New 15-item scale reliably measures parental agency in Chinese NICUsNew tool measures parent agency in the NICU

Frontiers in Medicine Published July 28, 2026 DOI ↗ Editorial oversight: Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

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Key Takeaway

Consider using the NICU-PAS to assess parental agency in Chinese NICUs, but its predictive validity is unproven.

This multicenter cross-sectional study psychometrically validated the NICU Parental Agency Scale (NICU-PAS), a 15-item instrument designed to measure parental agency in the neonatal intensive care unit. The study included 350 primary caregivers across eight NICUs in Suzhou, China.

Confirmatory factor analysis supported a four-domain structure (Treatment Understanding, Communication, Decision Making Participation, and Emotional Well-being) with acceptable fit indices (χ²/df = 1.69, CFI = 0.972, RMSEA = 0.045). Internal consistency was good, with Cronbach's α ranging from 0.783 to 0.860 for domains and 0.839 for the total scale. Convergent validity was supported by a significant negative correlation with parental stress (r = -0.189, p < 0.05).

Limitations include the cross-sectional design, which precludes assessment of predictive validity for clinical outcomes. The study did not report funding or conflicts of interest. The NICU-PAS appears to be a reliable and valid tool for measuring parental agency in Chinese NICU settings, but its utility in other populations or for predicting outcomes remains to be determined.

A new study tested a tool called the NICU Parental Agency Scale (NICU-PAS) to measure how much control and involvement parents feel they have in their baby's care in the neonatal intensive care unit (NICU). The study involved 350 primary caregivers in eight NICUs in Suzhou, China. Parents completed a 15-item questionnaire covering four areas: understanding treatment, communicating with staff, participating in decisions, and emotional well-being.

The results showed that the scale is reliable and valid. It had good internal consistency, meaning the questions worked well together. The scale also showed a small but significant link to lower parental stress, which suggests it measures something meaningful. However, this was a cross-sectional study, so it cannot show cause and effect.

The main limitation is that the study was done only in China, so the scale may need to be tested in other settings. Also, the study did not look at whether using the scale actually improves outcomes for babies or parents. The scale is a promising tool for helping NICU teams understand how parents are doing, but more research is needed to see if it leads to better care.

What this means for you:

A new 15-item scale reliably measures NICU parents' sense of agency, but more research is needed.

Common questions

What is the NICU Parental Agency Scale?

It is a 15-item questionnaire that measures how much control and involvement parents feel they have in their baby's care in the NICU. It covers four areas: treatment understanding, communication, decision-making, and emotional well-being.

How was the scale tested?

The scale was tested in 350 primary caregivers across eight NICUs in Suzhou, China. Researchers checked its reliability and validity using statistical methods like confirmatory factor analysis and correlations with parental stress.

Is the scale ready for use in all NICUs?

The scale shows good reliability and validity in this study, but it was only tested in China. More research is needed to see if it works in other countries and settings before widespread use.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedJul 2026

View Original Abstract ↓

BackgroundAdmission to the neonatal intensive care unit (NICU) places families in complex medical environments where parental agency, the perceived capacity to understand treatment, communicate effectively, participate in decisions, and maintain emotional well-being, is crucial for family-centered care. This study aimed to develop and psychometrically validate the NICU Parental Agency Scale (NICU-PAS), a brief instrument measuring this multidimensional construct.MethodsThe 15-item NICU-PAS was developed through literature review, expert panel evaluation, and parent focus groups. A multicenter cross-sectional study was conducted across eight NICUs in Suzhou, China, recruiting 350 primary caregivers. Psychometric validation included exploratory and confirmatory factor analysis, internal consistency reliability, and assessment of convergent validity (with parental stress) and discriminant validity (with general health and coping). Subgroup analyses compared first-time and experienced parents.ResultsConfirmatory factor analysis supported the four-domain structure of Treatment Understanding, Communication, Decision Making Participation, and Emotional Well-being (χ2/df = 1.69, CFI = 0.972, RMSEA = 0.045). Internal consistency was good (Cronbach's α = 0.783–0.860 for domains; 0.839 for total scale). Convergent validity was demonstrated by a significant negative correlation with parental stress (r = −0.189, p

New 15-item scale reliably measures parental agency in Chinese NICUsNew tool measures parent agency in the NICU

Common questions

Study Details

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New 15-item scale reliably measures parental agency in Chinese NICUsNew tool measures parent agency in the NICU

Common questions

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