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Research Article: Content validity of the Chinese version of the PRAP scale: a convergent parallel mixed-methods study

Date Published: 2026-09-28

Abstract:
This study aimed to evaluate the content validity of the Chinese-language version of the PRAP scale from comprehensive perspectives within the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) framework. We evaluated the content validity of the Chinese PRAP scale using COSMIN methodology in a convergent parallel mixed-methods design (August 2022–November 2023) at a tertiary children's hospital in Shanghai, with 57 content validity raters including nurses, social workers, and family caregivers. Quantitative (I-CVI, S-CVI/Ave) and qualitative data from semi-structured interviews were integrated. The scale showed strong overall content validity based on the quantitative ratings (S-CVI/Ave?=?0.92). Item 5 (“Parent/caregiver stress”) showed the lowest relevance rating (I-CVI?=?0.79). Qualitative feedback identified ambiguous phrasing in Items 4 and 5 and inconsistent interpretation of professional terminology. Despite uncertainties in comprehensibility identified by qualitative insights, the findings provide evidence supporting the content validity of the Chinese PRAP scale, while acknowledging that further psychometric evaluation is required.

Introduction:
Psychosocial risks are defined as social, emotional, familial, and cultural factors that profoundly impact children's health and psychological development ( 1 ). Unlike specific clinical conditions such as anxiety and depression, psychosocial risk is a multidimensional construct that reflects a child's overall susceptibility to adverse psychological, emotional, and social outcomes ( 2 ). Prevalence studies have demonstrated that 20% to 50% of hospitalized children experience psychosocial risks ( 2 , 3 ).…

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