Validation of an Arabic version of the Composite Abuse Scale (Revised)-Short Form (CASR- SF) as a measure of intimate partner violence in adult females from a Middle-Eastern country

doi:10.21203/rs.3.rs-4705094/v1

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Research Article

Validation of an Arabic version of the Composite Abuse Scale (Revised)-Short Form (CASR- SF) as a measure of intimate partner violence in adult females from a Middle-Eastern country

https://doi.org/10.21203/rs.3.rs-4705094/v1

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Background

Intimate partner violence (IPV) is a critical issue in the Arab world, exacerbated by the region's socioeconomic challenges and patriarchal societal structures. There is a pressing need for validated tools to measure abuse accurately among Arab-speaking women. This study aims to validate an Arabic translation of the Composite Abuse Scale (Revised)-Short Form (CASR-SF) to ensure its reliability and utility in capturing the experiences of abuse among Arabic-speaking women.

Methods

A cross-sectional study was conducted between January and May 2023 using the snowball sampling technique and an online questionnaire. The sample included 915 Lebanese women aged 18–50 years (mean age = 27.09 ± 9.28 years). The participants completed the Arabic CASR-SF along with the Columbia–Suicide Severity Rating Scale and the Child Abuse Self-Report Scale. Psychometric analyses, including factor analysis and reliability testing, were performed to assess the validity of the Arabic CASR-SF.

Results

CFA indicated that fit of the one-factor model of CASR-SF scores was modest: RMSEA = .124 (90% CI .118, .130), SRMR = .046, CFI = .892, TLI = .870. After adding correlations between residuals of items 5–6, 10–11 and 14–15, the results improved: RMSEA = .107 (90% CI .101, .113), SRMR = .042, CFI = .922, TLI = .903. The second-order model showed a good fit as well: RMSEA = .107 (90% CI .101, .113), SRMR = .042, CFI = .922, TLI = .903. The standardized estimates of factor loadings were all adequate. Internal reliability was very good (ω = .95; α = .95). Higher CASR-SF scores were significantly correlated with higher suicidal ideations (r = .32; p < .001), higher child psychological abuse (r = .35; p < .001), child physical abuse (r = .35; p < .001) and child sexual abuse (r = .38; p < .001) but not child neglect (r = .03; p = .361).

Conclusion

The Arabic translation of the CASR-SF appears to be a reliable and valid tool for assessing IPV among Arabic-speaking female adults, at least in Lebanon. Its use in future for clinical practice and research is recommended, to help advance understanding and efforts aiming at mitigating IPV in diverse populations.

Composite Abuse Scale-Short Form (CASR-SF)

Interpersonal violence

Psychometric properties

Arabic

Intimate partner violence (IPV) is defined by coercive behaviour within a romantic relationship through actions by current or former spouses or dating partners [1]. IPV is considered a grave human rights violation and a significant global social and public health concern affecting lives of millions of women worldwide [2]. It is estimated that, not only the prevalence rates of women experiencing physical, or sexual violence, or both, by an intimate partner at some point in their life ranges between 30 and 60%, but also that women were more at risk of violence by an intimate partner than from any other perpetrator [3]. According to the WHO it is more prevalent in women, where nearly 1 in 4 women (23.2%) have experienced severe physical violence by an intimate partner in their lifetime, compared to 1 in 7 men (13.9%) [4]. IPV encompasses physical and sexual violence, stalking and psychological aggression [5]. It can have major short-term and long-term both physical and mental health effects, such as migraines, gastrointestinal disorders, fatigue, post-traumatic stress disorder, suicidal ideation and attempts, anxiety and depression [6, 7]. Furthermore, a cross-sectional study conducted in Lebanon found that being divorced, illiterate, unemployed and having experienced child abuse were all factors associated with more violence against women [8]. Studies have shown that being exposed to IPV has been associated with a significant risk of suicidal ideations and self-harm [9]. Additionally, researchers have found that individuals who were exposed to childhood abuse or who have witnessed inter-parental violence had six times increased odds of experiencing IPV as adults [10]. Therefore, it is crucial to discuss and measure IPV due to its profound repercussions on individuals, families, and societies [11]. It can result in both physical and psychological trauma, perpetuate cycles of violence, impede social progress, and cause economic burden through leading to healthcare costs, loss of productivity, legal justice expenses, and the need for social services [12].

Scales to Measure Abuse

Many scales have been developed to assess IPV, including the Abuse Behavior Inventory (ABI) [13], the Past Feelings and Acts of Violence Scale (PFAV) [14], the Psychological Maltreatment of Women Inventory (PMWI) [15], the Intimate Violence and Traumatic Affect Scale (VITA Scale) [16], the IPV-GBM Scale for measuring IPV among gay and bisexual men [17], and the Scale of Psychological Abuse in Intimate Partner Violence [18].

Yet, when focusing on partner abuse, the Composite Abuse Scale (CAS) [19] stands out in the field of IPV measurement due to several key features: Being designed to capture a wide range of abuse experiences including physical, emotional and sexual abuse, its rigorous validation, and its ability to measure both the frequency and severity of abuse (Likert scale rating system); all ensure a deeper understanding and assessment of abuse and its impact on the victim. Originally developed by Hegarty, Bush, and Sheehan in 2005, the CAS aims to comprehensively measure the experience of abuse, including physical, emotional, sexual, and other forms of abuse [19]. The long version of the scale comprises 30 items, including sub-items, which are rated on a Likert scale to evaluate the frequency and severity of abuse experiences [19].

The CAS has since been used in clinical populations. Not only in Australia [20–22], but also in Russia [23], Netherlands [24, 25], Canada [26–29], and UK [30]. Previous studies have also validated and translated the CAS into multiple languages including Russian [23], Brazilian Portuguese [31], Dutch, Turkish, and Arabic language [32]. One study by Alhabib and colleagues (2010) validated the CAS in Arabic among a sample of Saudi women, demonstrating its applicability and reliability in an Arabic-speaking population [33].

Unlike the original 30-item Composite Abuse Scale, the Composite Abuse Scale (Revised) - Short Form (CASR-SF) consists of 15 items, including 12 from the original scale and 3 from expert consultation and literature [34]. This shorter version retains the comprehensive coverage of physical, emotional, and sexual abuse while offering improvements in brevity, reduced respondent burden, and clearer instructions. The original CASR-SF [34] is a valid and reliable measure of IPV experiences that retains the strengths of, but enhances, the existing CAS in key domains, while also providing a shorter, easier-to-answer scale for use in a range of contexts. While further testing is required in diverse settings, this brief scale represents a significant evolution in the measurement of IPV experiences that may adequately capture the complexity of IPV experiences among women than existing short surveys.

Compared to the long form, the CASR-SF [34] has only been translated to and validated in the Spanish population, where it successfully demonstrated the cross-cultural applicability and reliability of the CASR-SF in this population [35]. Yet, to date, no efforts have been made to validate the CASR-SF in Arabic. Previous studies have demonstrated the factor structure and validity of the CASR-SF. The original validation of the CASR-SF confirmed its three-factor structure, good internal consistency, and convergent validity [19]. The Spanish version of the CASR-SF also supported these findings, demonstrating robust psychometric properties and sex invariance, highlighting its applicability across different cultures and genders [35].

The Present Study

Validating the CASR-SF in Lebanon, where the long form is already reliable and valid [34], has key benefits: it reduces respondent burden, maintains cultural sensitivity, and simplifies administration and analysis. This validation is crucial in the Arab world due to sociocultural and economic factors contributing to high IPV prevalence [36]. Traditional gender norms and patriarchal structures [37] perpetuate male dominance, subjugate women's rights, and discourage reporting of abuse. Cultural norms, misinterpretation of religious rules [38], and honor-related violence [39] further complicate the issue, with violence often dismissed to avoid family shame [40]. Lebanon's recent economic challenges and political instability have increased IPV rates [41, 42]. Research on abuse impacts from Western contexts may not fully apply to Lebanon. Validating the CASR-SF in Arabic will aid global efforts in addressing IPV and allow comparative studies to inform interventions and policies [43]. This study aims to translate the CASR-SF into Arabic and assess its psychometric properties, including internal reliability, sex invariance, composite reliability, and correlations with measures of suicidal ideation and child abuse. We hypothesize that the Arabic CASR-SF will confirm a three-factor structure, exhibit strong internal consistency, and demonstrate satisfactory convergent and concurrent validity and cross sex-invariance.

Participants

Between January and May 2023, a cross-sectional study was conducted in Lebanon from all five governorates involving Lebanese women, who resided in Lebanon, aged between 18 and 50 years of age, both single and married, living with a partner or a family.

Procedures

Ethics approval

for this study was obtained from the ethics committee of the School of Pharmacy at the Lebanese International University (2023RC-028-LIUSOP). All data were collected via google form link between January and May 2023 using the snowball sampling method, with an online questionnaire distributed through messaging apps and social media platforms like WhatsApp and Instagram. Participants were informed of the study's purpose, assured of their anonymity, and asked to provide virtual informed consent by clicking a box in the Google Forms questionnaire. Inclusion criteria for participation included being Lebanese or origin and being a woman aged between 18 and 50. The questionnaire items were presented in a pre-randomized order to minimize order effects, and participants completed the survey voluntarily and without remuneration. No financial compensation was offered for participation.

Translation Procedure

Prior to implementation in the current study, the CASR-SF underwent a meticulous translation and adaptation process into Arabic language and context. The translation involved rendering the scale into literary Arabic (Modern Standard Arabic), the official language across Arab nations used for cross-group communication. The objective was to achieve semantic equivalence between the original and Arabic versions following international norms and recommendations [38]. This was accomplished through a forward and backward translation method. Initially, a Lebanese translator, not affiliated with the study, translated the English version into Arabic. Subsequently, a Lebanese psychologist proficient in English translated the Arabic version back into English. The translation team ensured a balanced approach, addressing any specific or literal translations. A committee of experts, including two psychiatrists, one psychologist, the research team, and the two translators, compared the initial and translated English versions to identify and rectify any inconsistencies, thereby ensuring translation accuracy [39]. To adapt the measure to the specific context, the translation team scrutinized for potential misunderstandings in item wording and evaluated the ease of item interpretation. This process aimed to guarantee conceptual equivalence between the original and Arabic scales in both contexts [40]. Following the translation and adaptation, a pilot study involving 30 participants was conducted to confirm comprehension of all questions. No changes were made after the pilot study, indicating the clarity and appropriateness of the translated scale.

Measures

Demographics

Participants were asked to provide their demographic characteristics, such as age. Beside demographics questions, they were requested to answer the statements in the following scales.

The Composite Abuse Scale (Revised)—Short Form (CASR-SF) (Ford-Gilboe et al., 2016) is a concise yet thorough tool, comprising 15 items that assess three key domains of abuse: physical, sexual, and psychological. This scale is designed to evaluate experiences of abuse over a lifetime, as well as recent and current exposure, while also considering the frequency of abusive incidents. Respondents answer using a yes/no format and, if applicable, indicate the frequency of abuse experienced in the last 12 months. For example, physical abuse items include “being slapped or kicked”, while sexual abuse items encompass “being forced into unwanted sexual activity”. Psychological abuse items cover experiences such as “being called names or sworn at”, and attempts to isolate the individual from their social support network. The total score on the CASR-SF ranges from 0 to 75, with higher scores indicating a greater severity of abuse.

Columbia–Suicide Severity Rating Scale (C-SSRS). Validated in Lebanon [41, 42], the C-SSRS is an instrument to assess suicidal thoughts and behavior. The presence of such ideas is deliberated if the participant replied by “yes” to any question of the 5 asked categories on the C-SSRS. A score of zero signifies the nonexistence of suicidal ideas.

Child Abuse Self-Report Scale (CASRS-12). Validated in Arabic [43], this scale is used to assess different types of childhood abuse classified into four categories: physical (e.g., “I was hit with an object by a caregiver”), emotional (e.g., “A caregiver threatened to harm me or someone I cared about”), sexual (e.g., “An adult or older child forced me to have sexual contact”), and neglect (e.g., “I did not have enough to eat because no one was there to provide for me”). Each item is scored on a Likert style scale from 0 “never” to 4 “very often”. Total scores are calculated by summing the responses, and higher scores indicate a higher likelihood of experiencing abuse.

Analytic Strategy

There were no missing responses in the dataset. To examine the factor structure of the CASR-SF, we conducted a Confirmatory Factor Analysis using the data from the total sample via SPSS AMOS v.29 software. A minimum sample varying between 45–300 participants was deemed necessary to conduct a confirmatory factor analysis following a recommendation between 3–20 times the number of the scale’s variables [44]. Our intention was to test the original model of the scale. Parameter estimates were obtained using the maximum likelihood method. Calculated fit indices were the Steiger-Lind root mean square error of approximation (RMSEA), the standardized root means square residual (SRMR), the Tucker-Lewis Index (TLI) and the comparative fit index (CFI). Values ≤ .08 for RMSEA, ≤ .05 for SRMR and .95 for CFI and TLI indicate good fit of the model to the data [45]. Multivariate normality was not verified at first (Critical ratio > 5; Bollen-Stine p = .002); therefore, we performed non-parametric bootstrapping procedure.

Further analyses. Composite reliability was assessed using McDonald’s ω and Cronbach’s alpha, with values greater than .70 reflecting adequate composite reliability. Normality of the CASR-SF score was verified since the skewness and kurtosis values for each item of the scale varied between − 1 and + 1 [46]. To assess concurrent validity, Pearson test was used to correlate CASR-SF scores with other continuous variables using the total sample.

Sociodemographic characteristics of the participants

915 women age d between 18 and 50 years with a mean age of 27.09 ± 9.28 years (min = 18; max = 50). The majority of participants were single (69%), while 31% were married. In terms of educational attainment, 82.4% had a university level, and in terms of living situation, 93.6% were living with a partner or family.

Confirmatory Factor Analysis of the CASR-SF Scale

Table 1

Standardized estimates of factor loadings of the 15-item Composite Abuse Scale- Short Form.
Item	Loading factor
Factor 1: Physical abuse
2- Shook, pushed, grabbed or threw me	.65
4- Used or threatened to use a knife or gun or other weapon to harm me	.78
6- Followed me or hung around outside my home or work	.78
8- Choked me	.84
12- Hit me with a fist or object, kicked or bit me	.84
14- Confined or locked me in a room or other space	.85
Factor 2: Sexual abuse
5- Made me perform sex acts that I did not want to perform	.86
9- Forced or tried to force me to have sex	.91
Factor 3: Psychological abuse
1- Blamed me for causing their violent behavior	.49
3- Tried to convince my family, children or friends that I am crazy or tried to turn them against me	.80
7- Threatened to harm or kill me or someone close to me	.86
10- Harassed me by phone, text, email or using social media	.69
11- Told me I was crazy, stupid or not good enough	.67
13- Kept me from seeing or talking to my family or friends	.81
15- Kept me from having access to a job, money or financial resources	.84

Concurrent validity

Higher CASR-SF scores were significantly associated with higher suicidal ideations (r = .32; p < .001), higher child psychological abuse (r = .35; p < .001), child physical abuse (r = .35; p < .001) and child sexual abuse (r = .38; p < .001) but not child neglect (r = .03; p = .361).

As IPV stands as the primary form of violence perpetrated by men against women, it remains concealed by secrecy and a culture of silence. Factors such as shame, stigma, fear of retaliation from the husband, safeguarding family reputation and privacy, feelings of affection toward the husband, and varying levels of cultural acceptance contribute to IPV remaining veiled and unrecognized [47, 48] despite the high pattern of abuse observed worldwide and especially in the Middle East [49]. Hence, there is a pressing need to assess IPV using reliable scales, among which the CASR-SF has emerged as a particularly valuable tool. To contribute to the expanding research in this area, we conducted a study to evaluate the psychometric properties of the Arabic version of the CASR-SF. Our findings robustly support its factorial structure, composite reliability, and concurrent validity.

In terms of factorial validity, as assessed through confirmatory factor analysis, the Arabic CASR-SF revealed a more robust three-factor structure, representing physical, sexual, and psychological abuse. CFA showed that the dimensions satisfactorily loaded on a higher-order construct, suggesting that despite this multidimensional structure the scale can be considered unidimensional for practical purposes, with the total score providing a comprehensive measure of IPV experiences. Additionally, the second-order model, with three factors contributing to one total score, demonstrated a good fit, further supporting the scale's validity, in agreement to the original version of the CASR-SF having a three-factor model (physical, sexual and psychological) [34]. However, the Spanish version [35] used the exploratory structured equation modelling and yielded a four-factor solution, where the EGA estimates suggested a fourth dimension denoted as “stalking”. This consistency suggests that the scale's structure remains stable across different populations, facilitating meaningful cross-national comparisons of abuse scores.

Our study found high internal reliability for the Composite Abuse Scale (Revised)—Short Form with McDonald's omega (ω = .95) and Cronbach's alpha (α = .95) coefficients, indicating strong consistency and robustness across diverse populations. These values surpassed those reported in both the original study by Ford-Gilboe et al. (2016) and the validation study of the Spanish version. Specifically, in the original study [34], Cronbach's alpha values were 0.91 for emotional abuse, 0.86 for physical abuse, harassment, and injury, and 0.83 for sexual abuse. Similarly, the Spanish version showed alpha/omega internal consistency coefficients exceeding 0.70, ensuring the scale's replicability across diverse cultural settings [35].

Regarding the association between IPV and other factors, the concurrent validity analysis showed significant associations between CASR-SF scores and other relevant variables, including higher levels of suicidal ideations, which aligns with preexisting literature [9, 22, 50–52]. A previous study [53] found a significant association between exposure to intimate partner abuse and suicidal ideations among women in low- and middle-income countries. In addition, another research indicated that women who experience IPV are at an increased risk of suicidal ideations [54]. Research has consistently shown that women experiencing both physical and sexual IPV are more likely to report suicidal ideations, highlighting the critical need for interventions addressing both forms of violence [55]. In addition, a strong positive association between more severe personal history of child abuse and adult IPV experiences was also significant in this study, in agreement with previous studies [56–58].Women who experienced childhood abuse may struggle to establish healthy boundaries in adulthood, potentially leading to involvement in abusive relationships. This pattern can be fueled by internalized unhealthy relationship norms and the lingering effects of childhood trauma, including emotional dysregulation and low self-esteem [59]. These findings underscore the importance of interventions that address the cyclical nature of abuse and provide support for survivors to break free from this pattern.

Clinical Implications

The validation of the Arabic translation of the CASR-SF holds significant clinical implications for the identification and management of intimate partner abuse violence among Arab-speaking women. Clinicians can utilize the validated CASR-SF as a reliable and valid tool to assess the prevalence and severity of IPV in this population, enabling early detection and intervention. The scale's robust psychometric properties, including strong internal reliability and concurrent validity, enhance its utility in clinical practice. Furthermore, the availability of a validated Arabic CASR-SF facilitates cross-cultural comparisons and the development of culturally sensitive interventions tailored to the needs of Arab-speaking women experiencing partner violence. Incorporating the CASR-SF into routine clinical assessments can improve the quality of care provided to survivors of ipv, leading to more effective interventions and better outcomes. Furthermore, future research could explore the scale's applicability and performance in other Arab countries to establish its cross-cultural validity and generalizability. Additionally, longitudinal studies could investigate the scale's sensitivity to change over time, providing insights into the effectiveness of interventions aimed at reducing IPV. Furthermore, qualitative studies could complement the quantitative findings by exploring the cultural factors influencing the experience and reporting of IPV in Arab societies.

Limitations

Our study has some limitations that warrant mentioning. Firstly, our use of a cross-sectional design restricts our ability to draw causal conclusions or assess changes over time. Secondly, while the online questionnaire format enhanced anonymity, it may limit the generalizability of our findings of the wider Lebanese population and introduce selection bias. Thirdly, although efforts were made to ensure the language and cultural equivalence of the translated version of the CASR-SF, it is crucial to acknowledge that language and cultural nuances can influence the interpretation of scale items and responses.

The validation of the Arabic translation of the CASR-SF in a sample of Arabic-speaking females from Lebanon represents a significant advancement in the measurement of intimate partner violence within the Arab and Middle-Eastern context. Through rigorous translation procedures and a comprehensive confirmatory factor analysis, the Arabic version of the CASR-SF exhibited robust psychometric properties, including adequate fit indices, strong internal reliability, and significant concurrent validity. Despite acknowledging the limitations related to cultural nuances and the representativeness of the sample, this study underscores the scale's utility in capturing the experiences of abuse among Arabic-speaking women. The validated Arabic CASR-SF provides a crucial tool for researchers and practitioners, paving the way for enhanced assessment and intervention strategies aimed at addressing IPV and promoting resilience within this population.

Ethics Approval and Consent to Participate: Ethics approval for this study was obtained from the ethics committee of the School of Pharmacy at the Lebanese International University (2023RC-028-LIUSOP). Written informed consent was obtained from all subjects; the online submission of the soft copy was considered equivalent to receiving a written informed consent. All methods were performed in accordance with the relevant guidelines and regulations.

Consent for publication: Not applicable.

Availability of data and materials: All data generated or analyzed during this study are not publicly available due the restrictions from the ethics committee, but are available upon a reasonable request from the corresponding author.

Competing interests: The authors have nothing to disclose.

Funding: None.

Author contributions: SH, SO and FFR designed the study; PM drafted the manuscript; SH carried out the analysis and interpreted the results; PM, DM, FS and MD collected the data. All authors reviewed the paper for intellectual content; all authors reviewed the final manuscript and gave their consent.

Acknowledgements: The authors would like to thank all participants.

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No competing interests reported.

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Validation of an Arabic version of the Composite Abuse Scale (Revised)-Short Form (CASR- SF) as a measure of intimate partner violence in adult females from a Middle-Eastern country

Status:

Version 1

Abstract

Background

Methods

Results

Conclusion

INTRODUCTION

Scales to Measure Abuse

The Present Study

METHODS

Participants

Procedures

Translation Procedure

Measures

Analytic Strategy

RESULTS

Sociodemographic characteristics of the participants

Confirmatory Factor Analysis of the CASR-SF Scale

Concurrent validity

DISCUSSION

Clinical Implications

Limitations

CONCLUSION

Declarations

References

Additional Declarations

Status:

Version 1