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Psychometric evaluation of the Turkish version of the Anesthesia Surrendering Instrument
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DOI：10.1186/s12871-026-03789-w.png)
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Abstract
En 中文
Background The Anesthesia Surrendering Instrument (ASI) was originally developed to evaluate patients ' psychological experiences of surrendering to anesthesia. However, a validated Turkish version has not been available. This study aimed to adapt the ASI into Turkish (ASI-TR) and evaluate its psychometric properties among surgical patients. Methods This methodological, cross-sectional study was conducted between January 2024 and June 2025 at Akdeniz University Faculty of Dentistry and the Medical Faculty Hospital. Cross-cultural adaptation followed key principles of the Beaton framework, including forward-backward translation, expert review, and pretesting in 20 patients. Data were collected from 407 postoperative patients representing oral and maxillofacial surgery, general surgery, orthopedics, gynecology, urology, and otorhinolaryngology departments. Content validity was evaluated using the item content validity index (I-CVI) and modified kappa (K*) coefficients based on expert ratings. Structural validity was assessed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Associations between ASI-TR scores and postoperative state anxiety measured by the State Anxiety Inventory (STAI-S) were examined as exploratory hypothesis testing using an external reference measure. Internal consistency was assessed using Cronbach's alpha. Results EFA supported a four-factor structure-Preparation by Avoidance, Control, Preparation by Understanding, and Feeling and Surrender-explaining 65.7% of the total variance (KMO= 0.860; Bartlett's chi 2 = 5871.47, p < 0.001). CFA indicated good model fit (RMSEA= 0.075; CFI = 0.921; GFI =0.901;TLI = 0.908; chi 2/df= 3.285). Cronbach's alpha coefficients showed acceptable to high internal consistency (alpha= 0.71-0.88). A weak negative association was observed between Feeling and Surrender and STAI-S (r=- 0.150, p = 0.002). Conclusions The ASI-TR demonstrated strong content validity, acceptable internal consistency, and satisfactory structural validity in a heterogeneous surgical sample. A weak association with postoperative state anxiety was observed, consistent with the conceptual distinction between general anxiety and anesthesia-related surrender. The ASI-TR appears to be a promising culturally adapted tool for assessing anesthesia-related surrender in Turkish-speaking patients.
Keywords:
Anesthesia
Surrender
Psychometrics
Cross-cultural adaptation
Reliability
Validity
STAI-S