Cross-Cultural Validation of the Refusal of Care Informant Scale (RoCIS) for European Portuguese Population

Objectives: Care refusal behaviours in dementia represent meaningful expressions of autonomy, yet validated assessment tools for Portuguese-speaking populations remain absent. The Refusal of Care Informant Scale (RoCIS) measures care refusal expressions during personal care interactions. This study aimed to conduct cross-cultural validation of the RoCIS for European Portuguese populations, establishing psychometric properties in nursing home settings. Methods: This cross-sectional study employed systematic translation and psychometric evaluation using classical test theory and Rasch analysis. A sample of 183 older adults living with dementia from 12 Portuguese nursing homes was assessed using the Portuguese RoCIS alongside validated measures including Cohen-Mansfield Agitation Inventory, Neuropsychiatric Inventory-Questionnaire, Barthel Index, and Functional Assessment Staging Tool. Results: The Portuguese RoCIS demonstrated internal consistency (Cronbach's α = 0.834; 95% CI: 0.796-0.867). Rasch analysis confirmed item reliability (0.91) and unidimensionality. Convergent validity was established through significant correlations with agitation (r = 0.523, p < 0.001) and neuropsychiatric symptoms (r = 0.427, p < 0.001). Known-groups validity showed significant discrimination across cognitive dependency levels (F(2,180) = 3.410, p = 0.035). Conclusion: The Portuguese RoCIS represents the first cross-cultural validation beyond the original country of development, providing strong evidence for the scale's international applicability and supporting relationship-centred dementia care globally.