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Article History

Received: 16 May 2026

Accepted: 23 August 2026

First Online: 1 September 2026

Declarations

Ethics approval and consent to participate: The research conducted in this study adhered to the Declaration of Helsinki and relevant national and institutional ethical standards. This study was approved by the Ethics Committee of School of Public Health and Allied Medical Sciences - Tehran University of Medical Sciences (Ethics approval: IR.TUMS.SPH.1404.073). All eligible participants received information about the study objectives, the voluntary nature of participation, the confidentiality of responses, and their right to withdraw at any time without affecting their care. Written informed consent was obtained from all participants before data collection. Data were collected anonymously, and no personally identifiable information was recorded in the analytical dataset. For participants included in the test–retest assessment, temporary contact information was used only for the second administration and was stored separately from questionnaire responses.

Competing interests: Tim Benson is the developer of the howRwe questionnaire and is affiliated with R-Outcomes Ltd. The other authors declare no competing interests.