Development and validation of supporting ability scale for caregivers of adolescents with non-suicidal self-injury

BACKGROUND: Non-suicidal self-injury (NSSI) is a significant mental health concern among adolescents, characterized by deliberate self-harm without suicidal intent. Caregivers play a crucial role in supporting adolescents with NSSI, yet there is a lack of standardized instruments to assess their supporting ability. The aim of this study was to develop and validate a scale to evaluate the supporting ability of caregivers for adolescents with NSSI. OBJECTIVE: The goal was to develop and validate a scale that assesses the supporting ability of caregivers of adolescents with NSSI, incorporating dimensions of knowledge, attitudes, practice, health, and interpersonal relationships and resource utilization. METHODS: The scale development process involved item generation through a comprehensive literature review, scale refinement via a two-round Delphi expert consultation, and validation through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The initial item pool was generated based on the "Knowledge-Attitude-Practice Theory" and Farran's caregiver skill model framework. A total of 15 experts participated in the Delphi consultation, and 431 caregivers of adolescents with NSSI were recruited for scale validation. The final scale was subjected to item analysis, EFA, and CFA to assess its psychometric properties. RESULT: The Delphi consultation resulted in a refined scale with 37 items across five dimensions. Item analysis and factor analysis led to the scale with 32 items across 5 dimensions. The EFA revealed a five-factor structure with a cumulative variance contribution rate of 75.38% and factor loadings ranging from 0.771 to 0.858. The CFA confirmed the factor structure with satisfactory fit indices. Validity analysis demonstrated that the scale had satisfactory convergent validity (AVE: 0.545-0.637; CR: 0.828-0.924) and discriminant validity. The scale demonstrated high internal consistency, with a Cronbach's α coefficient of 0.935 for the overall scale and coefficients ranging from 0.822 to 0.924 for individual dimensions. The split-half reliability analysis also showed a Spearman-Brown coefficient of 0.781. CONCLUSION: The scale provides a preliminary evaluation framework to identify caregiver supporting ability for NSSI adolescents. However, we did not assess the scale's external validity or its predictive relationship with adolescent outcomes. Therefore, the scale's clinical utility and effectiveness in evaluating interventions remain to be established through further research. Future research should explore the scale's test-retest reliability, responsiveness to change, and its utility in predicting adolescent outcomes.