Psychometric validation of the Chinese-adapted eczema behavior checklist extent scale in pediatric atopic dermatitis patients

Background Pediatric atopic dermatitis (AD) demonstrate significantly higher rates of both general behavioral problems and condition-specific maladaptive behaviors. These behavioral challenges often interfere with parental treatment adherence and compromise disease management effectiveness. The Eczema Behavior Checklist Extent Scale (EBC-ES), initially developed and validated in Australia, represents the first psychometric tool specifically designed to evaluate AD-specific behavioral problems in children. However, its cross-cultural applicability and validation in Chinese populations remain unexplored. Objective This study aimed to culturally adapt and validate the Chinese version of the EBC-ES for assessing AD-specific behavioral problems in pediatric patients across China. Methods The Chinese EBC-ES utilized Brislin's validated back-translation protocol for cultural adaptation. This cross-sectional study recruited 674 parents (mean age 35.5 ± 4.7 years, range 24–49) of 3–10-year-old children (mean 5.9 ± 1.8) with physician-diagnosed AD. The sample comprised 369 boys (54.7%) and 305 girls (45.3%). Participants completed the Chinese EBC-ES and the Eyberg Child Behavior Inventory-Intensity scale (ECBI-IS). Psychometric evaluation included exploratory and confirmatory factor analyses (EFA, CFA) to assess construct validity, content validity indices (CVI), internal consistency (Cronbach's α , McDonald's ω ), split-half reliability, and test-retest reliability. Results The final 24-item Chinese EBC-ES demonstrated a stable three-factor structure (eigenvalues >1), accounting for 80.44% of the total variance. The Kaiser-Meyer-Olkin measure confirmed sampling adequacy (KMO = 0.942), and Bartlett's test supported factorability ( χ ² = 14,091.013; p < 0.001). CFA indicated excellent model fit: chi-square degree of freedom ( χ ²/df) = 2.855, root mean square error of approximation (RMSEA) = 0.075, standardized root mean square residual (SRMR) = 0.041. Comparative Fit Index (CFI) = 0.948, Tucker Lewis Index (TLI) = 0.942, Normed Fit Index (NFI) = 0.923, and Incremental Fit Index (IFI) = 0.948. The scale showed strong content validity (CVI = 0.96), high internal consistency ( α =0.968, ω = 0.987), excellent test-retest reliability ( r = 0.969), and satisfactory split-half reliability ( r = 0.895). Conclusion The Chinese version of the EBC-ES demonstrates robust psychometric properties, confirming its reliability and validity for AD-specific child behavioral problems in both clinical practice and research settings within Chinese populations.