Validity and Reliability of “Parental Attitudes of Various Aspects of Cochlear Implantation”Questionnaire

Document Type: Original


1 Department of Audiology, School of Rehabilitation Sciences, Iran University of Medical Sciences (IUMS), Tehran, Iran.

2 Department of Basic Sciences in Rehabilitation, School of Rehabilitation Sciences, Iran University of Medical Sciences (IUMS), Tehran, Iran.

3 Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.


Parents are such important members of the cochlear-implant team that analysis of their views is essential in orderto improve services and outcomes. The authors developed a tool to assess parental attitudes towards various aspects of cochlear implantation in children who had passed aural rehabilitation sessions. The authors then went on to determine the validity and reliability of this questionnaire.
Materials and Methods:
A questionnaire entitled, “Parental attitudes towards various aspects of cochlear implantation”, was prepared and assessed for content validity by experts in the field. The questionnaire comprised six subgroups, each scored using a five-point Likert scale. Parents of children with severe-to-profound congenital hearing loss who had undergone an aural rehabilitation program between 2007 and 2012 were eligible to take part in the questionnaire validation study (n=92, mean age of cochlear implantation 3.97 years). Test-retest reliability was subsequently assessed in 17 patients within 1 month.
The content validity index of the questionnaire was 98.68%.The external and internal reliability of the questionnaire was assessed using Cronbach’s alpha (0.844 and 0.892, respectively). Mean scores of the six subgroups of the questionnaire, including communication skills, academic skills, social skills, cochlear-implant center services, costs of surgery and rehabilitation programs and decision-making process and total were 84.6%, 75.0%, 84.0%, 78.8%, 83.4%, 67.0% and 79.2%, respectively.
Overall, the results supported the validity, reliability and sensitivity of the questionnaire for use both in centers for cochlear implantation or aural rehabilitation clinics. The questionnaire would provide a valuable means of assessing the impact of cochlear implantation on children’s lives.


Main Subjects

1. Incesulu A, Vural M, Erkam U. Children with Cochlear Implants: Parental Perspective. Otol Neurotol 2003;24(4):605–11.

2. Huttunen K, Rimmanen S, Vikman S, Virokannas N, Sorri M, Archbold S, et al.Parents' views on the quality of life of their children 2-3 years after cochlear implantation. Int J Pediatr Otorhinolaryngol 2009;73(12):1786-94.

3. Nicholas JG, Geers AE. Personal, social, and family adjustment in school-aged children with a cochlear implant. Ear Hear 2003;24(1):69S–81S.

4. Archbold SM, Sach T, O’neill C, Lutman M, Gregory S. Outcomes from implantation for child and family: parental perspectives. Deafness Educ Int 2008;10(3):120–42.

5. Wood W. Attitude Change: Persuasion and Social Influence. Annu Rev Psychol 2000; 51: 539–70.

6. Vogel T, Bohner G, Wanke M. Attitudes and attitude change. Psychol Press 2014;6(6):438-54.

7. Bagozzi RP. A field investigation of causal relations among cognitions, affect, intentions, and behavior. J Marketing Res 1982;19;562–84.

8. Ajzen I. Nature and Operation of Attitudes. Annu Rev Psychol 2001;52: 27–58.

9. Archbold SM, Lutman ME, Gregory S, O’Neill C, Nikolopoulos TP. Parents and their deaf child: their perceptions three years after cochlear implantation. Deafness Educ Int 2002;4(1):12–40.

10. Fortunato-Tavares T, Befi-Lopes D, Bento RF, Andrade CR. Children with cochlear implants: communication skills and quality of life. Braz J Otorhinolaryngol 2012;78(1):15–25.

11. Clasen DL, Dormody TJ. Analyzing Data Measured by Individual Likert-Type Items. J Agric Educ 1994; 35(4):31–5.

12. Jamieson S. Likert Scales: How to (ab) Use Them. Med Educ 2004; 38(12):1217–8.

13. Yaghmaie F. Content Validity and Estimation. J Med Educ  2003; 3(1):25–7.

14. McGartland Rubio D. Content Validity. Encyclopedia of Social Measurement. Pittsburgh: Elsevier Inc.; 2005.

15. Bland JM, Altman DG. Cronbach's alpha. BMJ 1997; 314(7080):572.

16. Nunnally JC. Psychometric theory. 2nd ed. New York, NY: McGraw-Hill; 1978.

17. Thompson B, Daniel LG. Seminal readings on reliability and validity: A "hit parade" bibliography. Educ Psychol Meas  1996; 56: 741-45.

18. Nunes TPretzlik UIlicak S. Validation of a parent outcome questionnaire from pediatric cochlear implantation. J Deaf Stud Deaf Educ 2005; 10(4):330-56.

19. Henson RK. Understanding internal consistency reliability estimates: A conceptual primer on coefficient alpha. Meas Eval Couns Dev 2001;34 (3):177–89.

20.  Hyde M, Punch R, Komesaroff L. Coming to a decision about cochlear implantation: parents making choices for their deaf children. J Deaf Stud Deaf Educ 2010;15(2):162–78.

22. Eyalati N, Jafari Z, Ashayeri H, Salehi M, KamaliM. Effects of Parental Education Level
and Economic Status on the Needs of Families of Hearing-Impaired Children in the Aural Rehabilitation Program. Iran J Otorhinolaryngol 2013; 25(70):41–8.

23. Luterman D, Kurtzer-White E. Identifying hearing loss: Parents’ needs. Am J Audiol 1999;8(1): 13−8.

24. Hyde M, Punch R, Komesaroff L. A comparison of the anticipated benefits and received outcomes of pediatric cochlear implantation: parental perspectives. Am Ann Deaf 2010; 155(3):322–38.

25. Jeddi Z, Jafari Z, Motasaddi Zarandy M. Effects of Parents’ Level of Education and Economic Status on the Age at Cochlear Implantation in Children.Iran J Otorhinolaryngol 2012; 24(66):7–15.

26. Dalzell L, Orlando M, McDonald M, Berg A, Bradley M, Cacace A, et al. The New York State universal newborn hearing screening demonstration

project: Ages of hearing loss identification, hearing aid fitting, and enrollment in early intervention. Ear Hear 2000; 21(2):118–30.

27. Danhauer JL, Johnson CE. A case study of an emerging community-based early hearing detection and intervention program: Part I. Parents' compliance. Am J Audiol 2006;15(1):25–32.

28. Kennedy CR, McCann DC, Campbell MJ, Law CM, Mullee M, Petrou S, et al. Language ability after early detection of permanent childhood hearing impairment. N Engl J Med 2006; 354(20):2131–41.

29. Yucel E, Derim D, Celik D. The needs of hearing impaired children’s parents who attend to auditory verbal therapy-counseling program. Int J Pediatr Otorhinolaryngol 2008;72(7):1097−111.

30. Hehar SS,  Nikolopoulos TP,  Gibbin KPO'Donoghue GM. Surgery and functional outcomes in deaf children receiving cochlear implants before age 2 years. Arch Otolaryngol Head Neck Surg 2002; 128(1):11–4.

31. Zaidman-Zait. A Quality of Life among Cochlear Implant Recipients. International Encylopedia of rehabilitation 2010;293:1–18.

32. Christiansen JBLeigh IW. Children with cochlear implants: changing parent and deaf community perspectives. Arch Otolaryngol Head Neck Surg 2004;130(5):673–7.

33. Geers AE, Nicholas JG, Moog JS. Estimating the Influence of Cochlear Implantation on Language Development in Children. Audiol Med 2007; 5(4): 262–73.