Health care Professionals’ Attitudes Toward Patients with Chronic Pain: Scale Development Study

Published:September 23, 2022DOI:



      One of the obstacles in chronic pain management is the attitude of healthcare professionals. Although literature reports that the negative attitudes of healthcare professionals such as stigmatizing their patients with chronic pain and applying inadequate treatment cause failure in chronic pain management, there is no scale to measure the attitudes of healthcare professionals towards patients with chronic pain.


      This study aimed to develop a scale for identifying healthcare professionals’ attitudes towards patients with chronic pain.


      We prepared a draft scale in the form of five-point Likert. We applied the draft scale to 379 voluntary healthcare professionals working in two hospitals in 2019. Internal consistency and testretest methods were employed to determine the reliability of the scale. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used for construct validity.


      According to the EFA, the scale had two factors explaining 45.68 of the total variant. We labelled the first factor “sensitivity orientation” and the second factor was labelled “misconception orientation”. Cronbach Alpha coefficients were 0.88 and 0.75 for the first and second factors respectively. Test-retest method reliability was r = 0.83 in the first factor and r = 0.75 in the second factor. The CFA showed that they were within the limits of acceptable fit values.


      Our study found that the scale for healthcare professionals’ attitudes towards patients with chronic pain is a valid and reliable tool.Keywords: Healthcare professionals, chronic pain, attitude, scale development.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Pain Management Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • AbuBaker N.A.
        • Salim N.A.
        • Joshua R.
        • Jose A.
        Registered nurses’ perception about pain management of hospitalized patients in one of the governmental hospitals in Dubai, UAE: A cross-sectional study.
        Dubai Medical Journal. 2019; 2: 1-5
        • Al-Atiyyat N.
        • Salim N.A.
        • Tuffaha M.G.
        • Nigim H.A.A.
        • Mah'd Saleh M.
        • Alkhodary M.E.
        • Brant J.M
        A survey of the knowledge and attitudes of oncology nurses toward pain in United Arab Emirates oncology settings.
        Pain Management Nursing. 2019; 20: 276-283
        • Beck S.L.
        • Dunton N.
        • Berry P.H.
        • Brant J.M.
        • Guo J.W.
        • Potter C.
        • Spornitz B.
        • Eaton J.
        • Wong B.
        Dissemination and implementation of patient-centered indicators of pain care quality and outcomes.
        Medical Care. 2019; 57: 159-166
        • Breivik H.
        • Eisenberg E.
        • O'Brien T
        The individual and societal burden of chronic pain in Europe: The case for strategic prioritisation and action to improve knowledge and availability of appropriate care.
        BMC Public Health. 2013; 13: 1229
        • Briggs E.V.
        • Battelli D.
        • Gordon D.
        • Kopf A.
        • Ribeiro S.
        • Puig M.M.
        • Kress H.G.
        Current pain education within undergraduate medical studies across Europe: Advancing the Provision of Pain Education and Learning study.
        BMJ open. 2015; 5e006984
        • Büyüköztürk Ş.
        Manual of data analysis for social sciences.
        Pegem Akademi, 2008
        • Campbell E.
        Faculty perspectives of teaching pain management to nursing students.
        Pain Management Nursing. 2020; 21: 179-186
        • Carr D.B.
        Patients with pain need less stigma, not more.
        Pain Medicine. 2016; 17: 1391-1393
        • Cole D.A.
        Utility of confirmatory factor analysis in test validation research.
        Journal of Consulting and Clinical Psychology. 1987; 55: 584-594
        • Çokluk Ö
        • Şekercioğlu G
        • Büyüköztürk Ş.
        Multivariate statistics for social sciences: SPSS and LISREL applications.
        Pegem Akademi, 2010
        • Darawad M.
        • Alnajar M.K.
        • Abdalrahim M.S.
        • El-Aqoul A.M.
        Cancer pain management at oncology units: Comparing knowledge, attitudes and perceived barriers between physicians and nurses.
        Journal of Cancer Education. 2019; 34: 366-374
        • De Ruddere L.
        • Craig K.D.
        Understanding stigma and chronic pain: A-state-of-the-art review.
        Pain. 2016; 157: 1607-1610
      1. Ferrell, B. R., & McCaffery, M. (2008). Knowledge and attitudes survey regarding pain. Retrieved January 03, 2021, from,years%20to%20reflect%20changes%20in%20pain%20management%20practice.

        • Field A.
        Discovering statistics using SPSS.
        2nd ed. Sage, New York2005
        • Hair JF
        • Anderson RE
        • Tatham RL
        • Black WC
        Multivariate data analysis.
        5th ed. Prentice Hall, Upper Saddle River, NJ1998
      2. International Association for the Study of Pain (IASP). (2020). IASP pain terminology: taxonomy. Retrieved January 03, 2021, from http://www.iasp-pain.Org/Taxonomy#Pain.

      3. IASP. (2012). Unrelieved pain is a major global healthcare problem. Retrieved January 12, 2021, from

        • Kline P.
        An easy guide to factor analysis.
        Routledge, Oxfordshire1994
        • Kline R.B.
        Principles and Practice of Structural Equation Modeling.
        The Guilford Press, 2005
        • Lacasse A.
        • Connelly J.A.
        • Choinière M.
        The chronic pain myth scale: Development and validation of a French-Canadian instrument measuring knowledge, beliefs, and attitudes of people in the community towards chronic pain.
        Pain Research and Management. 2016; 20165940206
        • Lalonde L.
        • Leroux-Lapointe V.
        • Choinière M.
        • Martin E.
        • Lussier D.
        • Berbiche D.
        • Lamarre D.
        • Thiffault R.
        • Jouini G.
        • Perreault S.
        Knowledge, attitudes and beliefs about chronic noncancer pain in primary care: A Canadian survey of physicians and pharmacists.
        Pain Research and Management. 2014; 19: 241-250
        • Martorella G.
        • Lacasse A.
        • Kostic M.
        • Schluck G.
        Cross-cultural validation of the English chronic pain myth scale in emergency nurses.
        Pain Research and Management. 2019; 20191926987
        • Newton B.J.
        • Southall J.L.
        • Raphael J.H.
        • Ashford R.L.
        • LeMarchand K.
        A narrative review of the impact of disbelief in chronic pain.
        Pain Management Nursing. 2013; 14: 161-171
        • Ostelo R.W.J.G.
        • Stomp-van den Berg S.G.M.
        • Vlaeyen J.W.S.
        • Wolters P.M.J.C.
        • de Vet H.C.W
        Health care provider's attitudes and beliefs towards chronic low back pain: The development of a questionnaire.
        Manual Therapy. 2003; 8: 214-222
        • Özdamar K.
        Statistical data analysis with package programs.
        Nisan Kitabevi, 2013
        • Petrosky E.
        • Harpaz R.
        • Fowler K.A.
        • Bohm M.K.
        • Helmick C.G.
        • Yuan K.
        • Betz C.J.
        Chronic pain among suicide decedents, 2003 to 2014: Findings from the National Violent Death Reporting System.
        Annals of Internal Medicine. 2018; 169: 448-455
      4. Potter, P. A., Perry, A. G., Stockert, P. A., Hall, A., Astle, B. J., & Duggleby, W. (2018). Canadian Fundamentals of Nursing-E-Book. Elsevier Health Sciences. pp. 2047-2160.

        • Raja S.N.
        • Carr D.B.
        • Cohen M.
        • Finnerup N.B.
        • Flor H.
        • Gibson S.
        • Keefe F.J.
        • Mogil J.S.
        • Ringkamp M.
        • Sluka K.A.
        • Song X.J.
        • Stevens B.
        • Sullivan M.D.
        • Tutelman P.R.
        • Ushida T.
        • Vader K.
        The revised International Association for the Study of Pain definition of pain: Concepts, challenges, and compromises.
        Pain. 2020; 161: 1976-1982
        • Sucu Çakmak N.C.
        • Çalışkan N.
        Comparison of pain assessments made by patients and nurses in emergency services.
        Journal of Human Sciences. 2020; 17: 864-876
        • Sümer N.
        Yapısal esitlik modelleri: Temel kavramlar ve örnek uygulama.
        Türk Psikoloji Yazıları. 2000; 3: 49-73
        • Taylor C.R.
        • Lillis C.
        • LeMone P.
        • Lynn P.
        Fundamentals of nursing: The art and science of nursing care.
        Wolters Kluwer Lippincott Williams & Wilkins, Riverwoods, IL2011
        • Tezbaşaran A.
        Likert Type Scale Development Guide.
        Türk Psikologlar Derneği Yayını, 1997
      5. Treede, R. D., Rief, W., Barke, A., Aziz, Q., Bennett, M. I., Benoliel, R., ... & Wang, S. J. (2019). Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). pain, 160(1), 19-27.

        • Yurdugül H.
        Ölçek geliştirme çalışmalarında kapsam geçerliği için kapsam geçerlik indekslerinin kullanılması.
        XIV. Ulusal Eğitim Bilimleri Kongresi. 2005; 1: 771-774