[Examination of the reliability and validity of the Japanese version of the patient self-advocacy scale for psychiatric users]

Objective In 2020, > 6 million individuals with mental disorders received psychiatric care. Advocacy is important to ensure that the rights of psychiatric patients, for whom involuntary hospitalization sometimes occurs, are maintained. This study aimed to develop a Japanese version of the Patient Self-Advocacy Scale (PSAS) by Brashers et al. to measure the degree of patient self-advocacy and examine its reliability and validity.Methods Five researchers translated the original PSAS into Japanese. The translated questionnaire was piloted with five psychiatric users and further revised. The revised content was back-translated by a professional translator and checked by the original author. An online questionnaire was administered to verify the validity and reliability of the completed Japanese PSAS. The questionnaire was distributed to individuals who received mental health services on a mailing list. Some respondents were asked to complete the questionnaire a second time to examine the reliability of the retest method. Reliability was examined by calculating Cronbach's alpha coefficients for the entire scale and subscales and evaluating the results of the correlation coefficients with the retest. For validity, exploratory and confirmatory factor analyses were conducted, and correlation coefficients were calculated using related scales (the Japanese versions of the Desirability of Control, Desire for Autonomy, and Health Locus of Control scales).Results The questionnaire received 214 responses, and the test-retest questionnaire received 48 responses. Most respondents had been diagnosed with mood disorders (48.1%) or schizophrenia (40.7%), and 46.8% had been receiving psychiatric care for > 10 years. Cronbach's alpha coefficients for the overall scale and subscale analyses and correlation coefficients for retests ranged from 0.66-0.83 and 0.69-0.84, respectively. Regarding validity, exploratory factor analysis revealed three factors with items similar to those in the original version, and confirmatory factor analysis showed goodness of fit (CMIN/DF = 2.834, GFI = 0.896, AGFI = 0.841, RMSEA = 0.093, AIC = 198.542, CFI = 0.888). Correlations with relevant scales were significant with those of most subscales.Conclusion The Japanese PSAS was valid and reliable. This scale can be used to assess self-advocacy among psychiatric users and may help understand attitudes toward rights and advocacy.