Conclusiones y recomendaciones de exámenes anuales

KAOPS (Kogan, 1961) was developed to ‘facilitate the study of attitudes toward old people with respect to norms and differences’ (p. 144). In order to do this, Kogan

66 (1961) utilised a six-point Likert scale, with 17 pairs of statements; each matching pair contains both a positive and a negative statement, which were intended to measure the same facet of the attitude held by an individual (appendix 3; pp. 239 - 240). Hence, there are 34 items in total, to which the respondent gives a score ranging from ‘strongly disagree’ (scoring one), to ‘strongly agree’ (scoring six) (Kogan, 1961). The range of scores for KAOPS is 34 to 204; the higher the score, the more positive the attitude.

KAOPS was adapted from a scale designed to measure attitudes toward ethnic minority groups, in view of Kogan’s (1961) assertion that older people could be classed as a minority group. This ‘adaptation’ involved the substitution of the word ‘ethnic’ with the word ‘old’. These items were supplemented with items from Kogan’s and his associates own intuitions about societal attitudes toward older people at the time (Kogan, 1961).

KAOPS has been used extensively in attitude change research within nurse education (cf. table 2.2; p. 64). However, the use of KAOPS in particular could be questioned, from a critical realist point of view. As already stated, the notion of context is particularly important within critical realism, and hence within this study (Danermark, et al., 2002). McLafferty (2007) criticised KAOPS for seeming to ignore context, in relation to nurses and their work with ill older people, measuring instead societal attitudes. Only Engstr m and Fagerberg (2011) and Rodgers and Gilmour (2011) concede this point, but suggest that they made the decision to use it based on the reported reliability of KAOPS. This is perhaps surprising, considering the importance of contextual referents within educational research (Hinds, et al., 1992). Only a tool that acknowledges the centrality of context would have been appropriate in this study, in view of its basis in critical realism. Deltsidou, et al., (2010) cite this absence of reference to the context of nurses’ work with ill older people as the

67 reason for utilising McLafferty’s Attitude Scoring Tool in their study. As McLafferty (2007, p. 84) notes, KAOPS, in particular, does not reflect the ‘specific conditions under which nurses work with older people’, and that ‘consideration must be given to the contextual impact on nurses’ attitudes’.

The internal consistency of KAOPS (1961) is repeatedly cited as the rationale for its use to measure attitudes within nursing (cf. table 2.2; p. 64). However, more recent work on KAOPS has revealed what the authors refer to as ‘major flaws’ in its internal consistency, in relation to the paired statements (Iwasaki and Jones, 2008, p. 145). Iwasaki and Jones (2008) were mindful of the fact that Kogan’s (1961) sample from his seminal work, where he validated KAOPS, was predominantly upper class and male. Hence, their approach necessarily involved a sample more representative of the population. In testing KAOPS, they found a weaker than expected relationship between the pairs of statements, which raises questions about its reliability. This, they suggested, was problematic, because each statement in the pair was intended to measure the same aspect of the attitude. So, although some of the researchers who used KAOPS to measure attitudes did their own estimation of its reliability for their particular population, it may be that failings in its actual design, highlighted by Iwasaki and Jones (2008), mean that alternate tools may now be more appropriate for the measurement of attitudes.

The final criticism of KAOPS (1961) relates to the age of the tool, having been developed in the 1960s (Matarese, et al., 2013). As they suggest, older people were ‘different then’ in terms of ‘life expectancy, health status and resources’, offering that perhaps measurement tools ought to reflect current society, by taking into account these variables (Matarese, et al., 2013, p. 182). It is perhaps remarkable, then, that they recommend KAOPS for use in future pre-test/post-test research [in Italy]. Using a tool that does not necessarily measure attitudes toward older people in today’s

68 society may be challenging, particularly in view of its apparent failure to take into account contextual factors (McLafferty, 2007). Additionally, using KAOPS, within a weak research design, as recommended by Matarese, et al., (2013), may not move the debate forward, in terms of if and how nurse education can influence the attitudes of nursing students.

The revised version of KAOPS was developed by Hilt and Lipschultz (1999). Based on their use of KAOPS in previous studies measuring the attitudes of television personnel, they revised the scale by reducing the number of items from 34 to 22. This revision was intended to make KAOPS less onerous to complete. However, the process by which the item pool was reduced is not explained in detail, and the essence of the remaining statements within the scale remain the same. Hence, the revised version could be criticised on the same grounds as the original version; it is still ignorant of the context in which nurses and nursing students work with ill older people.

McLafferty’s Attitude Scoring Tool (McLafferty, 2001) was used to measure attitudes in this study. The development of this tool, and the rationale for using it will be explained in chapter three.