ABSTRACT

Background Unintentionally pregnant individuals in Germany seeking an abortion face challenges due to legal regulations, stigma and difficult access to abortion care. Abortion attitudes of (prospective) physicians influence the care situation. To measure these attitudes, psychometrically sound instruments like the Abortion Attitude Scale (AAS) are necessary. So far, no instruments assessing attitudes toward abortions are available in German. The aim of this study is to translate, culturally adapt and psychometrically test the AAS.

Methods This is a secondary analysis of a cross-sectional study on abortion attitudes of medical students in Germany. The English 14-item AAS was translated into German and adapted using a team translation protocol. Comprehensibility was tested via cognitive interviews (n=10 medical students). We analyzed acceptance (completion rate), factorial structure (confirmatory factor analysis (CFA), model fit), item characteristics (response distribution, item difficulties, corrected item-total correlations, inter-item correlations), and reliability (McDonald’s omega).

Results The translated and adapted AAS version was comprehensible. AAS data of 305 medical students could be included in analysis. Completion rate was above 98% for all items. The CFA results confirmed a one-factorial structure but a model without item 10 and correlations between item 8 and item 13 showed to have the best model fits. Floor or ceiling effects could be found for 7 items, item difficulties ranged between 0.39 and 0.94, corrected item-total-correlations ranged between 0.460 and 0.766 for the best model, inter-item correlations ranged between .129 to .681, and McDonald’s omega was above 0.9 for both models.

Conclusion The German AAS is a brief measure with high acceptance and good psychometric properties. Removal of item 10 could be discussed. The AAS can ease and improve the evaluation of attitudes toward abortions in Germany. This can potentially lead to the development of targeted interventions to reduce barriers and improve care for unintentionally pregnant individuals.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

Yes

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study was approved by the Local Ethics Committee of the University Medical Centre Hamburg-Eppendorf, Germany (LPEK-0628, May 27th, 2023).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

The data underlying the results presented in the study are available from the corresponding author.

LIST OF ABBREVIATIONSAASAbortion Attitude ScaleAICAkaike Information CriterionALAnja LindigAMOSAnalysis of Moment Structure, Statistical Package for the Social Sciences, International Business Machines CorporationBICBayesian Information CriterionCFAConfirmatory Factor AnalysisChi2Discrepancy Chi-squared StatisticCFIComparative Fit IndexCOSMINConsensus-based Standards for the Selection of Health Measurement InstrumentsDfDegree of freedomECEva ChristalleJZJördis ZillKMOKaiser-Meyer-Olkin criterionMBMirja BaumgartMLRmaximum likelihood estimatorMRMareike RutenkrögerRMSEARoot Mean Square Error of ApproximationSPSSStatistical Package for the Social Sciences, International Business Machines CorporationSRMRStandardized Root Mean Squared ResidualTLITucker-Lewis IndexTRAPDTranslation, Review, Adjudication, Pretesting, Documentation