Cross-cultural validation and psychometrics’ assessment of Pathak-Wieten Stoicism Ideology Scale among Chinese older people with knee osteoarthritis

Abstract

Stoicism ideology can generate expectations about ideal health - related behaviors. It affects individual health by persevering in the face of illness challenges. Measuring the stoic ideology of older adults with knee osteoarthritis (OA) would assist in tailoring culturally sensitive psychological strategies to encourage early care-seeking behavior for knee health. This study aimed to culturally adapt the Pathak-Wieten Stoicism Ideology Scale (PW-SIS) into Chinese and to evaluate its psychometric properties in older people with knee OA. The original PW-SIS was translated for Chinese following WHO guideline included forward translation, expert panel, back translation, and pre-testing and cognitive interviewing. From January to March 2025 in China, 231 participants aged 60 + were recruited to test the scale’s reliability and validity. Reliability was evaluated by Cronbach’s coefficient and test-retest reliability. Validity was assessed in terms of content, structure, convergence and criterion-related aspects. The Cronbach’s Alpha coefficient for the total scale was 0.92. For the four subscales of endurance, taciturnity, serenity, and death acceptance, it was 0.89, 0.88, 0.82, and 0.82. The test-retest reliability was 0.89. The item-content validity index (I-CVI) of the scale ranged from 0.83 to 1.00, and the average scale-level content validity index (S-CVI/Ave) for the overall scale was 0.94. The exploratory factor analysis indicated four dimensions with 12 items and a cumulative variance contribution rate of 78.63%. Confirmatory factor analysis showed very good model fit: root mean square error of approximation (RMSEA) = 0.05, goodness-of-fit index (GFI) = 0.94, and Tucker-Lewis Index (TLI) = 0.98. The 12-item Chinese version of PW-SIS demonstrates satisfactory reliability and validity. Therefore, it can be adopted to evaluate the stoicism ideology of elderly individuals in China. Not applicable.