D 0.61

62 I went over in my mind what I would say or do

D

SC -0.45

Cronbach-alpha: Not calculated

50 Refused to believe that it had happened EA 0.81

51 I made a promise to myself that things would be different next time EA

AR 0.62

Cronbach-alpha=0.65

5 Bargained or compromised to get something positive from the situation NA 0.58

19 I told myself things that helped me to feel better NA 0.59

20 I was inspired to do something creative PR 0.49

43 Kept others from knowing how bad things were SC 0.63

60 I prayed

SC

PR 0.44

Note. Label=factor label derived from the current study; label Folkman= factor label from Folkman et al. (1986) study; CC= Confrontive Coping; D= Distancing; SC=Self controlling; SSS= Seeking Social Support; EA=Escape Avoidance; PPS= Planful Problem Solving; PR=Positive Reappraisal; PT=Positive Thinking; NA=Not available indicating that special item was excluded from Folkman et al. analysis.

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Cronbach-alpha=0.78

8 Talked to someone to find out more about the situation SSS 0.71

22 I got professional help SSS 0.45

31 Talked to someone who could do something concrete about the problem SSS 0.73

42 I asked a relative or friend I respected for advice SSS 0.62

45 Talked to someone about how I was feeling SSS 0.69

66 I jogged or exercised

SSS

NA 0.42

Cronbach-alpha=0.76

23 Changed or grew as a person in a good way PR 0.80

26 I made a plan of action and followed it PPS 0.42

30 I came out of the experience better than when I went in PR 0.80

38 Rediscovered what is important in life PR 0.64

39 Changed something so things would turn out all right

PR

PPS 0.55

Cronbach-alpha=0.65

63 I thought about how a person I admire would handle this situation and used

that as a model

SC -0.62

64 I tried to see things from the other person’s point of view NA -0.71

65 I reminded myself how much worse things could be

PT

NA -0.71

Cronbach-alpha: Not calculated

25 I apologized or did something to make up AR -0.73

37 Maintained my pride and kept a stiff upper lip AR

NA 0.47

Note. Label=factor label derived from the current study; label Folkman= factor label from Folkman et al. (1986) study; CC= Confrontive Coping; D= Distancing; SC=Self controlling; SSS= Seeking Social Support; EA=Escape Avoidance; PPS= Planful Problem Solving; PR=Positive Reappraisal; PT=Positive Thinking; NA=Not available indicating that special item was excluded from Folkman et al. analysis.

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The first factor which I called “Planful problem solving” includes five items. Three items of these five items were loaded on Planful Problem Solving of Folkman et al. (1986) solution. This factor was also identified by an item that loaded on the Confrontive Coping factor and another one was loaded on Seeking Social Support in the Folkman et al (1986) solution. Factor loading in the current solution ranged from 0.47 to 0.75.

The second factor, Distancing I would call it, was identified by five items. Three of those five items were loaded on the same factor by Folkman et al. model, one item was not included in the solution by Folkman et al and another item was loaded on Self Control factor. Loadings ranged from -0.45 to 0.79.

The third factor, Escape Avoidance, identified by two items, one of which loaded on Escape Avoidance and the other one was loaded on Accepting Responsibility in the Folkman et al. solution. Factor loading was 0.81 for the first item and 0.62 for the second one.

The fourth factor, which I call Self Control, was identified by five items. Two of them loaded on Positive Reappraisal, one item loaded on Self control and two items were not included in the Folkman et al solution. Factor loadings ranged from 0.44 to 0.63.

The fifth factor, Seeking Social Support, was identified by six items where five of which loaded exactly the same factor in Folkman et al. solution. Another remained item was not included in their solution. Loading factors ranged from 0.42 to 0.73.

The sixth factor, Positive Reappraisal, was identified by five items. Three items of this factor were linked to the same factor in Folkman et al whereas the other two items loaded on Planful Problem Solving. Loadings ranged from 0.42 to 0.80.

The seventh factor, Positive Thinking, was represented by three factors, where two of them did not included in Folkman et al solution and one item was related to Self Control factor. Factor loadings ranged from -0.62 to -0.71.

And finally, the last factor, Accepting Responsibility was identified by two items. One item loaded on Accepting responsibility and the other one was excluded from Folkman et al. solution. Factor loading was -0.73 for the former item and 0.47 for the latter item.

The eight factors jointly accounted for 61% of the total variance.

The correlations among factors are shown in table 4. The highest correlation (0.28) is between factor 1 and 6. Inter-factor correlation coefficients range from 0.01 to 0.28.

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Table 4: Correlations among factors following oblique rotation

Factor1 Factor2 Factor3 Factor4 Factor5 Factor6 Factor7 Factor8

Factor 1 1 0.04 0.06 0.20 0.23 0.28 -0.22 -0.10

Factor 2 1 -0.03 0.11 -0.09 0.14 -0.01 -0.08

Factor 3 1 0.02 0.01 0.03 -0.09 -0.02

Factor 4 1 0.17 0.14 -0.17 -0.02

Factor 5 1 0.19 -0.20 -0.07

Factor 6 1 -0.15 -0.09

Factor 7 1 0.12

Factor 8 1

Communalities (how much variance in each variable is explained by the analysis) are calculated to use if the variables are well defined by the extracted factors. As shown in table 5, communality values for almost all the variables are considerably high

Table 5: Extraction communality values for 33 items analyzed by means of Factor analysis

Item # Communality Item # Communality Item # Communality3 0.59 26 0.64 48 0.62 5 0.57 30 0.64 49 0.75 8 0.62 31 0.66 50 0.68 13 0.65 37 0.63 51 0.66 18 0.67 38 0.62 52 0.52 19 0.47 39 0.64 60 0.37 20 0.59 42 0.69 62 0.56 21 0.58 43 0.59 63 0.63 22 0.44 44 0.53 64 0.73 23 0.69 45 0.54 65 0.75 25 0.68 46 0.71 66 0.43

Internal consistency Cronbach-alpha for the 66 item WOC questionnaire was 0.88 (Range: 0.53-0.79) (Table 3). . Two factors identified only by two items, therefore I did not calculate Cronbach-alpha for those factors due to the low number of items.

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Mean scores and relative scores Mean and relative scores for eight coping behaviors are calculated according to the description we gave earlier in Method section. The distribution of the mean scores and relative scores by demographic information of our sample are shown in Tables 6 and 7.

None of the coping strategies differed significantly between men and women; meaning that men and women are almost the same in using various coping behaviors (Table 6). Relative scores which we have shown in table 7, is another explanation of this phenomenon. For example, if males use Planful Problem Solving in 14.7% of the occasions, women use the same behavior in 13.1% of the occasions which is quite close to the corresponding value for men (P-value was not statistically significant). The same conclusion could be extracted from other coping behaviors, i.e., Distancing, Escape Avoidance, Self Control, Seeking Social Support, Positive Reappraisal, Positive Thinking and Accepting Responsibility (Table 7).

The same pattern is applied for marital status as well. Coping behaviors were almost the same between singles and married subjects (Tables 6, 7).

Some coping behaviors are preferred more in some categories of educational level, compared to other levels. For example, planful problem solving is used more by people with diploma (12 years of studying) compared to those with academic education (2.3±0.7 vs. 1.8±0.70, P-value<0.0001). No statistically significant difference was found for relative scores between sex, age groups, educational levels and marital status (Tables 6, 7). Relative score for positive reappraisal was higher compared to other coping strategies and as it is shown in table 7, participants use Positive reappraisal in 15.9% of the occasions. Positive Reappraisal is the most favorable coping behavior compared to other strategies, regardless of sex, age, educational level (except for less than 12 years studying, in which Planful Problem Solving has the highest percentage) and marital status. On the other hand, Distancing is used the least among individuals and they use distancing behavior only in 9.7% of the occasions (Table 7).

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Table 6: Mean ± standard deviation of the scores on coping behaviors by different

demographic characteristics of study population (n=100)

Coping behaviors

n PPS D EA SC SSS PR PT AR

Sex

Men

Women

50

50

2.1±0.69

1.9±0.74

1.3±0.56

1.4±0.60

1.6±0.9

1.7±0.81

1.9±0.67

1.8±0.67

1.7±0.76

1.8±0.73

2.2±0.63

2.2±0.53

1.5±0.80

1.7±0.80

1.6±0.73

1.6±0.68

Age group(yr)

20-29

30-39

40-49

>=50

36

24

18

22

1.9±0.65

2.1±0.63

1.9±0.90

2.0±0.77

1.2±0.53

1.3±0.47

1.4±0.67

1.6±0.58

1.7±0.81

1.6±0.92

1.3±0.77

2.0±0.81

1.8±0.67

2.0±0.61

1.8±0.66

1.9±0.74

1.7±0.82

1.9±0.52

1.8±0.78

1.8±0.78

2.2±0.66

2.2±0.44

2.1±0.61

2.2±0.59

1.7±0.82

1.5±0.74

1.5±0.85

1.6±0.82

1.6±0.66

1.5±0.50

1.6±0.82

1.8±0.86

Education

<12 years

12 years

Adv diploma

Academic

education

6

25

9

60

2.2±0.63

2.3±0.7*

2.2±0.6

1.8±0.70

1.6±0.61

1.5±0.70

1.3±0.74

1.2±0.50

1.6±0.92

1.8±0.97

1.8±0.67

1.6±0.83

2.0±0.74

2.2±0.5†

2.4±0.4†

1.7±0.70

1.7±0.70

1.9±0.86

2.1±0.47

1.7±0.71

1.8±0.54

2.4±0.65

2.4±0.59

2.1±0.52

1.4±0.54

1.7±0.79

2.3±0.51

1.5±0.81

1.9±0.97

1.9±0.70

1.6±0.78

1.5±0.60

Marital status

Single

Married

41

59

1.9±0.67

2.0±0.75

1.2±0.51

1.4±0.60

1.7±0.78

1.6±0.9

1.9±0.67

1.9±0.67

1.7±0.77

1.8±0.72

2.2±0.63

2.2±0.55

1.7±0.74

1.6±0.84

1.6±0.59

1.6±0.78

Total 100 2.0±0.72 1.3±0.58 1.7±0.85 1.9±0.67 1.8±0.74 2.2±0.58 1.6±0.80 1.6±0.70

Note. D= Distancing; SC=Self controlling; SSS= Seeking Social Support; EA=Escape Avoidance; PPS= Planful Problem Solving; PR=Positive Reappraisal; PT=Positive thinking; Adv. Diploma=Advanced diploma * P<0.0001, compared to academic education

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Table 7: Mean ± standard deviation of relative scores of different coping behaviors by different demographic characteristics of study population (n=100)

Coping behaviors

n PPS D EA SC SSS PR PT AR

Sex

Men

women

50

50

14.7±4.0

13.1±4.3

9.5±3.6

10.0±4.9

11.8±7.6

12.1±6.0

13.8±3.6

13.2±4.1

12.3±5.0

12.6±4.5

15.8±3.7

15.9±3.8

10.6±5.0

11.7±5.4

11.5±3.9

11.3±4.0

Age group(yr)

20-29

30-39

40-49

>=50

36

24

18

22

13.8±4.2

14.7±3.9

13.9±5.4

13.2±3.7

8.8±3.9

8.9±2.8

10.5±5.5

11.5±4.8

13.1±8.0

11.1±5.8

9.3±5.2

13.4±6.4

13.1±3.7

14.6±4.0

14.1±4.3

12.7±3.6

11.6±4.8

13.5±3.5

13.0±5.4

12.1±5.3

15.7±3.7

15.9±2.8

16.6±4.8

15.4±4.0

11.9±4.7

10.9±4.5

11.4±7.3

10.1±4.7

12.0±4.0

10.5±2.6

11.3±4.9

11.6±4.1

Education

<12 years

12 years

Adv diploma

Academic

education

6

25

9

60

15.5±4.4

14.9±3.6

13.6±3.1

13.3±4.6

11.1±2.7

10.2±5.1

8.0±4.0

9.7±4.1

10.8±3.9

11.0±5.4

11.2±3.9

12.6±7.8

14.0±2.0

14.2±2.8

15.1±2.1

13.0±4.5

13.1±6.8

11.4±4.4

13.0±2.3

12.7±4.9

12.7±1.9

15.5±4.3

15.0±2.4

16.4±3.7

10.0±2.1

10.4±4.2

14.4±2.7

11.1±5.9

12.6±4.1

12.4±3.4

9.7±4.0

11.1±4.0

Marital status

Single

Married

41

59

13.5±4.1

14.2±4.3

8.8±3.6

10.4±4.7

12.9±7.6

11.3±6.1

13.5±4.0

13.5±3.8

12.0±4.6

12.7±4.8

15.8±3.6

15.9±3.9

11.6±4.4

10.9±5.7

11.8±3.7

11.1±4.0

Total 100 13.9±4.2 9.7±4.3 12.0±6.8 13.5±3.9 12.4±4.7 15.9±3.8 11.2±5.2 11.4±3.9

Note. D= Distancing; SC=Self controlling; SSS= Seeking Social Support; EA=Escape Avoidance; PPS= Planful Problem Solving; PR=Positive Reappraisal; PT=Positive thinking; Adv. Diploma=Advanced diploma

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DISCUSSION

The result of the factor analysis is quite satisfactory and the identified scales can reflect most dimensions of the WOC questionnaire as it was meant by the English version. The low correlation coefficients among factors shown in table 4 are a good indicator of sustainability of the extracted factors from our data. The importance of having low correlation coefficients among factors is emphasized by Munet-Vilaro and colleagues (Munet-Vilaro, Gregorich & Folkman, 2002) in validation study of Spanish Version of WOC, while they did confirmatory factor analysis based on the eight-factor model by Folkman et al. (1986). However, they faced high interfactor correlations that guided them to establish a more appropriate factor structure.

In the current study, some of the factors were similar to those identified by Folkman et al. (1986). Seeking Social Support and Distancing are amongst those factors, but there are substantial differences for the rest of the factors. First, Confrontive Coping was not identified in our solution and all items related to this factor except “Stood my ground and fought for what I wanted”, were excluded in the very early stage of factor analysis, due to the measure of sampling adequacy test (KMO) less than the minimum acceptable level. Second, Positive Thinking is a new scale identified in the current study. It includes three items, two of which were identified by items that were not included in the Folkman et al. (1986) solution. The items in this scale are: “I thought about how a person I admire would handle this situation and used that as a model”, “I tried to see things from the other person’s point of view” and “I reminded myself how much worse things could be”.

Both items focus on cognitive wishful thinking about positive aspects of the stressful encounter and try to remind that the situation could be much worse than it is. Finally, factors such as Planful Problem Solving, Distancing, Seeking Social Support and Positive Reappraisal, include items with majority the same items consistent with the same solution of Folkman et al. (1986) and therefore we got the same label from their study. Contrary, remained factors consisted of items that were either excluded from their solution or consist of diverse range of items in the Folkman et al. (1986). Although these items shared the same conceptual similarities with the English structure of WOC, these similarities are not reflected in the same way in Persian version of WOC. Hence, the suggested labels are based on the culturally appropriate loads of meaning that the majority of the items in the scale convey.

After conducting the factor analysis of the items from Farsi version of WOC, we need to know the level of homogeneity or internal consistency of the resulting factors. Cudeck (Hulin et al., 2001) believes factor analysis and reliability are valuable assessments in construction of tests which can generate complementary information if they align with

27

each other. He argues a reliable test need not necessarily conform to a one-factor model, and conversely items that fit a single common factor may have low reliability (Hulin et al., 2001)

The Cronbach-alpha of the WOC was 0.88 and this result suggests that the Persian version of WOC has satisfactory internal consistency. Cronbach (1951) gives stronger emphasis to reliability of a certain instrument where he mentioned no validity and factor analysis can be interpreted without considering the magnitude of the error of instrument (error of instrument is another explanation of reliability). The results of Cronbach-alpha were satisfactory for Planful Problem Solving Seeking Social Support and Positive Reappraisal scales (Table 3). For Escape Avoidance and Accepting Responsibility Cronbach-alpha were not calculated due to the few numbers of items in these scales. There is an argument on inappropriateness of Cronbach-alpha as an indicator of reliability test for scales that compose of two items. Hulin and Cudeck believe that Cronbach-alpha is not a good test in this case. Their claim is based on mathematics and theroretical point of view. In his mathematical procedure, Hulin argues that there is no need to apply Cronbach-alpha for items that consist of two items. From theoretical point of view, Cudeck argues that the items in one scale are representative of a much larger collection of items designed to measure a common domain (Hulin et al., 2001). Based on theory, the interpretation of coefficient alpha is to estimate the correlation between one scale whose items are the ones that the researcher is studying, with a hypothetical alternative form that contain the same number of items. Therefore, alpha computed on two items is not a satisfactory sampling from the larger hypothetical domain and the problem of lacking representation of a two-item scale of the larger domain is still there.

Cronbach-alpha did not reach the satisfactory level for subscales Distancing, Self Control and Positive thinking. Distancing had the minimum level of internal consistency as it had in the data presented by Folkman and Lazarus on the original instrument (Folkman et al., 1986). In the English version of WOC, three scales were not internally consistent and among those, Distancing had the lower level alpha coefficient. The Spanish version of WOC (Munet-Vilaro et al., 2002) reported the alpha coefficient from 0.5 to 0.8 and they did not mention the corresponding scales of these values. Ahlström and her colleague (2002) reported acceptable internal consistency only when considering the total WOC score and Seeking Social support but not in other sub scales which may imply the problem with reliability in that specific situations (Lazarus & Folkman, 1984).

Sex, age group, education and marital status was not really a source of difference in terms of coping behaviors and although some scores were statistically higher in some levels of education but there is not any scientific justification for the reason that why for example participants with diploma (12 years of studying) use more Planful Problem Solving than those with academic education.

The results of current study revealed that Positive Reappraisal is being used among Iranians, i.e., they use this coping behavior in 15.9% occasions which is the highest percentage among other strategies (Table 7). It is one of the emotion-focused behaviors

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which describe efforts to create positive meaning of the stressful event. Positive Reappraisal refers to the ability of focusing on good aspects of the events that has occurred in a stressful encounter and try to find beneficial outcomes. Thinking of positive emotions as a utility to cope with stressful contexts started to be applied by coping researchers and according to Folkman and Moskowitz (2000) positive emotions help buffer against stress and increases the psychological well-being and health (Folkman & Moskowitz, 2000 b).The process is fully justified and elaborated by the means of “broaden-and-build” theory of positive emotions. The mechanism behind this theory is to broaden one’s thought-action repertoire, expanding the range of cognitions and actions that come into mind and therefore one can regulate the negative experience (Fredrickson, 2001).

CONCLUSION

According to the WHO/EHA guideline, there are not standards for coping strategies and it is more related to socio-cultural factors. Coping behaviors have been shown to vary by region, community, social group, household, gender, age, season and time in history and they are greatly influenced by individual’s previous experiences (WHO/EHA., 1999). Coping strategies are very much relied on all the abovementioned factors; the evidence from Spanish version of WOC shows that three groups of Latinos in this study, who were sampled from Mexico city, Puerto Rica and the San Francisco followed different ways of coping , even though they are all Spanish speaking and share many common factors (Munet-Vilaro et al., 2002).

Iranians in the current study tended to use Positive Reappraisal which is substantially influenced by norms, cultures and social situation in Iran. This scale has also a religious dimension and based on new coping models, religious beliefs are considered as an aid in the process of coping (Carone Jr & Barone, 2001). Religious beliefs can provide the idea that all is controlled and planned by God. Every thing happens to us is a part of our karma and benefits will be received either in life or afterlife and this is what helps religious people regulate their negative feelings and cope with stress. The effect of religious orientation on coping process is mentioned in many studies, for instance, McIntosh and colleagues (1993) studied parents who had lost infant due to Sudden Infant Death Syndrome. The researchers found that more religious the parents are, more meaning found in the loss of the infant and decreased distress in the parents, 18 months after the infant’s death.

Among 33 remainder items in the analysis, the highest ceiling effect (60%) was observed for item number 30, i.e., 60% of the respondents scored the highest level for the item “I came out of the experience better than when I went in”. This item belongs to Positive Reappraisal scale and this finding is quite well justified with Iranian’s high tendency to use Positive Reappraisal as the most favorable coping strategy.

29

Similar result was observed in an assessment of coping behaviors among Iranian college students (Aguilar-Vafaie & Abiari, 2007). In Aguilar-Vafaie and Abiari (2007) study, Positive Reappraisal did not comfort to an independent coping dimension in the first place; in order to improve psychometric properties of CRI and be able to measure religious orientation of participants, they developed Religious Coping factor, adding 20 items from Internal-External Religious Orientation Scale (Allport & Ross, 1967). The new added Iranian items to CRI inventory, improved its construct validity and these scales indicate that religious coping is an inevitable part of Iranian college students’ coping solution.

LIMITATIONS

The measuring of sampling adequacy for each variable indicates inadequate number of samples for 33 items out of 66 items of the questionnaire. It resulted in inclusion of very few items in some scales, e.g., Escape Avoidance, Accepting Responsibility or Positive Thinking. The modest reliabilities in some of the coping behaviors was due to this fact and therefore some reliabilities failed to reach the minimum level of condition to be accepted as reliable scales. This could be considered as one of the limitations of the present study. The issue whether these scales can be reproduced in Iranian population needs to be addressed in future studies with higher sample size. More individuals in the study might result in higher sampling adequacy measure for variables and they will probably be kept which will secure higher Cronbach-alpha reliability test for those scales.

Another point that might seem to be a limitation is the dynamic nature of coping and one might criticize that some coping efforts are adapted to some situations while others dimensions of coping are more relevant to some other types of problems. In this study we did not concern about the situations and we really do not know what was happening as stressful encounter for the participant. Therefore we are not able to relate the coping behavior and the context of the problem. What we did concern was the reliability of the instrument and we mainly focused on the internal consistency of the items, regardless of the type of the problem.

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REFERENCES

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- Allport, G. W., & Ross, J. M. (1967). Personal religious orientation and prejudice. Journal of Personality and Social Psychology, 5, 432–443.

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