Preliminary examination of the measurement invariance of the metacognition about health questionnaire: A study on Chinese and British nursing students

  • Lisha Dai
  • Yi Zhou
  • Meng Yin
  • Xiang Wang
  • Yunlong DengEmail author


Metacognition is a promising variable for understanding the development and maintenance of mental disorders. As a regulator and interpreter of cognition, it may be influenced by culture. The Metacognition about Health Questionnaire (MCQ-HA) is a tool especially designed for measuring health anxiety-related metacognitive beliefs. This study aimed to preliminarily test the measurement invariance of MCQ-HA between Chinese and British nursing students. With convenience sampling, 220 Chinese and 240 British nursing major students were assessed by the MCQ-HA. Confirmatory factor analysis and multi-group confirmatory factor analysis were performed to examine the factor structure and the measurement invariance between the two groups. Results of the confirmatory factor analysis provided support for the expected three-factor structure. A series of multi-group confirmatory factor analysis supported the full configural invariance, full metric invariance, partial scalar, and partial strict invariance. The intercepts of nine items and the error variances of seven items were not equivalent. The implications of these findings on a cross-national comparison of health anxiety-related metacognitive beliefs were discussed.


Health anxiety Metacognitive beliefs Measurement invariance Cultural difference 



The data from British nursing students was provided by Dr. Robin Bailey. We sincerely acknowledge his help in writing this paper.


This research was supported by the Science and Technology Innovation Plan of Hunan Province, China (grant no. 2017SK50127).

Compliance with Ethical Standards

Informed Consent

This study was carried out in accordance with the recommendations of the Institutional Review Board of the Third Xiangya Hospital and the University of Manchester’s ethnic committee with written informed consent from all subjects. All subjects gave written informed consent in accordance with the Declaration of Helsinki. The protocol was approved by the Institutional Review Board of the Third Xiangya Hospital and the University of Manchester’s ethnic committee.

Conflict of Interest

All authors declare that he/she has no conflict of interest.


  1. Bailey, R., & Wells, A. (2015). Development and initial validation of a measure of metacognitive beliefs in health anxiety: The MCQ-HA. Psychiatry Research, 230(3), 871–877. Scholar
  2. Brown, T. (2015). Confirmatory factor analysis for applied research, Second Edition. The Guilford Press.Google Scholar
  3. Byrne, B. M., Shavelson, R. J., & Muthen, B. (1989). Testing for the equivalence of factor covariance and mean structures: The issue of partial measurement invariance. Psychological Bulletin, 105, 456–466.CrossRefGoogle Scholar
  4. Carciofo, R., Song, N., Du, F., Wang, M. M., & Zhang, K. (2017). Metacognitive beliefs mediate the relationship between mind wandering and negative affect. Personality and Individual Differences, 107, 78–87. Scholar
  5. Chang, K.-A. J., Kim, K., Fava, M., Mischoulon, D., Hong, J. P., Kim, D. J., et al. (2016). Cross-national differences in hypochondriasis symptoms between Korean and American outpatients with major depressive disorder.  Psychiatry Research245, 127–132. CrossRefGoogle Scholar
  6. Cheung, G. W., & Rensvold, R. B. (2002). Evaluating goodness-of-fit indexes for testing measurement invariance. Structural Equation Modeling, 9(2), 233–255. Scholar
  7. Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155–159.CrossRefGoogle Scholar
  8. Dai, L., Bailey, R., & Deng, Y. (2018). The reliability and validity of the Chinese version of the Metacognitions about Health Questionnaire in college students. Quality of Life Research, 27(4), 1099–1108.Google Scholar
  9. Flavell, J. H. (1979). Metacognition and cognitive monitoring: A new area of cognitive developmental inquiry. American Psychologist, 34(10), 906–911.CrossRefGoogle Scholar
  10. French, B. F., & Finch, W. H. (2006). Confirmatory factor analytic procedures for the determination of measurement invariance. Structural Equation Modeling, 13, 378–402.CrossRefGoogle Scholar
  11. Ghafoor, H., Ahmad, R. A., Nordbeck, P., Ritter, O., Pauli, P., & Schulz, S. M. (2019). A cross-cultural comparison of the roles of emotional intelligence, metacognition, and negative coping for health-related quality of life in German versus Pakistani patients with chronic heart failure. British Journal of Health Psychology. Scholar
  12. Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55.CrossRefGoogle Scholar
  13. Kline, R. B. (2005). Principles and practice of structural equation modeling. New York: Guilford.Google Scholar
  14. Lee, S., Creed, F. H., Ma, Y. L., & Leung, C. M. (2015). Somatic symptom burden and health anxiety in the population and their correlates. Journal of Psychosomatic Research, 78(1), 71–76. Scholar
  15. Liu, Y. Z., & Zou, J. F. (2008). The spirit of worldliness and worrying mentality of Confucianism. Philosophy and Culture, 35(12), 151–166.Google Scholar
  16. Melli, G., Bailey, R., Carraresi, C., & Poli, A. (2018). Metacognitive beliefs as a predictor of health anxiety in a self-reporting Italian clinical sample. Clinical Psychology &. Psychotherapy, 25(2), 263–271.Google Scholar
  17. Mesquita, B., & Karasawa, M. J. (2002). Different emotional lives. Cognition and Emotion, 16(1), 127–141.CrossRefGoogle Scholar
  18. Nordahl, H., Hjemdal, O., Hagen, R., Nordahl, H. M., & Wells, A. (2019). What lies beneath trait-anxiety? Testing the self-regulatory executive function model of vulnerability. Frontiers in Psychology, 10, 122.
  19. Ployhart, R. E., & Oswald, F. L. (2004). Applications of mean and covariance structure analysis: Integrating correlational and experimental approaches. Organizational Research Methods, 7(1), 27–65. Scholar
  20. Rief, W., Hessel, A., & Braehler, E. (2001). Somatization symptoms and hypochondriacal features in the general population. Psychosom Med, 63(4), 595–602.CrossRefGoogle Scholar
  21. Ryder, A. G., Yang, J., Zhu, X., Yao, S., Yi, J., Heine, S. J., et al. (2008). The cultural shaping of depression: somatic symptoms in China, psychological symptoms in North America? Journal of Abnormal Psychology, 117(2), 300.CrossRefGoogle Scholar
  22. Samuel, D. B., South, S. C., & Griffin, S. A. (2015). Factorial invariance of the five-factor model rating form across gender. Assessment, 22(1), 65–75. Scholar
  23. Schmitt, N., & Kuljanin, G. (2008). Measurement invariance: Review of practice and implications. Human Resource Management Review, 18(4), 210–222.CrossRefGoogle Scholar
  24. Steenkamp, J. B., & Baumgartner, H. (1998). Assessing measurement invariance in cross-national consumer research. Journal of Consumer Research, 19(1), 3327–3333.Google Scholar
  25. Sun, X., Zhu, C., & So, S. H. W. (2017). Dysfunctional metacognition across psychopathologies: A meta-analytic review. European Psychiatry, 45, 139–153. Scholar
  26. Sunderland, M., Newby, J. M., & Andrews, G. (2013). Health anxiety in Australia: prevalence, comorbidity, disability and service use. British Journal of Psychiatry, 202(1), 56–61.Google Scholar
  27. Tosun, A., & Irak, M. (2008). Adaptation, validity, and reliability of the metacognition questionnaire-30 for the Turkish population, and its relationship to anxiety and obsessive-compulsive symptoms. Turkish Journal of Psychiatry, 19(1).Google Scholar
  28. Van De Schoot, R., Schmidt, P., De Beuckelaer, A., Lek, K., & Zondervan-Zwijnenburg, M. (2015). Editorial: measurement invariance. Frontiers in Psychology, 6, 1064. Scholar
  29. Wells, A. (2009). Metacognitive therapy for anxiety and depression. New York: Guilford Press.Google Scholar
  30. Wells, A., & Cartwright-Hatton, S. (2004). A short form of the metacognitions questionnaire: Properties of the MCQ-30. Behaviour Research and Therapy, 42(4), 385–396. Scholar
  31. Wen-chao, F. A. N., Zhong-fang, F. U., Wei, X., Ya-wen, Z. H. U., Meng, Y. U., & Jian-ping, W. (2017). Revision of the meta-cognitions questionnaire in Chinese college students. Chinese Journal of Clinical Psychology, 25(3), 448–452.Google Scholar
  32. Zhang, Q. (2015). The evolution of ancient Chinese thought. In An introduction to Chinese history and culture. Berlin, Heidelberg: Springer.Google Scholar
  33. Zhang, Y., Zhao, Y., Mao, S., Li, G., & Yuan, Y. (2014). Investigation of health anxiety and its related factors in nursing students. Neuropsychiatric Disease and Treatment, 10, 1223–1234. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Psychosomatic Health Institute, the Third Xiangya HospitalCentral South UniversityChangshaChina

Personalised recommendations