Journal of Modern Medical

Introduction
Searching for health information online is done in a wide range, but one of the biggest problems and challenges in this regard is the inability of users to recognize the quality and accuracy of information. A study showed that in 89% of pregnant women, the use of online health information increased during pregnancy compared to pre-pregnancy period. According to the studies, reliable health information has a significant effect on reducing maternal and infant mortality rates. Also, studies have shown that most mothers do not share the health information found from the internet with gynecologists or health care providers, and on the other hand, health care providers are not aware of the existence of incorrect health information available on the Internet. Most of studies that have investigated the online search for health information in pregnant women have used questionnaires related to different patients to collect data. There is a lack of standard questionnaire in Persian to assess the health information seeking behaviors of Iranian pregnant women. The current study aims to localize the Persian version of online health information seeking questionnaire developed by Ahadzadeh and Sharif.
Methods
The study population consists of all pregnant women referred to Fatemeh Al-Zahra Hospital in Ahvaz, Iran in 2019 (n=5176). Based on Cochran’s formula, the sample size was determined 357. First the online health information seeking questionnaire developed by Ahadzadeh and Sharif based on the technology acceptance model was translated using forward-backward technique. This questionnaire has four subscales: perceived usefulness, perceived ease of use, user attitude, and search intention. Two domains of internet use intensity and trust in internet information were adjusted and added to the Persian version. The initial Persian version had 34 items rated a five-point Likert scale. Data analysis was done in SPSS software, version 26 software, using exploratory factor analysis and confirmatory factor analysis. The research model was evaluated using chi-square fit indices, NFI, TLI or NNFI, and RMSEA.
Results
Most of the participants were in the age groups of 21-25 years (29.4%) and 26-30 years (25.2%). In terms of gestational age, 37.3% were in the 35-40 week of pregnancy. The results of the KMO test were 0.877, which indicated the adequacy of sampling for factor analysis. Bartlett’s test results which show the power of data to extract a specific factor, was also significant (X2=3766.187, P=0.000). In the factor analysis, considering the absolute value of 0.3, a large number of items were included in more than one factor. Therefore, the analysis was repeated with an absolute value of 0.5. At this stage, items 3, 4 and 28 were removed. The results of exploratory factor analysis showed 6 factors which were: user attitude, perceived ease of use, internet use intensity, health information about the baby, health information about childbirth, and health information during pregnancy. Next, in LISREL software, the structural modeling was performed using confirmatory factor analysis. Examining the goodness of fit indices for the model showed X2=2421.29, df=419 and P=0.000.
Discussion
The results of Cronbach’s alpha for the overall scale and its subscales showed that the Persian version of online health information seeking questionnaire can be used to investigate the online health information seeking behaviors of pregnant women in Iran. In examining the fit of the 6-factor model using the exploratory factor model, the results of Chi-square test, Bentler-Bont index, unstandardized goodness of fit index, and the root mean square error of approximation indicate the good fit of the 6-factor model of the present study.
It seems that pregnant women who constantly use the Internet and technology have more acceptance of technology and as a result, the anxiety caused by technology is reduced in them and they use the web to get health information with a better feeling and self-confidence.
Since human phenomena generally have various causes, their study requires consideration of multiple variables and constructs and examination of possibly complex relationships between them. Therefore, the use of structural equation modeling can be beneficial which was used in our study. the Persian version of online health information seeking questionnaire for pregnant women can be used in further studies in Iran. One of the limitations of current study was the difficulty recruiting the samples; therefore, since the current study was conducted among pregnant women of one city, it is recommended to use the instrument among a larger group of pregnant women in other cities of Iran for further reliability and validity assessment.

Ethical Considerations
Compliance with ethical guidelines
This article is part of a master thesis entitled: explaining predictors of online health information seeking behavior among pregnant women which had done using Davis's technology acceptance model. The present research received the code of ethics IR.AJUMS.REC.1398.590 from the National Committee of Ethics in Biological Research.

Funding
The present research was carried out with the financial support of Ahvaz Jundishapur University of Medical Sciences.

Authors' contributions
Conceptualization, methodology, writing original draft:  Ziva Sabaghinejad; Software, validation, formal analysis, article writing, article submission: Fatima Baji; Investigation, data collection: Maryam Vejdani.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
Authors gratefully acknowledge financial and moral support of the Research and Technology Vice-chancellor of Ahvaz Jundishapur University of Medical Sciences, and cooperation of Fatemeh Al-zahra Hospital staff.



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