---
title: "Psychometric validation of the Patient-Centered Communication Scale (PCCS) in Iranian clinical nur"
id: "plos-one-7-psychometric-features-of-the-patient-centered-communication-scale-among-iranian"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-7-psychometric-features-of-the-patient-centered-communication-scale-among-iranian"
content_type: "clinical_feed_article"
specialty: "General"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358575"
published_at: "2026-09-18T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Psychometric validation of the Patient-Centered Communication Scale (PCCS) in Iranian clinical nur
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-7-psychometric-features-of-the-patient-centered-communication-scale-among-iranian
- **Specialty:** [General](https://medichelpline.com/clinical-feed/general.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358575)
- **Published At:** 2026-09-18T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This methodological study translated, culturally adapted, and psychometrically evaluated the **Patient-Centered Communication Scale (PCCS)** for use among Iranian clinical nurses at hospitals affiliated with Shahroud University of Medical Sciences. - Two independent convenience samples of 150 nurses each (total n = 300) were collected to permit exploratory and confirmatory factor analyses. - Content validity was assessed using qualitative and quantitative feedback from specialists in patient-centered and nurse–patient communication; experts recommended deletion of item 4 because it substantially overlapped conceptually with item 5. - Exploratory factor analysis identified a single factor with an eigenvalue of 8.56 that explained 77.78% of variance for the Persian PCCS. - Confirmatory factor analysis supported the single-factor structure and model fit of the Persian version. - Internal consistency was satisfactory: Cronbach’s alpha and McDonald’s omega both exceeded 0.70. - External stability (test–retest reliability) was acceptable, with the intraclass correlation coefficient (ICC) > 0.80. - Authors conclude the Persian PCCS has favorable psychometric properties to assess nurse-reported **patient-centered communication** and to evaluate interventions, but generalizability is limited because data were collected at a single university medical center and may not represent other Iranian or private settings. - Data are not publicly available due to participant confidentiality; access can be requested from the corresponding author or the university research office under the stated conditions. - The study reported no specific funding and no competing interests.
## Clinical Analysis & Structured Key Points
Psychometric features of the Patient-Centered Communication Scale among Iranian clinical nurses | PLOS One Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click here . Article Authors Metrics Comments Media Coverage Peer Review Reader Comments Figures Figures Abstract Background Measuring patient-centered communication seems essential from the perspective of nurses as the primary healthcare providers. The Patient-Centered Communication Scale (PCCS) is one of the instruments that makes it possible to achieve this goal. Therefore, since no version apart from the original version of this instrument has been psychometrically tested in other countries, including Iran, this study aimed to culturally adapt and psychometrically evaluate the PCCS in Iranian clinical nurses. Methods The current methodological study was conducted in hospitals associated with Shahroud University of Medical Sciences. Content validity was examined through qualitative and quantitative methods by specialists in patient-centered communication and nurse-patient communication. Factor analysis, including exploratory and confirmatory approaches, was employed to determine the factor structure and model fit of the Persian version of the PCCS. The convenience sampling approach enabled the achievement of the aforementioned goal by collecting two independent samples of 150 qualified clinical nurses each, totaling 300 qualified clinical nurses. Internal consistency was evaluated using Cronbach’s alpha and McDonald’s omega coefficients, while external stability was quantified by the intraclass correlation coefficient (ICC). Results The expert panel’s comments suggested deleting item 4 due to substantial conceptual overlap with item 5. Exploratory factor analysis revealed a single factor with an eigenvalue of 8.56, explaining 77.78% of the entire variance of the Persian version of this scale. Confirmatory factor analysis also supported the single-factor structure of the Persian version of the mentioned scale. The Cronbach’s alpha and McDonald’s omega coefficients exceeded 0.70, indicating satisfactory internal consistency, while the ICC value exceeded 0.80, showing favorable external stability. Conclusion The favorable psychometric features suggest the use of the Persian version of the mentioned scale to identify factors related to this concept in clinical settings and determine the effectiveness of various interventions to promote this specific type of communication. However, the single-center data collection constrains the generalizability of the findings to clinical nurses employed in medical centers linked to other Iranian universities of medical sciences and non-university facilities, including private medical centers. Citation: Ghasempour S, Bagheri H, Sharif-Nia H, Ashrafi Z, Bagherian M, Abbasi A (2026) Psychometric features of the Patient-Centered Communication Scale among Iranian clinical nurses. PLoS One 21(9): e0358575. https://doi.org/10.1371/journal.pone.0358575 Editor: Maria José Nogueira, School of Nursing Sao Joao de Deus, Evora University, PORTUGAL Received: February 5, 2026; Accepted: September 2, 2026; Published: September 18, 2026 Copyright: © 2026 Ghasempour et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: The data supporting the results of this study contain potentially personally identifying and sensitive information about the participants. Therefore, this data cannot be made publicly available according to the policies and regulations of the Research Ethics Committee of Shahroud University of Medical Sciences. The ethical approval of this study also explicitly prohibits public sharing of the data to protect the confidentiality and privacy of the participants. However, the data will be accessible upon reasonable request from the corresponding author via email ( abbasi_msn@yahoo.com ) or from the Vice President for Research and Technology of this university at the electronic address https://shmu.ac.ir/research/en and at the telephone number +982332396714 via email ( vcr@shmu.ac.ir ) to researchers who meet the criteria for access to confidential data. Funding: The author(s) received no specific funding for this work. Competing interests: The authors declare that there are no conflicts of interest regarding the publication of this paper. Introduction Communication is an indispensable component of the nursing profession, facilitating the comprehension, investigation, and attention of the unique requirements of each patient [ 1 ]. This key component is essential for establishing therapeutic relationships with patients and their families, as well as fostering collaborative relationships with other healthcare providers (HCPs) [ 2 ]. However, nurses frequently encounter difficulties in communicating with patients, their families, and other HCPs. These challenges reduce the standard of nursing care and increase the likelihood of medication errors, which could result in undesirable consequences or even mortality [ 3 ]. Improved communication skills among nurses have also been associated in several studies with lower medical errors, outstanding nursing care, greater clinical performance, increased self-efficacy, stronger organizational commitment, and enhanced job satisfaction [ 4 – 6 ]. Therefore, nurses should communicate in a goal-oriented manner in their clinical practice, focusing on promoting the physical and mental health of patients. This approach is called patient-centered communication [ 7 ], also known as person-centered communication or client-centered communication [ 8 ]. Joo et al. (2024) defined patient-centered communication as a series of actions designed to empower patients and their families. This encompasses providing sufficient information, emotional support, empathetic expression, actively reflecting their values and preferences in decision-making, and engaging in treatment-related decisions [ 9 ]. In other words, patient-centered communication denotes a process that promotes the active involvement of patients and their families in decision-making on their care requirements [ 8 ]. Patient-centered communication cultivates trust and mutual respect in the care process, enhancing practices that correspond with the needs, concerns, and preferences of patients and caregivers [ 2 ]. This concept is crucial in achieving desirable health outcomes, as it reflects longstanding nursing values that prioritize individualized care [ 2 ]. The goal of patient-centered communication is to prevent illness and promote patient well-being through their active participation in treatment and decision-making, all based on respect for patients and their families [ 10 ]. In contrast, ineffective nurse-patient communication undermines patients’ trust in HCPs, which can lead to them withholding important information that requires immediate intervention [ 11 ]. This ineffective communication can also lead to increased length of stay, patient dissatisfaction, and waste of resources [ 12 ], as well as reduced quality of nursing care and increased patient stress. It can also make patients feel insecure and uninformed, leading them to view HCPs as inexperienced or incompetent [ 13 ]. Consequently, it is important to have a comprehensive, valid, and reliable instrument to assess patient-centered communication from the viewpoint of nurses as primary HCPs and to identify its associated factors in clinical settings. The Global Interpersonal Communication Competence Scale (GICCS) is commonly used to assess the communication skills of clinical nurses [ 14 ], despite not being specifically designed for nurses in clinical settings [ 9 ]. Alshammari et al. (2021) also conducted a study to determine the psychometric properties of the Arabic version of the Patient-Centered Communication Instrument (PCCI). This 36-item instrument, with satisfactory validity and reliability, measures six subscales: (a) exchanging information, (b) fostering healthy relationships, (c) making decisions, (d) responding to emotions, (e) enabling patient self-management, and (f) managing uncertainty from the perspectives of adults with cancer [ 15 ]. Similarly, Demiris et al. (2023) evaluated the validity and reliability of the English version of the Caregiver-Centered Communication Questionnaire (CCCQ). This 30-item questionnaire not only has desirable psychometric properties but also measures five subscales: (a) exchange of information, (b) fostering health relationships, (c) recognizing and responding to emotions, (d) managing care, and (e) decision-making from the perspective of family caregivers of patients hospitalized in hospice care [ 16 ]. The aforementioned instruments, while possessing suitable psychometric indicators and evaluating multiple dimensions of patient-centered communication, were specifically designed and psychometrically validated to measure this concept from the viewpoint of patients and their families [ 15 , 16 ]. However, patient-centered communication is an interactive concept, and assessing it solely from the perspective of patients and their families may not provide a comprehensive understanding of how this approach is realized in clinical practice. Nurses, who are the primary HCPs and have the most frequent and continuous interactions with patients and their families throughout this process, play a fundamental role in transforming the principles of patient-centered communication into everyday practical behaviors. Therefore, their perspective can provide unique information about communication behaviors, clinical decision-making processes, contextual factors, and organizational conditions that facilitate or inhibit this specific type of communication. On the other hand, evaluating this concept from the perspective of nurses may lead to identifying training needs, designing quality improvement programs, and developing effective interventions to improve patient-centered communication practices. For example, nurses can provide valuable information about how to apply communication strategies in clinical settings, how to address the needs, preferences, and concerns of patients and their families, how to facilitate their participation in the care process, and how to collaborate with other members of the treatment team. Such information can help identify factors that influence the achievement of patient-centered communication and better understand the mechanisms that facilitate or inhibit it, aspects that cannot be assessed solely from the perspective of patients and their families. Therefore, assessing patient-centered communication from the perspective of nurses does not replace assessing it from the perspective of patients and their families, but rather complements it. This approach contributes to a more multidimensional understanding of this concept in clinical settings [ 9 ]. In this regard, Joo et al. (2024) conducted a study with the aim of designing and validating the Patient-Centered Communication Scale (PCCS) in Korean clinical nurses. After conceptualizing patient-centered communication, the mentioned study designed the initial items of this scale through a literature review and online interviews with 10 qualified clinical nurses. 51 items were selected as the initial items of this scale. Following the removal, integration, and modification of some items in the content validity stage, a 31-item scale was obtained. Then, the remaining items were perceptually tested in terms of understandability, completion time, and layout appropriateness by 10 qualified clinical nurses. The construct validity of the mentioned scale was assessed using exploratory factor analysis (EFA) (on 175 qualified clinical nurses) and confirmatory factor analysis (CFA) (on 150 qualified clinical nurses). Finally, 12 items remained, covering three factors: (a) information sharing (5 items), (b) patient-as-person (4 items), and (c) therapeutic alliance (3 items). The positive and significant correlation between the PCCS and the GICCS also suggested its desirable convergent validity. Its reliability was also reported to be acceptable by the internal consistency method through Cronbach’s alpha coefficient for the aforementioned factors, as well as the entire scale [ 9 ]. Accordingly, Joo et al. (2024) introduced a valid and reliable instrument that assesses patient-centered communication as a three-dimensional construct by implementing a step-by-step and systematic approach [ 9 ]. On the other hand, no study has yet addressed the cultural adaptation and psychometric evaluation of the PCCS in clinical nurses from other societies. Only Amin et al. (2025) in a study that examined the mediating role of moral distress in the relationship between patient-centered communication and palliative care competence among Egyptian oncology nurses, despite not evaluating the psychometric properties of this scale in the aforementioned society, referred to the PCCS as a three-dimensional scale and used its total score in the analyses [ 17 ]. However, no other evidence was found regarding the factor structure and model fit of the original version of this scale in clinical nurses from other societies. Therefore, the present study, while translating and culturally adapting, first examines the three-dimensional model presented by the initial study of scale design, including information sharing, patient-as-person, and therapeutic alliance through CFA. If the presented three-dimensional model is rejected, then the factor structure and model fit of the Persian version of the PCCS are determined through exploratory and confirmatory approaches of factor analysis, respectively. Materials and methods Design and participants The present methodological study utilized a cross-sectional approach to initially translate and culturally adapt the PCCS for Iranian clinical nurses. Subsequently, the validity (in four forms: face, content, construct, and convergent) and reliability (using three approaches: internal consistency, construct reliability, and external stability) of the Persian version of this scale were evaluated in the aforementioned population. To achieve the study objective, two independent samples of 150 individuals each, totaling 300 clinical nurses from hospitals associated with Shahroud University of Medical Sciences (Imam Hossein and Bahar Hospitals), were chosen through a convenience sampling approach adhering to specified inclusion and exclusion criteria from May 10, 2025, to October 20, 2025. Inclusion and exclusion criteria The inclusion criteria required a bachelor of science in nursing (BSN) or higher, as well as a minimum of one year of full-time clinical experience. A minimum of one year of full-time clinical experience not only provides sufficient exposure to care situations and patient-centered interactions but also increases the likelihood of accurately comprehending the items based on actual clinical experience. On the other hand, a BSN or higher, as the minimum level of professional education in many nursing systems, including Iran, facilitates understanding and interpretation of the content of the items. These criteria were selected in line with previous psychometric studies in Iranian clinical nurses [ 18 – 20 ]. Conversely, the exclusion criteria included any interdepartmental transfers within the previous month. Data gathering Following the acquisition of the required approvals from the Vice Chancellor for Research and Technology at Shahroud University of Medical Sciences, essential connections were established with the respected officials of Imam Hossein and Bahar Hospitals. Subsequently, the principal investigator was present in the study environment, introduced himself to each participant, and explained the study’s objectives. Oral and written informed consent was secured from the participants to partake in the study. Finally, all participants were provided with the data collection instruments, including the demographic characteristics checklist and the PCCS, to complete in their spare time. Demographic characteristics checklist. This checklist includes information on age, gender, marital status, education level, work experience, department of practice, employment status, and income adequacy. Income adequacy evaluated the sufficiency of monthly income to cover living expenses using a three-point Likert scale: below average, average, and above average. The department of practice included internal wards (chemotherapy, internal medicine, gastroenterology, cardiology, post cardiac care unit [Post CCU], and infectious diseases); surgical wards (surgery, urology, and orthopedics); critical care units (dialysis, intensive care unit [ICU], and cardiac care unit [CCU]); emergency rooms; pediatrics and neonatology, as well as others. It is worth noting that each clinical nurse was assigned to work in only one of the aforementioned departments. Patient-Centered Communication Scale. This scale was developed and validated by Joo et al. (2024) to assess patient-centered communication skills in nurses. The PCCS consists of 12 items that assess three factors: (a) information sharing (items 1–5), (b) patient-as-person (items 6–9), and (c) therapeutic alliance (items 10–12). Each item is scored on a five-point Likert scale, with responses ranging from strongly disagree (1 point) to strongly agree (5 points). The numerical scores range from 12 (indicating the lowest patient-centered communication skills) to 60 (indicating the highest patient-centered communication skills), with higher scores representing more patient-centered communication skills in nurses and vice versa [ 9 ]. Translation and cultural adaptation The translation and cultural adaptation of the PCCS were based on the model established by Wild et al. (2005), which included ten steps [ 21 ]. Step 1: Preparation. After corresponding with Dr. Yang, the original designer of the scale, permission for translation and psychometric testing into Persian was obtained via email. Step 2: Forward translation. Two expert translators, fully proficient in English and Persian language and culture, independently translated the original version of the scale into Persian. Step 3: Reconciliation. The study team evaluated the two resulting Persian versions and consolidated them into a single version. Step 4: Backward translation. Two experienced translators, uninvolved in the preliminary translation and unaware of the current study process, independently translated the merged Persian version into English. Step 5: Review of backward translations. The study team compared the two English versions obtained and consolidated them into a single version. Finally, the merged English version was sent to the original scale designer for approval. Step 6: Harmonization. The final version from the previous step was compared to the original scale to identify and eliminate any linguistic problems and vocabulary differences. This confirmed alignment between the two versions. Step 7: Cognitive debriefing. Ten qualified clinical nurses were given the final version to identify any possible ambiguities or errors. Step 8: Review of cognitive debriefing. The study team reviewed the feedback from the nurses and discussed any issues raised. Necessary changes were then made to the final version. Step 9: Proofreading. A Persian language and literature expert corrected the final version for writing, grammar, and other errors. Step 10: Final report. After documenting all steps, the final version was used to assess validity and reliability [ 22 , 23 ]. Face validity The face validity of the PCCS was evaluated using both qualitative and quantitative methods. Qualitative face validity assessment. In the q
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