To validate the reliability and validity of Chinese version of the Attitudes Related to Trauma-Informed Care Scale (ARTICS) among psychiatric nurses in China.

Using convenience sampling, 720 nurses from 3 mental health centers in Shanghai were selected as the subjects for this study, from February to July 2021, including 41 males and 679 females, aged 20-55 (36.27±8.89) years old. The Chinese versions of ARTICS and Professional Quality of Life (ProQOL) scale were used for investigation. Reliability was tested by internal consistency and test-retest reliability. Validity was tested by content validity, structural validity, criterion validity, and convergent validity. Pearson correlation analysis was used to validate the criterion validity of the scale with ProQOL as the criterion.

Item analysis showed that the cut-off values of each item in the Chinese version of ARTICS were 17.996-22.164, and the correlation between each item and the total scale score were 0.613-0.720. The overall Cronbach′s α coefficient of ARTICS was 0.962, and the Cronbach′s α coefficients of the five domains were 0.916-0.931. The intra-class correlation coefficient (ICC) of test-retest reliability was 0.949, and the ICCs of each domain were 0.804 to 0.890 (all P<0.01). The content validity index of each item was 0.830-1.000, and the average content validity index was 0.947. Exploratory factor analysis extracted five domain factors from 35 items: underlying causes of problem behavior and symptoms, responses to problem behavior and symptoms, on-the-job behavior, self-efficacy at work and reactions to the work.The cumulative variance of the five factors contribution rate was 69.519%, and the factor loadings of each item on the corresponding common factors were 0.673-0.796. Confirmatory factor analysis showed good model fit, with chi-square degree of freedom ratio=1.847, the goodness of fit index=0.933, adjusted goodness of fit index=0.923, normed fit index=0.947, comparative fit index=0.975, incremental fit index=0.975, and root mean square error of approximation=0.034. Pearson correlation analysis showed that the Chinese version of ARTICS was significantly correlated with all domains of ProQOL. i.e. the ARTICS total score was positively correlated with compassion satisfaction (r=0.599, P<0.01), and negatively correlated with burnout and secondary trauma stress (r=-0.604, -0.593; both P<0.01).

The Chinese version of ARTICS has good reliability and validity, and can be used to evaluate the attitudes towards trauma-informed care among psychiatric nurses in China.

Reproducibility of results; Nurses; Attitudes Related to Trauma-Informed Care Scale