Validation of CARE Scale-7 in treatment-seeking patients with chronic pain: Measurement of sex invariance

Maisa Ziadni, Dokyoung Sophia You, Abby Chen, Anna C. Wilson, Beth D. Darnall

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objectives: Social and interpersonal factors impact the trajectory of chronic pain. We previously developed and validated a 2- factor, 7-item measure to assess interpersonal factors, including relationship guilt and worry and difficulty prioritizing self-care in chronic pain. Here, we confirm the factor structure and examine the sex invariance of the two-factor structure of the CARE Scale-7. Methods: Data were collected as part of routine clinical care at a tertiary pain clinic using the Collaborative Health Outcomes Information Registry. Patient participants (67% women) were predominantly middle-aged (M 5 50.9 years, SD 5 17.8), married (55.2%), and White/non-Hispanic (55.7%). Data included demographics, pain characteristics, CARE Scale-7, pain catastrophizing, and Patient-Reported Outcomes Measurement Information System psychological and physical function measures. Confirmatory factor analysis was conducted to validate the factor structure of the CARE Scale, and a stepwise approach to measurement invariances by sex examined configural, metric, and scalar invariance. Results: Internal consistency of the scale items ensured suitability for factor analyses. Confirmatory factor analysis findings revealed an overall good fit of the 2-factor model among males and females and that CARE Scale-7 is in fact sex invariant. Finally, CARE Scale-7 showed convergent validity with pain-related outcomes. Discussion: The CARE Scale is the first validated instrument to assess self-care in both sexes among patients with chronic pain. The subscale of difficulty prioritizing self-care emerged as a potentially unique factor that should be integrated in clinical assessment. CARE Scale may facilitate standardized measurement in research and clinical contexts, which may inform a comprehensive treatment focus that integrates individualized self-care planning.

Original languageEnglish (US)
Article numbere862
JournalPain Reports
Issue number6
StatePublished - Nov 1 2020


  • Chronic pain
  • Relationship guilt
  • Self-care
  • Sex invariance
  • Worry

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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