This study validated the Sinhalese BC scale in the Sri Lankan setting. Coping strategies that are used by patients with cancer have not received much attention in the Sri Lankan setting. Therefore, validation of the Brief COPE scale to the Sri Lankan setting was vital and imperative.
This study obtained good internal consistency and test-retest reliability of the S-BC when operationalized as two subscales. Cronbach's alpha of the overall scale was 0.819 but has not been shown in some studies [10, 24]. Adaptive coping had a high Cronbach's alpha of 0.861, whereas maladaptive coping had low reliability (0.396).
A high reliability coefficient for the subscales was not detected much throughout the current study, which contrasts with the results of others . In our study, most of the subscales showed lower internal consistencies, whereas three subscales scored higher internal consistency: instrumental support (0.85), emotional support (0.70), religion (0.79), and behavioral disengagement (1.00). Acceptable internal consistencies were conveyed for most of the subscales elsewhere, especially as in the original Brief COPE study [10, 24]. Nevertheless, others have reported better internal consistencies for maladaptive coping subscales , which is a difference from our results. Cronbach’s alphas were tested for both phases; adaptive and maladaptive coping had better reliabilities (˃.785). Test-retest reliability was also high due to the homogeneity and stability of the scale over a two-week period (reliability of 2 major subscales = r ˃ .650, p <0.01).
Correlations between the S-Brief COPE, CES-D, and WHOQOL-BREF were performed to confirm the criterion validity of the scale. Correlation findings among S-BC, CES-D, and QoL presented reverse association: evidence of measuring different constructs or concepts. Similar construction among items in the subscale had a similar correlation (convergent validity). Different structures amongst different subscales or correlations of items and dissimilar subscales had lower correlations (discriminant/divergent validity). Those were significant clues for high criterion validity between different subscales in the same tool.
Even though the factor structure of the scale has already been established, many studies have investigated it . Seven factors were extracted from the EFA in the current study, and each subscale/item (25 items) was included in seven relevant factors collectively (avoidance/behavioral disengagement, religion/acceptance, seeking support, planning, substance use/venting, self-blame, active/positive coping). A similar number of factors was obtained by Hagan et al.  and labeled self-blame, acceptance, denial, emotional support, positive reframing, active, and behavioral disengagement. Due to the dissimilar constructions of extracted factors in the current study, one factor was made as to the independent factor and consisted of an item of the single subscale (6th factor -self-blame comprised with item 13 of the self-blame subscales), while some factors incorporated clusters of different subscales and created broader domains (3rd factor – seeking support contained with items of self-distraction, acceptance, using emotional support and instrumental support subscales). These categories of broader dimensions and independent factors (e.g., religion, substance use, etc.) were revealed in previous studies also [24, 25]. These two studies had established broader dimensions for some factors; the study of Kapsou et al.  had broader factors for 1 (active/positive coping), 4 (seeking support), etc. and 1 (problem-solving/acceptance), 2 (negative venting/avoidance), 4 (self-blame/denial), and 6 (humor/self-distraction) broader domains were comprised in the Su et al.  also in line with our results that we were able to progress broader dimensions such as 1 (avoidance/behavioral disengagement), 2 (religion /acceptance), and 5 (substance use/ venting) in this study.
Furthermore, emotional and instrumental support subscales included one factor (seeking support), similar to others [24, 25]. Additionally, venting was loaded into the same factor in one study , whereas acceptance and self-distraction items were loaded into the 'seeking support' factor in our study. Religion, as an independent factor of the above two studies [24, 25], studies performance as a broader factor (religion and acceptance) and comprises different subscales, such as religion, acceptance, planning, positive reframing, and instrumental support.
Denial and self-blame subscales were clustered into the 4th factor (self-blame/denial) , whereas self-blame was extracted into the 1st (active/positive coping) and 8th factors (expression of negative feelings) of the study of Kapsou et al. . Self-blame was loaded into the 1st factor, and 6th factor and denial were extracted into the 1st factor in the present study. 'Substance use' was not a distinct factor in the study of Su et al.  but comprised the ‘negative venting/avoidance’ dimension. Independent factors were established for ‘substance use’ , whereas a broader dimension was established for substance use (substance use/venting) in our study.
Furthermore, most of the adaptive and maladaptive coping subscales had mixed up in the different studies and established new factors. However, new factors that are interrelated with adaptive coping (problem solving/acceptance, support seeking, reliance on spirituality, etc.) had been established in previous studies [24, 25] as comparable in this study (religion/acceptance, planning, active/positive coping, seeking support, etc.). Accordingly, the new factor structure had enough support for the original arrangement of the Brief COPE.