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Development and validation of the gynecologic examination anxiety scale (GEAS): A 20-item patient-reported measure
Hacer Demirtop1, Kerime Derya Beydağ2, Aysu Yıldız Karaahmet3
1Independent Researcher, Istanbul, Turkey.
Objective:
Gynecologic examinations often provoke anxiety, embarrassment, and a perceived loss of control. Valid, patient-focused tools that specifically quantify examination-related anxiety remain limited. This study developed and validated the gynecologic examination anxiety scale (GEAS).
Methods:
In a methodological study conducted in Turkey (October 1, 2023-April 1, 2024), women aged 18-65 years with prior gynecologic examination experience completed an online survey disseminated via social networks. Item generation yielded 44 candidates. Content validity was assessed by 17 experts using the Lawshe approach; four items were removed and minor edits followed a 10-person cognitive pretest, producing a 40-item draft. Psychometric evaluation comprised exploratory factor analysis and confirmatory factor analysis, plus reliability testing.
Results:
Data from 400 participants were analyzed. Sampling adequacy was acceptable (Kaiser-Meyer-Olkin (KMO) = 0.835; Bartlett's test of sphericity p < 0.001). Iterative refinement produced a 20-item, five-factor solution-healthcare personnel approach (4 items), healthcare personnel experience (5), negative experiences (5), hygiene concerns (3), and individual attitudes (3) explaining 60.18% of variance. Model fit was acceptable (chi-square/degrees of freedom [χ2/df] = 2.722; goodness of fit index [GFI] = 0.903; adjusted goodness of fit index [AGFI] = 0.872; comparative fit index [CFI] = 0.905; Tucker-Lewis index [TLI] = 0.908; root mean square error of approximation [RMSEA] = 0.066; standardized root mean square residual [SRMR] = 0.080). Internal consistency was good for the total scale (α = 0.867) and adequate across subscales (α = 0.685-0.818). Temporal stability was excellent (ICC = 0.897; n = 105 retested ≥2 weeks).
Conclusion:
The GEAS is a brief, valid, and reliable instrument that captures anxiety specific to gynecologic examination and is suitable for clinic-level screening/triage, tailoring of trauma-informed care, and quality-improvement efforts.
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