Validation of the CONSULT-PSYCHIATR Scale: reasons for reluctance to seek psychiatric consultation among workers in Peru

Christian R. Mejia; Gianella Vera; Oscar Mamani; Victor Serna-Alarcón; Jaime A. Yáñez; Neal M. Davies; María J. Erazo-Muñoz; Leonel Vega-Pérez; Camilo Vega-Useche

Resumen:

Introduction: Workers may be reluctant to attend psychiatric consultation because of stigma, interpersonal concerns, and practical barriers. In Peru, brief instruments specifically designed to assess these reasons in working populations are limited. This study examined the content validity, internal structure, and internal consistency of a Peruvian scale assessing reasons why workers are reluctant to attend consultations with a psychiatrist.Methods: An instrumental study was conducted in Peru. Item development was informed by a literature review and expert input. An initial 10-item version was evaluated by 20 experts for relevance, representativeness, and clarity using Aiken’s V. After a pilot test, the questionnaire was administered to 3001 workers from several Peruvian departments using non-random sampling. Item distribution was examined using descriptive statistics, skewness, excess kurtosis, floor and ceiling effects, and constant-response patterns. The sample was randomly divided into exploratory and confirmatory subsamples. A polychoric exploratory factor analysis was conducted in the exploratory subsample, followed by confirmatory analyses in the independent confirmatory subsample. Internal consistency was estimated using Cronbach’s alpha, ordinal alpha, and ordinal omega total.Results: Most Aiken’s V coefficients were 0.70 or higher, with only one lower value for the representativeness of item 9. The 10-item version showed adequate item distributions, although 46.95% of participants provided constant responses across all items, prompting sensitivity analyses. Exploratory factor analysis supported a one-factor structure, explaining 80.96% of the variance, with factor loadings ranging from 0.8425 to 0.9365. This structure remained stable after excluding constant-response patterns. In the confirmatory subsample, the 10-item one-factor model showed high standardized loadings and favorable CFI, TLI, and SRMR values, although RMSEA was less favorable and was interpreted jointly with the remaining indices. Reliability estimates were high in both the main and sensitivity analyses.Discussion: The CONSULT-PSYCHIATR is a brief 10-item instrument with evidence of content validity, internal structure, and internal consistency for assessing perceived reasons why workers in Peru may be reluctant to attend psychiatric consultation. Although the findings are encouraging, further studies are needed to examine its performance in other populations and settings and to assess additional sources of validity evidence.