Reliability and Validity of the Consultation and Relational Empathy (CARE) Scale

Background: The patient's perception of physician empathy has a positive influence on patient behavior and treatment effects. The scale of Consultation and Relational Empathy (CARE) scale has been widely used to measure patients' perceptions of doctor empathy. However, the CARE scale lacks a standardized Mandarin version. In this study, we developed a Mandarin version of the CARE scale and validated its quality. Methods: There were 341 patients with hypertension and/or diabetes from four primary healthcare centers in Zhejiang Province, China participated in the primary test. Exploratory factor analysis (EFA) was conducted to explore the underlying structure of the scale. Furthermore, the test-retest reliability of the scale was evaluated during this phase. Results: A total of 1085 patients from six primary-level clinics participated in the secondary test. Confirmatory factor analysis (CFA) was employed to confirm the underlying structure of the scale. The analysis result demonstrated that the Mandarin version of the CARE scale comprises 10 items and 3 dimensions. In the secondary test, the overall Cronbach's α of the scale was 0.91, and the CRs of the 3 dimensions were 0.90, 0.90, and 0.88, respectively, indicating acceptable Internal consistency reliability and composite reliability (CR) of the scale. The average variance extracted (AVE) ranged between 0.65 and 0.79, and all square root values of the AVE for the three dimensions were higher than their Spearman correlations, indicating the good convergent and discriminant validity. Conculsion: The scale could serve as an evaluation tool for patients' perceptions of doctors' empathy in primary-level medical service settings in Chinese mainland.