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A Chinese version of Kogan's Attitude toward Older People Scale: Reliability and validity assessment
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International Journal of Nursing Studies 46 (2009) 38–44 www.elsevier.com/ijns
A Chinese version of Kogan’s Attitude toward Older People Scale: Reliability and validity assessment Chi-Hua Yen a,b, Wen-Chun Liao c, Yu-Ru Chen d, Min-Chen Kao b, Meng-Chih Lee a,b, Cheng-Ching Wang c,* b
a Institute of Medicine, Chung Shan Medical University (CSMU), Taiwan Department of Family and Community Medicine, Chung Shan Medical University Hospital (CSMUH), Taiwan c College of Nursing, CSMU, Taiwan d Department of Nursing, CSMUH, Taiwan
Received 12 February 2008; received in revised form 17 May 2008; accepted 23 May 2008
Abstract Background: Taiwan is facing the dilemma of a rapidly growing elderly population and there is a perceived need for greater gerontological education. Several universities have recently started providing elective gerontological certification programs. In order to provide useful and sufficient information to increase students’ knowledge and attitudes, to develop a reliable and valid instrument is essential and helpful for faculty as well as the program director to pinpoint students’ strengths and weaknesses. Objective: To assess the reliability and validity of a Chinese version of Kogan’s Attitudes toward Older People (KAOP) among medical and nursing students at a medical university. Method: A two-phase data collection design was used. Two weeks following the first completion, another KAOP form, was given. Content validity, construct validity, internal consistency, and stability reliability were assessed. The final sample consisted of 275 students. Results: Scores were between 34 and 238. The study sample reported slightly positive attitudes (144.3 17.89), with half of the subjects (50.1%) above average. All of the 34 items were found to have significant item-to-total correlations ( p < .05). Two factors were extracted, Appreciation and Prejudice. The Prejudice and Appreciation contributed 33.6% and 21.1% to the variance. The Cronbach’s alpha was .82 for the total scale (.83 for Prejudice, .81 for Appreciation). Stability was 0.86 for Prejudice and 0.91 for Appreciation. Conclusions: The Chinese version of the KAOP can be considered reliable and valid scale for assessing the attitudes toward older people. # 2008 Elsevier Ltd. All rights reserved. Keywords: Attitude; Older people; Gerontological education; Gerontological nursing education; Instrument validation; Measurement
What is already known about this topic?
* Corresponding author at: CSMU, College of Nursing, No. 110, Section 1, Jianguo North Road, Taichung 402, Taiwan. Tel.: +886 4 24730022/11733; fax: +886 4 23248137. E-mail address: [email protected] (C.C. Wang).
Health professions, such as medicine, nursing, counseling and social work, are currently challenged with integrating gerontological/geriatric studies into their curricula to adequately prepare students for the elderly population boom. Previous studies have indicated that healthcare providers do not enjoy elderly care. Gerontological education could
0020-7489/$ – see front matter # 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.ijnurstu.2008.05.004
C.-H. Yen et al. / International Journal of Nursing Studies 46 (2009) 38–44
change these attitudes. In order to provide an appropriate gerontological education to our health-related professions, the students’ attitudes toward older people needs to be assessed; however, there was no reliable instrument can be used. Kogan’s Attitude toward Older People Scale (KAOP) has been widely used in many countries such as America, Japan, Swiss as well as Jordan. The KAOP is a reliable instrument to assess the students’ attitudes toward older people; however, the reliability and validity of the Taiwanese version of KAOP needs to be assessed first. What this paper adds? The reliability and validity of the Taiwanese version of KAOP have been established. 1. Introduction According to the Taiwan census, the elderly population will approach 20% within the next 20 years. This enhances the need for skilled and experienced healthcare providers, in many health care settings, who can address and meet the needs of older people. Physicians and nurses have a pivotal role as providers of care for older people and are uniquely positioned to influence the quality of their care (Stevens and Herbert, 1997). Therefore, healthcare providers in Taiwan need to increase their direct and indirect work with the elderly. However, previous studies have indicated that healthcare providers do not enjoy taking care of the elderly due to ignorance and poor attitude (Palmore, 1999). As the population grows older, attitudes towards the elderly require evaluating. However, no such exploration on health-related students’ attitudes towards older people has yet been carried out in Taiwan. In order to provide better care to the elderly population, exploring the students attitudes toward older people is a vital concern. The Kogan’s Attitude toward Older People (KAOP) scale has been found to possess high reliability and validity values in several international research studies; however, there has not been any verification of the Chinese version. This was the need that this study sought to fill. Consequently, it could be used as a measurement of KAOP for both health-related students and clinicians.
39
the final sample consisted of 275 students (88.4%). The students who were recruited for this study were as follows: who were able to speak and understand Chinese, whose major were either medicine or nursing, and who were willing to participate in this study. The Chung Shan Medical University Hospital has approved this study. 2.2. Measurement The KAOP consisted of 34 items regarding older people (Kogan, 1961). Seventeen items were negatively worded (KAOP ) while the rest were positively worded (KAOP+) statements. The scale is designed as a summed Likert attitude scale on a six-point responses categories that ranges from 1 (strongly disagree) to 7 (strongly agree). These categories were scored 1, 2, 3, 5, 6 and 7, respectively, with a score of 4 assigned in the rare case of failure to respond to an item (Kogan, 1961). Scores on the negatively worded items had to be reversed to obtain the total score. The possible score was between 34 and 238. Higher total scores indicated a more positive attitude. For the Japanese version, the Cronbach’s alpha was 0.87 for the total scale (Ogiwara et al., 2007). 2.3. Procedures Translation and Equivalence Assessment of the Chinese version. Permission was obtained from Professor Nathan Kogan, who holds the copyright for the KAOP. All translation processes followed Garyfallos et al. (1991) model of translation for maintaining equivalence: forward- and back-translation, evaluation of the translated version by a panel, testing of the translated version with bilingual students, and validating by an expert panel who are bilinguals. 2.4. Data collection Data was collected at two different points in time (a 2week interval). The questionnaire included a cover letter that addressed the purpose and importance of the study and informed consents and was given to participants by a teaching assistant (TA) during a class. The students volunteered to participate during class time. The instructor left the classroom during administration, but the TA remained to handle student questions. Two weeks following the first completion, another KAOP form, was given to thirty subjects who were willing to take part.
2. Methods 2.5. Data analysis 2.1. Participants Potential participants were medical and nursing undergraduates at a central Taiwan Medical University who may provide health care to the elderly in the future. Three hundred and eleven questionnaires were given out, but
Content validity, construct validity, internal consistency reliability, and stability were assessed. Content validity was assessed using an expert panel. Construct validity was assessed by factor analysis employing Principal Component Analysis. Cronbach’s alpha was used to estimate the internal
40
C.-H. Yen et al. / International Journal of Nursing Studies 46 (2009) 38–44
Table 1 Summary of major, year of study, gender, and mean score
3. Results
n
M
S.D.
3.1. Demographic data
Major (n = 275) Medicine Nursing
191 84
138.77 156.86
15.04 17.56
Year of study (n = 133) Sophomore Senior
196 79
146.01 140.04
18.59 15.31
Gender Male Female
140 135
140.47 148.27
15.93 18.97
275 students returned the KAOP. Demographic data of students are summarized in Table 1. Medical students were in the majority (n = 145), as were sophomores. The sample mean score was 144.30 (S.D. = 17.89), with approximately half of the subjects (50.1%) scoring above the mean. As shown in Table 1, females had higher scores (more positive attitudes), nursing students scored higher than medical students, and sophomores rated higher than seniors. 3.2. Validity
consistency reliability. Stability was assessed using a repeated measure design with a 2-week interval by Pearson correlations. SPSS (SPSS, Version 12.0 for Windows 2000) was used for data entry and analysis.
3.2.1. Content validity The content validity index (CVI) was used to determine item validity. Panel experts (5 general geriatricians, 1 faculty
Table 2 Factor loadings after varimax rotation for the KAOP scale Item
15N 12N 10N 14N 16N 9N 5N 11N 8N 13N 3N 17N 7N 4N 6N 1N 2N 10P 5P 7P 8P 15P 6P 14P 4P 9P 16P 3P 1P 12P 17P 13P 11P 2P
Item content
The elderly are irritable, grouchy and unpleasant The elderly have a negative influence on a neighborhood The elderly are always prying into the affairs of others The elderly are untidy The elderly complain about the young The elderly bore others with their stories The elderly have shabby home The elderly have irritating faults The elderly make others feel ill at ease The elderly are much alike The elderly are unable to change The elderly have excessive demands for love The elderly have too much influence in society The elderly quit work when they become pensioners Wisdom does not come with advancing age The elderly should live in special residences The elderly are different The elderly mind their own business The elderly have clean, attractive homes The elderly should have more power in society The elderly are relaxing to be with The elderly are cheerful, agreeable and good-humored The elderly grow wiser with advancing age The elderly are clean and neat The elderly prefer to work as long as they can It is nice when the elderly speak about their past The elderly seldom complain about the young The elderly are capable of new adjustment The elderly should live in special residences Neighborhoods are nice when integrated with the elderly The elderly need no more love than others The elderly are different from one another The elderly have the same faults as the young The elderly are no different from anyone else
Factor 1
Factor 2
Prejudice
Appreciation
.88 .82 .80 .76 .72 .71 .68 .66 .64 .63 .59 .57 .54 .52 .49 .46 .41 .24 .03 .03 .06 .15 .27 .21 .28 .15 .08 .23 .09 .20 .01 .07 .25 .02
.21 .19 .02 .04 .17 .26 .26 .05 .01 .17 .05 .09 .27 .09 .03 .15 .10 .75 .70 .69 .68 .66 .65 .65 .60 .58 .51 .50 .49 .48 .46 .45 .43 .43
C.-H. Yen et al. / International Journal of Nursing Studies 46 (2009) 38–44
member from the Department of Family Medicine, 2 gerontological experts and 1 school administrator) were asked to rate each item of the Chinese version of the KAOP based on relevance, clarity, and simplicity as 1 (not relevant), 2 (somewhat relevant), 3 (relevant), or 4 (very relevant). A CVI was computed using the proportion of experts who were in agreement about item relevance. The average CVI was .92 in the final version indicating adequate content validity (>.80; Polit and Beck, 2004). 3.2.2. Construct validity Construct validity was supported in the factor analysis. The numbers of factors were determined by eigenvalues (31), Kaiser–Meyer–Olkin (KMO), scree plots, loadings of over .40 (Stevens, 1996), and explainable percentages of variance. The KMO was 0.91 indicating sampling adequacy (>.50; Kaiser, 1974). Bartlett’s test of sphericity was sta-
41
tistically significant. Two factors were extracted and explained 54.7% of the variance (>70%; Stevens, 1996). All 34 items demonstrated moderate to strong loading (>.40; See Table 2). Factor 1, labeled Prejudice, consisted of 17 negative items, explaining 33.6% of the variance. Factor 2, labeled Appreciation, consisted of only positive items, explaining 21.1% of the variance. There are some similarities with other studies (Hweidi and Obeisat, 2006; Lambrinou et al., 2005), such as the items expressing Prejudice and Appreciation. 3.3. Reliability 3.3.1. Internal consistency reliability Cronbach’s alpha was 0.82 for the total scale, 0.83 for Prejudice, and 0.81 for Appreciation which indicate good internal consistency reliability.
Table 3 Means, standard deviations, spearman’s rank correlations, and item-total correlation (Rs) for KAOP items (N = 275) Item
Item content
M
S.D.
Rs
1N 1P 2N 2P 3N 3P 4N 4P 5N 5P 6N 6P 7N 7P 8N 8P 9N 9P 10N 10P 11N 11P 12N 12P 13N 13P 14N 14P 15N 15P 16N 16P 17N 17P
The elderly should live in special residences The elderly should live integrated with the young The elderly are different The elderly are no different from anyone else The elderly are unable to change The elderly are capable of new adjustment The elderly quit work when they become pensioners The elderly prefer to work as long as they can The elderly have shabby homes The elderly have clean, attractive homes Wisdom does not come with advancing age The elderly grow wiser with advancing age The elderly have too much influence in society The elderly should have more power in society The elderly make others feel ill at ease The elderly are relaxing to be with The elderly bore others with their stories It is nice when the elderly speak about their past The elderly are always prying into the affairs of others The elderly mind their own business The elderly have irritating faults The elderly have the same faults as the young The elderly have a negative influence on a neighborhood Neighborhoods are nice when integrated with the elderly The elderly are much alike The elderly are different from one another The elderly are untidy The elderly are clean and neat The elderly are irritable, grouchy and unpleasant The elderly are cheerful, agreeable and good-humored The elderly complain about the young The elderly seldom complain about the young The elderly have excessive demands for love The elderly need no more love than others
4.04 5.01 3.12 4.11 5.29 5.15 5.01 5.21 6.07 4.56 3.42 3.99 3.20 4.57 5.20 4.43 5.01 5.46 4.89 4.68 4.64 5.40 5.24 5.70 4.50 5.45 5.76 4.71 5.48 4.65 5.21 3.25 2.25 2.17
1.84 1.15 1.56 1.45 1.19 1.17 1.28 1.13 1.06 1.36 1.55 1.51 1.39 1.45 1.37 1.43 1.56 1.12 1.41 1.41 1.53 0.97 1.35 1.24 1.64 1.36 0.94 1.34 1.16 1.35 1.37 1.22 1.33 1.15
.31 * .42 * .30 * .31 * .51 * .47 * .32 * .56 * .49 * .40 * .34 * .45 * .34 * .54 * .54 * .60 * .50 * .50 * .46 * .62 * .59 * .33 * .54 * .52 * .45 * .44 * .55 * .62 * .58 * .44 * .48 * .38 * .34 * .30 *
*
p < .001.
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C.-H. Yen et al. / International Journal of Nursing Studies 46 (2009) 38–44
3.3.2. Stability reliability The Pearson-correlation coefficients for Prejudice and Appreciation were 0.86 and 0.91. Stability reliability was adequate in this study. 3.3.3. Means and standard deviation The means and standard deviation of each item are presented in Table 3. Thirteen out of 17 negative items had higher mean scores than positive items.
4. Discussion The Chinese version of the KAOP indicates good content validity because the CVI was .92. Construct validity was supported in the factor analysis. The factor analysis of the KAOP shows two factors. Two factors were explained 54.7% of the variance. The 54.7% of the variance seems not high but acceptable when compared with Greek version of KAOP including 6 factors with explaining the 41.5% of the variance (Lambrinou et al., 2005). There are some similarities with other studies, such as the items expressing ‘‘Prejudice’’ and ‘‘Appreciation’’ (Hweidi and Obeisat, 2006). Additionally, the KAOP shows good internal consistency reliability as well as stability. Results indicate that the KAOP scale is stronger and has higher scores than the KAOP+ scale, which is also in line with previous studies (Kogan, 1961). However, Chinese students who took part in this study reported slightly more positive attitudes when compared with Jordanian students (Hweidi and Obeisat, 2006). As in most of developed countries, Taiwan is facing the dilemma of a rapidly growing elderly population and there is a perceived need for greater gerontological education for health care professionals. Several universities have recently started providing elective certification programs on gerontology. In order to provide useful and sufficient information to increase students’ knowledge and attitudes, to develop a reliable and valid instrument is essential and helpful for
faculty as well as the program director to pinpoint students’ strengths and weaknesses. Educators in many academic programs, including medical and nursing curricula, must better prepare students for the booming elderly population.
5. Conclusions Psychometric analysis of the Chinese version of KAOP scale indicates high reliability (internal consistency and stability) and good content and construct validity. Results also reveal two different factors underlying student attitudes toward older people—one related to prejudice and the other associated with appreciation. Based on these findings, it is recommended that the Chinese version of the KAOP be incorporated or adapted by health-related professions as one of the tools used to assess the students’ and/or health care providers’ attitudes toward the elderly. The KAOP scale has higher scores than the KAOP+ scale in this study sample, which indicates more emphasis on gerontological curricula and training in undergraduate programs, is strongly needed. Hopefully, the medical and nursing programs could help in preparing health-related professionals capable of meeting the needs of older people by using the Chinese version of the KAOP scale.
Conflict of interest None declared.
Acknowledgements The authors wish to express their appreciation to Nathan Kogan and Dr. Carol Deets for their advanced advice. This research was partially supported by Research Grant CSMU96-OM-B-52 from Chung Shan Medical School, Taichung, Taiwan.
C.-H. Yen et al. / International Journal of Nursing Studies 46 (2009) 38–44
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Appendix A. Kogan’s Attitudes toward Old People Scale Directions: Please follow the key and then circle the LETTER following each statement based on your opinion of old people.
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C.-H. Yen et al. / International Journal of Nursing Studies 46 (2009) 38–44
Appendix A. (Continued )
References Garyfallos, G., Karastergiou, A., Adanipoulou, A., Moutzoukis, C., Alagiozidou, E., Mala, D., et al., 1991. Greek version of the General Health questionnaire: accuracy of translation and validity. Acta Psychiatric Scand. 84, 371–378. Hweidi, I.M., Obeisat, S.M., 2006. Jordanian nursing students’ attitudes toward the elderly. Nurse Educ. Today 26, 23–30. Kaiser, H.F., 1974. An index of factorial simplicity. Psychometrika 39, 31–36. Kogan, N., 1961. Attitudes toward old people: the development of a scale and an examination of correlates. J. Abnorm. Soc. Psychol. 64, 44–54. Lambrinou, E., Sourtzi, P., Kalokerinou, A., Lemonidou, C., 2005. Reliability and validity of the Greek version of
Kogan’s Old People Scale. J. Clin. Nurs. 14, 1241– 1247. Ogiwara, S., Inoue, K., Koshizu, S., 2007. Reliability and validity of a Japanese version of Attitudes toward the Elderly’ Scale. J. Phys. Ther. Sci. 19, 27–32. Palmore, E.B., 1999. Ageism: Negative and Positive, 2nd ed. Springer Publishing Company, New York. Polit, D.F., Beck, C.T., 2004. Nursing Research: Principles and Methods, 7th ed. Lippincott Williams and Wilkins, Philadelphia. Stevens, J., 1996. Applied Multivariate Statistics for the Social Science. Lawrence Erlbaum Associates, New Jersey. Stevens, J., Herbert, M., 1997. Ageism and nursing practice in Australia. Royal College of Nursing, Australia’s Discussion Document, No. 3.
International Journal of Nursing Studies 46 (2009) 38–44 www.elsevier.com/ijns
A Chinese version of Kogan’s Attitude toward Older People Scale: Reliability and validity assessment Chi-Hua Yen a,b, Wen-Chun Liao c, Yu-Ru Chen d, Min-Chen Kao b, Meng-Chih Lee a,b, Cheng-Ching Wang c,* b
a Institute of Medicine, Chung Shan Medical University (CSMU), Taiwan Department of Family and Community Medicine, Chung Shan Medical University Hospital (CSMUH), Taiwan c College of Nursing, CSMU, Taiwan d Department of Nursing, CSMUH, Taiwan
Received 12 February 2008; received in revised form 17 May 2008; accepted 23 May 2008
Abstract Background: Taiwan is facing the dilemma of a rapidly growing elderly population and there is a perceived need for greater gerontological education. Several universities have recently started providing elective gerontological certification programs. In order to provide useful and sufficient information to increase students’ knowledge and attitudes, to develop a reliable and valid instrument is essential and helpful for faculty as well as the program director to pinpoint students’ strengths and weaknesses. Objective: To assess the reliability and validity of a Chinese version of Kogan’s Attitudes toward Older People (KAOP) among medical and nursing students at a medical university. Method: A two-phase data collection design was used. Two weeks following the first completion, another KAOP form, was given. Content validity, construct validity, internal consistency, and stability reliability were assessed. The final sample consisted of 275 students. Results: Scores were between 34 and 238. The study sample reported slightly positive attitudes (144.3 17.89), with half of the subjects (50.1%) above average. All of the 34 items were found to have significant item-to-total correlations ( p < .05). Two factors were extracted, Appreciation and Prejudice. The Prejudice and Appreciation contributed 33.6% and 21.1% to the variance. The Cronbach’s alpha was .82 for the total scale (.83 for Prejudice, .81 for Appreciation). Stability was 0.86 for Prejudice and 0.91 for Appreciation. Conclusions: The Chinese version of the KAOP can be considered reliable and valid scale for assessing the attitudes toward older people. # 2008 Elsevier Ltd. All rights reserved. Keywords: Attitude; Older people; Gerontological education; Gerontological nursing education; Instrument validation; Measurement
What is already known about this topic?
* Corresponding author at: CSMU, College of Nursing, No. 110, Section 1, Jianguo North Road, Taichung 402, Taiwan. Tel.: +886 4 24730022/11733; fax: +886 4 23248137. E-mail address: [email protected] (C.C. Wang).
Health professions, such as medicine, nursing, counseling and social work, are currently challenged with integrating gerontological/geriatric studies into their curricula to adequately prepare students for the elderly population boom. Previous studies have indicated that healthcare providers do not enjoy elderly care. Gerontological education could
0020-7489/$ – see front matter # 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.ijnurstu.2008.05.004
C.-H. Yen et al. / International Journal of Nursing Studies 46 (2009) 38–44
change these attitudes. In order to provide an appropriate gerontological education to our health-related professions, the students’ attitudes toward older people needs to be assessed; however, there was no reliable instrument can be used. Kogan’s Attitude toward Older People Scale (KAOP) has been widely used in many countries such as America, Japan, Swiss as well as Jordan. The KAOP is a reliable instrument to assess the students’ attitudes toward older people; however, the reliability and validity of the Taiwanese version of KAOP needs to be assessed first. What this paper adds? The reliability and validity of the Taiwanese version of KAOP have been established. 1. Introduction According to the Taiwan census, the elderly population will approach 20% within the next 20 years. This enhances the need for skilled and experienced healthcare providers, in many health care settings, who can address and meet the needs of older people. Physicians and nurses have a pivotal role as providers of care for older people and are uniquely positioned to influence the quality of their care (Stevens and Herbert, 1997). Therefore, healthcare providers in Taiwan need to increase their direct and indirect work with the elderly. However, previous studies have indicated that healthcare providers do not enjoy taking care of the elderly due to ignorance and poor attitude (Palmore, 1999). As the population grows older, attitudes towards the elderly require evaluating. However, no such exploration on health-related students’ attitudes towards older people has yet been carried out in Taiwan. In order to provide better care to the elderly population, exploring the students attitudes toward older people is a vital concern. The Kogan’s Attitude toward Older People (KAOP) scale has been found to possess high reliability and validity values in several international research studies; however, there has not been any verification of the Chinese version. This was the need that this study sought to fill. Consequently, it could be used as a measurement of KAOP for both health-related students and clinicians.
39
the final sample consisted of 275 students (88.4%). The students who were recruited for this study were as follows: who were able to speak and understand Chinese, whose major were either medicine or nursing, and who were willing to participate in this study. The Chung Shan Medical University Hospital has approved this study. 2.2. Measurement The KAOP consisted of 34 items regarding older people (Kogan, 1961). Seventeen items were negatively worded (KAOP ) while the rest were positively worded (KAOP+) statements. The scale is designed as a summed Likert attitude scale on a six-point responses categories that ranges from 1 (strongly disagree) to 7 (strongly agree). These categories were scored 1, 2, 3, 5, 6 and 7, respectively, with a score of 4 assigned in the rare case of failure to respond to an item (Kogan, 1961). Scores on the negatively worded items had to be reversed to obtain the total score. The possible score was between 34 and 238. Higher total scores indicated a more positive attitude. For the Japanese version, the Cronbach’s alpha was 0.87 for the total scale (Ogiwara et al., 2007). 2.3. Procedures Translation and Equivalence Assessment of the Chinese version. Permission was obtained from Professor Nathan Kogan, who holds the copyright for the KAOP. All translation processes followed Garyfallos et al. (1991) model of translation for maintaining equivalence: forward- and back-translation, evaluation of the translated version by a panel, testing of the translated version with bilingual students, and validating by an expert panel who are bilinguals. 2.4. Data collection Data was collected at two different points in time (a 2week interval). The questionnaire included a cover letter that addressed the purpose and importance of the study and informed consents and was given to participants by a teaching assistant (TA) during a class. The students volunteered to participate during class time. The instructor left the classroom during administration, but the TA remained to handle student questions. Two weeks following the first completion, another KAOP form, was given to thirty subjects who were willing to take part.
2. Methods 2.5. Data analysis 2.1. Participants Potential participants were medical and nursing undergraduates at a central Taiwan Medical University who may provide health care to the elderly in the future. Three hundred and eleven questionnaires were given out, but
Content validity, construct validity, internal consistency reliability, and stability were assessed. Content validity was assessed using an expert panel. Construct validity was assessed by factor analysis employing Principal Component Analysis. Cronbach’s alpha was used to estimate the internal
40
C.-H. Yen et al. / International Journal of Nursing Studies 46 (2009) 38–44
Table 1 Summary of major, year of study, gender, and mean score
3. Results
n
M
S.D.
3.1. Demographic data
Major (n = 275) Medicine Nursing
191 84
138.77 156.86
15.04 17.56
Year of study (n = 133) Sophomore Senior
196 79
146.01 140.04
18.59 15.31
Gender Male Female
140 135
140.47 148.27
15.93 18.97
275 students returned the KAOP. Demographic data of students are summarized in Table 1. Medical students were in the majority (n = 145), as were sophomores. The sample mean score was 144.30 (S.D. = 17.89), with approximately half of the subjects (50.1%) scoring above the mean. As shown in Table 1, females had higher scores (more positive attitudes), nursing students scored higher than medical students, and sophomores rated higher than seniors. 3.2. Validity
consistency reliability. Stability was assessed using a repeated measure design with a 2-week interval by Pearson correlations. SPSS (SPSS, Version 12.0 for Windows 2000) was used for data entry and analysis.
3.2.1. Content validity The content validity index (CVI) was used to determine item validity. Panel experts (5 general geriatricians, 1 faculty
Table 2 Factor loadings after varimax rotation for the KAOP scale Item
15N 12N 10N 14N 16N 9N 5N 11N 8N 13N 3N 17N 7N 4N 6N 1N 2N 10P 5P 7P 8P 15P 6P 14P 4P 9P 16P 3P 1P 12P 17P 13P 11P 2P
Item content
The elderly are irritable, grouchy and unpleasant The elderly have a negative influence on a neighborhood The elderly are always prying into the affairs of others The elderly are untidy The elderly complain about the young The elderly bore others with their stories The elderly have shabby home The elderly have irritating faults The elderly make others feel ill at ease The elderly are much alike The elderly are unable to change The elderly have excessive demands for love The elderly have too much influence in society The elderly quit work when they become pensioners Wisdom does not come with advancing age The elderly should live in special residences The elderly are different The elderly mind their own business The elderly have clean, attractive homes The elderly should have more power in society The elderly are relaxing to be with The elderly are cheerful, agreeable and good-humored The elderly grow wiser with advancing age The elderly are clean and neat The elderly prefer to work as long as they can It is nice when the elderly speak about their past The elderly seldom complain about the young The elderly are capable of new adjustment The elderly should live in special residences Neighborhoods are nice when integrated with the elderly The elderly need no more love than others The elderly are different from one another The elderly have the same faults as the young The elderly are no different from anyone else
Factor 1
Factor 2
Prejudice
Appreciation
.88 .82 .80 .76 .72 .71 .68 .66 .64 .63 .59 .57 .54 .52 .49 .46 .41 .24 .03 .03 .06 .15 .27 .21 .28 .15 .08 .23 .09 .20 .01 .07 .25 .02
.21 .19 .02 .04 .17 .26 .26 .05 .01 .17 .05 .09 .27 .09 .03 .15 .10 .75 .70 .69 .68 .66 .65 .65 .60 .58 .51 .50 .49 .48 .46 .45 .43 .43
C.-H. Yen et al. / International Journal of Nursing Studies 46 (2009) 38–44
member from the Department of Family Medicine, 2 gerontological experts and 1 school administrator) were asked to rate each item of the Chinese version of the KAOP based on relevance, clarity, and simplicity as 1 (not relevant), 2 (somewhat relevant), 3 (relevant), or 4 (very relevant). A CVI was computed using the proportion of experts who were in agreement about item relevance. The average CVI was .92 in the final version indicating adequate content validity (>.80; Polit and Beck, 2004). 3.2.2. Construct validity Construct validity was supported in the factor analysis. The numbers of factors were determined by eigenvalues (31), Kaiser–Meyer–Olkin (KMO), scree plots, loadings of over .40 (Stevens, 1996), and explainable percentages of variance. The KMO was 0.91 indicating sampling adequacy (>.50; Kaiser, 1974). Bartlett’s test of sphericity was sta-
41
tistically significant. Two factors were extracted and explained 54.7% of the variance (>70%; Stevens, 1996). All 34 items demonstrated moderate to strong loading (>.40; See Table 2). Factor 1, labeled Prejudice, consisted of 17 negative items, explaining 33.6% of the variance. Factor 2, labeled Appreciation, consisted of only positive items, explaining 21.1% of the variance. There are some similarities with other studies (Hweidi and Obeisat, 2006; Lambrinou et al., 2005), such as the items expressing Prejudice and Appreciation. 3.3. Reliability 3.3.1. Internal consistency reliability Cronbach’s alpha was 0.82 for the total scale, 0.83 for Prejudice, and 0.81 for Appreciation which indicate good internal consistency reliability.
Table 3 Means, standard deviations, spearman’s rank correlations, and item-total correlation (Rs) for KAOP items (N = 275) Item
Item content
M
S.D.
Rs
1N 1P 2N 2P 3N 3P 4N 4P 5N 5P 6N 6P 7N 7P 8N 8P 9N 9P 10N 10P 11N 11P 12N 12P 13N 13P 14N 14P 15N 15P 16N 16P 17N 17P
The elderly should live in special residences The elderly should live integrated with the young The elderly are different The elderly are no different from anyone else The elderly are unable to change The elderly are capable of new adjustment The elderly quit work when they become pensioners The elderly prefer to work as long as they can The elderly have shabby homes The elderly have clean, attractive homes Wisdom does not come with advancing age The elderly grow wiser with advancing age The elderly have too much influence in society The elderly should have more power in society The elderly make others feel ill at ease The elderly are relaxing to be with The elderly bore others with their stories It is nice when the elderly speak about their past The elderly are always prying into the affairs of others The elderly mind their own business The elderly have irritating faults The elderly have the same faults as the young The elderly have a negative influence on a neighborhood Neighborhoods are nice when integrated with the elderly The elderly are much alike The elderly are different from one another The elderly are untidy The elderly are clean and neat The elderly are irritable, grouchy and unpleasant The elderly are cheerful, agreeable and good-humored The elderly complain about the young The elderly seldom complain about the young The elderly have excessive demands for love The elderly need no more love than others
4.04 5.01 3.12 4.11 5.29 5.15 5.01 5.21 6.07 4.56 3.42 3.99 3.20 4.57 5.20 4.43 5.01 5.46 4.89 4.68 4.64 5.40 5.24 5.70 4.50 5.45 5.76 4.71 5.48 4.65 5.21 3.25 2.25 2.17
1.84 1.15 1.56 1.45 1.19 1.17 1.28 1.13 1.06 1.36 1.55 1.51 1.39 1.45 1.37 1.43 1.56 1.12 1.41 1.41 1.53 0.97 1.35 1.24 1.64 1.36 0.94 1.34 1.16 1.35 1.37 1.22 1.33 1.15
.31 * .42 * .30 * .31 * .51 * .47 * .32 * .56 * .49 * .40 * .34 * .45 * .34 * .54 * .54 * .60 * .50 * .50 * .46 * .62 * .59 * .33 * .54 * .52 * .45 * .44 * .55 * .62 * .58 * .44 * .48 * .38 * .34 * .30 *
*
p < .001.
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3.3.2. Stability reliability The Pearson-correlation coefficients for Prejudice and Appreciation were 0.86 and 0.91. Stability reliability was adequate in this study. 3.3.3. Means and standard deviation The means and standard deviation of each item are presented in Table 3. Thirteen out of 17 negative items had higher mean scores than positive items.
4. Discussion The Chinese version of the KAOP indicates good content validity because the CVI was .92. Construct validity was supported in the factor analysis. The factor analysis of the KAOP shows two factors. Two factors were explained 54.7% of the variance. The 54.7% of the variance seems not high but acceptable when compared with Greek version of KAOP including 6 factors with explaining the 41.5% of the variance (Lambrinou et al., 2005). There are some similarities with other studies, such as the items expressing ‘‘Prejudice’’ and ‘‘Appreciation’’ (Hweidi and Obeisat, 2006). Additionally, the KAOP shows good internal consistency reliability as well as stability. Results indicate that the KAOP scale is stronger and has higher scores than the KAOP+ scale, which is also in line with previous studies (Kogan, 1961). However, Chinese students who took part in this study reported slightly more positive attitudes when compared with Jordanian students (Hweidi and Obeisat, 2006). As in most of developed countries, Taiwan is facing the dilemma of a rapidly growing elderly population and there is a perceived need for greater gerontological education for health care professionals. Several universities have recently started providing elective certification programs on gerontology. In order to provide useful and sufficient information to increase students’ knowledge and attitudes, to develop a reliable and valid instrument is essential and helpful for
faculty as well as the program director to pinpoint students’ strengths and weaknesses. Educators in many academic programs, including medical and nursing curricula, must better prepare students for the booming elderly population.
5. Conclusions Psychometric analysis of the Chinese version of KAOP scale indicates high reliability (internal consistency and stability) and good content and construct validity. Results also reveal two different factors underlying student attitudes toward older people—one related to prejudice and the other associated with appreciation. Based on these findings, it is recommended that the Chinese version of the KAOP be incorporated or adapted by health-related professions as one of the tools used to assess the students’ and/or health care providers’ attitudes toward the elderly. The KAOP scale has higher scores than the KAOP+ scale in this study sample, which indicates more emphasis on gerontological curricula and training in undergraduate programs, is strongly needed. Hopefully, the medical and nursing programs could help in preparing health-related professionals capable of meeting the needs of older people by using the Chinese version of the KAOP scale.
Conflict of interest None declared.
Acknowledgements The authors wish to express their appreciation to Nathan Kogan and Dr. Carol Deets for their advanced advice. This research was partially supported by Research Grant CSMU96-OM-B-52 from Chung Shan Medical School, Taichung, Taiwan.
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Appendix A. Kogan’s Attitudes toward Old People Scale Directions: Please follow the key and then circle the LETTER following each statement based on your opinion of old people.
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Appendix A. (Continued )
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