Eliminating an item with a negative corrected item-total correlation and two more Lonetto and Templer  defined death anxiety as an individual’s . una muestra de estudiantes a tres escalas de ansiedad ante la muerte y. Concurrent and divergent validity of the Spanish form of Templer’s Death Escala de Ansiedad ante la Muerte (Death Anxiety Scale: DAS). de Templer . PDF | On Jan 1, , Joaquín T. Limonero and others published Ansiedad ante la muerte. [Death anxiety].
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A sample of nursing students answered Fear of Death and Attitude toward death scales.
Content validity was checked by expert review; reliability was proven using Cronbach’s alpha; statistical analysis of the items, correlation between items and construct validity were checked by the correlation of the Scale with the Attitude toward death Scale.
The multidimensionality of the scale was fe through factor analysis with varimax rotation. The Fear of Death Scale possesses good dee consistency and construct validity, confirmed by the significant correlation with the Attitude toward death Scale. Factor analysis partially supports content validity of the subscale items, but presented a modified multidimensional structure that points towards the reconceptualization of the subscales in this sample. Fear; Death; Scales; Reliability; Validity.
Fear of death cannot be escals observed, which is why it should be inferred based on a subject’s conduct or self-reported answers.
Therefore, there is no simple criterion with which an instrument can be compared to establish its validity.
The Scale was dd in to eliminite the content heterogeneity problem of the items in the scales used to measure fear of death. Likewise, attitudes and emotional reactions can differ for oneself or for others. Thus, four sub-scales were distinguished: Next, in escal, a revised version was published that included the same number of items in each sub-scale 32 items.
Validation of Collett-Lester’s Fear of Death Scale in a sample of nursing students
Inthose items in each sub-scale that did not contribute to the significance of Cronbach’s alpha were eliminted, resulting in tenpler final item version 3. Also, measuring this construct in the health construct is relevant because the meaning of death entails a certain denial and evasion in our society, which includes health professionals The availability of valid instruments addressing fears of death permit research that helps to visualize one construct and factor at a time, which is considered determinant for people’s end-of-life quality of care 6 and quality of life Although countless instruments have been used to measure attitudes towards death, most of them are one-dimensional.
Their disadvantage is that they do not permit the identification and distinction of specific elements involved in fears of death.
For the same reason, a trend exists to use well-validated and multidimensional scales.
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In recent years, Collett-Lester’s 2, multidimensional fear of death instrument has been validated in several cultural contexts, evidencing acceptable psychometric characteristics.
The psychometric characteristics exhibited based on a sample of nursing students and health professionals were as follows: Moreover, the Spanish version demonstrated convergent and discriminant validity through a positive correlation with anxiety towards death and general anxiety In Chile, some instrument have been used, but these do not display adequate reliability and do not measure the death phenomenon as a state and, in turn, as a process, in a multidimensional way The Fear of death Scale and the Attitude toward death Scale were self-applied before the start of a class.
Ethical aspects of this research were guaranteed through review and approval by the Institutional Review Board of the School of Medicine and the Nursing Department Head. Finally, the researchers decided not to reveal the name of the colleges the students belonged to, due to the private nature of the research question. To perform the psychometric assessment of the CLFODS, first, the Scale was submitted to expert review to guarantee the understanding of the items, followed by a pilot test of the instrument, in which 30 participants showed good understanding of the scale.
Criterion and construct validity of the instrument was analyzed involving the definitive sample Moreover, the reliability of the original scale was assessed, followed by exploratory factor analysis. Reliability was studied through internal consistency, using Cronbach’s alpha coefficient. It was considered that the reagents optimally measured between 0. The validity of the fear of death construct was analyzed through element statistics, inter-element and element-total scale correlation.
For the latter analysis, a sample of students from the total sample was used. Finally, exploratory factor analysis was accomplished, which permitted proving whether the factors and variables that constitute the scale are in line with the pre-established theory of multidimensionality In this study, principal component analysis PCA with varimax rotation was used. In total, it contains 28 items, grouped in four sub-scales with seven items each.
The answers are given on a 1 nothing to 5 much Likert scale.
Scores are obtained for the total scale and for each sub-dimension, calculating the average of the respective answers. The highest mean scores indicate greater fear of death or the dying process The Attitude Toward Death Scale ATD measures the favorable or unfavorable attitude towards death, designed with 43 Likert-type items ranging from 1 to 5.
The highest score corresponds to the most unfavorable attitude towards death Univariate analysis of the Fear of death variables reflects a trend near the normal curve. The mean fear of death score among the nursing students was moderate-high. What the students fear less is their own death.
The highest score per sub-scale corresponded to the fear of other people’s death Table 1. Also, for each sub-scale, the obtained Cronbach’s alpha coefficients permit guaranteeing that the items or elements are homogeneous and that the scale consistently measures the characteristic for which it was elaborated Table 2.
The sub-scale “fear of one’s own death”, with a lower average score, shows greater oscillations 1. Moreover, the average inter-element correlation demonstrates a positive relation in each of the sub-scales.
The correlation matrix, in turn, evidences that, in sub-scale 1: The other correlations of element pairs range between 0. Dying of self, shows correlations higher than 0.
Sub-scale 3 Death of others displays a low correlation of 0. Sub-scale 4 dying of others shows correlations that vary between more approximate levels, ranging from 0. Going back to Table 2for the four sub-scales, each of the seven elements is positively correlated inside the respective sub-scale. The reliability coefficients continue without significant variations when eliminating these elements though, which is why none of the elements can be eliminated to strengthen the scale.
These results permit guaranteeing that the items or elements are homogeneous and that the four sub-scales consistently measure the characteristic they were elaborated for. Hence, they are reliable and show construct validity. Saturations higher than 0. The initial results before the rotation identified five factors, which summarize This first factor revealed ponderations ranging from 0. However, to confirm the multidimensionality hypothesis of the scale proposed in theory and to seek the best adjustment, the researchers decided to submit the PCA results to a varimax rotation.
The results produced a five-factor structure. The reliability and item-element total correlation analysis of these five factors shows that the total-item correlations exceeded 0.
Cronbach’s alpha coefficients for each of the five factors investigated all exceeded 0. Also, in the five factors, the alpha coefficient decreased if the item was eliminated. Regarding CLFODS reliability, its internal consistency or homogeneity was demonstrated through a high Cronbach’s alpha coefficient for the global scale as well as for each sub-scale of the original Scale, similar to the results obtained in studies that used the same instrument in a student population from Kuwait 21Nigeria 10 and Spain 12, The statistics to validate the fear of death construct, evaluated through the four sub-scale that measure the fear of one’s own death, fear of one’s own dying process, fear of other people’s death and fear of other people’s dying process reflect relations that point towards the same direction between element pairs, and show each of the seven elements, its contribution to its respective sub-scale, confirming this characteristic, which had already been observed in other studies 3, Likewise, the positive correlations between the Fear of Death and the Attitudes toward Death Scales support the construct validity in this study.
The convergence of the four sub-scales, in turn, offers a certain degree of support to the validity of the CLFODS dimensions. The magnitude of the relation reflects that it measures similar constructs. Hence, as the Fear of death increases, so does the unfavorable Attitude toward death.
Relations in the same sense are reflected in a study involving nursing students and nurses, in which the scale correlation demonstrated discriminant validity through a strong association with the anxiety toward death scale than with general anxiety Similar results were found among medical students, correlating the Scale with the anxiety toward death scale 10 and othersconfirming its convergent validity.
Its analysis through factor analysis, in this population, partially coincides with the hypothesis based on the items’ content. This study identified five factors with a reliable structure, like the original scale. The results point towards a reconceptualization, which considers fear of one’s own death and fear of one’s own dying process as one physical and another psychological dimension.
The rest of the items display significant loads in the structures similar to the initial dimensions. Various authors have tried to replicate its factor structure using PCA and varimax rotation, finding different results.
This started with the Scale creator who, after modifying it, studied its factor structure, a priori defining four factors, so as to prove the replicability of the theoretical structure. He concludes that consistent loads are observed for two factors, corresponding to “death of self” and “dying of self”. Regarding “death of others” and “dying of others”, however, the main load is found for factor 1 3.
Another study that also used the forced four-factor solution of PCA with varimax rotation equally shows significant loads like the factors in the previous study.
The other two factors partially load the sub-scales Another factor analysis, however, involving psychology students, obtained five factors, with a structure very near the theoretical proposal.
The author justifies the range of results found regarding factor structure in this final investigation, due to the correlation that exists among the sub-scales, which in turn would give rise to an inter-element correlation that would create a bystander factor of factor loads Multidimensionality is confirmed although, in this population, the notion of fear of death entails an additional perspective, which comprises two sub-components that are interesting for research purposes, which are the physical and psychological dimension of fear of one’s own death and fear of one’s own dying process.
These dimensions could comprise new conceptualizations of the construct, which would guide the elaboration of an appropriate instrument for the Chilean culture. Nevertheless, the study limitations should be taken into account.
The first limitation is the mainly female and young sample in a similar educational situation, characteristics that are repeated in most studies analised for this study. Therefore, the factor solution found based on this scale does not exclude the existence of other solutions in distinct samples.
A better adjustment of the models should be evaluated in the future through new exploratory factor analyses. Collett L, Lester D. The fear of death end the fear of dying. Lester D, Abdel-Khalek A. De cara a la muerte: On Death and Dying.
Mohamed Ali W, Said N. J Med Biomed Tempoer. Espinoza M Sanhueza O. Assessing nurses’ attitudes toward death and caring for dying patients in a comprehensive cancer center.