The Arabic Control Attitudes Scale-Revised: Method Effect (Negatively Worded Items) and Measurement Invariance as...

The Control Attitudes Scale-Revised (CAS-R) is widely used to explore cardiac patients' beliefs about their ability to manage illness. The CAS-R's construct validity may be questionable in different cultural contexts. Conclusions/applications based on inaccurate construct validity can be misleading and incorrect.

In this study, we aimed to evaluate the psychometric properties of the Arabic version of the CAS-R.

Within a cross-sectional design involving 180 Omani patients with heart failure (mean age = 70.3 ± 9.8 years, 51.7% females), exploratory/confirmatory factor analysis (CFA) and multigroup CFA were used to evaluate the construct validity and measurement invariance of the CAS-R across gender and marital groups.

In exploratory factor analysis, 2 factors with eigenvalues >1 explained 37.9% of the variance. Despite the poor fit of the unidimensional CAS-R, CFA revealed an excellent fit of a 2-factor structure. Negative (5 and 8) and cross-loading items (1) contributed to scale variance at the configural level. Eliminating negative items and item 6 improved model fit, reliability (Cronbach's α = 0.66 vs. 0.56), and invariance at all levels. In support of its convergent and criterion validity, the CAS-R 5 correlated with the CAS-R and depression ( r = 0.953, -0.268; P values <.01).

Negative items comprised a minor weak factor (helplessness) that was not stable across groups. Eliminating items 5, 6, and 8 resulted in a clean invariant short form (CAS-R 5) with superior properties that may implicate nursing decisions and interventions concerning perceived control.