Abstract:
Background: The University of California, San Diego Brief Assessment of Capacity to Consent (UBACC) is a tool to
assess the capacity of participants to consent in psychiatric research. However, little is known about the psy-
chometric properties in low and middle-income countries. This study aimed to examine the psychometric
properties of the UBACC.
Methods: We examined the reliability, latent factor structure, and item response of the first attempt of the UBACC
items in a sample of 32,208 adults (16,467 individuals with psychosis and 15,741 controls) in Ethiopia, Kenya,
South Africa, and Uganda; exploring these properties in the full sample and stratified by country, diagnostic
status, sex, and ethnolinguistic language groups.
Results: Exploratory factor analysis (EFA) suggested a two-factor model for the overall sample. However, a three-
factor model was more appropriate when examining the latent structure across country, language, and sex.
Confirmatory factor analyses (CFA) revealed an adequately fitting three-factor model for the full sample and
across country, sex, and language. A two-factor model, however, was more appropriate for English and Amharic
languages. Across all groups, the internal consistency of the UBACC was low, indicating below-threshold reli-
ability (Cronbach's α (95 % CI = 0.58 (0.57–0.59). Using a multidimensional item-response theory framework for
the full sample revealed that UBACC item 8, measuring understanding of the benefits of study participation, was
the most discriminating item. Many of the other items had below-threshold discriminating characteristics.
Conclusion: EFA and CFA converged towards a two and three-dimensional structure for the UBACC, in line with
the developers of the original scale. The differences in properties between populations and language groups, lowinternal consistency, and below-threshold item functioning suggest that investigations into the cultural and
linguistic nuances are still warranted. Understanding the utility of consent tools, such as the UBACC, in un-
derrepresented populations will be a part of the larger process which ensures that research participants are
adequately protected.