Structural validation of the Simplified Chinese version of the FAMily Engagement Scale in intensive care units: An exploratory and confirmatory factor analysis study

OBJECTIVE: Family engagement is critical for patient outcomes in intensive care units (ICUs), yet validated assessment tools are limited in China. This study aimed to translate the FAMily Engagement (FAME) scale into Simplified Chinese (FAME-SC) and evaluate its psychometric properties among family members of adult ICU patients in China. METHODS: A cross-sectional psychometric validation study was conducted in seven ICUs across four campuses of a tertiary hospital between December 2025 and February 2026. A total of 401 family members were recruited using convenience sampling. The sample was randomly split for exploratory factor analysis (EFA, n1 = 200) and confirmatory factor analysis (CFA, n2 = 201). Internal consistency, content validity, and construct validity were evaluated. RESULTS: The FAME-SC demonstrated excellent content validity (S-CVI = 0.98; I-CVI = 0.83-1.00) and good internal consistency (Cronbach's α = 0.896). EFA supported a two-factor solution explaining 63.05% of the total variance, comprising (1) family engagement in care and (2) family perceived support from the healthcare team. CFA confirmed acceptable model fit (χ2/df = 2.214, CFI = 0.949, IFI = 0.949, TLI = 0.936, and RMSEA = 0.078). CONCLUSION: The FAME-SC demonstrated satisfactory psychometric properties and appears to be a reliable and valid instrument for assessing family engagement in Chinese adult ICUs. The two-factor structure suggests that family engagement in this context may be organized around participatory involvement and relational support, which may reflect institutional visitation policies and cultural caregiving norms. IMPLICATION FOR CLINICAL PRACTICE: The FAME-SC provides ICU healthcare providers with a structured tool to assess patterns of family engagement and identify opportunities to strengthen family-centered care practices. Understanding the structure of family engagement may help ICU teams develop culturally responsive strategies to enhance active participation and provide relational and informational support for family members.