Wednesday, 29 March 2017

Measuring intention to work with older people

A systematic review of psychometric testing of instruments that measure intention to work with older people

Che Chong Chin, Noran Naqiah Hairi, Chong Mei Chan

This systematic review summarizes the psychometric properties of instruments used to measure intention to work with older people among nursing students. This is done to identify the most suitable measurement instrument with good quality which then can be used to assess the student nurses’ intention during the nursing education.

The topic of this systematic review is crucial in anticipating the need for well-educated and motivated nursing workforce in order to face the ageing population. Preparation of future nurses to meet the health needs of older people is a critical concern for the nursing profession. However, caring for older people is complex and challenging in terms of the physical, psychological and social needs of patients. In addition the quality of healthcare services provided to the older population is strongly influenced by healthcare providers’ attitudes towards older people which has been shown to be the most significant predictor for intention to work with older people. On that account, it is very important to nurture student nurses with positive attitudes towards older people and further promote intention to work with the older population.

A psychometric systematic review was undertaken to retrieve published studies of instruments that measure intention to work with older people among student nurses. Eight database searches were conducted between 2006 and 2016. The COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) checklist was used to assess the methodological quality of intention measurement instruments. The COSMIN checklist uses a 4-point scale to classify each assessment of a measurement property, where 3=excellent, 2=good, 1=fair and 0=poor, based on the scores of the items in the corresponding COSMIN box (Terwee et al. 2011).

The key findings of our paper were:
  • Seven different instruments were identified for psychometric evaluation. 
  • Measures of reliability were reported in eight papers and validity in five papers. 
  • Evidence for each measurement property was limited, with each instrument demonstrating a lack of information on measurement properties. 
  • Based on the COSMIN checklist, the overall quality of the psychometric properties was rated as poor to good. Only SINOPS (Koskinen et al. 2016) achieved a good score on the methodological quality of internal consistency and structural validity. 
  • We conclude that it is not possible to recommend the most suitable instrument for measuring intention to work with older people.
Gerontological nursing education plays an important role to improve the quality of older persons care. This is done through enhancing geriatric competencies encompassing knowledge, skills and attitudes of the student nurses. Ultimately, the goal will inspire student nurses to work with older people after they graduated. As postulated in the Theory of Planned Behavior (Ajzen 1991), intention to work with older people can be used as a proxy measurement of working with older people after they graduate. Nursing educators will then be able to evaluate the effectiveness of gerontological nursing teaching and learning process by assessing students’ intention to work with older people. With this in mind, it is very important to identify a psychometrically sound instrument to measure intention towards caring for our older people.


Ajzen I. (1991) The theory of planned behavior. Organizational Behavior and Human Decision Processes 50(2), 179-211.

Che C.C., Hairi N.N. & Chong M.C. (2017) A systematic review of psychometric testing of instruments that measure intention to work with older people. Journal of Advanced Nursing. doi: 10.1111/jan.13265

Koskinen S., Salminen L., Puukka P. & Leino-Kilpi H. (2016) Learning with older people--Outcomes of a quasi-experimental study. Nurse Education Today 37, 114-122. doi: 10.1016/j.nedt.2015.11.018

Terwee C. B., Mokkink L. B., Knol D. L., Ostelo R. W., Bouter L. M. & de Vet H. C. (2011) Rating the methodological quality in systematic reviews of studies on measurement properties: a scoring system for the COSMIN checklist. Quality of Life Research 21(4), 651-657. doi: 10.1007/s11136-011-9960-1.

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