Background The Rheumatology Attitudes Index is a widely used measure of learned helplessness (LH), an acquired pattern of behaviour in which, as a result of adverse past experiences, individuals believe their efforts will be ineffective. LH is associated with poorer quality of life in a variety of rheumatic diseases, and with increased morbidity and mortality in patients with rheumatoid arthritis. Despite the importance of learned helplessness in rheumatic conditions, there are no validated measures of this construct in Chinese or other Asian languages.
Objectives To assess the internal consistency, reliability and construct validity of a Chinese translation of the Rheumatology Attitudes Index (CRAI) and it’s Helplessness (CHS) and Internality (CIS) subscales.
Methods The source English RAI was translated into Chinese using standard techniques for cross-cultural adaptation. Chinese-speaking SLE patients completed identical, self-administered Chinese questionnaires containing the CRAI and assessing demographic and socio-economic variables twice within a 2 week period. SLE related activity, damage and quality of life were assessed using the BILAG, SLICC/ACR Damage Index and SF-36 Health Survey respectively. Scale psychometric properties were assessed through factor analysis, Cronbach’s alpha, intra-class correlations and quantifying test-retest differences. Relationships between the CRAI, its subscales and external variables (known-groups construct validity) were studied using Spearman’s rank correlation.
Results Active disease and disease related damage were present in 52.2% and 49.3% of 69 Chinese speaking SLE patients with a median disease duration of 4.7 years. Internal consistency and reliability were acceptable, with Cronbach’s a for the CHS, CIS and CRAI being 0.70, 0.69 and 0.74 respectively, mean differences in test-retest scores being 0.47, 0.55 and 0.93 points respectively (representing 1.6 to 2.4% of possible scale ranges) and intra class correlations ranging from 0.72 to 0.83. Factor analysis identified 2 major factors corresponding to the HS and IS subscales of the CRAI. Eight of 10 hypotheses relating the CRAI and CHS to demographic, disease and quality of life variables were confirmed, supporting the construct validity of these scales.
Conclusion The CRAI and it’s helplessness subscale are valid and reliable measures of learned helplessness in Chinese speaking SLE patients.