Psychometric properties of the Chinese version of the pros and cons of anorexia nervosa (P-CAN-C) scale: a validation study in patients with anorexia nervosa

J Eat Disord. 2025 Jun 16;13(1):111. doi: 10.1186/s40337-025-01314-x.

ABSTRACT

BACKGROUND: Individuals with anorexia nervosa (AN) often face significant challenges in maintaining motivation for recovery. Understanding the perceived pros and cons associated with the disorder is crucial for promoting recovery. This study aimed to translate, adapt, and validate the Pros and Cons of Anorexia Nervosa Scale (P-CAN) for use with Chinese adults with AN, thereby facilitating a clearer understanding of the motivations and barriers encountered by these patients.

METHODS: This study employed a cross-sectional survey design to collect data from 207 Chinese adults with AN (M_age25.58 and SD 6.011). Content validity was assessed by a panel of professionals. Reliability testing included internal consistency, test-retest reliability, item-total correlation, and correlation analysis between subscales. Principal Component Analysis (PCA) assessed the factor structure, focusing on two components (Pro and Con-AN) and ten subscales-Safe/Structured, Appearance, Fertility/Sexuality, Special, Fitness, Communicate Emotions/Distress for Pro-AN and Trapped, Guilt, Hatred, Stifled for Con-AN as per the original scale. Criterion validity was evaluated using the eating pathology tested by Eating Disorder Examination Questionnaire (EDE-Q) and Body Mass Index (BMI).

RESULTS: The content validity of the overall scale was 0.86. The Pro-AN and Con-AN subscales exhibited strong internal consistency (α = 0.84 and 0.82) and test-retest reliability (r = 0.912 and 0.704, p < 0.001). Item-Total Correlations exceeded 0.3 for all items except item 2, and there was no significant correlation between the Pro-AN and Con-AN subscales. The PCA results indicated that the Chinese P-CAN retained two components, which are consistent with the original scale. Differences emerged in more granular dimensions that may not be appropriate within the Chinese context. Significant correlations were found between the Pro-AN (r = 0.279, p < 0.001) and Con-AN (r = 0.240, p < 0.001) subscales and eating pathology and Con-AN was significantly correlated with BMI (r = -0.214, p < 0.01).

CONCLUSIONS: The P-CAN has shown promising psychometric properties among Chinese patients with AN. In terms of dimensionality, the Chinese context aligns closely with the original scale’s binary division into Pro-AN and Con-AN. However, the further differentiation into ten dimensions, may not be culturally appropriate for the Chinese context.

PMID:40524259 | DOI:10.1186/s40337-025-01314-x