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. 2025 Jun 16;13(1):111.
doi: 10.1186/s40337-025-01314-x.

Psychometric properties of the Chinese version of the pros and cons of anorexia nervosa (P-CAN-C) scale: a validation study in patients with anorexia nervosa

Xu Han  1 , Mei-Chun Cheung  2 , Xueni Li  3 , Lucy Serpell  4
Affiliations

Psychometric properties of the Chinese version of the pros and cons of anorexia nervosa (P-CAN-C) scale: a validation study in patients with anorexia nervosa

Xu Han et al. J Eat Disord. .

Abstract

Background: Individuals with anorexia nervosa (AN) often face significant challenges in maintaining motivation for recovery. Understanding the perceived pros and cons associated with the disorder is crucial for promoting recovery. This study aimed to translate, adapt, and validate the Pros and Cons of Anorexia Nervosa Scale (P-CAN) for use with Chinese adults with AN, thereby facilitating a clearer understanding of the motivations and barriers encountered by these patients.

Methods: This study employed a cross-sectional survey design to collect data from 207 Chinese adults with AN (Mage25.58 and SD 6.011). Content validity was assessed by a panel of professionals. Reliability testing included internal consistency, test-retest reliability, item-total correlation, and correlation analysis between subscales. Principal Component Analysis (PCA) assessed the factor structure, focusing on two components (Pro and Con-AN) and ten subscales-Safe/Structured, Appearance, Fertility/Sexuality, Special, Fitness, Communicate Emotions/Distress for Pro-AN and Trapped, Guilt, Hatred, Stifled for Con-AN as per the original scale. Criterion validity was evaluated using the eating pathology tested by Eating Disorder Examination Questionnaire (EDE-Q) and Body Mass Index (BMI).

Results: The content validity of the overall scale was 0.86. The Pro-AN and Con-AN subscales exhibited strong internal consistency (α = 0.84 and 0.82) and test-retest reliability (r = 0.912 and 0.704, p < 0.001). Item-Total Correlations exceeded 0.3 for all items except item 2, and there was no significant correlation between the Pro-AN and Con-AN subscales. The PCA results indicated that the Chinese P-CAN retained two components, which are consistent with the original scale. Differences emerged in more granular dimensions that may not be appropriate within the Chinese context. Significant correlations were found between the Pro-AN (r = 0.279, p < 0.001) and Con-AN (r = 0.240, p < 0.001) subscales and eating pathology and Con-AN was significantly correlated with BMI (r = -0.214, p < 0.01).

Conclusions: The P-CAN has shown promising psychometric properties among Chinese patients with AN. In terms of dimensionality, the Chinese context aligns closely with the original scale's binary division into Pro-AN and Con-AN. However, the further differentiation into ten dimensions, may not be culturally appropriate for the Chinese context.

Keywords: Anorexia nervosa; China; Pros and cons of anorexia nervosa scale; Scale validation.

Plain language summary

This study aimed to translate and culturally adapt the Pros and Cons of Anorexia Nervosa Scale (P-CAN) for Chinese adults with anorexia nervosa (AN). The adapted scale is designed to assess motivations and barriers among Chinese individuals with AN in the recovery process, providing insights for clinical practice.The study involved 207 Chinese adults with AN, who completed the translated scale. The scale was tested for accuracy (content validity), consistency (reliability), and its ability to measure what it’s supposed to measure (validity). The results showed that the Chinese version of the P-CAN is reliable and valid for use with Chinese adults with AN.The scale divides into two main parts: Pro-AN (reasons patients might see benefits in their disorder) and Con-AN (reasons they might see drawbacks). These two parts showed strong consistency and reliability. However, while the overall structure of the scale matched the original version, some of the more detailed subcategories (like “Safe/Structured” or “Trapped”) might not fit as well in the Chinese cultural context. The study also found that both the Pro-AN and Con-AN parts of the scale were linked to eating disorder symptoms, and the Con-AN part was also linked to body weight (BMI).In conclusion, the Chinese version of the P-CAN is a useful tool for understanding the motivations and challenges of Chinese adults with AN. While the overall structure works well, some of the finer details might need adjustment to better fit the Chinese cultural context. This tool can help clinicians and researchers better support patients in their recovery.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Survey and Behavioral Research Ethics Committee of The Chinese University of Hong Kong (Reference number: SBRE-23–0250 A). All participants reviewed and signed an informed consent form, which was provided either online or in a physical format prior to their participation. Consent for publication: Not applicable. This manuscript does not contain any individual person’s data in any form (including images, videos, or case reports). Competing interests: The authors declare no competing interests.

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