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Psychometric validation of the Chinese-adapted eczema behavior checklist extent scale in pediatric atopic dermatitis
Jian Sun1, Linna Li1, Chang Qi1
1Department of Dermatology and Venereology, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China.
Background:
Pediatric atopic dermatitis (AD) demonstrate significantly higher rates of both general behavioral problems and condition-specific maladaptive behaviors. These behavioral challenges often interfere with parental treatment adherence and compromise disease management effectiveness. The Eczema Behavior Checklist Extent Scale (EBC-ES), initially developed and validated in Australia, represents the first psychometric tool specifically designed to evaluate AD-specific behavioral problems in children. However, its cross-cultural applicability and validation in Chinese populations remain unexplored.
Objective:
This study aimed to culturally adapt and validate the Chinese version of the EBC-ES for assessing AD-specific behavioral problems in pediatric patients across China.
Methods:
The Chinese EBC-ES utilized Brislin's validated back-translation protocol for cultural adaptation. This cross-sectional study recruited 674 parents (mean age 35.5 ± 4.7 years, range 24-49) of 3-10-year-old children (mean 5.9 ± 1.8) with physician-diagnosed AD. The sample comprised 369 boys (54.7%) and 305 girls (45.3%). Participants completed the Chinese EBC-ES and the Eyberg Child Behavior Inventory-Intensity scale (ECBI-IS). Psychometric evaluation included exploratory and confirmatory factor analyses (EFA, CFA) to assess construct validity, content validity indices (CVI), internal consistency (Cronbach's α, McDonald's ω), split-half reliability, and test-retest reliability.
Results:
The final 24-item Chinese EBC-ES demonstrated a stable three-factor structure (eigenvalues >1), accounting for 80.44% of the total variance. The Kaiser-Meyer-Olkin measure confirmed sampling adequacy (KMO = 0.942), and Bartlett's test supported factorability (χ² = 14,091.013; p < 0.001). CFA indicated excellent model fit: chi-square degree of freedom (χ²/df) = 2.855, root mean square error of approximation (RMSEA) = 0.075, standardized root mean square residual (SRMR) = 0.041. Comparative Fit Index (CFI) = 0.948, Tucker Lewis Index (TLI) = 0.942, Normed Fit Index (NFI) = 0.923, and Incremental Fit Index (IFI) = 0.948. The scale showed strong content validity (CVI = 0.96), high internal consistency (α=0.968, ω = 0.987), excellent test-retest reliability (r = 0.969), and satisfactory split-half reliability (r = 0.895).
Conclusion:
The Chinese version of the EBC-ES demonstrates robust psychometric properties, confirming its reliability and validity for AD-specific child behavioral problems in both clinical practice and research settings within Chinese populations.
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