📄 social_science

Development and Evaluation of the Psychometric Properties of the Elder Neglect and Abuse Awareness Scale

This methodological study developed and validated a two-dimensional Elder Neglect and Abuse Awareness Scale, demonstrating its validity and reliability through robust statistical analyses of data collected from 512 healthcare professionals in Turkey.

Original authors: Bünyamin BAZYEL, Sezer AVCI

Published 2026-07-09

📖 5 min read🧠 Deep dive

CC BY 4.0

Original authors: Bünyamin BAZYEL, Sezer AVCI

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine the world's population is like a giant, growing tree. For a long time, the tree was full of young, sprouting leaves, but now, more and more of the branches are turning silver. This is the "aging population." While this is a natural part of life, it brings new challenges, specifically the risk that some of these silver branches might be neglected or hurt by those who are supposed to care for them. This is known as elder abuse and neglect.

The problem is that many people don't realize when this is happening, or they don't know what counts as abuse. It's like trying to fix a leak in a roof when you don't even know what a leak looks like.

This research paper is about building a flashlight to help people see these problems clearly. The researchers created a new tool called the Elder Neglect and Abuse Awareness Scale (ENAS). Think of this scale not as a test to grade people, but as a "thermometer" to measure how much the public (specifically healthcare workers in this study) knows and cares about the issue.

Here is how they built and tested this flashlight, explained simply:

1. Designing the Blueprint (The Creation)

The researchers started with a big pile of 40 questions (like 40 different colored lenses). They asked a panel of experts—people who know a lot about nursing, health, and psychology—to look at these questions.

The Filter: The experts said, "This question is great," "This one is okay but not quite right," or "Throw this one away."
The Result: They tossed out 5 questions that didn't make the cut, leaving a solid set of 35 questions to start with.

2. The First Test Run (The Pilot)

Before using the tool on a large group, they tried it out on a small group of 30 healthcare workers (doctors, nurses, etc.). This was like a "dress rehearsal" to see if the questions were confusing or if people were misinterpreting them. They made a few tweaks based on this practice run.

3. The Big Experiment (The Main Study)

The researchers then handed the scale to 512 healthcare professionals working in hospitals in Turkey. They split these people into two groups to test the tool in two different ways:

Group A (The Explorers): They looked at the answers to see what patterns naturally emerged. It's like looking at a box of mixed-up Lego bricks and seeing how they naturally snap together.
Group B (The Builders): They took the pattern Group A found and tried to build a specific structure to see if it held up under pressure.

4. What They Found (The Structure)

The "Lego bricks" (the questions) snapped together perfectly into two distinct towers:

Tower 1: Awareness of Abuse. This includes things like physical hitting, emotional yelling, or stealing money.
Tower 2: Awareness of Neglect. This includes ignoring someone's needs, not feeding them, or leaving them alone when they need help.

The study found that these two towers are separate but related. The tool successfully explained about 48% of the differences in how people think about these issues. In the world of research, that's a very strong signal.

5. Checking the Quality (Reliability and Validity)

To make sure this flashlight actually works and doesn't just flicker, the researchers ran several stress tests:

The "Shake" Test (Reliability): They asked the same group of people to take the test again four weeks later. The results were almost identical, proving the tool is stable and consistent. It's like a scale that gives you the same weight every time you step on it.
The "Fit" Test (Validity): They used complex math to check if the questions actually measured what they were supposed to measure. The numbers came back looking excellent, meaning the tool is accurate.
The "Expert" Check: They compared the answers of people who knew a lot about the topic versus those who knew very little. The tool successfully told the difference, proving it can spot high awareness from low awareness.

The Bottom Line

The researchers concluded that they have successfully built a reliable and accurate measuring stick for elder abuse and neglect awareness.

Just as a carpenter needs a good ruler to build a sturdy house, society needs good tools to understand and fix the problem of elder mistreatment. This new scale (ENAS) is that ruler. It allows researchers and doctors to measure exactly how much people know about the issue, which is the first step toward creating better training programs and laws to protect the elderly.

Important Note: The paper strictly focuses on building and testing this measuring tool. It confirms the tool works well, but it does not claim to have solved the problem of elder abuse itself, nor does it detail specific new laws or training programs yet—it simply provides the tool needed to design them.

Technical Summary: Development and Evaluation of the Psychometric Properties of the Elder Neglect and Abuse Awareness Scale (ENAS)

Problem Statement
The global demographic shift toward an aging population has exacerbated health and social challenges for the elderly, including a rising incidence of neglect and abuse. Despite estimates suggesting approximately 4% of the elderly population suffers from such maltreatment, these cases remain significantly underreported due to cultural variations in defining abuse and a lack of detection mechanisms. While healthcare professionals are positioned to identify these issues, existing literature indicates a gap in their knowledge and a lack of standardized tools to quantify societal awareness regarding elder neglect and abuse. The authors identified a need for a psychometrically sound instrument to assess awareness levels, facilitate educational program development, and inform social policies.

Methodology
This methodological study was conducted between September 2024 and May 2025 at Muş State Hospital and Malazgirt State Hospital in Turkey. The study population consisted of 512 healthcare professionals (including doctors, nurses, midwives, and geriatric care technicians). The research adhered to the Declaration of Helsinki and received ethical approval from Hasan Kalyoncu University.

The scale development process followed a rigorous sequence:

Item Generation: An initial pool of 40 items was developed based on a review of national and international literature regarding elder mistreatment.
Content Validity: A panel of 14 experts evaluated the items. Using Lawshe's technique, five items with a Content Validity Ratio (CVR) below the critical value were removed, resulting in a 35-item draft. The Content Validity Index (CVI) for this draft was 0.7836.
Pilot Study: A pilot test with 30 practitioners refined the instrument, leading to the final data collection phase.
Data Collection and Analysis: The total sample (N=512) was split into two groups: an Exploratory Factor Analysis (EFA) group (n=256) and a Confirmatory Factor Analysis (CFA) group (n=256).
- EFA: Utilized Principal Axis Factoring (PAF) with Promax rotation to determine the underlying factor structure.
- CFA: Employed the Weighted Least Squares Mean and Variance Adjusted (WLSMV) estimation method to validate the model fit.
- Reliability: Assessed via Cronbach's alpha, McDonald's omega, Composite Reliability (CR), item-total correlations, and test-retest reliability (using Intraclass Correlation Coefficients) over a four-week interval with a separate subgroup (n=45).
- Validity: Discriminant validity was tested using the Fornell-Larcker criterion and the Heterotrait-Monotrait (HTMT) ratio.

Key Results

Factor Structure: The EFA revealed a two-dimensional structure explaining 48.395% of the total variance. Factor 1 (Abuse) accounted for 30.284% of the variance, and Factor 2 (Neglect) accounted for 18.111%.
Item Reduction: Following the EFA, 11 items with loadings below 0.30 were excluded. During CFA, four additional items were removed due to high inter-item correlation and error variance overlap, resulting in a final 20-item scale (11 items for Abuse, 9 items for Neglect).
Model Fit: The CFA demonstrated excellent model fit indices: $\chi^2/df$ = 3.475, CFI = 0.966, TLI = 0.962, GFI = 0.990, NFI = 0.953, IFI = 0.966, SRMR = 0.056, and RMSEA = 0.070 (90% CI: 0.063–0.076).
Reliability:
- Internal Consistency: Both factors exceeded the 0.70 threshold. Factor 1 showed $\alpha$ = 0.925, $\omega$ = 0.924, and CR = 0.955. Factor 2 showed $\alpha$ = 0.891, $\omega$ = 0.890, and CR = 0.918.
- Item-Total Correlation: Corrected item-total correlations ranged from 0.416–0.531 for Factor 1 and 0.331–0.500 for Factor 2, surpassing the 0.30 threshold.
- Test-Retest: High temporal stability was confirmed with no statistically significant differences between pre- and post-test scores (p > 0.05). ICC values were 0.86 for Factor 1 and 0.82 for Factor 2.
Discriminant Validity: The square roots of the Average Variance Extracted (AVE) for both factors exceeded the inter-factor correlation (0.141), and the HTMT ratio (0.066) was well below the 0.85 threshold, confirming that the two dimensions are distinct constructs.
Discrimination Power: The scale successfully distinguished between high-performing and low-performing groups (top and bottom 27%), with significant differences in mean scores (p < 0.001).

Significance and Claims
The authors conclude that the Elder Neglect and Abuse Awareness Scale (ENAS) is a valid and reliable instrument for measuring societal awareness regarding elder neglect and abuse. The study claims that the scale addresses a critical gap in the literature by providing a tool that treats awareness as a multifaceted phenomenon encompassing knowledge, perception, attitude, and behavioral tendency.

The paper posits that the ENAS can be utilized to:

Identify current levels of public and professional awareness.
Guide the development of targeted educational programs and social policies.
Support clinical practice strategies and legislative regulations.
Serve as a foundation for future research in the field of elder maltreatment.

The authors emphasize that the scale's two-factor structure allows for independent or collective use of the "Abuse" and "Neglect" dimensions. They note that while the study was conducted with healthcare professionals, the tool is designed to assess broader societal awareness, potentially aiding in the detection of the "tip of the iceberg" regarding unreported elder abuse cases.