This study adopted a methodological approach. Following comprehensive training and approval from relevant hospitals, two clinicians and one clinical nurse from the Cancer Hospitals of Chengdu, Chongqing, and Jinzhou, China, conducted participant recruitment from April 2023 to January 2024. Inclusion criteria comprised parents of children aged ≤18 years diagnosed with cancer via pathological investigation, serving as primary caregivers, and providing informed consent for research participation. Exclusion criteria encompassed parents of children with additional severe or chronic illnesses, parents of children who received palliative treatment, and parents with communication or cognitive impairments, as determined by language proficiency and cognitive functioning assessments. This study was conducted under the authorization of Prof. Önal and obtained endorsement from the Ethics Committee of Jinzhou Medical University (Ethics Approval No. JZMULL2023129). Prior to survey administration, parents received clear explanations regarding the survey’s objectives, significance, and precautions.

Participant sample size was determined in accordance with factor analysis guidelines. Exploratory factor analysis (EFA) necessitates samples five to ten times the total number of scale items (Knapp and Sawilowsky, 2004), while confirmatory factor analysis (CFA) requires a minimum of 200 cases (Lasmarías et al., 2021). Considering different sample sources for EFA and CFA, and accounting for a 10% invalid questionnaire rate, a minimum of 352 cases was deemed necessary for inclusion. In this study, 400 questionnaires were distributed, with 385 recovered, and 377 deemed valid, yielding a valid recovery rate of 94.25%. Questionnaire completion time averaged 8–10 min, with data collected onsite. Subsequently, a follow-up survey was conducted with a randomly selected subset of 50 parents after a two-week interval to assess retest reliability.

Following authorization from Prof. Önal, the translation and refinement of the RSP-CC were meticulously conducted in accordance with the Brislin model (Brislin, 1970). Initially, the scale was translated into Chinese by a Ph.D. candidate in oncology proficient in English, alongside an English professor with overseas experience. Subsequently, forward translations were rendered into English by a nursing specialist and a foreign language instructor from the UK, respectively, forming reverse translation versions. Finally, two proficient bilingual specialists compared and deliberated on the translations and the original scale, culminating in the development of a draft Chinese version of the RSP-CC.

A panel of seven experts (comprising two pediatricians, two psychologists, and three oncologists) was convened to refine the draft RSP-CC. Selection criteria mandated a minimum of 6 years of relevant research in pediatric oncology psychology, attainment of at least an attending physician level, and possession of a master’s degree. The expert panel consisted of 5 males and 2 females, with 3 holding master’s degrees and 4 doctorates, and averaging (18.14 ± 6.01) years of professional experience.

After cross-cultural adaptation, a preliminary investigation involving 30 parents was conducted utilizing the revised RSP-CC. This phase aimed to gather feedback on scale comprehension, content relevance, and emotional resonance. Among the participants, one mother suggested revising item 7 from “Having cancer in my life has made me a more understanding and tolerant person” to “In my life, the presence of my child’s cancer has made me a more understanding and tolerant person.” Additionally, she proposed changing item 13 from “The advent of cancer in my life has caused me to become an anxious person” to “In my life, the appearance of my child’s cancer has turned me into an anxious person” to provide a clearer definition of cancer and better alignment with the reading preferences of Chinese people. Similarly, a father suggested changing item 15 from “I have not been sleeping as well since cancer entered my life” to “I have not slept as well since my child was diagnosed with cancer.” The research team reviewed and incorporated these recommendations, and finally, the Chinese version of the RSP-CC was developed.

Data analysis was performed using AMOS 24.0 and SPSS 26.0. Continuous data were expressed as mean ± standard deviation, while categorical data were presented as frequency and percentage (%). Significance was established at p < 0.05.

This study involved a total sample of 377 parents, comprising 120 fathers (31.8%) and 257 mothers (68.2%). Among them, 228 (60.5%) were aged between 31 and 40, with an average age of (35.19 ± 5.94) years. Furthermore, 123 (32.6%) had graduated from junior high school, 80 (21.1%) were unemployed, 124 (32.9%) reported a family income ranging from 2,001 to 4,000 yuan per month, and 164 (43.5%) resided in urban areas. Detailed information is available in Table 1.

Regarding the children of participating parents, 241 (63.9%) were male, with 199 (52.8%) aged ≤6 years and an average age of (6.72 ± 4.39) years. Additionally, 145 (38.5%) had acute lymphoblastic leukemia, 72 (19.1%) had other types of leukemia, and 63 (16.7%) had lymphoma. Among them, 286 (75.9%) were undergoing current treatment. Detailed information is provided in Table 2.

The results of the item analysis revealed critical ratios (t-values) ranging from 10.59 to 22.47, indicating a high level of item differentiation within the scale. Moreover, the correlation coefficients between individual item scores and their corresponding factor scores ranged from 0.71 to 0.89, indicating a high degree of homogeneity among the items of the scale. Furthermore, the Cronbach′s α coefficient of the corresponding factor decreased after deleting any of the item, so all 24 items could be retained. For detailed information, please see Table 3.

In this study, a total of seven experts meeting the specified criteria were enlisted to assess the items of the RSP-CC. The results revealed I-CVI values ranging from 0.86 to 1.00, with an S-CVI of 0.97.

The EFA results showed a KMO value of 0.93 and a significant Bartlett’s sphericity test (χ² = 2785.34, p = 0.004). Four factors were extracted, each comprising a minimum of three items. The factor loadings did not intersect, and all exceeded 0.40. The cumulative variance contribution amounted to 63.58% (> 40%). Refer to Table 4 for detailed information. The results of the CFA indicated favorable model fit indices: χ²/ν = 1.40 (<3); RMSEA = 0.05 (<0.08), RMSEA 90% confidence interval was 0.03–0.06; RMSR = 0.03 (<0.05); CFI = 0.98, TLI = 0.97 and IFI = 0.97. Additional details can be found in Figure 1.

The AVE values for the four factors ranged from 0.65 to 0.78, and the CR values ranged from 0.90 to 0.96. The square roots of the AVE values ranged from 0.81 to 0.88, all surpassing the correlation coefficients of the relevant components. For more detailed information, please refer to Table 5.

The results of the reliability analysis indicated that the Cronbach’s α coefficient of the scale was 0.95, with respective coefficients for the four dimensions of 0.95, 0.90, 0.88, and 0.91. The total split-half reliability was 0.82, with corresponding coefficients for the four dimensions of 0.94, 0.90, 0.90, and 0.91. Furthermore, the total retest reliability was 0.95, with coefficients for the four dimensions of 0.93, 0.90, 0.91, and 0.95, respectively.

Compared with family caregivers of children with other common diseases, parents of children with cancer experience greater caregiver burdens and emotional stress (Palacio et al., 2020). The presence of childhood cancer and its accompanying challenges can have significant implications for the physiological and mental health of parents (Shi et al., 2017; Bajjani-Gebara et al., 2019). Resilience, as a defensive strategy, directly impacts an individual’s self-worth, overall contentment, and sense of wellness, aiding in the preservation of both physical and mental health (Merino-Godoy et al., 2022). Studies have indicated that parents with strong resilience exhibit higher levels of hope and employ more proactive coping strategies when confronted with adversity (Rosenberg et al., 2019; Liu et al., 2021). Therefore, resilience training plays a vital role in enhancing parents’ ability to cope with challenges, highlighting the importance of understanding and assessing resilience among parents of children with cancer (Kunzler et al., 2020).

Currently, there remains a need for improved assessment tools to measure the resilience of these parents in China. We expect the introduction of a more dynamic, multidimensional, and tailored instrument to meet these assessment needs. The RSP-CC was developed based on the Resilience Model for Families of Children with Cancer, following an extensive literature review, expert consultation, and pilot study evaluation (Ye et al., 2017). This study was the first to translate the RSP-CC into Chinese and to validate its psychometric properties among these parents. It can serve as a critical tool for clinical staff in formulating specific interventions.

In the items analysis, the critical ratios (t-values) for each item of the scale ranged from 10.59 to 22.47, demonstrating a high level of item differentiation. The correlation coefficients between individual item scores and their corresponding factor scores ranged from 0.71 to 0.89, all exceeding 0.40, indicating extreme homogeneity across the overall scale.

Validity is the degree to which evidence and theory support the interpretations of test scores entailed by proposed uses of tests (AERA, APA, and NCME, 2014). In the original scale, the I-CVI values ranged from 0.88 to 1.00, and the S-CVI was 0.99 (Önal et al., 2023). In this study, the results from expert consultation showed I-CVI values ranging from 0.86 to 1.00, with an S⁃CVI of 0.97. Although these values were slightly lower than those reported for the original scale, they still exceeded the reference standards (I-CVI ≥ 0.78 and S-CVI ≥ 0.90) (Zamanzadeh et al., 2015), indicating good content validity for both versions. Furthermore, EFA extracted a four-factor structure with a cumulative variance contribution of 63.58%, slightly higher than the original scale’s 62.19%. The CFA further confirmed a well-matched four-factor model, indicating satisfactory internal validity. Finally, AVE values for the four factors ranged from 0.65 to 0.78, while CR values ranged from 0.90 to 0.96. The square roots of the AVE values were 0.81 to 0.88, surpassing the relevant components’ correlation coefficients, signifying strong convergent and discriminant validity.

Reliability refers to the ability of an instrument to consistently measure the thing or variable being measured (Koo and Li, 2016). In this study, the Cronbach′s α coefficient and split-half reliabilities for both the overall scale and its dimensions exceeded 0.7, indicating high internal consistency. The retest reliability after 2 weeks was 0.95, with dimensions ranging from 0.90 to 0.95, suggesting better temporal stability for the Chinese version of the RSP-CC.

It is worth noting that there are still certain constraints in this study. First of all, we only examined the content validity and internal structural validity of the scale, omitting investigation into response validity and the construction of criterion validity. In order to further demonstrate the validity of the scale, it is worth considering the addition of more refined validity validation methods. Secondly, predictive validity was not explored, nor was the correlation of the scale’s total score with other potentially relevant measurement variables. Finally, potential biases arising from using the same data source for both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were not addressed, potentially introducing method bias and selection bias.

In future studies, it is recommended that researchers in related fields undertake further investigations into the structural validity of the Chinese version of the RSP-CC, and response validity and criterion validity should be incorporated into existing studies to elucidate the significance of the scale scores.

Secondly, exploring correlations between the scale scores and theoretically relevant measurement variables is crucial. For instance, examining predictive relationships between resilience and key variables such as anxiety, depression (van Gils et al., 2022), self-efficacy (Sousa et al., 2023), and coping styles (Koutelekos et al., 2023) could yield valuable insights. An innovative approach could involve exploring the transformation of ordinal scores into linear, equal-interval values using a logistic test model with Rasch methods, thereby demonstrating hierarchical relations among components in the parent caregiver response structure.

Furthermore, to mitigate method bias, future research could provide evidence of known group differences and employ a criterion approach to validity using the obtained parent score distribution. Specifically, researchers should endeavor to establish cross-modal correlations validation studies that validate differences in resilience scores between parents against relevant qualitative markers. These criterion data could be obtained from parent interviews or observer scores. Additionally, consideration of biological and neurological markers is warranted.

Lastly, to address the selection bias resulting from using the same data sources for both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), future researchers should implement resampling or bootstrapping methods for data collection.