Validation study of the Korean version of the parent protection scale

Protective parental behavior is crucial for children's safety and emotional well-being, but excessive protection may hinder their autonomy. This issue is particularly relevant for caregivers of children with chronic or rare diseases, who may adopt heightened protective behaviors. The Parent Protection Scale (PPS) is a validated patient-reported tool for assessing parental overprotection. Given Korea's unique cultural context, which emphasizes close family ties, this study aimed to translate and validate PPS for Korean populations.

A total of 179 caregivers of pediatric patients aged 5-10 years with cancer or rare diseases were recruited from eight hospitals across Korea between August 2023 and December 2024. The PPS was translated into Korean through a forward-backward translation process. Exploratory factor analysis (EFA) with principal axis factoring and direct oblimin rotation was performed to examine the factor structure. Internal consistency was assessed by Cronbach's alpha, and concurrent validity was evaluated using Pearson correlation with questionnaires for anxiety, depression, and social support measures.

EFA revealed a four-factor structure, which differed from that of the original PPS subscales-strict behavioral control, emotional intrusiveness, anxious ambivalence, and autonomy restriction-accounting for 44.85% of the total variance. Internal consistency was acceptable for the total scale (α = 0.79) and moderate for two subscales (anxious ambivalence and autonomy restriction; α = 0.66-0.75) but lower for the others (strict behavioral control and emotional intrusiveness; α = 0.57-0.64). Significant negative correlations were found between strict behavioral control, anxious ambivalence, and autonomy restriction and caregiver anxiety, depression, and social support, supporting concurrent validity. No significant associations were observed between emotional intrusiveness and caregiver anxiety, depression, or social support.

This study provides evidence that the Korean PPS is a culturally adapted tool with acceptable overall reliability for assessing parental protection, with the potential to inform family-centered care and culturally adapted interventions. In clinical practice, it may support more precise identification of protective parenting patterns and guide targeted interventions to balance protection with the promotion of child autonomy.