Measurement invariance across Genders on the Childhood Illness Attitude Scales (CIAS)

Objective: The Childhood Illness Attitude Scales (CIAS) were created as a developmentally appropriate measure for symptoms of health anxiety (HA) in school-aged children. Despite overall sound psychometric properties reported in previous studies, more comprehensive examination of the latent structure and potential response bias in the CIAS is needed. The purpose of the present study was to cross-validate the latent structure of the CIAS across genders and to examine gender-specific variations in CIAS scores. Methods: The sample comprised data from 602 Canadian and Danish school-aged children (M-age = 10.54, SD = 0.99; 52.5% girls). Confirmatory factor analyses were conducted to test 3-, modified 3-, and 4-factor models in both samples. Multigroup confirmatory factor analysis was performed to test factor structure invariance across boys and girls in a combined sample. Differential Item Functioning (DIF) was assessed using test characteristic curves. Results: A modified 3-factor solution (i.e., fears = 11 items, help-seeking = 6 items, and symptom effects = 4 items) provided the best fit to the data (chi(2) (364, N = 602) = 681.7, p < 0.001; chi(2)/df = 1.803; RMSEA = 0.037; CFI = 0.926). The factor structure was stable, well-fitting, and indicated measurement invariance across groups. DIF analyses revealed no gender-based response bias at the scale level. Conclusion: Results support a revised 3-factor version of the CIAS that can be used with confidence to assess symptoms of HA in school-aged boys and girls.