Psychometric properties of a Chinese version of the Fraboni scale of ageism: evidence from medical students sample

Fan et al. BMC Medical Education (2020) 20:197 https://doi.org/10.1186/s12909-020-02111-7 RESEARCH ARTICLE Open Access Psychometric properties of a Chinese version of the Fraboni scale of ageism: evidence from medical students sample Jun-Yao Fan, Hui-Min Zhao, Yue-Ting Liu, Ling-Lin Kong, Jing Mao and Jie Li* Abstract Background: The increasing of older adults has led to enormous demand for medical care. However, as a group with unique needs and characteristics, older adults are often discriminated against in the medical field. In this paper, we aimed to translate the Fraboni Scale of Ageism (FSA) into Chinese and examine its construct validity, content validity, and reliability in Chinese mainland medical students. In order to evaluate the prevalence of ageism in Chinese medical students and prompt medical college to adopt necessary teaching methods to mitigate ageism in medical students. Methods: By Brislin’s translation guidelines, FSA was translated to Chinese. The convenient sampling method was used to select samples for this survey, including 1,974 students from two medical schools in central and north China. Construct validity was verified by the exploratory and confirmatory factor analysis. The content validity index (CVI) was used to assess content validity. The Cronbach’s alpha coefficients and intraclass correlation coefficient (ICC) were used to estimate reliability. Results: The alpha coefficients for FSA (Chinese version) was 0.81 and ICC was 0.87. The CVI was 0.93. Three factors were identified by exploratory factor analysis explaining 34.84% of the total variance and a three-factor model was confirmed to fit by confirmatory factor analysis. Conclusions: FSA (Chinese version) is a reliable and valid scale for measuring discrimination degree against older adults in Chinese medical students. Keywords: Ageism, Fraboni scale of ageism, Discrimination, Reliability, Validity, Medical students Background With the development of world economy and medical technology, average life expectancy has been extended and the aging of population has become a global phenomenon rapidly. The World Health Organization reported the number of people over 60 will rise to 2 billion by 2050 [1]. Now more and more countries has entered the aging society all around the world. In Chinese * Correspondence: School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd., Qiaokou District, Wuhan 430030, Hubei Province, China mainland, situation is even more serious. Data from the National Bureau of Statistics [2], the number of older people over 60 in China has reached 250 million, accounting for 17.9% of the total population by the end of 2018. Ageism has become a ripe research topic for scholars in the context of global population ageing. People are accustomed to associate the older adults with many negative traits [3]. In 1960, Butler first used the concept “ageism” to express prejudice and discrimination toward older adults only because they are old [4]. Then Palmore defined ageism in terms of individual’s cognitive and © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Fan et al. BMC Medical Education (2020) 20:197 affective towards older adults [5]. The Encyclopedia of China defines ageism as the prevailing prejudice against older adults and the resulting behaviors [6]. In a word, ageism includes people’s jaundiced attitudes, emotions, and behaviors towards older adults. According to literature, the identified attitudes of medical students or workers towards older adults varied greatly in different countries [7]. In a Spanish university, 54% final year medical students held a positive attitude towards older adults [8]. Faronbi reported 66.1% nursing students in Nigeria had a positive attitude [9]. The health care professionals also showed generally positive attitude to older patients [10]. However, there were several studies reported negative attitudes among medical students toward older adults [11, 12]. Rathnayake reported nearly half of nursing students in a Sri Lankan nursing school had negative attitude to older adults [11]. In an Australian university, 87.5% nursing students admitted negative behaviors to older adults [12]. Compared to other country, the English article about medical students’ attitude towards older adults in China is insufficient, and the prevalence of ageism among Chinese medical students remains unclear. Moreover, influenced by the traditional culture of Chinese ancestors advocating filial piety, it is generally believed that Chinese people have a low degree of ageism. But contrary to the common view, studies revealed that Chinese young people actually hold more negative attitudes toward older adults compared to American and British youth [13, 14]. Will the same phenomenon occur among Chinese medical students? Therefore, it is essential to acquire an applicable and effective measurement with Chinese context, which could provide feasibility of conducting study to demonstrate status quo regarding ageism among medical students. There are several tools frequently-used to measure the prevalence of ageism among medical students [15]. Kogan’s Attitudes toward Old People Scale (KAOP) contains 34 items and adopts 6-point Likert, with negative to positive responses [16]. Study confirmed that KAOP had good reliability and validity [17]; Facts on Aging Quiz (FAQ), an indirect measure of negative and positive ageism, includes 25 true-false items, mainly used to measure individuals’ knowledge of some factual knowledge on physiological, psychological and social roles during aging [18]. Therefore, the scale cannot measure the extent of ageism directly. The Fraboni Scale of Ageism (FSA) was prepared based on the concept of ageism proposed by Butler [19]. It is commonly used to evaluate the cognitive status of ageism, containing 29 items. Among above instruments, KAOP mainly focuses on assessment of stereoty (...truncated)