For this study, ethical approval was granted by an institutional Ethics Committee, as indicated by the reference number [1422024], in accordance with the Declaration of Helsinki (as revised in 2013). The research was conducted in two distinct stages, after obtaining permission from the authors of the English version of the PIKQ [9].

The PIKQ, a validated tool intended for self-administration, is aimed at evaluating patient knowledge through two distinct scales, each consisting of 12 items. These scales focus on topics related to UI and POP, covering areas such as epidemiology, diagnosis, and treatment modalities.

In the process of adapting the PIKQ for our population, modifications were made in the third section of the questionnaire, dedicated to demographic data (Fig. 1c). Specifically, question 6 was altered from assessing annual household income in US dollars to evaluating monthly income in Jordanian Dinar. Furthermore, question 13 was removed owing to its irrelevance in the context of this study.

a Arabic Prolapse and Incontinence Knowledge Quiz (PIKQ) Urinary Incontinence scale. b Arabic PIKQ Pelvic Organ Prolapse scale. c Demographic questions

The translation of the PIKQ from English into Arabic, the intended language, was conducted by two gynecologists. Among them was a native speaker of Arabic who is also bilingual in English. Additionally, a urogynecology expert contributed to the translation, resulting in the creation of three distinct Arabic adaptations of the questionnaire. Each translation was conducted independently. To ensure uniformity and accuracy, a consensus meeting was organized where the team discussed and resolved any discrepancies and established a unified Arabic version (Fig. 1a, b).

To verify the precision of the translation, the Arabic version was retranslated back into English by two linguists. These individuals were skilled in English as their first foreign language and had no previous familiarity with the PIKQ, lacking a medical background. A comparative examination was then performed between the original PIKQ and its English retranslation. Discrepancies identified in this comparison were thoroughly addressed and resolved in a revision meeting that involved all members of the translation team.

Participants for this study were recruited from the obstetrics and gynecology unit of a tertiary-care government hospital in the southern region of Jordan, during the period June 2023 to December 2023. Inclusion criteria encompassed women over the age of 18 who visited the hospital and were willing to participate in the study. Although the questionnaire was designed for self-administration, women who were unable to read and expressed a willingness to participate were provided with non-intrusive assistance from a research assistant.

Exclusion criteria for the study were age younger than 18 years, pregnancy, inadequate cooperation, or submission of incomplete questionnaire responses.

Before commencing the questionnaire, all enrolled participants provided informed consent by signing a written consent form. This form was accompanied by a cover letter that comprehensively outlined the study's objectives and assured participants of the strict confidentiality measures in place to safeguard their provided data.

In addition to the questionnaire assessing knowledge related to UI and POP (Fig. 1a, b), participants were presented with a second component comprising demographic questions (Fig. 1c). These demographic questions were also translated and included inquiries about participants' age, employment status, educational background, marital status, menstrual history, and the number of childbirths. Additionally, binary “yes” or “no” questions were included to identify any reported issues related to urinary leakage, POP, or prior treatments for these conditions. Participants were required to complete both components in their entirety.

Body weight and height measurements were taken during the interview sessions, and the calculation of body mass index (BMI) was based on these measurements obtained at the time of the examination. BMI classifications were defined as follows: underweight (< 18.5 kg/m2), normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obese (≥ 30 kg/m2) [10].

The translated questionnaire was administered to a cohort of 32 women. Each participant provided written consent prior to participation. They were informed that a follow-up session would be conducted 2 weeks later for repeat administration of the questionnaire. This preliminary investigation was designed to evaluate the content validity of the questionnaire and to refine it to its final form. This refinement process involved conducting interviews with participants to discuss any ambiguous questions or difficulties encountered with the questionnaire.

Furthermore, the pilot study facilitated the assessment of the internal consistency of the questionnaire, examining the interrelationship among its items. It also enabled the evaluation of test–retest reliability, assessing the stability of responses provided by individuals across the two administrations of the questionnaire.

In the formal comparative study, 300 women were enrolled after obtaining informed consent with the same inclusion criteria for those recruited in the pilot study.

In each scale of the questionnaire, a scoring mechanism was implemented where correct answers were assigned a value of 1, whereas “do not know”, incorrect, or unprovided responses were assigned a value of 0. The total scores for the UI and POP scales were computed by summing the correct responses, yielding a score range from 0 to 12. A higher score is indicative of a greater knowledge level regarding UI and POP (Fig. 1a, b).

The psychometric properties of the UI and POP scales were rigorously evaluated. This evaluation encompassed an analysis of scale validity, internal consistency, and test–retest reliability. To quantify internal consistency, Cronbach’s alpha coefficient was utilized for each scale. Furthermore, to determine test–retest reliability, the PIKQ was re-administered to a subset of 32 participants from the pilot cohort, 2 weeks after their initial questionnaire completion.

Statistical analysis in this study employed IBM SPSS Statistics 25.0 (2017; IBM, Armonk, NY, USA) for descriptive statistics, including mean, standard deviation, frequencies, and percentages. Psychometric properties of knowledge scales were assessed through reliability analysis, specifically Cronbach's alpha coefficient for internal consistency. Test–retest reliability was assessed using the intraclass correlation coefficient (ICC) and 95% confidence intervals (CI). Pearson's Chi-squared test and Fisher’s exact test examined the relationships between categorical variables and outcomes, with significance set at p ≤ 0.05. The Kaiser–Meyer–Olkin (KMO) test assessed sample sufficiency and multivariate normality. Bartlett's test of sphericity evaluated sample suitability for factor analysis to assess construct validity. Factor analysis was performed using principal component analysis with varimax rotation.

In line with established literature guidelines, the determination of the study's sample size followed the recommendation of a minimum of 10 participants per parameter for confirmatory factor analysis [11,12,13]. Initially, an estimation of 240 subjects was made, considering PIKQ with its 24-item survey, including two 12-item subscales. However, to account for potential dropouts or data collection losses, the sample size was subsequently increased.

Ordinal logistic regression was applied to identify the contribution of demographic and clinical variables and information-seeking preferences to the knowledge score.