It is well documented that cancer and its treatment have adverse effects on the physical and psychological well-being of children [1–3]. The cumulative physical effects of chemotherapy and/or radiotherapy include damage to normal body tissues and impaired physical fitness, leading to reduced cardiorespiratory function and decreased muscle strength [4]. Such adverse effects may begin at diagnosis and continue for months or years after the completion of therapy [5]. Adverse long-term effects on the psychological well-being of children with cancer include decreased self-esteem and increased anxiety and depression, which can decrease the children’s quality of life [3, 6, 7]. A study on the effects of cancer on Hong Kong Chinese children’s physical, emotional, and psychosocial well-being indicated that children had relatively high anxiety scores at their admission for cancer treatment and that nearly all children hospitalised with cancer expressed varying degrees of sadness and worry [2]. In addition, more than half of the participants were at risk of developing depression or presented some depressive symptoms during their stay in hospital.
An increasing number of studies have examined patients’ resilience and adaptation to having cancer [8]. Resilience is defined as the ability of an individual to utilise a collection of protective factors, such as personal and social resources and a perceived level of family cohesion, to maintain mental well-being in the face of stress and adversity [9, 10]. Numerous studies have indicated that resilience prevents the development of mental health problems and is associated with positive mental health outcomes in children and adolescents, such as reduced levels of anxiety, depression and obsessive-compulsive symptoms [11–13]. The assessment of resilience in children with cancer is therefore crucial, as it enables a thorough understanding of their responses to stress and adversity. This understanding is a prerequisite for the design of appropriate psychological interventions to enhance such children’s resilience and foster the development of their coping mechanisms and positive mental well-being. Previous studies, conducted in Western countries, have examined the relationships between resilience and psychological well-being in adult patients with cancer [8, 14, 15]. The results of these studies revealed that resilience is an important psychological predictor of quality of life and that higher resilience in cancer patients was associated with better psychological well-being. However, there is a paucity of research on resilience in children with cancer; most studies have focused on promoting resilience in parents, caregivers or other family members of children with cancer. A review of the literature revealed that no study has examined resilience in children with cancer and how it affects their psychological well-being in the Hong Kong Chinese context. This is a notable research gap, as culture appears to play a critical role in the expression of resilience by children and adolescents [16]. In addition, as Hong Kong Chinese children live in a cultural context that is vastly different from that of their Western counterparts, the way in which Chinese children view the nature and meaning of their cancer, as well as their resilience and adaptation to diagnosis and treatment, may also differ considerably from that of Western children. Hence, a reliable and valid instrument that accurately measures resilience in Hong Kong Chinese children with cancer must be developed. Unfortunately, there are no resilience-assessment tools with effective psychometric properties that are suitable for use in children in the Hong Kong Chinese context.
One scale for assessing resilience is the Resilience Scale (RS). The RS is a 25-item scale that uses a 7-point rating and was developed by Wagnild and Young based on a conceptual model derived from a qualitative study of a group of women who exhibited adaptation after a major life event [17]. The five characteristics that serve as the conceptual foundation of resilience are a sense of meaning and purpose, authenticity, equanimity, self-reliance and perseverance. The psychometric properties of the RS were tested and validated, and the results demonstrated its adequate internal consistency reliability [17]. The concurrent validity of the RS was supported by the identification of significant correlations between the RS scores and the measures of morale, life satisfaction and depression [17]. A factor analysis indicated that the RS assesses two factors: personal competence and the acceptance of self and life [17]. A review of the RS confirmed that its internal consistency was consistently high and its construct validity was appropriate [18]. The RS has been translated into and validated in a variety of languages, and it has been widely used by researchers and healthcare professionals to measure resilience in adolescents and adults in various populations over the past decade [18].
Subsequent to the validation of the RS, the Resilience Scale for Children (RS-10) was developed to measure children’s capacity to respond to life changes [19]. The RS10 is positively worded and easily understood by children as young as 7 years old and has been translated from English into Arabic and Swedish. However, it has not been used to assess resilience in Hong Kong Chinese children. Given that resilience is a personality characteristic that moderates the response to stress and enhances the ability to face adversity, and thereby promotes adaptation [9, 10], it is of paramount importance that the resilience of Hong Kong Chinese children with cancer is assessed and understood to enable the development of appropriate interventions for them. It is vital therefore to first translate the RS-10 to Chinese. Moreover, it is crucial to evaluate both its linguistic and cultural equivalence. Additionally, the psychometric properties of the Chinese version of the RS-10 needed to be empirically tested.
This study aimed to translate the original English version of the RS-10 into traditional Chinese. The psychometric properties of the resulting traditional Chinese version of the RS-10 were examined, and its factorial structure was examined using a confirmatory factor analysis (CFA).