Dimensionality and Reliability of the Adult Responses to Children's Symptoms Questionnaire in Iranian Children with Chronic Diseases

Background: The purpose of this research is to determine the dimensionality and reliability assessment of the questionnaire of Adult Responses to Symptoms (ARCS) of Iranian children suffering from chronic diseases. When adults respond appropriately to the physical symptoms of sick children, they can manage chronic diseases more effectively and prevent the worsening of symptoms associated with psychological factors. Methods: In this psychometric and validation study, 290 parents of children aged 4 to 16 with chronic diseases were selected through consecutive sampling. They were recruited from a children's educational and therapeutic center in Rasht city (north of Iran) and participated by answering the ARCS questionnaire between December 2021 and June 2022. Confirmatory factor analysis (CFA) was used to determine the construct validity. Pearson correlation coefficient and intraclass correlation coefficient (ICC) were employed to assess the test-retest reliability over a 4-week interval. Results: In the CFA, the factor loadings of all the items were above 0.3, and the fit indices of the modified Iranian model (PCFI = 0.69, PNFI = 0.62, CMIN/DF = 2.80, RMSEA = 0.07, IFI = 0.90, CFI = 0.90 and GFI = 0.92) were obtained, which shows the confirmation of the three-factor model of the ARCS questionnaire (i.e. protective, encouraging and minimizing dimensions). The test-retest reliability of the ARCS questionnaire scores for the dimensions of protective, encouraging/monitoring and minimizing responses were equal to 0.85, 0.94 and 0.87 (p = 0.001). Furthermore, ICC for the dimensions of protective, encouraging/monitoring and minimizing responses was obtained as 0.90, 0.97, and 0.93, respectively. The Cronbach's alpha coefficients were also calculated for the three above-mentioned subscales as 0.83, 0.70, and 0.60, respectively. Conclusions: The ARCS questionnaire has desirable reliability coefficients and construct validity. It can be used for clinical monitoring, educating families of children with chronic illnesses, and evaluating improvements in treatment outcomes.