Validation and cross-cultural measurement invariance of the English and French versions of the Decision Regret Scale among people living with chronic noncancer pain: A secondary analysis of the DECIDE-PAIN pan-Canadian survey.

Abstract

Decision regret is a key outcome in health decision-making studies. However, little is known about its psychometrics in chronic noncancer pain populations. We sought to assess the measurement properties of the English and French versions of the Decision Regret Scale (DRS). Following COnsensus-based Standards for the selection of health status Measurement INstruments guidelines, we conducted a secondary analysis of a pan-Canadian cross-sectional online survey among adults living with chronic noncancer pain. In the primary study, participants completed the DRS related to the most difficult decision they faced to manage their condition. We assessed score distribution, structural validity, internal consistency, and measurement invariance across age, sex, education, health literacy, and language groups. Analyses were performed separately for English-version (n = 1103) and French-version (n = 270) samples. In the English sample, the mean age was 51.3 years (SD=16.4), 52.1 % identified as women, and 50 % had a university education. In the French sample, the mean age was 51.5 years (SD=16.2), 39.6 % identified as women, and 44.4 % had a university education. Both language versions showed floor effects at the item and total score levels. Confirmatory factorial analysis indicated good model fit (CFI > 0.99, RMSEA ∼ 0.06, SRMR < 0.02). Internal consistency was acceptable (α = 0.86, ω = 0.78). Measurement invariance was supported across language and health literacy groups at configural, metric, scalar, and strict level (CFI > 0.99, ΔCFI < 0.01, ΔRMSEA < 0.015, ΔSRMR < 0.01). However, only partial invariance was found across sex and age. The English and French versions of the DRS demonstrated adequate structural validity and internal consistency, with evidence supporting cross-cultural measurement invariance. The DRS may be used for cross-sectional assessment of decision regret across language groups; however, comparisons across age or sex subgroups should be interpreted with caution due to limited measurement invariance.