Translation, adaptation and psychometric evaluation of the German version of the Abortion Attitude Scale - a secondary analysis of a cross-sectional study among medical students

BackgroundUnintentionally 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. MethodsThis 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 (McDonalds omega). ResultsThe 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 McDonalds omega was above 0.9 for both models. ConclusionThe 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.