Adaptation and exploratory factor analysis of a PCOS-specific HRQoL questionnaire in a South Indian population

INTRODUCTION: Polycystic Ovary Syndrome (PCOS) is a multifaceted disorder with physical, emotional, and social implications. Culturally adapted tools for assessing Health-Related Quality of Life (HRQoL) in Indian women, particularly those under 18 and over 45 years of age, need to be developed. This study aimed to culturally adapt the Nasiri-Amiri PCOS-specific HRQoL questionnaire for Malayalam-speaking women, evaluate its reliability and factor structure using exploratory factor analysis (EFA), and identify key HRQoL domains in this population. METHODS: Between July 2024 and December 2025, a 52-item Malayalam-adapted questionnaire was distributed to women aged 13-52 years, of whom 201 met the inclusion criteria. Reliability assessments were performed using Cronbach's alpha. The ability of the data to be factored was evaluated using the Kaiser-Meyer-Olkin test and Bartlett's Test of Sphericity. Maximum likelihood extraction with Equamax rotation was used for exploratory factor analysis, with factor retention guided by the root-mean-square residual. RESULTS: Strong internal consistency for the instrument (Cronbach's α = 0.818) and adequate sampling adequacy (KMO = 0.794; Bartlett's p < 0.001) were assessed for exploratory factor analysis (EFA), which provided eight clinically relevant HRQoL domains (29 items total). The domains identified in this study included hirsutism, skin disease, menstrual irregularities, physical/emotional burden, emotional inconsistency, body image, problems with self-care, and social support. The major contributors to impaired HRQoL were menstrual dysfunction and other visible symptoms. Within the study sample, women reported greater distress associated with their weight than their appearance. Paracetamol use was comparatively higher for self-medicated pain relief during menstruation. CONCLUSION: Extending the assessment beyond the conventional 18-45 year reproductive window reveals that the PCOS-related burden persists into adolescence and adulthood. The adapted Malayalam PCOS-HRQoL tool showed acceptable reliability, making it a useful measure of quality of life in women with PCOS in this population. Further confirmatory factor analysis and longitudinal studies are required to confirm these findings.