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Psychometric Analysis of the Brief Religious Coping Scale (Brief RCOPE) in Cancer Patients from Southern Peru

This study validates the Brief Religious Coping Scale (Brief RCOPE) for use among cancer patients in Southern Peru, confirming its two-factor structure, strong reliability, measurement invariance across demographic and clinical groups, and convergent validity with negative affect.

Original authors: Rosa Angélica Seperak Viera, Sumara Ali Coila, Carlo Hancco Castillo, Fridda Chara Quiroz, Sergio Dominguez Lara

Published 2026-09-28

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CC BY 4.0

Original authors: Rosa Angélica Seperak Viera, Sumara Ali Coila, Carlo Hancco Castillo, Fridda Chara Quiroz, Sergio Dominguez Lara

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

When a person faces a life-altering illness, the mind often turns to something larger than itself for comfort. For many, this is religion. Psychologists call this process "religious coping," which is simply the way people use their faith, prayers, or spiritual beliefs to manage the stress of a difficult situation. It is not just about praying for a cure; it is about finding meaning in the suffering, feeling a sense of connection to a divine power, or, conversely, feeling angry or abandoned by that power. Researchers have long known that how a person relates to their faith during a crisis can shape their emotional health. Some find a deep sense of peace and resilience, while others experience intense spiritual struggle, feeling that God has turned against them. Understanding which of these paths a patient is walking is crucial for doctors and counselors, as it can influence how well a person adapts to their diagnosis and treatment.

In the southern region of Peru, where a significant majority of the population identifies with a religion, a team of researchers set out to test a specific tool designed to measure these spiritual reactions. They focused on a group of 445 people diagnosed with cancer who were receiving care at a public hospital in the city of Arequipa. These patients, mostly women with an average age of 52, were facing the same fears and uncertainties that come with a cancer diagnosis, but they were also navigating a healthcare system that often serves those with the fewest resources. The researchers wanted to know if a standard questionnaire, known as the Brief RCOPE, could accurately capture the spiritual experiences of this specific group. The tool asks 14 questions to sort religious coping into two categories: positive coping, which involves feeling close to God and finding comfort, and negative coping, which involves feelings of anger, doubt, or a sense that the divine has abandoned the sufferer.

The study confirmed that the questionnaire works well for this population. When the researchers analyzed the answers, the data clearly separated into the two expected groups: those who were finding spiritual support and those who were struggling spiritually. The questions fit together so well that the tool could be trusted to measure these distinct feelings without confusion. Furthermore, the researchers checked if the tool worked the same way for different types of people within the group. They compared men and women, younger and older patients, those with different levels of education, and those with different types or stages of cancer. The results showed that the tool functioned consistently across all these groups. A 20-year-old with breast cancer and a 60-year-old with stomach cancer would answer the questions in a way that the tool could interpret fairly and accurately. This consistency is vital, as it means doctors can use the same questions to understand the spiritual needs of any patient in this region, regardless of their background.

The researchers also looked at how these spiritual reactions connected to the patients' overall emotional state. They found a clear link between negative religious coping and negative emotions. Patients who reported feeling abandoned by God or struggling with their faith also reported higher levels of sadness, fear, and anger. In contrast, those who felt a secure relationship with the divine tended to have lower levels of these negative emotions. However, the study did not find a strong link between positive religious coping and life satisfaction. Even patients who felt close to God and found comfort in their faith did not necessarily report being happier with their lives overall. The researchers suggest this is because life satisfaction is a complex feeling built over a lifetime, influenced by many factors like family support, financial stability, and physical pain, which a spiritual connection alone cannot always fix. While faith can help manage the immediate stress of illness, it does not automatically erase the heavy burdens of a serious disease.

This work provides a reliable way for healthcare providers in southern Peru to identify patients who might be suffering from spiritual distress. By using this tool, medical teams can spot individuals who are feeling angry or abandoned by God and offer them specific psychological or spiritual support. The study concludes that while faith is a powerful resource for many, it can also be a source of deep pain for others, and recognizing this difference is a key step in providing compassionate, whole-person care. The findings support the idea that spiritual health is an essential part of treating cancer, and that understanding a patient's relationship with the divine can help guide them toward a more peaceful and resilient journey through their illness.

Technical Summary: Psychometric Analysis of the Brief RCOPE in Southern Peruvian Cancer Patients

Problem Statement
Religious coping is a critical mechanism for managing stress and adversity, particularly among individuals facing life-threatening illnesses such as cancer. While the Brief Religious Coping Scale (Brief RCOPE) is a widely used instrument globally, its psychometric properties have not been rigorously validated within the specific context of cancer patients in Southern Peru. Existing validation studies vary in their analytical approaches (e.g., relying solely on Exploratory Factor Analysis or Confirmatory Factor Analysis) and often fail to address measurement invariance across diverse sociodemographic and clinical subgroups. Furthermore, specific items (notably items 12 and 13) have historically shown poor performance in various cultural contexts. This study addresses the need to establish the validity, reliability, and structural stability of the Brief RCOPE for a population of cancer patients receiving care in the public health system of Southern Peru, a region characterized by specific socioeconomic vulnerabilities and high rates of religious affiliation.

Methodology
The study employed an instrumental research design involving 445 individuals diagnosed with cancer and receiving treatment at a specialized public hospital in Arequipa, Peru. The sample was predominantly female (78.2%) with a mean age of 52.20 years. Participants were assessed using the Brief RCOPE (14 items), the Satisfaction With Life Scale (SWLS), and the Positive and Negative Affect Schedule (PANAS).

Data analysis utilized advanced structural equation modeling techniques:

Internal Structure: Both Confirmatory Factor Analysis (CFA) and Exploratory Structural Equation Modeling (ESEM) were conducted using the Weighted Least Squares Mean and Variance Adjusted (WLSMV) estimator to account for ordinal data and non-normality.
Validity Evidence: Convergent and discriminant validity were assessed using Average Variance Extracted (AVE) and squared interfactor correlations.
Measurement Invariance: Configural, weak, strong, and strict invariance were tested across four grouping variables: age, educational level, cancer stage, and cancer type.
Reliability: Internal consistency was evaluated using both Cronbach's alpha ( $\alpha$ ) and McDonald's omega ( $\omega$ ).
External Relations: Pearson correlations examined associations between religious coping dimensions and life satisfaction, positive affect, and negative affect.

Key Results

Factor Structure: The study supported a two-factor structure comprising Positive Religious Coping and Negative Religious Coping. Both CFA and ESEM models demonstrated excellent fit indices (CFA: CFI = .983, TLI = .980, RMSEA = .039; ESEM: CFI = .971, TLI = .958, RMSEA = .056). Factor loadings were generally moderate to high (> .50).
Item Performance: Unlike previous studies where items 12 and 13 often showed poor fit, no problematic item functioning was identified in this sample, suggesting construct replicability across cultures.
Measurement Invariance: The instrument demonstrated strict measurement invariance across all examined groups (age, education, cancer stage, and cancer type), indicating that the scale functions equivalently across these diverse subgroups.
Reliability: Both subscales exhibited high reliability. McDonald's omega coefficients were .900 for both Positive and Negative Religious Coping, while Cronbach's alpha was .834 and .809, respectively.
Convergent/Discriminant Validity: AVE values exceeded the squared interfactor correlations, confirming discriminant validity.
External Validity:
- Negative Religious Coping showed a significant positive association with negative affect.
- Positive Religious Coping showed a significant negative association with negative affect.
- No significant associations were found between either coping dimension and life satisfaction or positive affect.
- No significant group differences were observed in coping scores across the demographic or clinical variables tested.

Key Contributions

Methodological Advancement: The study is among the first to apply ESEM alongside CFA to the Brief RCOPE in an oncology population, allowing for a more nuanced examination of cross-loadings and confirming the robustness of the two-factor model.
Contextual Validation: It provides the first psychometric evidence supporting the use of the Brief RCOPE specifically for cancer patients in Southern Peru, a population often underrepresented in cross-cultural psychometric research.
Invariance Evidence: The demonstration of strict measurement invariance across age, education, and clinical variables (stage and type) strengthens the instrument's utility for comparative research within this specific patient population.
Item Stability: The study challenges previous findings regarding the poor performance of items 12 and 13, suggesting these items function adequately in this specific cultural and clinical context.

Significance and Claims
The authors conclude that the Brief RCOPE demonstrates adequate psychometric properties, including validity, reliability, and measurement invariance, supporting its use for assessing religious coping among cancer patients in Southern Peru.

The study claims that the instrument is a valuable tool for clinical practice, particularly in identifying patients at risk of psychological distress. Specifically, the ability to distinguish between positive and negative religious coping allows clinicians to recognize "spiritual struggles" (Negative Religious Coping) that may exacerbate emotional distress. The authors suggest that integrating this assessment into psycho-oncological interventions can facilitate the development of adaptive coping strategies and promote a healthier relationship with the illness experience.

However, the paper maintains a modest stance regarding the relationship between religious coping and subjective well-being. The lack of association with life satisfaction is interpreted through the lens of Diener's theoretical framework, suggesting that while religious coping may mitigate negative affect, it does not necessarily override the profound impact of physical pain, life project disruption, or the awareness of mortality on overall life satisfaction. The authors emphasize that the findings support the need for multidisciplinary interventions that address the spiritual dimension but do not claim that religious coping alone guarantees improved life satisfaction in the face of advanced disease.

Technical Summary: Psychometric Analysis of the Brief RCOPE in Southern Peruvian Cancer Patients

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