Cross-Cultural Validation of the Refusal of Care Informant Scale (RoCIS) for European Portuguese Population

Partel Araujo, Joao, Luz, Helena, Melo, Rosa, Van Son, Catherine and Backhouse, Tamara (2026) Cross-Cultural Validation of the Refusal of Care Informant Scale (RoCIS) for European Portuguese Population. Aging & Mental Health. ISSN 1360-7863 (In Press)

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Abstract

Objectives: Care refusal behaviours in dementia represent meaningful expressions of autonomy, yet validated assessment tools for Portuguese-speaking populations remain absent. The Refusal of Care Informant Scale (RoCIS) measures care refusal expressions during personal care interactions. This study aimed to conduct cross-cultural validation of the RoCIS for European Portuguese populations, establishing psychometric properties in nursing home settings. Methods: This cross-sectional study employed systematic translation and psychometric evaluation using classical test theory and Rasch analysis. A sample of 183 older adults living with dementia from 12 Portuguese nursing homes was assessed using the Portuguese RoCIS alongside validated measures including Cohen-Mansfield Agitation Inventory, Neuropsychiatric Inventory-Questionnaire, Barthel Index, and Functional Assessment Staging Tool. Results: The Portuguese RoCIS demonstrated internal consistency (Cronbach's α = 0.834; 95% CI: 0.796-0.867). Rasch analysis confirmed item reliability (0.91) and unidimensionality. Convergent validity was established through significant correlations with agitation (r = 0.523, p < 0.001) and neuropsychiatric symptoms (r = 0.427, p < 0.001). Known-groups validity showed significant discrimination across cognitive dependency levels (F(2,180) = 3.410, p = 0.035). Conclusion: The Portuguese RoCIS represents the first cross-cultural validation beyond the original country of development, providing strong evidence for the scale's international applicability and supporting relationship-centred dementia care globally.

Item Type:	Article
Additional Information:	Data Availability Statement: The complete dataset will be made available upon request to the corresponding author after publication, subject to institutional data sharing agreements and ethical approvals for secondary data use. Any data reuse will require a data sharing agreement ensuring participant confidentiality and compliance with the original ethical approval conditions.
Uncontrolled Keywords:	dementia,care refusal,cross-cultural validation,portugese,psychometrics,behavioural assessment
Faculty \ School:	Faculty of Medicine and Health Sciences > School of Health Sciences
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Centres > Mental Health and Social Care (fka Lifespan Health) Faculty of Medicine and Health Sciences > Research Groups > Dementia & Complexity in Later Life
Depositing User:	LivePure Connector
Date Deposited:	15 Jan 2026 11:30
Last Modified:	15 Jan 2026 11:30
URI:	https://ueaeprints.uea.ac.uk/id/eprint/101616
DOI:	issn:1360-7863

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