The Arabic Control Attitudes Scale-Revised: Method Effect (Negatively Worded Items) and Measurement Invariance as Threats to Its Construct Validity Are Remedied in a 5-Item Version With Improved Performance

Ali, Amira MohammedAl-Dossary, Saeed A.Alharrasi, MaryamLaranjeira, CarlosAyed, AhmadEl-Gazar, Heba EmadZoromba, Mohamed AliAtalla, Amal Diab GhanemAlamer, RasmiehAl-Abri, KhaloodSubih, MahaPakai, Annamaria2026-04-202026-04-202026-01-28Ali, Amira Mohammed PhD, MSN, RN; Al-Dossary, Saeed A. PhD, MSN; Alharrasi, Maryam PhD, MSN, RN; Laranjeira, Carlos PhD, MSN; Ayed, Ahmad PhD, MSN, RN; El-Gazar, Heba Emad PhD, MSN, RN; Zoromba, Mohamed Ali PhD, MSN, RN; Atalla, Amal Diab Ghanem PhD, MSN, RN; Alamer, Rasmieh PhD, MSN, RN; Al-Abri, Khalood PhD, MSN, RN; Subih, Maha PhD, MSN, RN; Pakai, Annamaria PhD, MSN, RN. The Arabic Control Attitudes Scale-Revised: Method Effect (Negatively Worded Items) and Measurement Invariance as Threats to Its Construct Validity Are Remedied in a 5-Item Version With Improved Performance. Journal of Cardiovascular Nursing ():10.1097/JCN.0000000000001294, January 28, 2026. | DOI: 10.1097/JCN.00000000000012940889-4655http://hdl.handle.net/10400.8/16160Background: The Control Attitudes Scale-Revised (CAS-R) is widely used to explore cardiac patients’ beliefs about their ability to manage illness. The CAS-R’s construct validity may be questionable in different cultural contexts. Conclusions/applications based on inaccurate construct validity can be misleading and incorrect. Objective: In this study, we aimed to evaluate the psychometric properties of the Arabic version of the CAS-R. Methods: Within a cross-sectional design involving 180 Omani patients with heart failure (mean age = 70.3 ± 9.8 years, 51.7% females), exploratory/confirmatory factor analysis (CFA) and multigroup CFA were used to evaluate the construct validity and measurement invariance of the CAS-R across gender and marital groups. Results: In exploratory factor analysis, 2 factors with eigenvalues >1 explained 37.9% of the variance. Despite the poor fit of the unidimensional CAS-R, CFA revealed an excellent fit of a 2-factor structure. Negative (5 and 8) and cross-loading items (1) contributed to scale variance at the configural level. Eliminating negative items and item 6 improved model fit, reliability (Cronbach’s α = 0.66 vs. 0.56), and invariance at all levels. In support of its convergent and criterion validity, the CAS-R 5 correlated with the CAS-R and depression (r = 0.953, −0.268; P values <.01). Conclusions: Negative items comprised a minor weak factor (helplessness) that was not stable across groups. Eliminating items 5, 6, and 8 resulted in a clean invariant short form (CAS-R 5) with superior properties that may implicate nursing decisions and interventions concerning perceived control.engArabic Control Attitudes Scale-RevisedArabic Patient Health Questionnaire-2Heart failureKnown-group validityMeasurement invarianceThe Arabic Control Attitudes Scale-Revised: Method Effect (Negatively Worded Items) and Measurement Invariance as Threats to Its Construct Validity Are Remedied in a 5-Item Version With Improved Performancejournal article10.1097/jcn.00000000000012941550-5049