Vol.3, No.9, 602-608 (2011)
doi:10.4236/health.2011.39101
C
opyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
Health
The validity and reliability of Kogan’s attitude towards
old people scale in the Turkish society*
Dilek Kiliç#, Derya Adibelli
Department of Nursing, Health Sciences Faculty, Ataturk University, Erzurum, Turkey;
#Corresponding Author: dkilic25@mynet.com
Received July 28th, 2011; revised August 9th, 2011; accepted August 25th, 2011.
ABSTRACT
This study was conducted methodologically in
order to determine the validity and reliability of
Kogan’s Attitude towards Old People Scale afte r
being adapted to the Turkish Society. 145 female
students, attending the 4th and 5th year of the
faculty o f Med ical Scie nc es at Atatür k Uni versity,
and 118 nurses, working at Ataturk University
Aziziye-Yakutiye Research Hospitals, were in-
cluded in the study. The sample group was
chosen from the population using a non-prob-
ability convenience sampling method. A form
containing demographic characteristics of nurses
and nursing students, and the Turkish version
of Kogan’s Attitude towards Old People Scale
were used to gather the required data. Data w as
analysed using the t-test, Cronbach’s alpha co-
efficient, correlation, and factor analyses. In the
study, Cronbach’s Alpha Reliability Coefficient
for Kogan’s Attitude towards Old People Scale
was 0.81, and the scale comprised of one factor.
The attitude of working nurses towards old
people was more positive in comparison to the
attitude of student nurses. After analysis, the
scale was deemed highly valid and reliable, and
suitable to be used for Turkish society. The
scale may be used in studies to evaluative atti-
tude toward old people and quality of the care
offered to older people.
Keywords: Older People; Attitude; Validity;
Reliability; Nursing
1. INTRODUCTION
In Turkey, just like the rest of the world, the average
life expectancy has increased with the increase in the
level of welfare, and the rate of older people has in-
creased within the general population. In 2010, the world
population was about 6.9 billion; 27% of the population
was 15 and under, 8% was 65 and over [1]. In 2010, the
population in Turkey was 73.6 million; the expectation
is that this population will reach 85 million in 2025, and
94.7 million in 2050 [1]. While the population growth
rate has decreased in young age groups in recent years,
the population of older age groups have increased faster
than the average in Turkey, and the elderly population
has reached 7% [2,3]. This indicates that nearly 5 mil-
lion of the population is 65 or over. In Turkey, at birth,
the life expectancy for women is 74 years, and the life
expectancy for men is 69 years; the average life expec-
tancy is 72 years [1]. The attitude towards older people
differs from the attitude towards other patients because
older people generally suffer from more than one illness,
elderly individuals require more professional or institu-
tional care, and with age they become dependent on oth-
ers in order to carry out daily life activities as a result of
these demographic changes [4].
As well as the occupational experience of care-givers,
their knowledge and skills, the properties of the care
environment, and the characteristics of the older people,
the attitude towards older people also affect the quality
of the care offered to older people [5-7]. In all communi-
ties, the attitudes towards older people are generally
positive, adverse, and mixed; however, the attitude tends
to be adverse. The attitude of health workers towards
older people usually encompasses all three. These atti-
tudes are affected by the individual’s past life, family
and beliefs, cultural values, education level, and motiva-
tion [7]. While some societies consider older people as
incapable and worthless, as for traditional societies they
respect their elders, and try to benefit from their wisdom,
and the experience and knowledge they have accumu-
lated over the years. While in Turkish culture respecting
elders, listening to elders, and taking care of elders is a
traditional and fixed expectation, nowadays, the respect
*This study was presented as a poster announcement at the Turkish
Geriatrics 2010 National Elderly Health Congress, held between the 1st
and 4th April 2010.
D. Kiliç et al. / Health 3 (2011) 602-608
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
603603
and status of elderly within society has started to change
[8]. A study conducted to assess the attitude of nurses
towards older people indicated that older nurses and
bachelor graduate nurses had a more positive attitude
towards older people [9]. Lookinland, Lavender, and
Linton determined that, in general, American and Afri-
can nurses had a positive attitude towards older people,
and that in comparison to retired nurses, working nurses
and nurses doing a masters degree had a more positive
attitude towards older people [10]. A similar study con-
ducted to assess the attitude of working nurses towards
older people indicated that in comparison to polyclinic
nurses, clinic nurses had a more positive attitude towards
older people [11]. Adequate knowledge is not available
regarding the attitude of care-giving nurses and student
nurses towards older people in Turkey.
The purpose of this study is to investigate the adapta-
tion, validity, and reliability of Kogan’s attitude towards
old people scale in the Turkish society.
2. METHODS
2.1. Design
This study, aimed to determine the adaptation, validity,
and reliability of the Turkish version of Kogan’s Atti-
tude towards Old People Scale, was conducted method-
ologically between September-December 2009 at Erzu-
rum City Centre.
2.2. Participants
The study population was 263 individuals; 145 female
students, attending the 3rd and 4th year (2008-2009 school
year) of health sciences faculty at a university, and 118
nurses, working at a university hospital. In the study, the
two groups were formed to assess the impact of the
working environment and experience on attitude. The
sample group was chosen from the population using a
non-probability convenience sampling method.
2.3. Data Collection and Procedure
A form containing introductory characteristics of nurses
and nursing students, and the Turkish version of Kogan’s
Attitude towards Old People Scale were used to gather
the required data.
1) The form containing introductory characteristics:
This form contains information about the age, class,
marital status, and years of experience for nurses and
nursing students.
2) Kogan’s Attitude towards Old People Scale: The
scale was developed by Kogan in 1961. It was estab-
lished to measure the attitudes of individuals towards
older people. It does not contain medical terminology; it
has a social context, and is a 6-point likert-type scale
[12]. As well as being used for heath workers, it is also
used to determine the attitudes of society. The scale
comprises of 34 items; it contains 17 positive and 17
negative statements. Odd numbered items contain a
negative statement, while even numbered items contain a
positive statement. In accordance with the structure of
the scale, negative statements are marked as 6 5 4 3 2 1,
from right to left, while positive statements are marked
as 1 2 3 4 5 6, from left to right. The scores for every
item are added together to give a total score; 34 is the
lowest score, and 204 is the highest score obtained from
the scale. A high score obtained from the scale indicates
a positive attitude towards older people.
The validity and reliability of the tools used to gather
data was assessed in accordance with the views of ex-
perts on the subject, and the rules stated in relevant
sources [13-20]. After explaining the purpose of the
study, data was gathered using a questionnaire contain-
ing the introductory characteristics form and the Turkish
Kogan’s Attitude towards Old People Scale form.
2.4. Data Analysis
Data was assessed using the t-test, correlation analysis,
Cronbach’s Alpha Coefficient, and factor analysis with
SPSS (Statistical Package for Social Science) 11.0 soft-
ware.
3. RESULTS
3.1. Participants Demographics
55.1% of participants were nursing students, and 44.9%
were nurses. The average age of nursing students was
20.17 ± 1.40, and the average age of nurses was 27.36 ±
4.54 (Table 1).
3.2. Findings Relating to the Language
Validity of Kogan’s Attitude towards
Old People Scale
Two different methods were used to determine the
language validity of the Turkish Kogan’s Attitude to-
wards Old People Scale, having been translated from
English by language experts.
1) Once the scale was translated into Turkish it was
then translated back into English by an English language
expert. No discrepancies were detected in conclusion of
the examination conducted after the re-translation.
2) The correlation between the total scores of the
Turkish and English scales was calculated. The correla-
tion of 0.63 was determined as significant at a signifi-
cance level of p < 0.05. These findings prove that the
scale is valid in terms of language, and can be used in its
D. Kiliç et al. / Health 3 (2011) 602-608
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
604
Table 1. The demographic characteristics of participating (n =
263).
Characteristics N %
Participants
Working nurses 118 44.9
Nursing students 145 55.1
Age Mean ± SD
Working nurses 27.36 ± 4.54
Nursing students 20.17 ± 1.40
current form.
3.3. The Validity of a Scale Similar to
Kogan’s Attitude towards Old People
Scale
The validity of Kogan’s Attitude towards Old People
Scale was determined using the similar scale validity
method. In order to achieve this, the relationship be-
tween the Attitude towards Old People in the Family
Inventory and Kogan’s Attitude towards Old People
Scale correlation was calculated using Pearson Prod-
uct-Moment Correlation Analysis. The correlation was r =
0.68, and was found significant at a significance level of
p < 0.05. This result proves that the validity is high ac-
cording to the similar scale application.
3.4. Findings Regarding the Test Re-Test
Reliability of Kogan’s Attitude towards
Old People Scale
In order to determine the test-retest reliability of Ko-
gan’s Attitude towards Old People Scale, Kogan’s Atti-
tude towards Old People Scale was applied to 145 nurs-
ing students and 118 nurses (n = 263), and then retest
was applied after 30 days. The correlation between the
pre-test scores and the post-test scores was calculated
with Pearson Product-Moment Correlation Analysis. The
correlation was r = 0.78 at a significance level of p <
0.05.
3.5. Findings Regarding the Item-Total
Score Reliability of Ko gan’s Attitude
towards Old People Scale
The item-total score correlation was assessed to de-
termine how the 34 items of Kogan’s Attitude towards
Old People Scale affect the total score. The correlation
was between 0.22 and 0.51 at a significance level of p <
0.05, excluding items 13 and 14 (Table 2).
3.6. The Factor Structure of the Items
of Kogan’s Attitude towards Old
People Scale
The construct validity of Kogan’s Attitude towards
Old People Scale was determined using factor analysis;
factor loads for the 32-item scale varied between .30
and .65 (Table 2). This study was based on a factor load
of 0.30; items 7, 8, 19, 20, 21, and 22 were eliminated as
they were below .30, and factor analysis was re-applied
to the remaining items. After factor analysis, the scale’s
Kaiser-Meyer Olkin (KMO) coefficient was 0.760 and
the result of the Barlett’s test determined the significance
level as x2 = 450.089, p = 0.000. In conclusion of factor
analysis, the remaining 26 items gathered under one
factor, and only one factor that had an eigen value above
1 and described 28% of the total variance was found.
3.7. Findings Regarding the Cronbach
Alpha Reliability of Kogan’s Attitu de
towards Old People Scale
Cronbach’s Alpha Coefficient, an indicator of the in-
ternal consistency and homogeneity of the items com-
prising Kogan’s Attitude towards Old People Scale, was
calculated and found to be 0.81 (Table 3).
3.8. Findings Regarding the Two Split
Half Reliability of Kogan’s Attitude
towards Old People Scale
The scale was split in two half for the internal consis-
tency reliability coefficient of Kogan’s Attitude towards
Old People Scale; consistency values for both halves
were analysed. Results of the analysis showed that two
split-half reliability values relating to the internal con-
sistency of Kogan’s Attitude towards Old People Scale
was high according to 26 items.
3.9. The Distinctiveness of Kogan’s Attitude
towards Old People Scale
The total scores obtained from Kogan’s Attitude to-
wards Old People Scale, after distinctiveness validity
analysis, went from low to high. After listing was com-
plete, 27% of the lower group, and 27% of the upper
group was taken. The t-test was used to identify whether
or not every item in the scale illustrated distinctiveness
between the two groups. The t-values relating to every
item and total score were found significant at a signifi-
cance level of p < 0.05.
3.10. The Score Mean for Kogan’s Attitude
towards Old People Scale
Kogan’s Attitude towards Old People Scale was com-
D. Kiliç et al. / Health 3 (2011) 602-608
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605605
Table 2. Principal components analysis followed by varimax rotation factor loadings and item-total correlations of the scale and the
mean items of the scale (n = 263).
Items of The Scale Item-total
correlations Factor
loading X ± SD
1) It would probably be better if most old people lived in residential units with people their
own age. 0.342** 0.422 4.34 1.53
2) It would probably be better if most people lived in residential units with younger people. 0.466** 0.520 3.96 1.38
3) There is something different about most people; it’s hard to find out what makes them tick. 0.451** 0.588 2.85 1.31
4) Most old people are really no different from anybody else; they’re as easy to understand as
younger people. 0.355** 0.300 3.33 1.43
5) Most old people get set in their ways and are unable to change. 0.387** 0.466 3.39 1.43
6) Most old people are capable of new adjustments when the situation demands it. 0.559** 0.647 3.49 1.28
7) Most old people tend to let their homes become shabby and unattractive. 0.420** 0.454 4.30 1.26
8) Most old people can generally be counted on to maintain a clean, attractive home. 0.472** 0.600 3.66 1.32
9) It is foolish to claim that wisdom comes with age. 0.322** 0.300 3.90 1.36
10) People grown wiser with the coming of old age. 0.393** 0.390 3.66 1.27
11) Most old people make one feel ill at ease. 0.393** 0.527 4.38 1.20
12) Most old people are very relaxing to be with. 0.469** 0.624 4.29 1.17
13) Most old people bore others by their insistence on talking “about the good old days”. 0.502** 0.488 4.11 1.26
14) One of the most interesting and entertaining qualities of most old people is their accounts
of their past experiences. 0.254** 0.417 4.41 1.22
15) In order to maintain a nice residential neighborhood, it would be best if too many old
people did not live in it. 0.309** 0.364 4.68 1.18
16) You can count on finding a nice residential neighborhood when there is a sizeable number
of old people living in it. 0.556** 0.646 3.39 1.35
17) There are a few exceptions, but in general most old people are pretty much alike. 0.254** 0.348 3.35 1.27
18) It is evident that most old people are very different from one another. 0.271** 0.427 4.27 1.12
19) Most old people should be more concerned with their personal appearance; they’re too
untitdy. 0.461** 0.513 4.46 1.25
20) Most old people seem quite clean and neat in their personal appearance. 0.508** 0.580 3.99 1.16
21) Most old people are irritable, grouchy, and unpleasant. 0.483** 0.648 3.66 1.29
22) Most old people are cheerful, agreeable, and good humored. 0.503** 0.597 3.99 1.13
23) Most old people are constantly complaining about the behavior of the younger generation. 0.425** 0.551 3.95 1.25
24) One seldom hears old people complaining about the behavior of the younger generation. 0.450** 0.498 3.01 1.22
25) Most old people make excessive demands for love and reassurance than anyone else. 0.323** 0.394 3.34 1.32
26) Most old people need no more love and reassurance than anyone else. 0.422** 0.475 2.48 1.48
**p < 0.01.
Table 3. Minimum, maximum Scores, scale mean, standard deviation and Cronbach’s alpha (n = 263).
Total Items Minimum Maximum Mean SD α
26 50 130 97.76 11.18 0.81
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606
prised of 26 items in total and the mean score was 97.76 ±
11.18. The highest score obtainable was 156, and the
lowest score obtainable was 26 (Table 3). The score
mean obtained from Kogan’s Attitude towards Old People
Scale was 83.51 ± 9.46 for student nurses participating
in the study, and 98.08 ± 13.13 for the nurses working at
the clinic (Table 4, p < 0.001).
4. DISCUSSION
This section analyses the findings related to the valid-
ity, reliability, and factor structure of the adapted Turk-
ish version of Kogan’s Attitude towards Old People
Scale. The test-retest method was used to assess the time
invariance of the scale with language validity. The
test-retest reliability indicates that results will always be
consistent and time invariant, regardless of the applica-
tion method of the measuring device [13-17]. The corre-
lation between the pre-test scores and the post-test scores
was calculated using Pearson Product-Moment Correla-
tion analysis. The correlation was r = 0.78 at a signifi-
cance level of p < 0.05. This result proves that the level
of reliability and time invariance of the scale according
to test-retest method was high.
Item-total score correlation was analysed in an effort
to determine the effect the 34 items of Kogan’s Attitude
towards Old People Scale has on the total score. The
correlation coefficients were between 0.22 and 0.51 at a
significance level of p < 0.05, excluding items 13 and 14.
Literature states that an item-total score correlation
above 0.20 and an adequate level of correlation and im-
portance deems the item as good; the level of effective-
ness of the item increases together with the increase in
correlation [14-16]. The two items with a correlation
below 0.20 were eliminated from the scale, leaving the
scale with 32 items.
Factor analysis was used to assess the construct valid-
ity of Kogan’s Attitude towards Old People Scale. “Prin-
ciple Component Analysis (basic components)” method
was used to determine the factor load distribution of the
scale’s 32 items. Factor analysis was conducted in ac-
cordance with Varimax rotation [13,18-20]. When as-
sessed, the factor loads of the scale changed between
0.300 and 0.648. The minimum factor load/factor coeffi-
cient to describe the relationship between item and factor
was 30. This study was based on a factor load of 0.30;
items 7, 8, 19, 20, 21, and 22 (a total of six items) were
eliminated as they were below 0.30 and factor analysis
was re-applied to the remaining items. After factor
analysis, the scale’s Kaiser-Meyer Olkin (KMO) coeffi-
cient was 0.760 and the result of the Barlett’s test deter-
mined the significance level as x2 = 450.089, p = 0.000.
The fact that the scale’s KMO measure was between 70
Table 4. The comparison between attitudes towards older peo-
ple portrayed by nurses and student nurses (n = 263).
Participants Mean ± SD t and p
Working nurses 98.08 ± 13.13 t = 10.44
Nursing students 83.51 ± 9.46 p = 0.000
and 79 indicated that the sample group was adequate for
analysis. The fact that the Barlett’s test was significant
indicated that the items of the scale were suitable to
conduct factor analyses [18,20].
Cronbach’s Alpha Coefficient, an indicator of the in-
ternal consistency and homogeneity of the items com-
prising Kogan’s Attitude towards Old People Scale, was
calculated and found to be 0.81. Cronbach’s Alpha Co-
efficient, a known reliability measure, must be used to
assess the internal consistency of a likert-type scale. The
assumption is that high the alpha coefficient the more
consistent the items that establish the scale and the scale
consists of items predicting the same characteristic ele-
ments. Literature states that if Cronbach’s Alpha Coeffi-
cient is higher than 0.70, then the measuring tool is reli-
able and can be used in studies [14,18,20]. This study,
aimed to determine the validity and reliability of Ko-
gan’s Attitude towards Old People Scale (KATOPS),
applied the scale to two different groups, and split the
scale in half (positive and negative). Psychology stu-
dents (n = 482) established the first group; Cronbach’s
Alpha Coefficient was 0.77 for the positive scale, and
0.76 for the negative scale. Staff at a geriatrics centre (n =
204) established the second group; Cronbach’s Alpha
Coefficient was 0.73 for the positive scale, and 0.83 for
the negative scale [12]. Schoen assess the scale in two
parts (positive and negative); Cronbach’s Alpha Coeffi-
cient was 0.82 for the positive scale, and 0.86 for the
negative scale [21]. Gallagher et al. assessed Kogan’s
Attitude towards Old People Scale as positive and nega-
tive; they indicated that Cronbach’s Alpha Coefficient
changed between 0.73 and 0.75 [22]. Hilt studied the
scale as a whole and found Cronbach’s Alpha Coeffi-
cient as 0.81 [23]. In line with these results, the internal
consistency and homogeneity of the items in the Turkish
version of Kogan’s Attitude towards Old People Scale
are adequate. The Cronbach’s Alpha Reliability Coeffi-
cient of this study complies with results stated in litera-
ture.
The scale was split in half to determine the internal
consistency coefficient of Kogan’s Attitude towards Old
People Scale. The two split half reliability relating to the
internal consistency of Kogan’s Attitude towards Old
People Scale was high as per 26 items. This indicates
that the internal consistency reliability of Kogan’s Atti-
D. Kiliç et al. / Health 3 (2011) 602-608
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
607607
tude towards Old People Scale is high.
The total scores obtained from Kogan’s Attitude to-
wards Old People Scale, after distinctiveness validity
analysis, went from low to high. After listing was com-
plete, 27% of the lower group, and 27% of the upper
group was taken. The t-test was used to identify whether
or not every item in the scale illustrated distinctiveness
between the two groups. The t-values relating to every
item and total score gained significance at a significance
level of p < 0.05. This helps to distinguish high and low
levels of attitude towards older people depending on the
total score and the individual scores of the 26 items of
Kogan’s Attitude towards Old People Scale.
Kogan’s Attitude towards Old People Scale was com-
prised of 26 items and the mean score was 97.76 ± 11.18.
This indicates that those participating in the study have a
positive attitude towards older people. The attitude of
working nurses towards older people was more positive
in comparison to the attitude of student nurses. In an-
other study, first-year nurses had more negatives thoughts
about older people in comparison to working nurses [24].
The many studies conducted on the subject indicate that
nurses working in clinics have a more positive attitude
towards older people [9-11]. The results of this study
support those stated in literature.
That the reliability and validity of Kogan’s Attitude
towards Old People Scale was made on only nurses is
the limitation of study.
5. CONCLUSIONS
In conclusion of this methodological study, we deter-
mined that Kogan’s Attitude towards Old People Scale
had one factor, and its Cronbach Alpha Coefficient was
0.81. The results of statistical analysis proved that the
scale was valid and reliable, and could be used on Turk-
ish society. The Turkish version of Kogan’s Attitude
towards Old People Scale, tested for validity and reli-
ability, comprised of 26 items and its mean score was
97.76. Working nurses displayed a more positive attitude
towards older people in comparison to student nurses. It
is suggested that broader groups are used to represent
various socio-economic levels in assess the invariance of
Kogan’s Attitude towards Old People Scale in future
studies.
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