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Development and psychometric testing of the active aging scale for Thai adults

Development and psychometric testing of the active aging scale for Thai adults Journal name: Clinical Interventions in Aging Journal Designation: Original Research Year: 2014 Volume: 9 Running head verso: Thanakwang et al Clinical Interventions in Aging Dovepress Running head recto: Development of the active aging scale for Thai adults open access to scientific and medical research DOI: http://dx.doi.org/10.2147/CIA.S66069 Open Access Full Text Article O r I g I n A l r ese A r C h Development and psychometric testing of the active aging scale for Thai adults 1,2 Background: Active aging is central to enhancing the quality of life for older adults, but its Kattika Thanakwang 2,3 conceptualization is not often made explicit for Asian elderly people. Little is known about sang-arun Isaramalai active aging in older Thai adults, and there has been no development of scales to measure the Urai hatthakit expression of active aging attributes. Institute of n ursing, s uranaree Purpose: The aim of this study was to develop a culturally relevant composite scale of active University of Technology, n akhon ratchasima, Thailand; research aging for Thai adults (AAS-Thai) and to evaluate its reliability and validity. Center for Caring s ystem of Thai Methods: Eight steps of scale development were followed: 1) using focus groups and in-depth elderly, Faculty of n ursing, Prince interviews, 2) gathering input from existing studies, 3) developing preliminary quantitative mea- of songkla University, songkla, Thailand sures, 4) reviewing for content validity by an expert panel, 5) conducting cognitive interviews, 6) pilot testing, 7) performing a nationwide survey, and 8) testing psychometric properties. In a nationwide survey, 500 subjects were randomly recruited using a stratified sampling technique. Statistical analyses included exploratory factor analysis, item analysis, and measures of internal consistency, concurrent validity, and test–retest reliability. Results: Principal component factor analysis with varimax rotation resulted in a final 36-item scale consisting of seven factors of active aging: 1) being self-reliant, 2) being actively engaged with society, 3) developing spiritual wisdom, 4) building up financial security, 5) maintaining a healthy lifestyle, 6) engaging in active learning, and 7) strengthening family ties to ensure care in later life. These factors explained 69% of the total variance. Cronbach’s alpha coefficient for the overall AAS-Thai was 0.95 and varied between 0.81 and 0.91 for the seven subscales. Concurrent validity and test–retest reliability were confirmed. Conclusion: The AAS-Thai demonstrated acceptable overall validity and reliability for mea- suring the multidimensional attributes of active aging in a Thai context. This newly developed instrument is ready for use as a screening tool to assess active aging levels among older Thai adults in both community and clinical practice settings. Keywords: active aging, scale development, psychometric evaluation, culturally sensitive measure, Thai elderly Introduction With a growing aging population worldwide, the World Health Organization (WHO) has devoted considerable effort to encouraging all countries to promote quality of 1,2 life among older adults. As part of these efforts, the WHO has recently initiated a policy framework of active aging, defined as “the process of optimizing opportuni - ties for health, participation, and security in order to enhance quality of life as people Correspondence: Kattika Thanakwang Institute of nursing, suranaree University age”. The policy framework builds upon the premise that the vast majority of people of Technology, 111 University Avenue, of all ages, especially older people, want to be active participants and contributors Tambon, suranaree, Amphur Muang, nakhon ratchasima 30000, Thailand to society. The WHO argues that countries can afford to achieve quality of life for Tel +66 44 223 520 the aging population if governments, international organizations, and civil society Fax +66 44 223 506 email kattika@sut.ac.th enact “active aging” policies and programs that enhance the health, participation, submit your manuscript | www.dovepress.com Clinical Interventions in Aging 2014:9 1211–1221 Dovepress © 2014 Thanakwang et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further http://dx.doi.org/10.2147/CIA.S66069 permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Thanakwang et al Dovepress 2 2 and security of older citizens. However, active aging is a The WHO has also suggested that active aging is broad and internally complex notion. Although the concept influenced by cultural factors in addition to physical, cogni - is central to a global strategy for the management of aging tive, psychological, social, and environmental factors and 3,4 populations, active aging has been den fi ed in various ways economic resources. There is a need to explore how active across different countries and organizations. Countries need aging might be defined and perceived within the cultural to utilize the WHO’s active aging framework to conceptualize context of Thailand to illuminate those aspects of active aging active aging and its components within the context of their that are unique versus those that are common across cultures. own unique cultures and values. We attempt to add to the knowledge of active aging in older The extent to which older persons are active or productive adults by identifying the processes involved with being is of central interest to societies with growing numbers of actively engaged in life, and we present efforts to understand older people, and the need to understand how to age actively those components of active aging that are indigenous to older or productively is a challenge to all countries. Understanding Thai adults. Such knowledge is essential to anyone involved the processes associated with active aging has become a key in government agencies or scholarship research on aging, 5,7,8 focus for gerontological researchers. However, research and should be considered a prerequisite for policy-making on active aging has been plagued by a lack of consistency to promote active aging in Thailand. in the definition and measurement of the concept. This may Establishing the meaning and definition of active aging stem from the multidimensional attributes of active aging, for Thai adults is an essential preliminary step towards iden- which depend upon a variety of influences or determinants tifying attributes for use in scale development. A standard surrounding elderly individuals, families, and nations. The and culturally sensitive instrument, which covers diverse lack of a consistent definition is reflected in the wide range dimensions of active aging in Thailand, is essential to assess of models and indicators found in the literature covering levels of active aging. This type of scale would form the different approaches to the study of active aging. scientific basis for systematic assessment and intervention Research on active aging has grown over recent decades, designed to enhance the active aging and quality of life of but theories continue to be based overwhelmingly on Western Thai older people. Therefore, this study aimed to develop studies that may not be applicable to ethnoculturally diverse a culturally relevant composite scale of active aging for societies, such as those in Asian countries. This is regrettable Thai adults (AAS-Thai) and to evaluate its reliability and given the substantial cultural differences between East and validity. We surveyed a large sample of older Thai adults West; for example, the strong emphasis on independence and analyzed their perceptions and understanding of active in the West as contrasted with Thai persons’ acceptance of aging using this new tool. interdependence. The measurement of culturally-specific variables using measures developed in other parts of the Materials and methods world can be problematic due to differences in cultural The procedure we used to develop a comprehensive, cultur- contexts. The development of culturally-sensitive measures ally sensitive measure for older Thai adults was based on for research on aging in a particular context has proved the multistep strategy outlined by Ingersoll-Dayton. The challenging. first step involved conducting focus groups and in-depth There have been only a few studies on active aging in interviews. To identify culturally meaningful domains of Thailand. Kespichayawattana and Wiwatvanich explored active aging for elderly Thai adults, we used a qualitative active aging attributes in elite Thai elderly adults, and approach to conduct focus groups and in-depth interviews Nantsupawat et al focused on active aging in older Thai with 64 older adults. This initial step identified six domains adults living in one rural village in the northeastern region of of active aging experienced by the participants (for more the country. To our knowledge, little is known about active details, see Thanakwang et al). aging in lay older Thai adults. Specifically, there have been In the second step, we reviewed existing studies of active no attempts to develop scales to measure the expression of and positive aging, focusing particularly on studies of elderly 8,12,13,15–17 active aging in large samples, perhaps because of a lack Thai adults. We examined the literature for reference of expertise in developing this type of instrument. Thus, a to factors of active aging similar to the six dimensions of standard and culturally sensitive instrument, which covers active aging that had emerged from the interviews and focus multiple dimensions of active aging in Thai adults, needs to groups. Combining the input from other studies with n fi dings be developed. from the present study provided a comprehensive insight submit your manuscript | www.dovepress.com Clinical Interventions in Aging 2014:9 Dovepress Dovepress Development of the active aging scale for Thai adults into active aging domains and facilitated the development of the items of the AAS-Thai were easy to understand by all of some closed-ended items. participants, and only minor rewording was suggested. It The third step was to develop a preliminary quantitative was also noted that some words were redundant, and some measure, generating an item pool from the specie fi d domains questions were considered to be too long. Using data obtained of active aging obtained. According to DeVellis, several from the respondents’ perceptions and interpretations, prob- processes are necessary to generate an item pool; for example, lematic items with the potential to elicit response error were developing conceptual definitions of each specified domain, revised, ensuring the comprehensibility and practicality of formulating operational definitions of the domains, identify - the scale for lay older adults in Thailand. ing observable indicators of each domain, and constructing The participants in our sample of ten suggested that a blueprint of the item matrix. We incorporated words and the 5-level scale format was too long and quite difficult for phrases from the study participants’ statements. The initial older adults to respond to. Attributes of active aging do not, item pool consisted of 81 items within six domains. of course, relate solely to perceptions, but constitute the In the fourth step, the 81 items were reviewed by a panel reality of everyday life. Therefore, in order to improve the of seven experts specializing in multidisciplinary areas rel- clarity and practicality of the scale, the number of response evant to the study (ie, two experts on gerontological nursing, categories was reduced to a 4-level scale format. We revised one on geriatric medicine, one on social gerontology, one on the response set to incorporate different degrees of truth population development, one on linguistic and cultures, and (ranging from “not at all true” to “very true”), which was one on instrument development). The experts were instructed more easily understood by the respondents. The response to rate each item on a 4-point scale based on relevance and choices appeared as 1 (not at all true), 2 (slightly true), 3 appropriateness, ranging from 1 (not relevant), 2 (some- (somewhat true), and 4 (very true). This format was deemed what relevant), 3 (quite relevant), to 4 (highly relevant). In most appropriate to measure the process of active aging in addition, the experts were asked to evaluate the clarity and elderly people; it had fewer choices and no middle choice, conciseness of the closed-ended items of the AAS-Thai by which prevents middle-point choosing, a typical habit of using “yes” or “no” responses on each item. They were also elderly Thai adults. Finally, the third draft, 60-item scale invited to suggest revised wordings for any items that seemed using a 4-point Likert type scale was finalized. ambiguous, unclear, or inappropriate. The content validity of In step 6, the 60-item AAS-Thai was pilot-tested in one the measure was based on the expert concurrence using the community using a convenience sample of 30 older adults. content validity index (CVI), calculated for category evalu- Preliminary psychometric testing with the 60-item scale ation and item evaluation. Values on the CVI greater than was carried out using item analysis. Three criteria were or equal to 0.80 indicated an acceptable content validity of used in the process of deciding which items to retain: 1) the instrument. For this study, the overall CVI was 0.91. a minimum interitem correlation of 0.20 and a maximum of The items rated at levels 3 or 4 were retained, whereas those 0.70, 2) a minimum corrected item–total correlation coef- rated at levels 1 or 2 by three or more experts were deleted ficient of 0.30, and 3) a minimum Cronbach’s reliability of 20,21 or modified according to the experts’ suggestions. In total, 0.70. Five items (items 4, 12, 14, 17, and 32) were deleted 21 items were deleted; the final questionnaire contained since they had corrected item–total correlation coefficients 60 items. of less than 0.30. Three items (items 11, 13, and 34) were The fifth methodological step was to conduct cognitive deleted because they had interitem correlations of less than interviews with ten active elderly Thai adults, who were 0.20. Furthermore, five items (items 28, 29, 43, 44, and 46) members of the Health Promotion and Rehabilitation Center were removed since they had interitem correlations higher for the Elderly, Faculty of Nursing, Prince of Songkla Uni- than 0.8 suggesting redundancy. This process culminated versity, Thailand. In recruiting these individuals, efforts were in a 47-item scale. The alpha coefficient for the overall made to ensure that they had the capacity to think about the scale was 0.97, and the six subscales ranged from 0.81 to clarity of the closed-ended items from their own perspective 0.92, indicating good internal consistency. The corrected as well as from the perspective of older Thai people with less item–total correlations among the remaining 47 items were education. A think-aloud question and a probing question between 0.44 and 0.79. were used in conjunction to explore participants’ general In steps 7 and 8, this version of the AAS-Thai was tested perceptions as well as their reactions to specific aspects of by means of a nationwide survey, and further psychometric the questions. The participants’ review indicated that most testing was conducted to examine the validity and reliability submit your manuscript | www.dovepress.com Clinical Interventions in Aging 2014:9 Dovepress Thanakwang et al Dovepress of this newly developed measure of active aging for Thai was selected. The inclusion criteria were 1) being an older adults. The sample and setting, instrument, data collection, person who is dwelling in the community, 2) being aged and data analysis are detailed in the next section. 60 years or older, 3) not suffering severe disabilities, severe dementia, or psychiatric disorders, and 4) being able to under- sample and setting stand and speak Thai. If any household had more than one The sample size was chosen according to MacCallum older person who met the inclusion criteria, simple random et al’s method of determining sample size in factor analysis. sampling was conducted by putting all their names in the A minimum of five to ten samples per item is recommended pool and selecting one. 19,21 for the psychometric evaluation of a new measure. Specifically, MacCallum et al recommend that a sample Instruments size of 500 or more in factor analytic studies is excellent. The fourth draft of the AAS-Thai, which was revised after We therefore obtained a sample of 500 participants to test the pretesting step and included a demographic data form, the scale. As our aim was to conduct a national survey, was used as an instrument. The Healthy Aging Instrument the sample was randomly selected from four regions (HAI) was used to examine construct validity. of the country (central, north, northeast, and south) using The HAI was developed by Thiamwong et al for use the stratified sampling technique to make it representative with elderly Thai participants. The HAI consists of 35 items to Thai older adults. and a 4-point rating scale (1–4). There are nine components: A v fi e-stage random sampling method was used to select 1) being self-sufc fi ient and living simply, 2) managing stress, the study subjects: 3) having social relationships and support, 4) making merit 1. Selecting provinces: one province of each region of and good deeds, 5) practicing self-care and self-awareness, Thailand (north, northeast, central, and south) was 6) staying physically active, 7) staying cognitively active, randomly selected. They were Nan (north), Nakhon 8) having social participation, and 9) accepting aging. The Ratchasima (northeast), Kanchanaburi (central), and HAI demonstrates good validity and reliability (Cronbach’s Songkla (south). alpha =0.88). 2. Selecting districts: one district of each province selected in stage one was randomly selected using a ballot method Procedure without replacement, yielding four districts for the Prior to data collection, the research protocol was approved study. by the Institutional Review Board of the Faculty of Nurs- 3. Selecting subdistricts: two subdistricts (or “tambons”) ing, Prince of Songkla University, Thailand according to the of each selected district, one in an urban area (munici- tenets of the Declaration of Helsinki. Anonymity, privacy, pal) and another in a rural area (nonmunicipal), were and the right to withdraw from the study without negative selected by simple random sampling, resulting in eight consequences were guaranteed. Confidentiality was main - subdistricts. tained in all data collecting and analysis processes, reports, 4. Selecting villages/communities: two villages/ communities and subsequent publications. of each selected subdistrict were recruited using simple Data were gathered from January to April 2013. Face- random sampling. This yielded 16 villages/ communities; to-face interviews were conducted in each respondent’s eight located in urban areas and eight in rural areas. home by researchers and trained interviewers. Before 5. Selecting household and respondents: from a total informed consent was given, respondents were informed number of older adults (2,778) in 16 selected villages/ of the overall purposes and protocols of the study and of communities, the number of possible subjects was the time required to complete it. Those participants who calculated proportional to the size of each village or met all eligibility criteria were then fully enrolled in the community. The proportion sampled for this study was study. The participants who were educated or well-read 0.18 (equal to 500/2,778). were asked to fill out a demographic sheet and to complete To select households according to the calculated number the questionnaire themselves. Researchers assisted nonlit- of the study sample in each village, we conducted system- erate participants or those with any limitations by slowly atic random sampling using household lists. One elderly reading the questionnaire aloud and then asking them to respondent per household, who met the inclusion criteria, rate each item. submit your manuscript | www.dovepress.com Clinical Interventions in Aging 2014:9 Dovepress Dovepress Development of the active aging scale for Thai adults statistical analyses problems, for example, insignificant loadings, too many low Data were analyzed using the SPSS 14.0 software package for communalities, and cross-loadings. The f fi th step was to label Windows (SPSS Inc., Chicago, IL, USA). Sociodemographic the extracted factors according to the meaning of the items characteristics of the respondents were first analyzed using loading on them. descriptive statistics. We calculated internal consistency Construct validity was examined through concurrent of the scale and carried out an item analysis and a factor validity. Concurrent validity examines the extent to which a analysis. measurement scale under development correlates with other Internal consistency reliability was examined by analyz- scales that are designed to assess closely related constructs. ing across items within the scale using internal consistency As the concepts of healthy aging and active aging may and item analysis. We used Cronbach’s alpha coefficient to be interconnected, we hypothesized that active aging is measure reliability for the overall scale and its subscales. positively associated with healthy aging. Concurrent valid- A Cronbach’s alpha value of 0.70 and above indicates suf- ity between AAS-Thai and HAI was assessed by Pearson’s ficient internal consistency for a new tool. correlation coefficient. Item analysis was further performed to check whether We used a test-retest technique to evaluate the stability the scale had acceptable internal consistency. This is one of of the AAS–Thai. Data obtained from two different points the statistical techniques used to investigate the pattern of in time were analyzed using Pearson’s product moment cor- responses for each item of the scale, and it provides a basis relation coefficient to estimate scale stability. The closer the for revisions to improve the effectiveness of test items and coefficient is to 1.00, the more stable the measurement. the validity of test scores. Following recommendations of Results the criteria for item analysis proposed by Ferketich and Nunnally and Bernstein, items of the AAS-Thai were sample characteristics examined, and decisions were made as to which items were The 500 participants were older Thai adults living in com- to be retained, revised, or deleted. munities across four regions of Thailand. About two-thirds Exploratory factor analysis (EFA) was used to condense of them (64%) were female. Ages of the sample ranged and group highly correlated items together to create a new from 60 to 96 years, with a mean of 71 years (standard composite factor that represented each group of items. deviation =7.88), and half of them (50%) were young elderly, Before conducting EFA, the Kaiser–Meyer–Olkin value was aged 60 to 69 years. Most of them (88%) were Buddhist. obtained to determine whether the sample was adequate; More than half (54%) of the subjects were married and liv- we also carried out Bartlett’s test of sphericity, which tests ing with their spouses. Most of them (69%) had completed whether there is sufficient correlation between the variables primary school (grade 4), and about 76% were able to read and hence justification for the factor analysis. We then and write. The majority of them (52.8%) were not working. performed an EFA using 1) factor extraction using principle With regard to economic status, about one-fourth of them component analysis and 2) factor rotation using the varimax (26%) had a monthly income of 500–1,000 Baht, and nearly method. An eigenvalue equal to or greater than 1.0 is consid- one-third (31%) had an annual income lower than the poverty ered as a criterion to determine the number of components line (12,000 Baht). About 28% of them suffered from income to retain. Following the process of factor interpretation insufc fi iency. More than half (54%) lived in urban areas. The outlined by Hair et al we conducted the analysis in v fi e steps. majority of them (82%) coresided with adult children, and We first examined the factor matrix of loadings, focusing about 12% coresided with only a spouse. on the factor pattern matrix. It is recommended that factor loadings of 0.40 and higher have practical significance. We Psychometric analyses then examined the magnitude and signic fi ance of the loadings Item analysis on each variable, and we also examined any cross-loadings. The 47-item AAS-Thai was analyzed to examine the inter- Thirdly, we assessed communalities (the amount of vari- item correlation, intersubscale correlation, and item–total ance accounted for by the factor solution). A communality correlation. The results showed that the interitem correla- score of less than 0.50 was considered as not explaining tions ranged from 0.18 to 0.74, the intersubscale correlations enough variance. The fourth step was to respecify the factor ranged from 0.34 to 0.80, and the item–total correlation model if necessary in the event of finding any one of several coefficients ranged from 0.16 to 0.75. However, two items submit your manuscript | www.dovepress.com Clinical Interventions in Aging 2014:9 Dovepress Thanakwang et al Dovepress (item 22 and 23) had item–total correlations of less than 0.30 accounted for 68.53% of the total variance. The seven factors, 20,21 and were removed. The 45-item AAS-Thai was retained corresponding eigenvalues, percentage of variances and reanalyzed. The results showed that the interitem correla- accounted for by each factor, and cumulative percentages tions ranged from 0.27 to 0.74, the intersubscale correlations of variance are presented in Table 1. All of the 36 retained ranged from 0.44 to 0.80, and the item–total correlation coef- items had loading values greater than 0.40 on only one of the ficients ranged from 0.36 to 0.76. The alpha coefficients of seven factors and could be meaningfully explained in terms of the six subscales ranged from 0.82 to 0.91, and the reliability their corresponding components. The factor loadings ranged for the total scale was 0.96, which is considered excellent. from 0.45 to 0.89, with statistical significance ( P0.001). The communality values ranged from 0.54 to 0.87, indicat- exploratory factor analysis ing that the extracted factors explained a high proportion EFA using principal component analysis with varimax rota- of item variance (see Table 2). The new seven factors of tion was performed. The criteria used to consider the number active aging were optimal, concise, theoretically organized, of factors were 1) an eigenvalue greater than 1; 2) scree and presented a simple structure. These factors were named 21,24 plot characteristics; and 3) interpretability. Specifically, with respect to the process of being actively engaged in life: items were removed when 1) the item-factor loading was 1) being self-reliant, 2) being actively engaged with society, below 0.40; 2) the loading(s) on each variable was (were) 3) developing spiritual wisdom, 4) building up financial insignificant; 3) the communality score was less than 0.50; security, 5) maintaining a healthy lifestyle, 6) engaging in 4) the cross-loadings indicated relatively high loadings on active learning, and 7) strengthening family ties with respect more than one factor; and 5) the item did not contribute to to being cared for in late life. 18,21,24 factor interpretability. The results indicated that seven The overall internal consistency reliability of the scale factors had a cumulative percentage of variance of 67.51%. was 0.95, indicating that it is a reliable instrument for mea- All factor loadings were greater than 0.40 with statistical suring the multidimensional attributes of active aging. The significance. However, nine items (items 7, 14, 21, 27, 28, Cronbach’s alpha coefc fi ients for the seven subscales ranged 34, 39, 40, and 41) were eliminated since they had relatively from 0.81 to 0.91. The correlations between subscales ranged high loadings on more than one factor. The remaining 36-item from 0.30 to 0.65, and the correlations between the seven AAS-Thai draft was then reanalyzed. subscales and the entire scale ranged from 0.56 to 0.87 with The results of this last factor analysis with varimax statistical significance ( P0.001), as shown in Table 3. rotation showed a Kaiser–Meyer–Olkin value of 0.933, indicating sample adequacy for factor analysis. Bartlett’s Concurrent validity test of sphericity was significant ( χ =12595.21, P0.001), Concurrent validity of the AAS-Thai was tested by examin- indicating the appropriateness of the data for further fac- ing possible relationships with the Healthy Aging Scale, tor analysis. In the end, seven factors with eigenvalues a theoretically relevant scale, to compare the scale with greater than 1 were generated and 36 items retained. The previously established, conceptually related variables. With eigenvalues ranged from 5.77 to 1.65, and all components regard to the hypothesis that active aging is positively related Table 1 Total loading, percent of variance, and cumulative percentage of the final draft 36-item AAS-Thai classified by eigenvalues greater than 1 Factor Extraction sums of square loading Rotation extraction sums of square loadings Total % of variance Cumulative % Total % of variance Cumulative % 1 13.834 38.427 38.427 5.773 16.037 16.037 2 2.635 7.320 45.747 4.970 13.805 29.842 3 2.401 6.670 52.417 3.577 9.936 39.778 4 1.737 4.824 57.241 3.131 8.697 48.474 5 1.650 4.583 61.824 2.865 7.960 56.434 6 1.279 3.553 65.377 2.709 7.525 63.959 7 1.135 3.154 68.531 1.646 4.572 68.531 Notes: The seven factors of active aging: 1, being self-reliant; 2, being actively engaged with society; 3, developing spiritual wisdom; 4, building up financial security; 5, maintaining a healthy lifestyle; 6, engaging in active learning; 7, strengthening family ties to ensure care in later life. Abbreviation: AAs-Thai, scale of active aging for Thai adults. submit your manuscript | www.dovepress.com Clinical Interventions in Aging 2014:9 Dovepress Dovepress Development of the active aging scale for Thai adults Table 2 Factor loading of each item and factor of the 36-item AAs-Thai Item Factor Communality 1 2 3 4 5 6 7 1 0.80 0.71 2 0.76 0.69 11 0.72 0.69 9 0.68 0.68 3 0.67 0.59 13 0.65 0.65 42 0.63 0.61 15 0.55 0.55 24 0.74 0.79 26 0.73 0.62 32 0.73 0.68 25 0.69 0.79 31 0.69 0.64 30 0.67 0.62 12 0.62 0.70 29 0.61 0.65 37 0.89 0.87 38 0.87 0.82 36 0.70 0.62 33 0.61 0.59 35 0.60 0.54 44 0.87 0.87 43 0.84 0.85 45 0.71 0.66 8 0.48 0.56 19 0.81 0.69 18 0.72 0.74 20 0.71 0.71 17 0.54 0.69 16 0.45 0.66 5 0.78 0.69 4 0.68 0.71 6 0.60 0.62 10 0.57 0.66 46 0.68 0.73 47 0.68 0.72 Notes: The seven factors of active aging: 1, being self-reliant; 2, being actively engaged with society; 3, developing spiritual wisdom; 4, building up financial security; 5, maintaining a healthy lifestyle; 6, engaging in active learning; 7, strengthening family ties to ensure care in later life. Abbreviation: AAs-Thai, scale of active aging for Thai adults. Table 3 Correlation coefficients of subscale to subscale and subscale to entire scale, and alpha coefficients of the final draft 36-item AAs-Thai (n =500) Scale 1 2 3 4 5 6 7 Cronbach’s alpha 1. Being self-reliant 1.00 0.91 2. Being actively engaged with society 0.65* 1.00 0.91 3. Developing spiritual wisdom 0.46* 0.51* 1.00 0.86 4. Building up financial security 0.58* 0.51* 0.43* 1.00 0.85 5. Maintaining healthy lifestyle 0.60* 0.50* 0.45* 0.48* 1.00 0.81 6. engaging in active learning 0.62* 0.63* 0.40* 0.45* 0.38* 1.00 0.82 7. strengthening family ties to ensure 0.46* 0.36* 0.40* 0.50* 0.48* 0.30* 1.00 0.85 care in later life 8. entire scale 0.87* 0.86* 0.67* 0.73* 0.71* 0.74* 0.56* 1.00 0.95 Note: *P0.001. Abbreviation: AAs-Thai, scale of active aging for Thai adults. submit your manuscript | www.dovepress.com Clinical Interventions in Aging 2014:9 Dovepress Thanakwang et al Dovepress Table 4 Pearson’s correlation coefficients between the AAS-Thai context as an alternative to importing standardized Western and hAI (n =30) instruments that may not be relevant to Eastern cultures. Scale HAI The active aging scale for Thai adults (AAS-Thai) can be 1. Being self-reliant 0.64* assumed to be a culturally sensitive instrument because the 2. Being actively engaged with society 0.65* items emerged from the indigenous perspectives of lay older 3. Developing spiritual wisdom 0.61* adults in Thailand. 4. Building up financial security 0.64* 5. Maintaining healthy lifestyle 0.63* 6. engaging in active learning 0.65* seven factors of the AAs-Thai 7. strengthening family ties to ensure care in later life 0.55* The factor analysis supported the proposition that the AAS- 8. entire scale 0.84* Thai assesses the multidimensional nature of active aging or Note: *P0.001. Abbreviations: AAs-Thai, scale of active aging for Thai adults; hAI, healthy Aging the process of being actively engaged in life. Instrument. The first important factor of active aging is being self- reliant, which is the factor that explains the greatest variance to healthy aging, the findings indicated that the AAS-Thai on the AAS-Thai. This factor included eight items represent- had a significant positive association with the HAI ( r=0.84, ing a person’s ability to independently take care of himself/ P0.001), and that the subscales of the AAS-Thai had sig- herself and includes tasks related to family-care (performing nificantly strong associations with the HAI ( r=0.55–0.65, various activities in the household). From the perspective of P0.001), indicating the satisfactory construct validity of older adults, being able to do what they wish is meaningful for the AAS-Thai (see Table 4). their autonomy and implies that they are able to manage their 26–28 lives on their own. Having meaningful activities in daily Test–retest reliability life that keep elderly individuals busy makes them proud that To evaluate the stability of the n fi al draft 36-item AAS-Thai, they are independent and not a burden on others. This notion test–retest reliability within a 2-week interval was examined is consistent with the valued concept of individualism among using 30 community-dwelling elderly participants. The mean elderly Western people. Many Western scholars point out score of the AAS-Thai at time one was 105.03, and the that active aging is based on the concept of selfhood, which mean score at time two was 106.80. The Pearson correlation assumes that elderly individuals must have self-responsibility 27,29 coefficient between the two sets of scores was 0.92, indicat - and self-care for their own life. However, the findings ing good stability. In addition, the correlations of the seven of the present study expand upon the Western concept of subscales between time one and time two ranged from 0.78 self-reliance; among elderly Thai adults, this capacity is not to 0.92 (see Table 5). The results indicate that the 36-item only focused on self-caring but also incorporates the notion AAS-Thai is stable in terms of its test–retest reliability. of caring for family. This rationale may come from the col- lectivistic nature of the Thai culture, in which people are Discussion considered to be fundamentally interdependent; therefore, This study attempted to highlight the importance of develop- the self is viewed as interconnected, and people are mutually 15,30 ing a culturally relevant measure of active aging within a Thai responsible for one another. This n fi ding is congruent with Table 5 stability estimates of the total scores for AAs-Thai in time one and time two Scale AAS-Thai time one AAS-Thai time two r Mean SD Mean SD 1. Being self-reliant 27.57 4.96 28.00 4.00 0.88* 2. Being actively engaged with society 19.13 6.82 20.20 5.60 0.92* 3. Developing spiritual wisdom 16.27 2.03 16.07 1.93 0.81* 4. Building up financial security 9.53 3.74 9.40 3.35 0.90* 5. Maintaining healthy lifestyle 15.50 3.08 15.73 2.33 0.85* 6. engaging in active learning 10.20 3.12 10.57 2.43 0.78* 7. strengthening family ties to ensure 6.83 0.95 6.83 0.83 0.89* care in later life 8. entire scale 105.03 18.71 106.80 14.23 0.92* Note: *P0.001. Abbreviations: AAs-Thai, scale of active aging for Thai adults; sD, standard deviation. submit your manuscript | www.dovepress.com Clinical Interventions in Aging 2014:9 Dovepress Dovepress Development of the active aging scale for Thai adults research by Nantsupawat et al suggesting that active aging related to spiritual wisdom; thus, this component of active incorporates activities that benefit both elderly individuals aging may be unique to elderly Thai people. and their families. Building up financial security (factor 4) was character - Being actively engaged with society (factor 2) incorpo- ized as preparing financially for later life and for funerary rated eight items, including engaging in social participation activities as well as having enough money for daily expenses. and social contribution. These findings reflect the fact that This component was extracted from the initial conceptual elderly Thai adults perceive active aging as not just about framework by EFA. This finding is congruent with numer - being self-reliant but also about participating and contributing ous previous findings, suggesting that financial security has 7,12 in the community and society at large. All countries require been associated with active aging, including successful the participation of active or productive elderly people; in aging. Being financially secure maximizes one’s sense of Thailand, this requirement is included in the national plan security and autonomy. Numerous studies have indicated for older people. Maintaining socially active engagement is that financial security is considered crucial by elderly Thai 8,12,13,38 5 evident in a myriad of meaningful activities through which adults. However, a study by Bowling argued that the elderly connect with others and contribute to the whole some elderly British participants also mentioned finances as society. Therefore, productive engagement has been identi- a constituent of active aging. Thus, n fi ancial security may be e fi d as an important indicator of active aging. Elderly people significant for elderly Thai since most of them have limited can make many social and economic contributions that are of income stability and depend on financial support from their great value to older people themselves, to their families, as children. Moreover, the importance of predeath preparations 9,13,32 well as to society at large. In other words, it can be said for financial security is probably uniquely found in research that active aging implies the utilization of older people’s life on elderly Thai people. In Thailand, elderly people prepare competences as part of the human capital within society. for their funerals by becoming a member of a community Developing spiritual wisdom (factor 3) was also identi- funeral fund to ensure that their children will have enough 8,13 fied as an important aspect of active aging. This component money to arrange their funerals. involves having inner strength and calmness, including The five items that loaded on factor 5 (maintaining a trusting in religion and making merits. It is widely agreed healthy lifestyle) identified key aspects of health-promoting that spiritual growth is an important aspect of living a human- behaviors, such as eating healthy food and practicing physical istic and meaningful life, which involves “going beyond”, activity or exercise. This suggests that those elderly adults enabling one to contribute to a meaningful relationship with who practice healthy lifestyles experience more active aging. others and relating to God, religion, or transcendence. This finding is consistent with numerous studies suggesting Ardelt defines wisdom as an integration of cognitive, that a health promoting lifestyle has a strong association with 15,16 39 40 reflective, and affective (compassionate) characteristics in healthy aging and successful aging. Bowling indicated relation to understanding the truth of life, engaging in self- that elderly British people also define active aging in terms examination to develop self-awareness and self-insight, of good physical health and fitness, identifying exercise as and decreasing self-centeredness; the embodiment of these a key part of this. characteristics tends to result in compassionate love and Engaging in active learning (factor 6) consisted of four concern for the welfare of others. The majority of elderly items reflecting the capacity of an elderly individual to learn Thai people are Buddhist. The Thai people rely heavily on about new information technologies to make them cogni- their Buddhist doctrines of doing good deeds as a way of tively active and healthy. This n fi ding suggests that engaging 15,17 “making merit”. As one gets older, one has more wisdom in active lifelong learning is important for older adults in and free time to be involved with higher forms of religious Thailand, consistent with the findings of many prior studies activities, engaging in mental development (meditation) and that have confirmed that continued learning is important for 7,27,41 teaching the doctrine, or showing truth to others, activities active aging. At present, lifelong learning is imperative that are considered as rendering more merit. In Thailand, it for older adults in an era of modernization, in which tech- is not surprising that positive spirituality has been identified nologies are rapidly changing. There is a variety of ways for 15–17 8 as the key indicator of healthy aging and active aging. elderly people to extend their formal and informal learning This concept is considered by older Thai people to be an over the course of their lives. Thus, policies to promote important component of active or productive aging. Active lifelong learning for older people in relation to their interests aging as defined by the WHO does not incorporate an aspect and circumstances should be established. submit your manuscript | www.dovepress.com Clinical Interventions in Aging 2014:9 Dovepress Thanakwang et al Dovepress The final factor of active aging that we identified was study limitations termed “Strengthening family ties to ensure care in later There are some limitations in this study that should be life” (factor 7). This consisted of two items: strengthening noted. First, the study results may be biased by participants family ties and teaching children about filial piety. This responding in a socially desirable manner in order to pres- dimension concerns activities engaged in by parents to ent themselves in a positive light, particularly if they were ensure that their children will care for them when they are interviewed in the presence of family members or neighbors. old or frail. This finding is congruent with a few studies Future use of the AAS-Thai should incorporate simultane- in the Western context, but is more frequently the sub- ous social desirability testing to confirm that these findings ject of research on Eastern cultures, particularly that of are not subject to bias. Second, this study did not compare 8,13 Thailand. It is prominently within the Thai context that standardized active aging or healthy aging scales developed elderly support is expected by family members, based on for use with Western samples. Thus, we were unable to social norms such as filial piety and reciprocal exchanges. examine which factors are culturally specific and which are If children respect and care for older parents, it helps universally applicable across different cultures. A future older parents feel that they have succeeded in nurturing comparison with a Western active aging scale would be use- 10,14 and teaching their offspring, ensuring that they will be ful to explore which dimensions of the AAS-Thai are unique secure in later life. and which are universal. Psychometric properties of AAs-Thai Conclusion The psychometric properties of the AAS-Thai were tested The AAS-Thai could potentially be the first culturally con - for two key issues: validity and reliability. With regard to textualized, relevant, and valid multidimensional scale of the construct validity, factor analysis and concurrent validity active aging in Thailand. Our study demonstrated that the were examined. For the reliability, internal consistency and 36-item AAS-Thai has satisfactory validity and reliability for test–retest reliability were calculated. assessing active aging levels among older Thai adults, sug- The results of the EFA indicated that the 7-factor AAS- gesting that it could be used in both community and clinical Thai with the retained 36 items is a well-constructed instru- practice settings. ment for measuring active aging in Thai people. All items had loading values greater than 0.40 and loaded on only one Acknowledgments factor, suggesting that the underlying factors are meaningful. KT, SI, and UH conceived and designed the research. KT was The communalities were greater than 0.50, indicating that the responsible for data collection. KT and SI were responsible extracted factors satisfactorily explained the item variance. for data analysis. All authors contributed toward drafting and The eigenvalues of the seven factors ranged from 5.77 to revising the manuscript and have approved the final version. 1.65, and all components accounted for 68.53% of the total The authors wish to thank Professor Dr Berit Ingersoll-Day- variance, which is greater than 50% of explained variance ton, Associate Professor Dr Aranya Chowalit, and Assistant for the factors, indicating that the AAS-Thai is adequate Professor Dr Wipavee Kong-in for their advice and their for capturing the many of the attributes of active aging for helpful comments on earlier versions of this manuscript. an elderly Thai sample. Our results supported the hypothesis that the AAS-Thai Disclosure demonstrated a statistically significant association with the The authors report no conflicts of interest in this work. closely related constructs measured by the HAI. 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Development and psychometric testing of the active aging scale for Thai adults

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Abstract

Journal name: Clinical Interventions in Aging Journal Designation: Original Research Year: 2014 Volume: 9 Running head verso: Thanakwang et al Clinical Interventions in Aging Dovepress Running head recto: Development of the active aging scale for Thai adults open access to scientific and medical research DOI: http://dx.doi.org/10.2147/CIA.S66069 Open Access Full Text Article O r I g I n A l r ese A r C h Development and psychometric testing of the active aging scale for Thai adults 1,2 Background: Active aging is central to enhancing the quality of life for older adults, but its Kattika Thanakwang 2,3 conceptualization is not often made explicit for Asian elderly people. Little is known about sang-arun Isaramalai active aging in older Thai adults, and there has been no development of scales to measure the Urai hatthakit expression of active aging attributes. Institute of n ursing, s uranaree Purpose: The aim of this study was to develop a culturally relevant composite scale of active University of Technology, n akhon ratchasima, Thailand; research aging for Thai adults (AAS-Thai) and to evaluate its reliability and validity. Center for Caring s ystem of Thai Methods: Eight steps of scale development were followed: 1) using focus groups and in-depth elderly, Faculty of n ursing, Prince interviews, 2) gathering input from existing studies, 3) developing preliminary quantitative mea- of songkla University, songkla, Thailand sures, 4) reviewing for content validity by an expert panel, 5) conducting cognitive interviews, 6) pilot testing, 7) performing a nationwide survey, and 8) testing psychometric properties. In a nationwide survey, 500 subjects were randomly recruited using a stratified sampling technique. Statistical analyses included exploratory factor analysis, item analysis, and measures of internal consistency, concurrent validity, and test–retest reliability. Results: Principal component factor analysis with varimax rotation resulted in a final 36-item scale consisting of seven factors of active aging: 1) being self-reliant, 2) being actively engaged with society, 3) developing spiritual wisdom, 4) building up financial security, 5) maintaining a healthy lifestyle, 6) engaging in active learning, and 7) strengthening family ties to ensure care in later life. These factors explained 69% of the total variance. Cronbach’s alpha coefficient for the overall AAS-Thai was 0.95 and varied between 0.81 and 0.91 for the seven subscales. Concurrent validity and test–retest reliability were confirmed. Conclusion: The AAS-Thai demonstrated acceptable overall validity and reliability for mea- suring the multidimensional attributes of active aging in a Thai context. This newly developed instrument is ready for use as a screening tool to assess active aging levels among older Thai adults in both community and clinical practice settings. Keywords: active aging, scale development, psychometric evaluation, culturally sensitive measure, Thai elderly Introduction With a growing aging population worldwide, the World Health Organization (WHO) has devoted considerable effort to encouraging all countries to promote quality of 1,2 life among older adults. As part of these efforts, the WHO has recently initiated a policy framework of active aging, defined as “the process of optimizing opportuni - ties for health, participation, and security in order to enhance quality of life as people Correspondence: Kattika Thanakwang Institute of nursing, suranaree University age”. The policy framework builds upon the premise that the vast majority of people of Technology, 111 University Avenue, of all ages, especially older people, want to be active participants and contributors Tambon, suranaree, Amphur Muang, nakhon ratchasima 30000, Thailand to society. The WHO argues that countries can afford to achieve quality of life for Tel +66 44 223 520 the aging population if governments, international organizations, and civil society Fax +66 44 223 506 email kattika@sut.ac.th enact “active aging” policies and programs that enhance the health, participation, submit your manuscript | www.dovepress.com Clinical Interventions in Aging 2014:9 1211–1221 Dovepress © 2014 Thanakwang et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further http://dx.doi.org/10.2147/CIA.S66069 permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Thanakwang et al Dovepress 2 2 and security of older citizens. However, active aging is a The WHO has also suggested that active aging is broad and internally complex notion. Although the concept influenced by cultural factors in addition to physical, cogni - is central to a global strategy for the management of aging tive, psychological, social, and environmental factors and 3,4 populations, active aging has been den fi ed in various ways economic resources. There is a need to explore how active across different countries and organizations. Countries need aging might be defined and perceived within the cultural to utilize the WHO’s active aging framework to conceptualize context of Thailand to illuminate those aspects of active aging active aging and its components within the context of their that are unique versus those that are common across cultures. own unique cultures and values. We attempt to add to the knowledge of active aging in older The extent to which older persons are active or productive adults by identifying the processes involved with being is of central interest to societies with growing numbers of actively engaged in life, and we present efforts to understand older people, and the need to understand how to age actively those components of active aging that are indigenous to older or productively is a challenge to all countries. Understanding Thai adults. Such knowledge is essential to anyone involved the processes associated with active aging has become a key in government agencies or scholarship research on aging, 5,7,8 focus for gerontological researchers. However, research and should be considered a prerequisite for policy-making on active aging has been plagued by a lack of consistency to promote active aging in Thailand. in the definition and measurement of the concept. This may Establishing the meaning and definition of active aging stem from the multidimensional attributes of active aging, for Thai adults is an essential preliminary step towards iden- which depend upon a variety of influences or determinants tifying attributes for use in scale development. A standard surrounding elderly individuals, families, and nations. The and culturally sensitive instrument, which covers diverse lack of a consistent definition is reflected in the wide range dimensions of active aging in Thailand, is essential to assess of models and indicators found in the literature covering levels of active aging. This type of scale would form the different approaches to the study of active aging. scientific basis for systematic assessment and intervention Research on active aging has grown over recent decades, designed to enhance the active aging and quality of life of but theories continue to be based overwhelmingly on Western Thai older people. Therefore, this study aimed to develop studies that may not be applicable to ethnoculturally diverse a culturally relevant composite scale of active aging for societies, such as those in Asian countries. This is regrettable Thai adults (AAS-Thai) and to evaluate its reliability and given the substantial cultural differences between East and validity. We surveyed a large sample of older Thai adults West; for example, the strong emphasis on independence and analyzed their perceptions and understanding of active in the West as contrasted with Thai persons’ acceptance of aging using this new tool. interdependence. The measurement of culturally-specific variables using measures developed in other parts of the Materials and methods world can be problematic due to differences in cultural The procedure we used to develop a comprehensive, cultur- contexts. The development of culturally-sensitive measures ally sensitive measure for older Thai adults was based on for research on aging in a particular context has proved the multistep strategy outlined by Ingersoll-Dayton. The challenging. first step involved conducting focus groups and in-depth There have been only a few studies on active aging in interviews. To identify culturally meaningful domains of Thailand. Kespichayawattana and Wiwatvanich explored active aging for elderly Thai adults, we used a qualitative active aging attributes in elite Thai elderly adults, and approach to conduct focus groups and in-depth interviews Nantsupawat et al focused on active aging in older Thai with 64 older adults. This initial step identified six domains adults living in one rural village in the northeastern region of of active aging experienced by the participants (for more the country. To our knowledge, little is known about active details, see Thanakwang et al). aging in lay older Thai adults. Specifically, there have been In the second step, we reviewed existing studies of active no attempts to develop scales to measure the expression of and positive aging, focusing particularly on studies of elderly 8,12,13,15–17 active aging in large samples, perhaps because of a lack Thai adults. We examined the literature for reference of expertise in developing this type of instrument. Thus, a to factors of active aging similar to the six dimensions of standard and culturally sensitive instrument, which covers active aging that had emerged from the interviews and focus multiple dimensions of active aging in Thai adults, needs to groups. Combining the input from other studies with n fi dings be developed. from the present study provided a comprehensive insight submit your manuscript | www.dovepress.com Clinical Interventions in Aging 2014:9 Dovepress Dovepress Development of the active aging scale for Thai adults into active aging domains and facilitated the development of the items of the AAS-Thai were easy to understand by all of some closed-ended items. participants, and only minor rewording was suggested. It The third step was to develop a preliminary quantitative was also noted that some words were redundant, and some measure, generating an item pool from the specie fi d domains questions were considered to be too long. Using data obtained of active aging obtained. According to DeVellis, several from the respondents’ perceptions and interpretations, prob- processes are necessary to generate an item pool; for example, lematic items with the potential to elicit response error were developing conceptual definitions of each specified domain, revised, ensuring the comprehensibility and practicality of formulating operational definitions of the domains, identify - the scale for lay older adults in Thailand. ing observable indicators of each domain, and constructing The participants in our sample of ten suggested that a blueprint of the item matrix. We incorporated words and the 5-level scale format was too long and quite difficult for phrases from the study participants’ statements. The initial older adults to respond to. Attributes of active aging do not, item pool consisted of 81 items within six domains. of course, relate solely to perceptions, but constitute the In the fourth step, the 81 items were reviewed by a panel reality of everyday life. Therefore, in order to improve the of seven experts specializing in multidisciplinary areas rel- clarity and practicality of the scale, the number of response evant to the study (ie, two experts on gerontological nursing, categories was reduced to a 4-level scale format. We revised one on geriatric medicine, one on social gerontology, one on the response set to incorporate different degrees of truth population development, one on linguistic and cultures, and (ranging from “not at all true” to “very true”), which was one on instrument development). The experts were instructed more easily understood by the respondents. The response to rate each item on a 4-point scale based on relevance and choices appeared as 1 (not at all true), 2 (slightly true), 3 appropriateness, ranging from 1 (not relevant), 2 (some- (somewhat true), and 4 (very true). This format was deemed what relevant), 3 (quite relevant), to 4 (highly relevant). In most appropriate to measure the process of active aging in addition, the experts were asked to evaluate the clarity and elderly people; it had fewer choices and no middle choice, conciseness of the closed-ended items of the AAS-Thai by which prevents middle-point choosing, a typical habit of using “yes” or “no” responses on each item. They were also elderly Thai adults. Finally, the third draft, 60-item scale invited to suggest revised wordings for any items that seemed using a 4-point Likert type scale was finalized. ambiguous, unclear, or inappropriate. The content validity of In step 6, the 60-item AAS-Thai was pilot-tested in one the measure was based on the expert concurrence using the community using a convenience sample of 30 older adults. content validity index (CVI), calculated for category evalu- Preliminary psychometric testing with the 60-item scale ation and item evaluation. Values on the CVI greater than was carried out using item analysis. Three criteria were or equal to 0.80 indicated an acceptable content validity of used in the process of deciding which items to retain: 1) the instrument. For this study, the overall CVI was 0.91. a minimum interitem correlation of 0.20 and a maximum of The items rated at levels 3 or 4 were retained, whereas those 0.70, 2) a minimum corrected item–total correlation coef- rated at levels 1 or 2 by three or more experts were deleted ficient of 0.30, and 3) a minimum Cronbach’s reliability of 20,21 or modified according to the experts’ suggestions. In total, 0.70. Five items (items 4, 12, 14, 17, and 32) were deleted 21 items were deleted; the final questionnaire contained since they had corrected item–total correlation coefficients 60 items. of less than 0.30. Three items (items 11, 13, and 34) were The fifth methodological step was to conduct cognitive deleted because they had interitem correlations of less than interviews with ten active elderly Thai adults, who were 0.20. Furthermore, five items (items 28, 29, 43, 44, and 46) members of the Health Promotion and Rehabilitation Center were removed since they had interitem correlations higher for the Elderly, Faculty of Nursing, Prince of Songkla Uni- than 0.8 suggesting redundancy. This process culminated versity, Thailand. In recruiting these individuals, efforts were in a 47-item scale. The alpha coefficient for the overall made to ensure that they had the capacity to think about the scale was 0.97, and the six subscales ranged from 0.81 to clarity of the closed-ended items from their own perspective 0.92, indicating good internal consistency. The corrected as well as from the perspective of older Thai people with less item–total correlations among the remaining 47 items were education. A think-aloud question and a probing question between 0.44 and 0.79. were used in conjunction to explore participants’ general In steps 7 and 8, this version of the AAS-Thai was tested perceptions as well as their reactions to specific aspects of by means of a nationwide survey, and further psychometric the questions. The participants’ review indicated that most testing was conducted to examine the validity and reliability submit your manuscript | www.dovepress.com Clinical Interventions in Aging 2014:9 Dovepress Thanakwang et al Dovepress of this newly developed measure of active aging for Thai was selected. The inclusion criteria were 1) being an older adults. The sample and setting, instrument, data collection, person who is dwelling in the community, 2) being aged and data analysis are detailed in the next section. 60 years or older, 3) not suffering severe disabilities, severe dementia, or psychiatric disorders, and 4) being able to under- sample and setting stand and speak Thai. If any household had more than one The sample size was chosen according to MacCallum older person who met the inclusion criteria, simple random et al’s method of determining sample size in factor analysis. sampling was conducted by putting all their names in the A minimum of five to ten samples per item is recommended pool and selecting one. 19,21 for the psychometric evaluation of a new measure. Specifically, MacCallum et al recommend that a sample Instruments size of 500 or more in factor analytic studies is excellent. The fourth draft of the AAS-Thai, which was revised after We therefore obtained a sample of 500 participants to test the pretesting step and included a demographic data form, the scale. As our aim was to conduct a national survey, was used as an instrument. The Healthy Aging Instrument the sample was randomly selected from four regions (HAI) was used to examine construct validity. of the country (central, north, northeast, and south) using The HAI was developed by Thiamwong et al for use the stratified sampling technique to make it representative with elderly Thai participants. The HAI consists of 35 items to Thai older adults. and a 4-point rating scale (1–4). There are nine components: A v fi e-stage random sampling method was used to select 1) being self-sufc fi ient and living simply, 2) managing stress, the study subjects: 3) having social relationships and support, 4) making merit 1. Selecting provinces: one province of each region of and good deeds, 5) practicing self-care and self-awareness, Thailand (north, northeast, central, and south) was 6) staying physically active, 7) staying cognitively active, randomly selected. They were Nan (north), Nakhon 8) having social participation, and 9) accepting aging. The Ratchasima (northeast), Kanchanaburi (central), and HAI demonstrates good validity and reliability (Cronbach’s Songkla (south). alpha =0.88). 2. Selecting districts: one district of each province selected in stage one was randomly selected using a ballot method Procedure without replacement, yielding four districts for the Prior to data collection, the research protocol was approved study. by the Institutional Review Board of the Faculty of Nurs- 3. Selecting subdistricts: two subdistricts (or “tambons”) ing, Prince of Songkla University, Thailand according to the of each selected district, one in an urban area (munici- tenets of the Declaration of Helsinki. Anonymity, privacy, pal) and another in a rural area (nonmunicipal), were and the right to withdraw from the study without negative selected by simple random sampling, resulting in eight consequences were guaranteed. Confidentiality was main - subdistricts. tained in all data collecting and analysis processes, reports, 4. Selecting villages/communities: two villages/ communities and subsequent publications. of each selected subdistrict were recruited using simple Data were gathered from January to April 2013. Face- random sampling. This yielded 16 villages/ communities; to-face interviews were conducted in each respondent’s eight located in urban areas and eight in rural areas. home by researchers and trained interviewers. Before 5. Selecting household and respondents: from a total informed consent was given, respondents were informed number of older adults (2,778) in 16 selected villages/ of the overall purposes and protocols of the study and of communities, the number of possible subjects was the time required to complete it. Those participants who calculated proportional to the size of each village or met all eligibility criteria were then fully enrolled in the community. The proportion sampled for this study was study. The participants who were educated or well-read 0.18 (equal to 500/2,778). were asked to fill out a demographic sheet and to complete To select households according to the calculated number the questionnaire themselves. Researchers assisted nonlit- of the study sample in each village, we conducted system- erate participants or those with any limitations by slowly atic random sampling using household lists. One elderly reading the questionnaire aloud and then asking them to respondent per household, who met the inclusion criteria, rate each item. submit your manuscript | www.dovepress.com Clinical Interventions in Aging 2014:9 Dovepress Dovepress Development of the active aging scale for Thai adults statistical analyses problems, for example, insignificant loadings, too many low Data were analyzed using the SPSS 14.0 software package for communalities, and cross-loadings. The f fi th step was to label Windows (SPSS Inc., Chicago, IL, USA). Sociodemographic the extracted factors according to the meaning of the items characteristics of the respondents were first analyzed using loading on them. descriptive statistics. We calculated internal consistency Construct validity was examined through concurrent of the scale and carried out an item analysis and a factor validity. Concurrent validity examines the extent to which a analysis. measurement scale under development correlates with other Internal consistency reliability was examined by analyz- scales that are designed to assess closely related constructs. ing across items within the scale using internal consistency As the concepts of healthy aging and active aging may and item analysis. We used Cronbach’s alpha coefficient to be interconnected, we hypothesized that active aging is measure reliability for the overall scale and its subscales. positively associated with healthy aging. Concurrent valid- A Cronbach’s alpha value of 0.70 and above indicates suf- ity between AAS-Thai and HAI was assessed by Pearson’s ficient internal consistency for a new tool. correlation coefficient. Item analysis was further performed to check whether We used a test-retest technique to evaluate the stability the scale had acceptable internal consistency. This is one of of the AAS–Thai. Data obtained from two different points the statistical techniques used to investigate the pattern of in time were analyzed using Pearson’s product moment cor- responses for each item of the scale, and it provides a basis relation coefficient to estimate scale stability. The closer the for revisions to improve the effectiveness of test items and coefficient is to 1.00, the more stable the measurement. the validity of test scores. Following recommendations of Results the criteria for item analysis proposed by Ferketich and Nunnally and Bernstein, items of the AAS-Thai were sample characteristics examined, and decisions were made as to which items were The 500 participants were older Thai adults living in com- to be retained, revised, or deleted. munities across four regions of Thailand. About two-thirds Exploratory factor analysis (EFA) was used to condense of them (64%) were female. Ages of the sample ranged and group highly correlated items together to create a new from 60 to 96 years, with a mean of 71 years (standard composite factor that represented each group of items. deviation =7.88), and half of them (50%) were young elderly, Before conducting EFA, the Kaiser–Meyer–Olkin value was aged 60 to 69 years. Most of them (88%) were Buddhist. obtained to determine whether the sample was adequate; More than half (54%) of the subjects were married and liv- we also carried out Bartlett’s test of sphericity, which tests ing with their spouses. Most of them (69%) had completed whether there is sufficient correlation between the variables primary school (grade 4), and about 76% were able to read and hence justification for the factor analysis. We then and write. The majority of them (52.8%) were not working. performed an EFA using 1) factor extraction using principle With regard to economic status, about one-fourth of them component analysis and 2) factor rotation using the varimax (26%) had a monthly income of 500–1,000 Baht, and nearly method. An eigenvalue equal to or greater than 1.0 is consid- one-third (31%) had an annual income lower than the poverty ered as a criterion to determine the number of components line (12,000 Baht). About 28% of them suffered from income to retain. Following the process of factor interpretation insufc fi iency. More than half (54%) lived in urban areas. The outlined by Hair et al we conducted the analysis in v fi e steps. majority of them (82%) coresided with adult children, and We first examined the factor matrix of loadings, focusing about 12% coresided with only a spouse. on the factor pattern matrix. It is recommended that factor loadings of 0.40 and higher have practical significance. We Psychometric analyses then examined the magnitude and signic fi ance of the loadings Item analysis on each variable, and we also examined any cross-loadings. The 47-item AAS-Thai was analyzed to examine the inter- Thirdly, we assessed communalities (the amount of vari- item correlation, intersubscale correlation, and item–total ance accounted for by the factor solution). A communality correlation. The results showed that the interitem correla- score of less than 0.50 was considered as not explaining tions ranged from 0.18 to 0.74, the intersubscale correlations enough variance. The fourth step was to respecify the factor ranged from 0.34 to 0.80, and the item–total correlation model if necessary in the event of finding any one of several coefficients ranged from 0.16 to 0.75. However, two items submit your manuscript | www.dovepress.com Clinical Interventions in Aging 2014:9 Dovepress Thanakwang et al Dovepress (item 22 and 23) had item–total correlations of less than 0.30 accounted for 68.53% of the total variance. The seven factors, 20,21 and were removed. The 45-item AAS-Thai was retained corresponding eigenvalues, percentage of variances and reanalyzed. The results showed that the interitem correla- accounted for by each factor, and cumulative percentages tions ranged from 0.27 to 0.74, the intersubscale correlations of variance are presented in Table 1. All of the 36 retained ranged from 0.44 to 0.80, and the item–total correlation coef- items had loading values greater than 0.40 on only one of the ficients ranged from 0.36 to 0.76. The alpha coefficients of seven factors and could be meaningfully explained in terms of the six subscales ranged from 0.82 to 0.91, and the reliability their corresponding components. The factor loadings ranged for the total scale was 0.96, which is considered excellent. from 0.45 to 0.89, with statistical significance ( P0.001). The communality values ranged from 0.54 to 0.87, indicat- exploratory factor analysis ing that the extracted factors explained a high proportion EFA using principal component analysis with varimax rota- of item variance (see Table 2). The new seven factors of tion was performed. The criteria used to consider the number active aging were optimal, concise, theoretically organized, of factors were 1) an eigenvalue greater than 1; 2) scree and presented a simple structure. These factors were named 21,24 plot characteristics; and 3) interpretability. Specifically, with respect to the process of being actively engaged in life: items were removed when 1) the item-factor loading was 1) being self-reliant, 2) being actively engaged with society, below 0.40; 2) the loading(s) on each variable was (were) 3) developing spiritual wisdom, 4) building up financial insignificant; 3) the communality score was less than 0.50; security, 5) maintaining a healthy lifestyle, 6) engaging in 4) the cross-loadings indicated relatively high loadings on active learning, and 7) strengthening family ties with respect more than one factor; and 5) the item did not contribute to to being cared for in late life. 18,21,24 factor interpretability. The results indicated that seven The overall internal consistency reliability of the scale factors had a cumulative percentage of variance of 67.51%. was 0.95, indicating that it is a reliable instrument for mea- All factor loadings were greater than 0.40 with statistical suring the multidimensional attributes of active aging. The significance. However, nine items (items 7, 14, 21, 27, 28, Cronbach’s alpha coefc fi ients for the seven subscales ranged 34, 39, 40, and 41) were eliminated since they had relatively from 0.81 to 0.91. The correlations between subscales ranged high loadings on more than one factor. The remaining 36-item from 0.30 to 0.65, and the correlations between the seven AAS-Thai draft was then reanalyzed. subscales and the entire scale ranged from 0.56 to 0.87 with The results of this last factor analysis with varimax statistical significance ( P0.001), as shown in Table 3. rotation showed a Kaiser–Meyer–Olkin value of 0.933, indicating sample adequacy for factor analysis. Bartlett’s Concurrent validity test of sphericity was significant ( χ =12595.21, P0.001), Concurrent validity of the AAS-Thai was tested by examin- indicating the appropriateness of the data for further fac- ing possible relationships with the Healthy Aging Scale, tor analysis. In the end, seven factors with eigenvalues a theoretically relevant scale, to compare the scale with greater than 1 were generated and 36 items retained. The previously established, conceptually related variables. With eigenvalues ranged from 5.77 to 1.65, and all components regard to the hypothesis that active aging is positively related Table 1 Total loading, percent of variance, and cumulative percentage of the final draft 36-item AAS-Thai classified by eigenvalues greater than 1 Factor Extraction sums of square loading Rotation extraction sums of square loadings Total % of variance Cumulative % Total % of variance Cumulative % 1 13.834 38.427 38.427 5.773 16.037 16.037 2 2.635 7.320 45.747 4.970 13.805 29.842 3 2.401 6.670 52.417 3.577 9.936 39.778 4 1.737 4.824 57.241 3.131 8.697 48.474 5 1.650 4.583 61.824 2.865 7.960 56.434 6 1.279 3.553 65.377 2.709 7.525 63.959 7 1.135 3.154 68.531 1.646 4.572 68.531 Notes: The seven factors of active aging: 1, being self-reliant; 2, being actively engaged with society; 3, developing spiritual wisdom; 4, building up financial security; 5, maintaining a healthy lifestyle; 6, engaging in active learning; 7, strengthening family ties to ensure care in later life. Abbreviation: AAs-Thai, scale of active aging for Thai adults. submit your manuscript | www.dovepress.com Clinical Interventions in Aging 2014:9 Dovepress Dovepress Development of the active aging scale for Thai adults Table 2 Factor loading of each item and factor of the 36-item AAs-Thai Item Factor Communality 1 2 3 4 5 6 7 1 0.80 0.71 2 0.76 0.69 11 0.72 0.69 9 0.68 0.68 3 0.67 0.59 13 0.65 0.65 42 0.63 0.61 15 0.55 0.55 24 0.74 0.79 26 0.73 0.62 32 0.73 0.68 25 0.69 0.79 31 0.69 0.64 30 0.67 0.62 12 0.62 0.70 29 0.61 0.65 37 0.89 0.87 38 0.87 0.82 36 0.70 0.62 33 0.61 0.59 35 0.60 0.54 44 0.87 0.87 43 0.84 0.85 45 0.71 0.66 8 0.48 0.56 19 0.81 0.69 18 0.72 0.74 20 0.71 0.71 17 0.54 0.69 16 0.45 0.66 5 0.78 0.69 4 0.68 0.71 6 0.60 0.62 10 0.57 0.66 46 0.68 0.73 47 0.68 0.72 Notes: The seven factors of active aging: 1, being self-reliant; 2, being actively engaged with society; 3, developing spiritual wisdom; 4, building up financial security; 5, maintaining a healthy lifestyle; 6, engaging in active learning; 7, strengthening family ties to ensure care in later life. Abbreviation: AAs-Thai, scale of active aging for Thai adults. Table 3 Correlation coefficients of subscale to subscale and subscale to entire scale, and alpha coefficients of the final draft 36-item AAs-Thai (n =500) Scale 1 2 3 4 5 6 7 Cronbach’s alpha 1. Being self-reliant 1.00 0.91 2. Being actively engaged with society 0.65* 1.00 0.91 3. Developing spiritual wisdom 0.46* 0.51* 1.00 0.86 4. Building up financial security 0.58* 0.51* 0.43* 1.00 0.85 5. Maintaining healthy lifestyle 0.60* 0.50* 0.45* 0.48* 1.00 0.81 6. engaging in active learning 0.62* 0.63* 0.40* 0.45* 0.38* 1.00 0.82 7. strengthening family ties to ensure 0.46* 0.36* 0.40* 0.50* 0.48* 0.30* 1.00 0.85 care in later life 8. entire scale 0.87* 0.86* 0.67* 0.73* 0.71* 0.74* 0.56* 1.00 0.95 Note: *P0.001. Abbreviation: AAs-Thai, scale of active aging for Thai adults. submit your manuscript | www.dovepress.com Clinical Interventions in Aging 2014:9 Dovepress Thanakwang et al Dovepress Table 4 Pearson’s correlation coefficients between the AAS-Thai context as an alternative to importing standardized Western and hAI (n =30) instruments that may not be relevant to Eastern cultures. Scale HAI The active aging scale for Thai adults (AAS-Thai) can be 1. Being self-reliant 0.64* assumed to be a culturally sensitive instrument because the 2. Being actively engaged with society 0.65* items emerged from the indigenous perspectives of lay older 3. Developing spiritual wisdom 0.61* adults in Thailand. 4. Building up financial security 0.64* 5. Maintaining healthy lifestyle 0.63* 6. engaging in active learning 0.65* seven factors of the AAs-Thai 7. strengthening family ties to ensure care in later life 0.55* The factor analysis supported the proposition that the AAS- 8. entire scale 0.84* Thai assesses the multidimensional nature of active aging or Note: *P0.001. Abbreviations: AAs-Thai, scale of active aging for Thai adults; hAI, healthy Aging the process of being actively engaged in life. Instrument. The first important factor of active aging is being self- reliant, which is the factor that explains the greatest variance to healthy aging, the findings indicated that the AAS-Thai on the AAS-Thai. This factor included eight items represent- had a significant positive association with the HAI ( r=0.84, ing a person’s ability to independently take care of himself/ P0.001), and that the subscales of the AAS-Thai had sig- herself and includes tasks related to family-care (performing nificantly strong associations with the HAI ( r=0.55–0.65, various activities in the household). From the perspective of P0.001), indicating the satisfactory construct validity of older adults, being able to do what they wish is meaningful for the AAS-Thai (see Table 4). their autonomy and implies that they are able to manage their 26–28 lives on their own. Having meaningful activities in daily Test–retest reliability life that keep elderly individuals busy makes them proud that To evaluate the stability of the n fi al draft 36-item AAS-Thai, they are independent and not a burden on others. This notion test–retest reliability within a 2-week interval was examined is consistent with the valued concept of individualism among using 30 community-dwelling elderly participants. The mean elderly Western people. Many Western scholars point out score of the AAS-Thai at time one was 105.03, and the that active aging is based on the concept of selfhood, which mean score at time two was 106.80. The Pearson correlation assumes that elderly individuals must have self-responsibility 27,29 coefficient between the two sets of scores was 0.92, indicat - and self-care for their own life. However, the findings ing good stability. In addition, the correlations of the seven of the present study expand upon the Western concept of subscales between time one and time two ranged from 0.78 self-reliance; among elderly Thai adults, this capacity is not to 0.92 (see Table 5). The results indicate that the 36-item only focused on self-caring but also incorporates the notion AAS-Thai is stable in terms of its test–retest reliability. of caring for family. This rationale may come from the col- lectivistic nature of the Thai culture, in which people are Discussion considered to be fundamentally interdependent; therefore, This study attempted to highlight the importance of develop- the self is viewed as interconnected, and people are mutually 15,30 ing a culturally relevant measure of active aging within a Thai responsible for one another. This n fi ding is congruent with Table 5 stability estimates of the total scores for AAs-Thai in time one and time two Scale AAS-Thai time one AAS-Thai time two r Mean SD Mean SD 1. Being self-reliant 27.57 4.96 28.00 4.00 0.88* 2. Being actively engaged with society 19.13 6.82 20.20 5.60 0.92* 3. Developing spiritual wisdom 16.27 2.03 16.07 1.93 0.81* 4. Building up financial security 9.53 3.74 9.40 3.35 0.90* 5. Maintaining healthy lifestyle 15.50 3.08 15.73 2.33 0.85* 6. engaging in active learning 10.20 3.12 10.57 2.43 0.78* 7. strengthening family ties to ensure 6.83 0.95 6.83 0.83 0.89* care in later life 8. entire scale 105.03 18.71 106.80 14.23 0.92* Note: *P0.001. Abbreviations: AAs-Thai, scale of active aging for Thai adults; sD, standard deviation. submit your manuscript | www.dovepress.com Clinical Interventions in Aging 2014:9 Dovepress Dovepress Development of the active aging scale for Thai adults research by Nantsupawat et al suggesting that active aging related to spiritual wisdom; thus, this component of active incorporates activities that benefit both elderly individuals aging may be unique to elderly Thai people. and their families. Building up financial security (factor 4) was character - Being actively engaged with society (factor 2) incorpo- ized as preparing financially for later life and for funerary rated eight items, including engaging in social participation activities as well as having enough money for daily expenses. and social contribution. These findings reflect the fact that This component was extracted from the initial conceptual elderly Thai adults perceive active aging as not just about framework by EFA. This finding is congruent with numer - being self-reliant but also about participating and contributing ous previous findings, suggesting that financial security has 7,12 in the community and society at large. All countries require been associated with active aging, including successful the participation of active or productive elderly people; in aging. Being financially secure maximizes one’s sense of Thailand, this requirement is included in the national plan security and autonomy. Numerous studies have indicated for older people. Maintaining socially active engagement is that financial security is considered crucial by elderly Thai 8,12,13,38 5 evident in a myriad of meaningful activities through which adults. However, a study by Bowling argued that the elderly connect with others and contribute to the whole some elderly British participants also mentioned finances as society. Therefore, productive engagement has been identi- a constituent of active aging. Thus, n fi ancial security may be e fi d as an important indicator of active aging. Elderly people significant for elderly Thai since most of them have limited can make many social and economic contributions that are of income stability and depend on financial support from their great value to older people themselves, to their families, as children. Moreover, the importance of predeath preparations 9,13,32 well as to society at large. In other words, it can be said for financial security is probably uniquely found in research that active aging implies the utilization of older people’s life on elderly Thai people. In Thailand, elderly people prepare competences as part of the human capital within society. for their funerals by becoming a member of a community Developing spiritual wisdom (factor 3) was also identi- funeral fund to ensure that their children will have enough 8,13 fied as an important aspect of active aging. This component money to arrange their funerals. involves having inner strength and calmness, including The five items that loaded on factor 5 (maintaining a trusting in religion and making merits. It is widely agreed healthy lifestyle) identified key aspects of health-promoting that spiritual growth is an important aspect of living a human- behaviors, such as eating healthy food and practicing physical istic and meaningful life, which involves “going beyond”, activity or exercise. This suggests that those elderly adults enabling one to contribute to a meaningful relationship with who practice healthy lifestyles experience more active aging. others and relating to God, religion, or transcendence. This finding is consistent with numerous studies suggesting Ardelt defines wisdom as an integration of cognitive, that a health promoting lifestyle has a strong association with 15,16 39 40 reflective, and affective (compassionate) characteristics in healthy aging and successful aging. Bowling indicated relation to understanding the truth of life, engaging in self- that elderly British people also define active aging in terms examination to develop self-awareness and self-insight, of good physical health and fitness, identifying exercise as and decreasing self-centeredness; the embodiment of these a key part of this. characteristics tends to result in compassionate love and Engaging in active learning (factor 6) consisted of four concern for the welfare of others. The majority of elderly items reflecting the capacity of an elderly individual to learn Thai people are Buddhist. The Thai people rely heavily on about new information technologies to make them cogni- their Buddhist doctrines of doing good deeds as a way of tively active and healthy. This n fi ding suggests that engaging 15,17 “making merit”. As one gets older, one has more wisdom in active lifelong learning is important for older adults in and free time to be involved with higher forms of religious Thailand, consistent with the findings of many prior studies activities, engaging in mental development (meditation) and that have confirmed that continued learning is important for 7,27,41 teaching the doctrine, or showing truth to others, activities active aging. At present, lifelong learning is imperative that are considered as rendering more merit. In Thailand, it for older adults in an era of modernization, in which tech- is not surprising that positive spirituality has been identified nologies are rapidly changing. There is a variety of ways for 15–17 8 as the key indicator of healthy aging and active aging. elderly people to extend their formal and informal learning This concept is considered by older Thai people to be an over the course of their lives. Thus, policies to promote important component of active or productive aging. Active lifelong learning for older people in relation to their interests aging as defined by the WHO does not incorporate an aspect and circumstances should be established. submit your manuscript | www.dovepress.com Clinical Interventions in Aging 2014:9 Dovepress Thanakwang et al Dovepress The final factor of active aging that we identified was study limitations termed “Strengthening family ties to ensure care in later There are some limitations in this study that should be life” (factor 7). This consisted of two items: strengthening noted. First, the study results may be biased by participants family ties and teaching children about filial piety. This responding in a socially desirable manner in order to pres- dimension concerns activities engaged in by parents to ent themselves in a positive light, particularly if they were ensure that their children will care for them when they are interviewed in the presence of family members or neighbors. old or frail. This finding is congruent with a few studies Future use of the AAS-Thai should incorporate simultane- in the Western context, but is more frequently the sub- ous social desirability testing to confirm that these findings ject of research on Eastern cultures, particularly that of are not subject to bias. Second, this study did not compare 8,13 Thailand. It is prominently within the Thai context that standardized active aging or healthy aging scales developed elderly support is expected by family members, based on for use with Western samples. Thus, we were unable to social norms such as filial piety and reciprocal exchanges. examine which factors are culturally specific and which are If children respect and care for older parents, it helps universally applicable across different cultures. A future older parents feel that they have succeeded in nurturing comparison with a Western active aging scale would be use- 10,14 and teaching their offspring, ensuring that they will be ful to explore which dimensions of the AAS-Thai are unique secure in later life. and which are universal. Psychometric properties of AAs-Thai Conclusion The psychometric properties of the AAS-Thai were tested The AAS-Thai could potentially be the first culturally con - for two key issues: validity and reliability. With regard to textualized, relevant, and valid multidimensional scale of the construct validity, factor analysis and concurrent validity active aging in Thailand. Our study demonstrated that the were examined. For the reliability, internal consistency and 36-item AAS-Thai has satisfactory validity and reliability for test–retest reliability were calculated. assessing active aging levels among older Thai adults, sug- The results of the EFA indicated that the 7-factor AAS- gesting that it could be used in both community and clinical Thai with the retained 36 items is a well-constructed instru- practice settings. ment for measuring active aging in Thai people. All items had loading values greater than 0.40 and loaded on only one Acknowledgments factor, suggesting that the underlying factors are meaningful. KT, SI, and UH conceived and designed the research. KT was The communalities were greater than 0.50, indicating that the responsible for data collection. KT and SI were responsible extracted factors satisfactorily explained the item variance. for data analysis. All authors contributed toward drafting and The eigenvalues of the seven factors ranged from 5.77 to revising the manuscript and have approved the final version. 1.65, and all components accounted for 68.53% of the total The authors wish to thank Professor Dr Berit Ingersoll-Day- variance, which is greater than 50% of explained variance ton, Associate Professor Dr Aranya Chowalit, and Assistant for the factors, indicating that the AAS-Thai is adequate Professor Dr Wipavee Kong-in for their advice and their for capturing the many of the attributes of active aging for helpful comments on earlier versions of this manuscript. an elderly Thai sample. Our results supported the hypothesis that the AAS-Thai Disclosure demonstrated a statistically significant association with the The authors report no conflicts of interest in this work. closely related constructs measured by the HAI. 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