The Cyber Paranoia and Fear Scale-Updated (CPFS-U): development and implications for digital health engagement

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Not reported in abstract — specific factor loadings, variance explained, and effect size metrics are absent

• Primary Outcome: A four-factor structure was supported for the CPFS-U, representing: (1) AI and digital dependence, (2) technological risk awareness, (3) perceived data vulnerability, and (4) surveillance-related mistrust

• Nnt Or Sensitivity: Not applicable for a psychometric development study; sensitivity/specificity for identifying digital health disengagement not reported. Internal consistency described as 'good' but specific Cronbach's alpha or omega values not provided in abstract

• Confidence Interval: Not reported

Clinical Application

The CPFS-U is a self-report questionnaire suitable for administration in clinical and research settings. Online or paper-based delivery is feasible. However, until CFA validation, test-retest reliability, and predictive validity data are published, clinical deployment should be considered exploratory. The scale is not yet ready for high-stakes clinical decision-making. Australia's digital health ecosystem — including My Health Record (opt-out since 2018), the Australian Digital Health Agency's National Digital Health Strategy 2023–2028, and the rapid expansion of telehealth following COVID-19 — creates a directly relevant context for this instrument. Cyber paranoia and surveillance mistrust are plausible barriers to My Health Record uptake and telehealth engagement, particularly among populations with historical reasons for distrust of government data systems (e.g., First Nations communities). The RACGP has emphasised digital health literacy and patient trust as priorities in its Standards for General Practices. The CPFS-U could inform TGA-regulated digital health app design and ADHA risk communication strategies, though Australian normative data would be required before local clinical deployment. PBS and TGA regulatory frameworks do not currently apply to psychometric instruments, but TGA's Software as a Medical Device (SaMD) guidance may become relevant if the scale is embedded in clinical decision-support tools. Adults engaging with digital health platforms, telehealth services, electronic health records, and AI-assisted health tools; particularly relevant for populations identified as at risk of digital health disengagement due to mistrust, including older adults, individuals with mental health conditions, and those from marginalised communities

Abstract

OBJECTIVES: To update and revalidate the Cyber Paranoia and Fear Scale to reflect current technological contexts and examine its relevance to digital health readiness and engagement. METHODS: Using an online community sample (n=433), exploratory factor analysis was conducted to examine the factor structure of the revised item pool. Items were refined through consultation with Patient and Public Involvement and Engagement groups to ensure contemporary relevance and clarity. RESULTS: Analysis supported a four-factor structure representing artificial intelligence (AI) and digital dependence, technological risk awareness, perceived data vulnerability and surveillance-related mistrust. The updated Cyber Paranoia and Fear Scale-Updated (CPFS-U) demonstrated good internal consistency and supported construct validity. Cyber-paranoia and fear were conceptually and empirically distinct from general paranoia and anxiety, highlighting the specific cognitive and emotional responses elicited by digital technologies. CONCLUSIONS: The CPFS-U offers a psychometrically robust, modernised measure for understanding individuals' responses to digital and AI-based technologies. Its application in digital health research and practice can inform risk communication, user engagement strategies and the design of trustworthy digital interventions. By identifying individuals who may disengage due to online mistrust, the CPFS-U has the potential to inform more inclusive and psychologically informed digital health systems.

References

1. 1.Greenway, F. T., Weal, M., & Palmer-Cooper, E. (2026). The Cyber Paranoia and Fear Scale-Updated (CPFS-U): development and implications for digital health engagement. BMJ Open. https://doi.org/10.1136/bmjopen-2025-115399