Finding workers to care for older adults in healthcare settings has become a priority, and research identifying factors influencing a nursing student’s intention to make geriatrics a career choice is needed. This calls for the development of a reliable measure of students’ perceptions and attitudes.
To determine the adaptability of Carolina Opinions on Care of Older Adults (COCOA) to assess nursing students’ attitudes to older adults and their intentions to work with them in two countries.
Cross-sectional survey.
Nursing students enrolled in an introduction to gerontological nursing course in the United States and Israel.
A convenience sample of 231 undergraduates pursuing a Bachelor of Science in nursing in the United States (N=122) and Israel (N=109).
Students completed the COCOA instrument and basic demographics using an electronic platform.
Exploratory Factor Analysis (EFA) produced five factors explaining 59% of the variation, with the majority of the items (17, 71%) loading above 0.40 on subscales from the instrument’s original structure. EFA led to the elimination of one subscale (Value of Older Adults) and the creation of a new subscale (Older versus Younger Adults) with three items. The reliability scores were good to acceptable for all subscales in both Israeli and American samples (α-Cronbach 0.80 to 0.60). Confirmatory FA supported the data’s fit to the 21 items of the modified COCOA instrument (CMIN/DF=1.55, CFI=0.93, IFI=0.93, RMSEA=0.05). The analysis of model equivalence for American and Israeli samples revealed significant differences only on the Experience in Caring for Older Adults subscale.
The modified COCOA demonstrated good construct validity and reliability and can serve as estimation of nursing students’ attitudes to older adults and their intention to make geriatrics a career choice. Future studies should further evaluate its predictive validity.

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