Reliability and validity of the Chinese version of the Brief Emotion and Regulation Beliefs Scale in Chinese nursing students

Emotion regulation processes are goal-oriented behaviors functioning to modify dynamic features of emotion, such as the magnitude and duration of behavioral, experiential, and physiological responses [1, 2]. Emotion regulation refers to the processes by which we influence which emotions we have, when we have them, and how we experience and express them. It could be affected by intra- and extra-familial social factors [3], and also improved by interventions [4]. Emotion dysregulation has been linked to a variety of mental problems [5, 6], and teens with difficulty modulating emotions may be involved in more illegal activities, for poorly regulated emotions may interfere with cognitive function that reminds youth of rules during decision making [7]. Conversely, effective emotion regulation promotes mental health and is related to multiple positive mental outcomes, such as greater perceived well-being, better interpersonal relationships, and better physical health [5]. As a result, emotion regulation is crucial to successful social interactions and health and is used a lot in our daily life [8‐10].

Nursing students are facing a range of pressure, such as academic pressure, interpersonal pressure, and professional pressure, which cause emotional issues easily. Nursing education involves situations where students engage in interaction with other people, learning to care for and help patients involves a variety of emotions [11]. For example, dissection and autopsies in the course of the preclinical study can provoke strong emotional reactions in some medical students [12]. The clinical placement experiences can elicit negative emotions in nursing students. However, nursing students may be unprepared for regulating their emotions [13‐15]. Emotion is a key source of stress for the early career of nurses and nursing students. Developing emotional intelligence behaviors should be a very useful measure to improve academic and clinical performance [16‐18], and effective emotion regulation to enhance nursing students’ professional identity and build the skills for effective patient care and their health and well-being [19, 20]. In clinical work, nurses do a lot of physical and mental work, but also pay more emotional work [21, 22]. In recent years, more and more scholars have realized the importance of nurses' physical and mental health to guarantee clinical nursing quality and stabilize nursing teams [21, 23, 24]. As future nurses, nursing students are experiencing complex learning environments and will experience complex work environments in future clinical work, which probably lead to emotional problems directly [25, 26]. However, one’s beliefs about controlling their emotions portend a series of vital psychological outcomes [27]. So, it is especially important to search for suitable tools to assess the emotion and regulation beliefs of nursing students, and give timely intervention to improve their physical and mental health [10, 27].

The Emotion and Regulation Beliefs Scale (ERBS), which was originally developed by Veilleux et al. in America, is a simple and effective tool to assess emotion and regulation belief. The ERBS assesses beliefs that emotions can hijack self-control, emotion regulation is a worthwhile pursuit, and emotions can constrain behavior. The ERBS has excellent internal consistency and powerfully predicts clinically relevant outcomes even after controlling for an existing short measure of beliefs in emotion controllability [28]. In Veilleux et al. 's study, participants were recruited from Amazon Mechanical Turk, has showed that negative beliefs about emotion are higher in individuals who would meet criteria for an eating disorder and depression, and Emotion Constraint predicts clinical groups uniquely [28].

Therefore, this study was to translate the American version of the ERBS into Chinese, revise the original scale and form a simplified version, and assess the reliability and validity of the brief Chinese version in nursing students.

The CVI of the items ranged from 0.850 to 0.930, and the CVI of the scale was 0.920, which indicated excellent content validity.

Construct validity is usually assessed by factor analysis. The ideal result is that each item has a higher load value than 0.40 on one of the common factors, having a low load value on other common factors, and the cumulative variance contribution ratio of the extracted common factors is not less than 40% [34]. In the EFA model, the Brief-ERBS had three common factors, which were in accordance with the American version. In the American version, the three extracted factors accounted for only 36.00% of the total variance, and the three-factors CFA model had acceptable model fit (CMIN/DF = 1.630, CFI = 0.930, RMSEA = 0.050) [28]. However, in the Brief-ERBS, all item loads in the common factors were above 0.40, the communality of each item ranged between 0.359 and 0.680, and the total accounted for variance was 51.023%, which were highly interpretable and demonstrated excellent construct validity [33]. In the CFA, the model fit indices were evaluated by CMIN/DF < 5, GFI > 0.900, AGFI > 0.900, CFI > 0.900, IFI > 0.900, TLI > 0.900, RMSEA < 0.08 [35]. The CFA showed all measurements of the model are well fitted in our research, CMIN/DF = 4.092, GFI = 0.949, AGFI = 0.927, CFI = 0.913, IFI = 0.914, TLI = 0.908, RMSEA = 0.061. The results indicated that there is strong factor loading and interpretation variance, accord with EFA results, and have an excellent model fitting index.

As for convergent validity, a highly positive correlation between the Brief-ERBS total score and the ERBS total score was found (r = 0.972, P < 0.01), which indicate that the Brief-ERBS has excellent convergent validity.

The recommended value of Cronbach’s α coefficient is not lower than 0.60 [33]. In the Brief-ERBS, the overall Cronbach’s α coefficient was 0.798, which indicate acceptable homogeneity. The Cronbach’s α coefficient was 0.782 in the dimension of Regulation Worth, which was slightly higher than the original version. In other two dimensions, the Cronbach’s α coefficient was all somewhat less than the American version. As the number of items decreased, internal consistency decreased. The split-half reliability was 0.784. Moreover, the item-total score correlations were statistically significant, and the correlations ranged from 0.400 and 0.634, within the recommended standard (not smaller 0.4) [33]. Therefore, the homogeneity of the Brief-ERBS was acceptable. The retest coefficient was 0.879, which indicated acceptable stability.

In general, the results showed that the Brief-ERBS had good content validity, construct validity, discriminant validity, convergent validity, as well as homogeneity and stability. Therefore, the Brief-ERBS is a suitable tool for assessing Emotion and Regulation for nursing students. Furthermore, measuring the emotions may be culturally sensitive in some culture. However, emotions and regulation belief are vital psychological constructs that need to be measured as well as possible, so that researchers can well understand the impact on psychological processes, and timely intervention can be provided based on the assessment [36]. In order to increase effective response rate, the emotions and regulation belief can be collected by interviewer administered such as anonymous way and web-based surveys [37, 38]. In our study, the anonymous measures were taken and most of the participants finished the questionnaires effectively.

A cross-sectional study was conducted in our study, so further work is needed with longitudinal research to confirm these results. The participants were nursing students in two universities of Liaoning Province, and only two schools were selected in the survey. Hence, further work is needed to expand the sample coverage and take into consideration the adaptability of different groups. However, as a result of our study, a brief self-assessment tool is available for Chinese nursing undergraduate students to evaluate Emotion and Regulation belief.

The study examined the psychometric properties of the Brief-ERBS in Chinese nursing students and showed good validity and reliability of the scale. The content and structure are simple, the evaluation method is flexible, and may be used for the beliefs about emotional management in Chinese nursing students.