Development and Factorial Structure of the Surgical Patient’s Anxious Condition Assessment Scale (SPAC)

Objective: The objective was to develop the Surgical Patient’s Anxious Condition Assessment Scale (SPAC) to provide evidence supporting clinical non-pharmacological interventions. Methods: A qualitative study was conducted at Leshan People’s Hospital in Sichuan Province, China. Semi-structured interviews were carried out with 11 patients to create an item pool for the scale. This was followed by a Delphi expert inquiry (N = 16) and a pilot test (N = 30), with subsequent adjustments to the scale based on patient feedback. Surgical inpatients from the same hospital were surveyed using the scale, and an exploratory factor analysis (EFA) was performed on a random sample (N = 376). A confirmatory factor analysis (CFA) was conducted on a second sample (N = 386). Results: The finalized SPAC Assessment Scale included three dimensions: medical provider, process and effect, and hospital environment, comprising a total of ten items. The overall Cronbach’s alpha coefficient was 0.893. The EFA revealed a Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy of 0.892 and a Bartlett’s Test of Sphericity, which yielded a chi-square value of 2886.217, df = 45, p < 0.001. Principal Component Analysis (PCA) identified three common factors, accounting for 63.20% of the cumulative variance. The rotated factor structure was distinct, with each item demonstrating high loadings (> 0.7) on its respective factor and minimal cross-loading. The CFA results indicated a chi-square/degrees of freedom ratio of 2.87, a Comparative Fit Index (CFI) of 0.942, a Tucker-Lewis Index (TLI) of 0.928, a Root Mean Square Error of Approximation (RMSEA) of 0.078, and a Standardized Root Mean Square Residual (SRMR) of 0.048, confirming a very good fit of the three-factor model to the data. Conclusion: The SPAC assessment scale exhibits excellent factorial validity and internal consistency. It provides a reliable clinical tool for identifying and addressing anxiety among surgical patients, facilitating standardized perioperative psychological management.