Validity and Reliability of the Indonesian version of Approaches to Dementia Questionnaire among Migrant Indonesian Care Staff Caring for Persons with Dementia in Japanese Long Term Care Facilities

Validity and Reliability of the Indonesian version of Approaches to Dementia Questionnaire among Migrant Indonesian Care Staff Caring for Persons with Dementia in Japanese Long Term Care Facilities | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Validity and Reliability of the Indonesian version of Approaches to Dementia Questionnaire among Migrant Indonesian Care Staff Caring for Persons with Dementia in Japanese Long Term Care Facilities Woro Mustika Weni, Megumi Shimizu-Yaginuma, Chiaki Ando‐Ohmura, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6949948/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 Apr, 2026 Read the published version in Journal of Cross-Cultural Gerontology → Version 1 posted You are reading this latest preprint version Abstract Many migrant Indonesian care staff first encounter dementia care while working in long-term care facilities in Japan. Their perspectives may be influenced by Japanese cultural values, potentially shaping their attitudes toward individuals with dementia differently from those in Indonesia. This study aimed to translate, culturally adapt, and assess the validity and reliability of the Approaches to Dementia Questionnaire (ADQ) among migrant Indonesian nurses and care workers in Japanese long-term care facilities. The ADQ was translated into Indonesian and administered to 218 migrant Indonesian care staff. A retest was conducted 1–2 weeks later with 75 participants. The psychometric evaluation included exploratory and confirmatory factor analyses, known-group validity, convergent-divergent validity, internal consistency, and test-retest reliability. Exploratory factor analysis identified a two-factor model for the Indonesian ADQ, conceptualized as Hope and Person-Centered . Confirmatory factor analysis indicated that a bifactor model with two factors grouped under one general factor provided the best fit. Known-group validity analysis showed significantly higher ADQ scores among those familiar with person-centered care (p < 0.05). Convergent and divergent validity were supported through correlations with three subscales of the Person-Centered Care Assessment Tool. The Indonesian ADQ demonstrated acceptable internal consistency (α = 0.63) and moderate test-retest reliability (ICC = 0.53). Overall, the Indonesian ADQ demonstrated sound validity and reliability for assessing the attitudes of Indonesian care staff toward individuals with dementia in Japanese long-term care facilities. Dementia Attitude Translation Reliability and Validity Figures Figure 1 Introduction As of 2022, approximately 29% of Japan's population, which is over 36 million people, were aged 65 or older. This reflects Japan's status as one of the most rapidly aging societies in the world (Japan Cabinet Office, 2023 ). Moreover, in 2025, around 7 million people in Japan will live with dementia (Japan Ministry of Health Labor and Welfare, 2019). Among them, roughly 5 million people will experience difficulties in their daily lives that require support and care from informal or formal caregivers (Japan Ministry of Health Labor and Welfare, 2023 ). To deal with this situation, it is estimated that approximately 2.5 million nursing care workers will be needed in 2025 (Japan Ministry of Health Labor and Welfare, 2014 ). One of Japan's strategies to secure the number of care personnel is to import nurses and care workers from countries such as Indonesia, Philippines, and Vietnam. Several programs have been established to bring overseas nurses and care workers to Japan (Japan Ministry of Health Labor and Welfare, 2025 ). Approximately four thousand Indonesian nurses and care workers have been accepted to work in health care and long-term care (LTC) facilities in Japan since 2009 (Japan Ministry of Health Labor and Welfare, 2024 ). In 2016, among Japanese older people living in LTC facilities, 95.6% of them lived with dementia (Japan Ministry of Health Labor and Welfare, 2016). Accordingly, we assume that most Indonesian nurses and care workers working in LTC facilities in Japan have been exposed to dementia care. Currently, there is no specific curriculum covering dementia care in nursing education. However, in 2023 Ministry of Health of the Republic of Indonesia established a psychiatric geriatric care training curriculum for nurses in healthcare facilities and communities, that includes a dementia care curriculum (signs and symptoms, nursing process for caring for persons with dementia, etc.) (Ministry of Health of Republic Indonesia & Magelang Prof. Dr. Soerojo Mental Hospital, 2023). Consequently, Indonesian nurses and care workers who come to Japan before 2023 and have no work experience in healthcare facilities and communities in Indonesia might not have knowledge and skills in dementia care which will influence their attitude toward persons with dementia. A study on awareness, attitudes, and beliefs of dementia among the general population in Indonesia explains that nearly two-thirds of study participants had not heard of the term dementia and or Alzheimer`s disease before. They would describe people who showed dementia symptoms mostly as forgetfulness, memory loss, amnesia, and other terms such as being dazed, confused, absent-minded, crazy, stupid, old age, psychologically disturbed person, or other health conditions like stroke or depression (Farina et al., 2024 ). Another study, specifically on Indonesian care staff working in Japan suggests that only few of study participants had experience caring for persons with dementia before coming to Japan (Weni et al., 2023 ). This suggests that not only the general population but also Indonesian healthcare staff do not have sufficient knowledge about dementia and are rarely exposed to dementia care, which might cause them to have a negative attitude towards persons with dementia. Hence, the evaluation of attitudes toward persons with dementia, especially among Indonesian nurses and care workers working in LTC facilities in Japan is paramount. To measure attitudes toward persons with dementia, researchers have developed several questionnaires. The questionnaires that are available in the Indonesian language are the Dementia Attitude Scale (DAS) (Mulyani et al., 2023 ; O’Connor & McFadden, 2010 ) and the Approaches to Dementia Questionnaire (ADQ) (Lintern & Woods, 2001 ). The DAS, however, was developed and primarily validated with general population samples, including family caregivers and college students, rather than formal caregivers in long-term care settings. In contrast, the ADQ was specifically designed for and validated by healthcare professionals in residential care facilities (Lintern & Woods, 2001 ). It is one of the most widely used instruments for measuring healthcare professionals' attitudes toward individuals with dementia (Tullo & Young, 2014 ) and has been translated and validated in various countries (Kada et al., 2009 ; Kang et al., 2011 ; Suzuki et al., 2021 ; Zhao et al., 2022 ). An Indonesian version of the ADQ has also been developed and tested for validity and reliability among health-related students in Indonesia (Mulyani et al., 2025 ). However, that version was validated with students who largely lacked practical experience in dementia care. In contrast, migrant Indonesian care staff in Japanese long-term care (LTC) facilities regularly provide hands-on dementia care in environments supported by more advanced infrastructure, policies, and education than those typically available in Indonesia. Moreover, their attitudes may be influenced by Japanese cultural values and care practices, potentially differing from those shaped solely within the Indonesian context. Therefore, this study aims to translate, culturally adapt, and evaluate the validity and reliability of the ADQ for use among Indonesian care staff working in LTC facilities in Japan. Methods and Materials Approaches to Dementia Questionnaire (ADQ) The ADQ measures healthcare professionals' attitudes toward individuals with dementia. It comprises two subscales: Hope and Person-Centred . The Hope subscale reflects varying levels of optimism or pessimism regarding the abilities and future of individuals with dementia. A higher score indicates more positive views about the potential and capabilities of people with dementia (Lintern & Woods, 2001 ). The Person-Centred subscale assesses the extent to which healthcare professionals recognize individuals with dementia as sentient beings deserving of dignity and respect (Lintern & Woods, 2001 ). The ADQ was developed based on person-centred care principles, with input from Professor Tom Kitwood, well known for his groundbreaking work on person-centered care (PCC) (Lintern & Woods, 2001 ). The ADQ consists of 19 items rated on a five-point Likert scale, ranging from “ strongly disagree” to “strongly agree” . Items 1, 2, 3, 4, 6, 8, 10, 13, and 14 are reverse-scored, with strongly disagree valued at 5 points. Items 5, 7, 9, 11, 12, 15, 16, 17, 18, and 19 are positively scored, with strongly agree valued at 5 points. The total score is the sum of all item responses, ranging from 19 to 95. Higher scores indicate more positive attitudes among care staff toward individuals with dementia. The original ADQ demonstrated satisfactory psychometric properties, with a Cronbach’s alpha of 0.83 for the total scale, 0.76 for the Hope subscale, and 0.85 for the Person-Centred subscale. Test-retest reliability was 0.76 for the total scale, 0.70 for Hope , and 0.69 for Person-Centred (Lintern & Woods, 2001 ). Participants The study participants were migrant Indonesians who worked as nurses or care workers in LTC facilities in Japan, whose mother tongue is Indonesian, were able to communicate in Japanese, and who received nursing education in Indonesia. Scale Translation The translation of the ADQ into Indonesian, including forward translation, back-translation, expert committee review, and pretesting (Beaton et al., 2000 ). Two Indonesian nursing graduate students carried out the forward translation, converting the questionnaire items from English to Indonesian. One student specialized in gerontological nursing (master's degree), while the other focused on mental health nursing (doctoral degree). This step resulted in two initial drafts of the Indonesian ADQ translation. The two translators then collaborated to reconcile differences and produced a single consensus draft. Next, two Indonesian translators, both without medical backgrounds or familiarity with the subject matter, conducted the back-translation, converting the consensus draft back into English. This process generated two back-translated drafts of the ADQ. An expert committee was convened to resolve discrepancies between the forward and back translations. The committee included the two nursing graduate students, the two translators, an expert in gerontology and home healthcare nursing, and an expert in palliative care nursing. Through their discussions, a refined draft of the Indonesian ADQ was developed for pretesting. The pretest involved 13 participants with diverse backgrounds, including medical Ph.D. students studying in Japan, nurses with undergraduate and vocational degrees working in Japanese long-term care facilities, and nurses with undergraduate degrees working in Indonesian hospitals. After completing the ADQ draft, participants were interviewed to gather their opinions and suggestions on the items. The final translation was then sent to the original author of the ADQ for feedback and approval. Procedure The survey to evaluate scale validity and reliability was conducted from September to November 2021 through an online survey platform. Along with the questionnaire distribution, we provided a detailed explanation of the study objectives and assurances about the protection of personal information. Participants were informed that participation was voluntary, and consent was implied by completing the questionnaire. A combination of purposive and convenience sampling was used for participant recruitment. Initially, through purposive sampling, we contacted 296 facilities employing foreign nurses and care workers, explaining the study and inviting their participation. Twenty-one facilities agreed to cooperate by distributing the survey to Indonesian nurses and care workers (henceforth referred to as Indonesian care staff) employed at their sites. From these facilities, we obtained responses from 52 Indonesian care staff. To expand the participant pool, we employed convenience sampling by sharing informational posters detailing the survey's purpose, target participants, research process, ethical considerations, and participation instructions. These posters were distributed via group chats of Indonesian nurse organizations, migrant Indonesian community groups in Japan, and social media platforms. Participants were encouraged to share the posters within their networks to further promote recruitment. As a result, 166 additional responses were collected, all from migrant Indonesian care staff working in Japanese LTC facilities. In total, 218 responses were gathered from the initial survey. One to two weeks later, participants were reminded to complete a follow-up test-retest survey, resulting in 75 responses. Measurement Demographic Characteristics The survey included questions on migrant Indonesian care staff's sociodemographic information, such as age, gender, years of work experience, and possession of Japanese national qualification. To assess the known-group validity of the Indonesian version of the ADQ, participants were asked whether they were familiar with person-centred care and whether they had received training on dementia, with yes/no responses. In addition to these, the survey explored job-related factors through several key questions. To measure job satisfaction, participants were asked, "Overall, how satisfied are you with working in your current workplace?" Responses were rated on a five-point Likert scale ranging from “very satisfied” to “not satisfied at all” . Participants' intention to continue working in dementia care was assessed through the question, "Do you want to continue working in a field related to dementia care?" Responses were captured on a five-point Likert scale from “strongly agree” to “strongly disagree” . To understand participants' sense of pride in their work, they responded to the statement, "I feel proud of my work," with answers ranging from “always” to “almost never” on a five-point Likert scale. The Indonesian version of the Person-Centered Care Assessment Tool (P-CAT) To assess convergent and divergent validity, we used the Indonesian version of the Person-Centered Care Assessment Tool (P-CAT) (Weni et al., 2023 ). The P-CAT measures the extent of PCC delivered by care staff in long-term care (LTC) facilities (Edvardsson et al., 2010 ) Indonesian P-CAT comprises three dimensions: the Extent of Personalizing Care , the Amount of Environmental Support , and the Degree of Flexibility in Caring Activities (Weni et al., 2024 ). An example of a questionnaire item is: "The life history of the residents is formally used in the care plans we use". The Indonesian version of the P-CAT has been tested for its validity and reliability. It consists of 13 items rated on a five-point scale, ranging from 1 ( disagree completely ) to 5 ( agree completely ). The total score ranges from 13 to 65, with higher scores indicating a greater degree of PCC practice. Ethical Consideration Ethics approval for the study was obtained from the Ethics Committee of the Tohoku University Graduate School of Medicine (Approval number: 2021-1-155). Data Analysis We employed two sampling methods to collect data and assessed their equivalence using chi-square tests and independent sample t-tests. Among participant characteristics, only years of work experience in Japan showed a statistically significant difference (Table 1 ). Since the data from the two sampling methods were largely equivalent, we merged them for analysis. Table 1 Demographic Characteristics of Study Participants (n = 218) Variable Purposive sampling ( n = 52) Snowball sampling ( n = 166) p- value* n (%) Mean (SD) n (%) Mean (SD) Age (in years) .854 ≤ 20 0 (0) 1 (0.6) 21–30 40 (76.9) 127 (76.5) ≥ 31 12 (23.1) 38 (22.9) Gender .287 Male 15 (28.8) 61 (36.7) Female 37 (71,2) 105 (63.3) Nursing education level in Indonesia .082 Vocational (3 years) 41 (78.8) 99 (59.6) Undergraduate (4 years) 4 (7.7) 22 (13.3) Undergraduate + 1 year clinical practice (5 years) 7 (13.5) 42 (25.3) Other 0 (0) 3 (1.8) Dementia care experience in Indonesia .543 Yes 11 (21.2) 42 (25.3) No 41 (78.8) 124 (74.7) Japanese Language Proficiency Test .961 N1 (advanced) 0 (0) 1 (0.6) N2 20 (38.5) 61 (36.7) N3 25 (48.1) 75 (45.2) N4 2 (3.8) 8 (4.8) N5 (beginner) 0 (0) 1 (0.6) No certificate qualification 5 (9.6) 20 (12.1) Working experience in Japan (year) ‡ .002 < 4 36 (69.2) 75 (45.2) ≥ 4 16 (30.8) 91 (54.8) Japanese Qualification .066 Certified Nurse 5 (9.6) 22 (13.3) Certified Care Worker 10 (19.2) 57 (34.3) No qualifications 37 (71.2) 87 (52.4) ADQ Total Score 64.79 (5.88) 65.16 (5.88) .694 Note. ADQ, Approaches to Dementia Questionnaire; SD, Standard Deviation. a p value was obtained from chi-square test and independent t-test; p < 0.05. b Years of working experience in Indonesia is categorized into < 2 and ≥ 2 because in the Indonesia-Japan Economic Partnership Agreement (IJEPA) program to apply as a nurse, a candidate must have at least 2 years of working experience in Indonesia. c Years of working experience in Japan is categorized into < 4 and ≥ 4 years because the IJEPA program working contract is 4 years. All statistical analyses were conducted using SPSS Statistics Version 29.0 (IBM Corporation). Descriptive analyses were performed for each questionnaire item. To confirm the normality of the data we used skewness (-2 to + 2) and kurtosis (> 10) (George & Mallery, 2010 ). Exploratory Factor Analysis To evaluate the dimensionality of the ADQ, we conducted an Exploratory Factor Analysis (EFA) using the maximum likelihood method with oblique (Promax) rotation. The Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy (> 0.60) and Bartlett’s test of sphericity (p < 0.05) were used to assess the suitability of the data for factor analysis (Burton & Mazerolle, 2011 ). The number of factors to retain was determined based on eigenvalues greater than 1 (Kaiser’s criterion) and visual inspection of the scree plot (Kaiser, 1960 ; Yong & Pearce, 2013 ). Item loadings of > 0.3 were considered the threshold for a good fit (Costello & Osborne, 2005 ). We began the EFA with a one-factor model and gradually increased the number of factors (two-factor, three-factor, and so on) to identify the optimal solution. Confirmatory Factor Analysis Confirmatory factor analysis was performed to examine the structure of the Indonesian ADQ. First, we tested the simple structure correlated factors models (one-factor, two-factor, three-factor models) extracted from EFA, and the bifactor model to compare which models have the best fit. Recently, the bifactor model has been known in the structural modeling of psychology (psychopathology, psychosis, cognitive functioning, etc.) (Markon, 2019 ). Since attitude is one of the object studies in psychology, we included the bifactor model in the CFA. We evaluated the goodness of fit of the statistical model using chi-square statistics/degrees of freedom ratio (CMIN/DF) (good fit < 2 and acceptable fit 0.97 and acceptable fit > 0.95), and root mean square error of approximation (RMSEA) (good fit < 0.05 and acceptable fit < 0.08) (Bentler, 1990 ; Hooper et al., 2008 ; Schermelleh-Engel et al., 2003 ). Known-Group Validity Known-group validity was assessed using independent samples t-tests (p < 0.05) to compare groups based on their knowledge of PCC, as the ADQ was developed based on the PCC concept (Lintern, 2001 ). We hypothesized that the mean ADQ scores would differ between the two groups, with participants who were familiar with PCC expected to have significantly higher scores compared to those who were not. Additionally, we hypothesized that participants who had received training in dementia care, were satisfied with their job, intended to continue working in the field of dementia care, and took pride in their work would have higher ADQ scores. Convergent and Divergent Validity Convergent and divergent validity were assessed by calculating Pearson correlation coefficients ( r ) between the total scale of the Indonesian ADQ and the subscales of the Indonesian P-CAT, which measure related or separate constructs. We expected a higher correlation between the total scale of the Indonesian ADQ and the Extent of Personalizing Care subscale of the Indonesian P-CAT, indicating convergent validity. Conversely, lower or no correlations were expected between the total scale of the Indonesian ADQ and the Degree of Flexibility in Caring Activity and Amount of Environmental Support subscales, indicating divergent validity. A correlation ( r ) above 0.30 was considered acceptable, and a value below 0.30 was interpreted as low or no correlation (Polit & Beck, 2017 ). Internal Consistency For reliability testing, we conducted statistical analyses of internal consistency (Cronbach’s α) (0.6–0.7 is considered acceptable, and ≥ 0.8 is very good) (Ursachi et al., 2015 ) and corrected item-total correlation (> 0.3) (Nunnally & Bernstein, 1994 ). Paired t-tests were also conducted to compare test-retest means ( p ≤ 0.05). Test-retest Reliability Test-retest reliability was examined through a single-rater, absolute agreement, two-way mixed-effect model of the Intraclass Correlation Coefficient (ICC) (Koo & Li, 2016 ), those with an ICC of < 0.5 is considered poor, 0.5–0.75 is moderate, 0.75–0.90 is good, and 0.90-1 is considered excellent (Koo & Li, 2016 ). RESULTS Indonesian Translation of ADQ We contacted the original author of the ADQ via email and received feedback on our translations. The author specifically commented on the translation of "ordinary people" in item 19 relates to approaching people with dementia with the same respect and normalcy as ordinary people. We had not used the literal translation ("orang biasa") for "ordinary people." In the context of the item, the literal translation would not have been culturally appropriate, as "orang biasa" is typically used to express humility. Therefore, we opted for a more culturally suitable synonym, "orang pada umumnya" (meaning "people in general"), which more accurately conveys the idea that people with dementia are equal to those without dementia. Demographic Characteristics of the Participants A total of 218 participants completed the questionnaire, with no missing data recorded. The online survey platform required responses for all items before submission, ensuring that only fully completed questionnaires were accepted. Skewness and kurtosis values indicated a normal distribution of the data (Table 2 ). Table 2 ADQ Two-factor structure of scale content with factor loading, total variance explained, and Cronbach`s α of Indonesian ADQ (n = 218). Item a Mean (SD) Skewness Kurtosis Subscale 1 b Hope Subscale 2 b Person-centred Communalities ADQ 1 3.24 (0.89) -0.10 -0.33 0.45 -0.15 0.25 ADQ 2 2.63 (1.00) 0.54 -0.35 0.35 -0.30 0.25 ADQ 3 4.06 (0.71) -0.40 -0.03 0.62 0.24 0.41 ADQ4 3.20 (0.95) -0.28 -0.37 0.46 -0.13 0.25 ADQ 6 2.99 (1.01) 0.03 -0.61 0.42 -0.24 0.27 ADQ 7 2.95 (1.01) -0.12 -0.54 -0.38 0.23 0.22 ADQ 8 3.59 (0.85) -0.30 -0.28 0.63 0.13 0.4 ADQ 13 3.36 (0.83) 0.08 -0.30 0.53 -0.05 0.29 ADQ 14 3.95 (0.91) -0.81 0.41 0.50 0.19 0.27 ADQ 5 3.94 (0.85) -1.01 1.84 0.08 0.76 0.58 ADQ 9 3.58 (0.82) -0.48 0.44 -0.12 0.66 0.47 ADQ 10 2.35 (0.77) 0.99 1.69 0.12 -0.69 0.51 ADQ 11 3.99 (0.82) -0.88 1.39 0.15 0.90 0.79 ADQ 12 3.84 (0.80) -0.84 1.69 0.07 0.86 0.73 ADQ 15 3.33 (0.83) -0.39 0.22 -0.19 0.45 0.27 ADQ 16 3.05 (0.69) -0.23 1.65 0.03 0.36 0.13 ADQ 17 3.81 (0.81) -0.72 1.05 0.02 0.78 0.61 ADQ 18 3.46 (0.80) -0.93 1.27 -0.04 0.59 0.36 ADQ 19 3.75 (0.80) -0.96 1.72 -0.03 0.75 0.58 Explained variance (%) 45.87 14.90 30.97 Note. ADQ, Approaches to Dementia Questionnaire; SD, Standard Deviation. a Item numbers are based on the original final version of the P-CAT questionnaire. b Factor loading > 0.3 is in bold print. Most participants were female (n = 142, 65.1%), with a mean age of 28.86 ± 2.94 years (range: 20–40 years). Only one participant held an advanced Japanese Language Proficiency qualification. The majority had less than four years of work experience (n = 111, 50.9%). Among the participants, 27 (12.4%) were Indonesian nurses with a Japanese-certified nurse qualification, 67 (30.7%) had a Japanese-certified care worker qualification, and 124 (56.9%) held no Japanese qualifications. The demographic characteristics of the study participants are detailed in Table 1 . Exploratory Factor Analysis The Kaiser-Meyer-Olkin test (0.87) and Bartlett’s test of sphericity ( p < 0.001) were satisfactory. The EFA suggested a three-factor model as two factors had eigenvalues above one. Factor loadings, communalities, and total variance explained by the Indonesian version of ADQ items are presented in Table 2 . Confirmatory Factor Analysis The CFA results for models derived from EFA and the original ADQ are presented in Table 3 . While the two-factor model extracted from EFA demonstrated a poor fit, it still exhibited better fit indices compared to other models, with a CMIN/DF of 2.73, CFI of 0.83, and RMSEA of 0.09. To further explore the structure, we tested a bifactor model, comprising one general factor and two specialized factors, based on the EFA-derived two-factor model, as it showed the best performance among the tested models. Table 3 Comparison of CFA indices between different versions and 1, 2, 3-factor structures of Indonesian ADQ (n = 218). Model χ 2 df Δχ 2 /df CMIN/df CFI RMSEA 1-factor 585.10 152 Ref 2.46 0.72 0.12 2-factor 412.60 151 172.5(1)*** 2.73 0.83 0.09 Bifactor model 273.68 133 138.92(18) *** 2.06 0.91 0.07 3-factor 408.48 149 4.12(2) 2.74 0.83 0.09 Lintern`s 2-factor 545.43 171 -132.83(20)*** 3.19 0.75 0.11 Note. CFA, Confirmatory Factor Analysis; ADQ, Approaches to Dementia Questionnaire. df, degree of freedom; CMIN, qui-square statistics; CFI, Comparative Fit Index; RMSA, Root Mean Square Error of Approximation. *** p < 0.001 The bifactor model demonstrated fully acceptable fit indices and significantly outperformed the EFA two-factor model, with a CMIN/DF of 2.06, CFI of 0.91, and RMSEA of 0.07. The bifactor model of the Indonesian ADQ is illustrated in Fig. 1. Subscale 1: Hope includes items 1, 2, 3, 4, 6, 7, 8, 13, and 14, while Subscale 2: Person-Centred comprises items 5, 9, 10, 11, 12, 15, 16, 17, 18, and 19. These findings suggest that the Indonesian ADQ has a different structural composition compared to the original version, indicating cultural and contextual adaptations. Known-group Validity The results revealed a significant difference in ADQ scores between participants who were familiar with PCC (n = 85, M = 66.44 ± 5.46) and those who were not (n = 133, M = 64.20 ± 5.97), with p = .006. However, no significant differences were found in ADQ scores based on whether participants had received dementia care training, were satisfied or unsatisfied with their job, intended or did not intend to continue working in dementia care, or felt proud or not proud of their work. Convergent and Divergent Validity For convergent validity, the total scale of the Indonesian ADQ demonstrated a significant positive correlation with the Extent of Personalizing Care subscale of the P-CAT (r = 0.44, p < .001, 95% CI [0.33, 0.54], N = 218). Regarding divergent validity, the total Indonesian ADQ showed a smaller but significant positive correlation with the Amount of Environmental Support subscale (r = 0.22, p < .001, 95% CI [0.09, 0.34], N = 218) and no significant correlation with the Degree of Flexibility in Caring Activity subscale (r = 0.10, p = .149, 95% CI [-0.04, 0.23], N = 218). The detailed results for convergent and divergent validity are presented in Table 4 . Table 4 Correlation of the Indonesian Version of the ADQ and P-CAT (n = 218) Total ADQ r 95% CI (Lower-Upper) p P-CAT Subscale 1: Extent of Personalizing Care 0.44 0.33–0.54 < .001 P-CAT Subscale 2: Amount of Environmental Support 0.22 0.09–0.34 < .001 P-CAT Subscale 3: Degree of Flexibility in Caring Activity 0.10 -0.04– 0.23 .149 Total P-CAT 0.45 0.34–0.55 < .001 Note . ADQ, Approaches to Dementia Questionnaire; P-CAT, Person-centered Care Assessment Tool; CI, confidence interval. r values were calculated using Pearson r correlation. Convergent validity measurement: P-CAT subscale Extent of Personalizing Care . Divergent validity measurement: P-CAT subscale Amount of Environmental Support and P-CAT subscale Degree of Flexibility in Caring Activity. Internal Consistency The internal consistency analysis showed a Cronbach’s α of 0.63 for the total scale, 0.58 for Subscale 1, and 0.80 for Subscale 2. The Cronbach’s α values if an item was deleted ranged from 0.57 to 0.69, while the corrected item-total correlations ranged from − 0.02 to 0.58. Detailed internal consistency results for individual items, subscales, and the total scale are presented in Table 5 . Table 5 Item performance for Indonesian ADQ (n = 218). Item Mean (SD) Cronbach`s α if Item Deleted Corrected Item-Total Correlation Cronbach`s α Subscale 1: Hope 0.58 1 3.24 (0.89) 0.64 0.06 2 2.63 (1.00) 0.66 -0.08 3 4.06 (0.71) 0.60 0.40 4 3.20 (0.95) 0.63 0.14 6 2.99 (1.01) 0.65 -0.02 7 2.95 (1.01) 0.65 -0.02 8 3.59 (0.85) 0.61 0.32 13 3.36 (0.83) 0.62 0.19 14 3.95 (0.91) 0.61 0.31 Subscale 2: Person-centred 0.80 5 3.94 (0.85) 0.59 0.43 9 3.58 (0.82) 0.60 0.38 10 2.35 (0.77) 0.69 -0.40 11 3.99 (0.82) 0.57 0.58 12 3.84 (0.80) 0.59 0.48 15 3.33 (0.83) 0.62 0.18 16 3.05 (0.69) 0.61 0.30 17 3.81 (0.81) 0.58 0.53 18 3.46 (0.80) 0.59 0.42 19 3.75 (0.80) 0.59 0.45 Total score 0.63 Note. ADQ, Approaches to Dementia Questionnaire; SD, Standard Deviation. Test-retest Reliability The test-retest reliability analysis revealed significant positive correlations between scores on the initial and follow-up assessments. Subscale 1: Hope showed a Pearson correlation of 0.62 (p < .001, N = 75), Subscale 2: Person-centred had a correlation of 0.49 (p < .001, N = 75), and the ADQ total scale demonstrated a correlation of 0.70 (p < .001, N = 75). The Intraclass Correlation Coefficient (ICC) was 0.53 for the total scale, 0.62 for Subscale 1, and 0.47 for Subscale 2. Detailed test-retest reliability results are presented in Table 6 . Table 6 Test and Retest Reliability of Indonesian ADQ (n = 75). Test Mean ± SD Retest Mean ± SD p a Pearson Correlation ICC (95% CI) Subscale 1: Hope 30.36 (3.97)) 35.87 (4.40) .732 0.62*** 0.62 (0.46–0.74) Subscale 2: Person-centred 30.49 (3.69) 36.57 (3.42) .136 0.49*** 0.47 (0.27–0.63) ADQ Total scale 62.89 (5.27) 67.07 (5.34) < .001 0.70*** 0.53 (0.01–0.77) Note. ADQ, Approaches to Dementia Questionnaire; SD, standard deviation; CI, confidence interval. a p- value was two-tailed p-value obtained from Paired t-test. * p < .05; ** p < .01; *** p < .001. Discussion The findings of our study support the translation and psychometric evaluation of the ADQ for use among migrant Indonesian care staff providing dementia care in Japanese LTC facilities. The attitudes of migrant Indonesian care staff toward persons with dementia are effectively reflected in the content, structure, and attributes of the Indonesian version of the ADQ. The development of this version is expected to serve as a valuable tool for researchers in assessing the attitudes of Indonesian care staff toward individuals with dementia. Indonesian ADQ has a two-factor model, different from the original version. The Indonesian version of subscale 1: Hope comprised items 1, 2, 3, 4, 6, 7, 8, 13, and 14, while the original version comprises items 1, 2, 3, 4, 6, 8, 10, and 13. In the Indonesian version, item 10, which relates to how dementia causes a person to decline in function, is no longer associated with items in the original subscale of Hope . Within their everyday lives and in the social context of grief and loss, stress, exhaustion, and ongoing management of the behaviors of the person with dementia, hope is the potential for a positive future (Duggleby et al., 2009 ). Considering the overall positive attitude toward persons with dementia, a large number of participants agree with item 10, implying that they think a decline in the function of people with dementia is bound to happen. Presumably, participants perceived dementia as a part of the natural decline in function of aging. The Indonesian version of subscale 2: Person-centred comprised items 5, 9, 10, 11, 12, 15, 16, 17, 18, and 19, while the original version is comprised of items 5, 7, 9, 11, 12, 14, 15, 16, 17, 18, and 19. In the Indonesian version, item 7 (related to providing choices) and 14 (related to responding to declining memory function) are not related to items in the original subscale but related to items in subscale 1: Hope. This phenomenon may suggest that by offering choices and treating persons with dementia respectfully—despite their declining memory—migrant Indonesian care staff demonstrate a sense of hope in the individuals they care for. The results of CFA on the 2-factor model derived from EFA suggested that the bifactor model shows a better fit compared with the simple structure correlated factors model. These results indicate that Indonesian ADQ has a single general factor that influences all items while there are two distinct dimensions within. It also means that Indonesian ADQ reflects a complex interplay of a general construct and specific dimensions of attitude toward persons with dementia. Attitude is a complex concept in psychology that involves affective (emotion), cognitive (belief and thoughts), and behavior (Breckler, 1984 ; Ostrom, 1969 ). This phenomenon is captured in Indonesian ADQ as each item and dimension constructing attitude in ADQ intricates with each other under one general concept of attitude. Regarding validity testing, we examine the known group validity and convergent/divergent validity of Indonesian ADQ. For known group validity, those who knew about PCC had significantly higher scores on Indonesian ADQ. Therefore, Indonesian ADQ appears to be able to distinguish scores for groups that have been shown to vary in the variables being assessed (Polit & Beck, 2017 ). Regarding convergent/divergent validity, the correlation between Indonesian ADQ and P-CAT subscale was acceptable with subscale 1: Extent of Personalizing Care , low or no correlation with subscale 2: Amount of Environmental Support , and subscale 3: Degree of Flexibility in Caring Activity . As expected, acceptable positive relationship was found between ADQ and subscale Extent of Personalizing Care , as it reflects how care staff individualize everyday activities for residents. Low to no correlation was predicted between ADQ and subscale Amount of Environmental Support and Degree of Flexibility in Caring Activity, as they measure environmental aspects of PCC, which is a distinct concept from attitude. The overall Indonesian ADQ shows acceptable internal consistency; however, it is lower than the original version. Presumably, this is due to study participants had different age, education, work experience, and qualifications, which led to different interpretations of the questionnaire items. Regarding test-retest reliability, the overall ICC of the Indonesian ADQ was considered moderate, possibly due to inconsistencies in participants' interpretations. For example, item 2—which compares a person with dementia to a child—may be understood differently depending on cultural background, life experience, or personal values. In the first survey, some participants may have associated children with negative traits such as emotional instability or dependency, leading to less favorable responses. By the second survey, however, they might have reflected more deeply and associated children with positive qualities like innocence, sincerity, or living in the moment, resulting in more favorable responses. Such shifts in interpretation over time could contribute to variability in item responses. Nevertheless, our version has higher internal consistency compared to the Indonesian version tested among health students in Indonesia (Mulyani et al., 2025 ). Our study has limitations, first regarding the utilization of two sampling methods: purposive and snowball sampling. We used snowball sampling as the number of participants recruited from purposive sampling was small. Using snowball sampling might lead to selection bias, as participants recruited in the study are more socially connected. Those who are not well-connected are possibly excluded from the study, which leads to under-representation of certain groups. We used snowball sampling after purposive sampling failed to gather study participants. Snowball sampling is effective as it can reach study participants who are difficult to identify (Polit & Beck, 2017 ) since not all Japanese LTC facilities employ migrant Indonesian care staff. However, no significant difference between the characteristics of participants in both sampling methods, except for years of working experience in Japan. Secondly, since the Indonesian ADQ was tested on migrant Indonesian care staff working in LTC facilities in Japan, its generalizability to care staff in Indonesia may be limited. The influence of Japanese culture and workplace practices may have shaped participants’ responses, making them different from those of care staff in Indonesia. However, testing the Indonesian ADQ in this context could enhance its validity and reliability, as the participants have direct, daily experience in providing care for individuals with dementia—unlike many health-related students or care workers in Indonesia, who may have limited or no practical experience in dementia care. Conclusion Similar to the original version, the Indonesian ADQ is conceptualized around two core dimensions: Hope and Person-centredness. However, the specific items that correlate within each subscale differ somewhat from the original. We tested three models: the original structure, a correlated factors model derived from EFA, and a bifactor model. The bifactor model—with two specific factors loading onto a general overarching factor—provided the best fit. These findings suggest that the Indonesian ADQ is a valid and reliable tool for measuring attitudes toward persons with dementia among Indonesian care staff working in long-term care facilities in Japan. Declarations Acknowledgement The authors would like to thank all study participants and those who participated in the translation of the Indonesian version of ADQ. Funding The authors declare that no external funds, grants, or other support were received for conducting this study. Data availability The datasets are not publicly available due to ongoing studies, but are available from the corresponding author on reasonable request. Ethic approval: Ethical approvals were sought and granted by the Ethics Committee of the authors’ affiliation. Consent to participants: All participants provided fully informed consent by answering the questionnaire survey. 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BMC Medical Education , 25 (1), 798. https://doi.org/10.1186/s12909-025-07332-2 Mulyani, S., Saifullah, A. D., Dewi Cahyani, K., Sukmawati, A. S., & Aisy, S. R. (2023). Validity and Reliability of Dementia Knowledge Assessment Scale and Dementia Attitude Scale in the Indonesian Language among Nursing Students. Open Access Macedonian Journal of Medical Sciences , 11 (B), 671–677. https://doi.org/10.3889/oamjms.2023.11630 Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric Theory (3rd ed.). McGraw-Hill. O’Connor, M. L., & McFadden, S. H. (2010). Development and Psychometric Validation of the Dementia Attitudes Scale. International Journal of Alzheimer’s Disease , 2010 , 1–10. https://doi.org/10.4061/2010/454218 Ostrom, T. M. (1969). The relationship between the affective, behavioral, and cognitive components of attitude. Journal of Experimental Social Psychology , 5 (1), 12–30. https://doi.org/10.1016/0022-1031(69)90003-1 Polit, D. F., & Beck, C. T. (2017). 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International Psychogeriatrics , 26 (1), 165–171. https://doi.org/10.1017/S1041610213001737 Ursachi, G., Horodnic, I. A., & Zait, A. (2015). How Reliable are Measurement Scales? External Factors with Indirect Influence on Reliability Estimators. Procedia Economics and Finance , 20 , 679–686. https://doi.org/10.1016/S2212-5671(15)00123-9 Weni, W. M., Shimizu, M., Ando‐Ohmura, C., Ohashi, Y., Edvardsson, D., Backman, A., Baxter, R., Kloos, N., & Ozaki, A. (2023). Psychometric evaluation of the Indonesian version of the Person‐centered Care Assessment Tool. International Journal of Older People Nursing . https://doi.org/10.1111/opn.12565 Weni, W. M., Shimizu, M., Ando-Ohmura, C., & Ozaki, A. (2024). Factor Structure of the Indonesian Version of the Approaches to Dementia Questionnaire. Geriatric Nursing Journal , Manuscript under review . Yong, A. G., & Pearce, S. (2013). A Beginner’s Guide to Factor Analysis: Focusing on Exploratory Factor Analysis. Tutorials in Quantitative Methods for Psychology , 9 (2), 79–94. https://doi.org/10.20982/tqmp.09.2.p079 Zhao, Y., Liu, L., Ding, Y., Shan, Y., & Chan, H. Y. L. (2022). Translation and validation of Chinese version of sense of competence in dementia care staff scale in healthcare providers: a cross-sectional study. BMC Nursing , 21 (1), 35. https://doi.org/10.1186/s12912-022-00815-3 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 06 Apr, 2026 Read the published version in Journal of Cross-Cultural Gerontology → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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1","display":"","copyAsset":false,"role":"figure","size":5713,"visible":true,"origin":"","legend":"\u003cp\u003eThis image is not available with this version.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6949948/v1/fde2107be656311fdf277f2b.png"},{"id":106810578,"identity":"d5780016-19c1-416e-985c-48a039cd8386","added_by":"auto","created_at":"2026-04-13 16:15:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1575764,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6949948/v1/5afa33a3-b660-42e6-9112-907de63c7678.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Validity and Reliability of the Indonesian version of Approaches to Dementia Questionnaire among Migrant Indonesian Care Staff Caring for Persons with Dementia in Japanese Long Term Care Facilities","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAs of 2022, approximately 29% of Japan's population, which is over 36\u0026nbsp;million people, were aged 65 or older. This reflects Japan's status as one of the most rapidly aging societies in the world (Japan Cabinet Office, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Moreover, in 2025, around 7\u0026nbsp;million people in Japan will live with dementia (Japan Ministry of Health Labor and Welfare, 2019). Among them, roughly 5\u0026nbsp;million people will experience difficulties in their daily lives that require support and care from informal or formal caregivers (Japan Ministry of Health Labor and Welfare, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). To deal with this situation, it is estimated that approximately 2.5\u0026nbsp;million nursing care workers will be needed in 2025 (Japan Ministry of Health Labor and Welfare, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOne of Japan's strategies to secure the number of care personnel is to import nurses and care workers from countries such as Indonesia, Philippines, and Vietnam. Several programs have been established to bring overseas nurses and care workers to Japan (Japan Ministry of Health Labor and Welfare, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Approximately four thousand Indonesian nurses and care workers have been accepted to work in health care and long-term care (LTC) facilities in Japan since 2009 (Japan Ministry of Health Labor and Welfare, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn 2016, among Japanese older people living in LTC facilities, 95.6% of them lived with dementia (Japan Ministry of Health Labor and Welfare, 2016). Accordingly, we assume that most Indonesian nurses and care workers working in LTC facilities in Japan have been exposed to dementia care. Currently, there is no specific curriculum covering dementia care in nursing education.\u003c/p\u003e\u003cp\u003eHowever, in 2023 Ministry of Health of the Republic of Indonesia established a psychiatric geriatric care training curriculum for nurses in healthcare facilities and communities, that includes a dementia care curriculum (signs and symptoms, nursing process for caring for persons with dementia, etc.) (Ministry of Health of Republic Indonesia \u0026amp; Magelang Prof. Dr. Soerojo Mental Hospital, 2023). Consequently, Indonesian nurses and care workers who come to Japan before 2023 and have no work experience in healthcare facilities and communities in Indonesia might not have knowledge and skills in dementia care which will influence their attitude toward persons with dementia.\u003c/p\u003e\u003cp\u003eA study on awareness, attitudes, and beliefs of dementia among the general population in Indonesia explains that nearly two-thirds of study participants had not heard of the term dementia and or Alzheimer`s disease before. They would describe people who showed dementia symptoms mostly as forgetfulness, memory loss, amnesia, and other terms such as being dazed, confused, absent-minded, crazy, stupid, old age, psychologically disturbed person, or other health conditions like stroke or depression (Farina et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAnother study, specifically on Indonesian care staff working in Japan suggests that only few of study participants had experience caring for persons with dementia before coming to Japan (Weni et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). This suggests that not only the general population but also Indonesian healthcare staff do not have sufficient knowledge about dementia and are rarely exposed to dementia care, which might cause them to have a negative attitude towards persons with dementia. Hence, the evaluation of attitudes toward persons with dementia, especially among Indonesian nurses and care workers working in LTC facilities in Japan is paramount.\u003c/p\u003e\u003cp\u003eTo measure attitudes toward persons with dementia, researchers have developed several questionnaires. The questionnaires that are available in the Indonesian language are the Dementia Attitude Scale (DAS) (Mulyani et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; O’Connor \u0026amp; McFadden, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2010\u003c/span\u003e) and the Approaches to Dementia Questionnaire (ADQ) (Lintern \u0026amp; Woods, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2001\u003c/span\u003e). The DAS, however, was developed and primarily validated with general population samples, including family caregivers and college students, rather than formal caregivers in long-term care settings.\u003c/p\u003e\u003cp\u003eIn contrast, the ADQ was specifically designed for and validated by healthcare professionals in residential care facilities (Lintern \u0026amp; Woods, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2001\u003c/span\u003e). It is one of the most widely used instruments for measuring healthcare professionals' attitudes toward individuals with dementia (Tullo \u0026amp; Young, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) and has been translated and validated in various countries (Kada et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Kang et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Suzuki et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Zhao et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). An Indonesian version of the ADQ has also been developed and tested for validity and reliability among health-related students in Indonesia (Mulyani et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHowever, that version was validated with students who largely lacked practical experience in dementia care. In contrast, migrant Indonesian care staff in Japanese long-term care (LTC) facilities regularly provide hands-on dementia care in environments supported by more advanced infrastructure, policies, and education than those typically available in Indonesia. Moreover, their attitudes may be influenced by Japanese cultural values and care practices, potentially differing from those shaped solely within the Indonesian context. Therefore, this study aims to translate, culturally adapt, and evaluate the validity and reliability of the ADQ for use among Indonesian care staff working in LTC facilities in Japan.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Methods and Materials","content":"\u003cp\u003e\u003cb\u003eApproaches to Dementia Questionnaire (ADQ)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe ADQ measures healthcare professionals' attitudes toward individuals with dementia. It comprises two subscales: \u003cem\u003eHope\u003c/em\u003e and \u003cem\u003ePerson-Centred\u003c/em\u003e. The \u003cem\u003eHope\u003c/em\u003e subscale reflects varying levels of optimism or pessimism regarding the abilities and future of individuals with dementia. A higher score indicates more positive views about the potential and capabilities of people with dementia (Lintern \u0026amp; Woods, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2001\u003c/span\u003e). The \u003cem\u003ePerson-Centred\u003c/em\u003e subscale assesses the extent to which healthcare professionals recognize individuals with dementia as sentient beings deserving of dignity and respect (Lintern \u0026amp; Woods, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2001\u003c/span\u003e). The ADQ was developed based on person-centred care principles, with input from Professor Tom Kitwood, well known for his groundbreaking work on person-centered care (PCC) (Lintern \u0026amp; Woods, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2001\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe ADQ consists of 19 items rated on a five-point Likert scale, ranging from “\u003cem\u003estrongly disagree”\u003c/em\u003e to \u003cem\u003e“strongly agree”\u003c/em\u003e. Items 1, 2, 3, 4, 6, 8, 10, 13, and 14 are reverse-scored, with \u003cem\u003estrongly disagree\u003c/em\u003e valued at 5 points. Items 5, 7, 9, 11, 12, 15, 16, 17, 18, and 19 are positively scored, with \u003cem\u003estrongly agree\u003c/em\u003e valued at 5 points. The total score is the sum of all item responses, ranging from 19 to 95. Higher scores indicate more positive attitudes among care staff toward individuals with dementia.\u003c/p\u003e\u003cp\u003eThe original ADQ demonstrated satisfactory psychometric properties, with a Cronbach’s alpha of 0.83 for the total scale, 0.76 for the \u003cem\u003eHope\u003c/em\u003e subscale, and 0.85 for the \u003cem\u003ePerson-Centred\u003c/em\u003e subscale. Test-retest reliability was 0.76 for the total scale, 0.70 for \u003cem\u003eHope\u003c/em\u003e, and 0.69 for \u003cem\u003ePerson-Centred\u003c/em\u003e (Lintern \u0026amp; Woods, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2001\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study participants were migrant Indonesians who worked as nurses or care workers in LTC facilities in Japan, whose mother tongue is Indonesian, were able to communicate in Japanese, and who received nursing education in Indonesia.\u003c/p\u003e\u003cp\u003e\u003cb\u003eScale Translation\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe translation of the ADQ into Indonesian, including forward translation, back-translation, expert committee review, and pretesting (Beaton et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2000\u003c/span\u003e). Two Indonesian nursing graduate students carried out the forward translation, converting the questionnaire items from English to Indonesian. One student specialized in gerontological nursing (master's degree), while the other focused on mental health nursing (doctoral degree). This step resulted in two initial drafts of the Indonesian ADQ translation. The two translators then collaborated to reconcile differences and produced a single consensus draft.\u003c/p\u003e\u003cp\u003eNext, two Indonesian translators, both without medical backgrounds or familiarity with the subject matter, conducted the back-translation, converting the consensus draft back into English. This process generated two back-translated drafts of the ADQ.\u003c/p\u003e\u003cp\u003eAn expert committee was convened to resolve discrepancies between the forward and back translations. The committee included the two nursing graduate students, the two translators, an expert in gerontology and home healthcare nursing, and an expert in palliative care nursing. Through their discussions, a refined draft of the Indonesian ADQ was developed for pretesting.\u003c/p\u003e\u003cp\u003eThe pretest involved 13 participants with diverse backgrounds, including medical Ph.D. students studying in Japan, nurses with undergraduate and vocational degrees working in Japanese long-term care facilities, and nurses with undergraduate degrees working in Indonesian hospitals. After completing the ADQ draft, participants were interviewed to gather their opinions and suggestions on the items. The final translation was then sent to the original author of the ADQ for feedback and approval.\u003c/p\u003e\u003cp\u003e\u003cb\u003eProcedure\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe survey to evaluate scale validity and reliability was conducted from September to November 2021 through an online survey platform. Along with the questionnaire distribution, we provided a detailed explanation of the study objectives and assurances about the protection of personal information. Participants were informed that participation was voluntary, and consent was implied by completing the questionnaire.\u003c/p\u003e\u003cp\u003eA combination of purposive and convenience sampling was used for participant recruitment. Initially, through purposive sampling, we contacted 296 facilities employing foreign nurses and care workers, explaining the study and inviting their participation. Twenty-one facilities agreed to cooperate by distributing the survey to Indonesian nurses and care workers (henceforth referred to as Indonesian care staff) employed at their sites. From these facilities, we obtained responses from 52 Indonesian care staff.\u003c/p\u003e\u003cp\u003eTo expand the participant pool, we employed convenience sampling by sharing informational posters detailing the survey's purpose, target participants, research process, ethical considerations, and participation instructions. These posters were distributed via group chats of Indonesian nurse organizations, migrant Indonesian community groups in Japan, and social media platforms. Participants were encouraged to share the posters within their networks to further promote recruitment. As a result, 166 additional responses were collected, all from migrant Indonesian care staff working in Japanese LTC facilities. In total, 218 responses were gathered from the initial survey. One to two weeks later, participants were reminded to complete a follow-up test-retest survey, resulting in 75 responses.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMeasurement\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eDemographic Characteristics\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe survey included questions on migrant Indonesian care staff's sociodemographic information, such as age, gender, years of work experience, and possession of Japanese national qualification.\u003c/p\u003e\u003cp\u003eTo assess the known-group validity of the Indonesian version of the ADQ, participants were asked whether they were familiar with person-centred care and whether they had received training on dementia, with yes/no responses.\u003c/p\u003e\u003cp\u003eIn addition to these, the survey explored job-related factors through several key questions. To measure job satisfaction, participants were asked, \"Overall, how satisfied are you with working in your current workplace?\" Responses were rated on a five-point Likert scale ranging from \u003cem\u003e“very satisfied”\u003c/em\u003e to \u003cem\u003e“not satisfied at all”\u003c/em\u003e.\u003c/p\u003e\u003cp\u003eParticipants' intention to continue working in dementia care was assessed through the question, \"Do you want to continue working in a field related to dementia care?\" Responses were captured on a five-point Likert scale from \u003cem\u003e“strongly agree”\u003c/em\u003e to \u003cem\u003e“strongly disagree”\u003c/em\u003e.\u003c/p\u003e\u003cp\u003eTo understand participants' sense of pride in their work, they responded to the statement, \"I feel proud of my work,\" with answers ranging from \u003cem\u003e“always”\u003c/em\u003e to \u003cem\u003e“almost never”\u003c/em\u003e on a five-point Likert scale.\u003c/p\u003e\u003cp\u003e\u003cb\u003eThe Indonesian version of the Person-Centered Care Assessment Tool (P-CAT)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTo assess convergent and divergent validity, we used the Indonesian version of the Person-Centered Care Assessment Tool (P-CAT) (Weni et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The P-CAT measures the extent of PCC delivered by care staff in long-term care (LTC) facilities (Edvardsson et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2010\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eIndonesian P-CAT comprises three dimensions: the \u003cem\u003eExtent of Personalizing Care\u003c/em\u003e, the \u003cem\u003eAmount of Environmental Support\u003c/em\u003e, and the \u003cem\u003eDegree of Flexibility in Caring Activities\u003c/em\u003e (Weni et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). An example of a questionnaire item is: \"The life history of the residents is formally used in the care plans we use\".\u003c/p\u003e\u003cp\u003eThe Indonesian version of the P-CAT has been tested for its validity and reliability. It consists of 13 items rated on a five-point scale, ranging from 1 (\u003cem\u003edisagree completely\u003c/em\u003e) to 5 (\u003cem\u003eagree completely\u003c/em\u003e). The total score ranges from 13 to 65, with higher scores indicating a greater degree of PCC practice.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEthical Consideration\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\u003cp\u003efor the study was obtained from the Ethics Committee of the Tohoku University Graduate School of Medicine (Approval number: 2021-1-155).\u003c/p\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eWe employed two sampling methods to collect data and assessed their equivalence using chi-square tests and independent sample t-tests. Among participant characteristics, only years of work experience in Japan showed a statistically significant difference (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Since the data from the two sampling methods were largely equivalent, we merged them for analysis.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eDemographic Characteristics of Study Participants (n = 218)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003ePurposive sampling (\u003cem\u003en\u003c/em\u003e = 52)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eSnowball sampling (\u003cem\u003en\u003c/em\u003e = 166)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003ep-\u003c/em\u003evalue*\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean (SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMean (SD)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge (in years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.854\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e≤ 20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1 (0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21–30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40 (76.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e127 (76.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e≥ 31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (23.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e38 (22.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.287\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 (28.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e61 (36.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37 (71,2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e105 (63.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNursing education level in Indonesia\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.082\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVocational (3 years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41 (78.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e99 (59.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUndergraduate (4 years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (7.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e22 (13.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUndergraduate + 1 year clinical practice (5 years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (13.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e42 (25.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3 (1.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDementia care experience in Indonesia\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.543\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (21.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e42 (25.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41 (78.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e124 (74.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eJapanese Language Proficiency Test\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.961\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN1 (advanced)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1 (0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (38.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e61 (36.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25 (48.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e75 (45.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (3.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8 (4.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN5 (beginner)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1 (0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo certificate qualification\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (9.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20 (12.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWorking experience in Japan (year)\u003c/b\u003e\u003csup\u003e\u003cb\u003e‡\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt; 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 (69.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e75 (45.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e≥ 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16 (30.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e91 (54.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eJapanese Qualification\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.066\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCertified Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (9.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e22 (13.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCertified Care Worker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (19.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e57 (34.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo qualifications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37 (71.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e87 (52.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eADQ Total Score\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e64.79 (5.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e65.16 (5.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.694\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003eNote.\u003c/em\u003e ADQ, Approaches to Dementia Questionnaire; SD, Standard Deviation.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003ea\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e value was obtained from chi-square test and independent t-test; \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003eb\u003c/sup\u003eYears of working experience in Indonesia is categorized into \u0026lt; 2 and ≥ 2 because in the Indonesia-Japan Economic Partnership Agreement (IJEPA) program to apply as a nurse, a candidate must have at least 2 years of working experience in Indonesia.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003ec\u003c/sup\u003eYears of working experience in Japan is categorized into \u0026lt; 4 and ≥ 4 years because the IJEPA program working contract is 4 years.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eAll statistical analyses were conducted using SPSS Statistics Version 29.0 (IBM Corporation). Descriptive analyses were performed for each questionnaire item. To confirm the normality of the data we used skewness (-2 to + 2) and kurtosis (\u0026gt; 10) (George \u0026amp; Mallery, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2010\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eExploratory Factor Analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTo evaluate the dimensionality of the ADQ, we conducted an Exploratory Factor Analysis (EFA) using the maximum likelihood method with oblique (Promax) rotation. The Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy (\u0026gt; 0.60) and Bartlett’s test of sphericity (p \u0026lt; 0.05) were used to assess the suitability of the data for factor analysis (Burton \u0026amp; Mazerolle, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2011\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe number of factors to retain was determined based on eigenvalues greater than 1 (Kaiser’s criterion) and visual inspection of the scree plot (Kaiser, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e1960\u003c/span\u003e; Yong \u0026amp; Pearce, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Item loadings of \u0026gt; 0.3 were considered the threshold for a good fit (Costello \u0026amp; Osborne, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). We began the EFA with a one-factor model and gradually increased the number of factors (two-factor, three-factor, and so on) to identify the optimal solution.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConfirmatory Factor Analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eConfirmatory factor analysis was performed to examine the structure of the Indonesian ADQ. First, we tested the simple structure correlated factors models (one-factor, two-factor, three-factor models) extracted from EFA, and the bifactor model to compare which models have the best fit. Recently, the bifactor model has been known in the structural modeling of psychology (psychopathology, psychosis, cognitive functioning, etc.) (Markon, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Since attitude is one of the object studies in psychology, we included the bifactor model in the CFA.\u003c/p\u003e\u003cp\u003eWe evaluated the goodness of fit of the statistical model using chi-square statistics/degrees of freedom ratio (CMIN/DF) (good fit \u0026lt; 2 and acceptable fit \u0026lt; 3), comparative fit index (CFI) (good fit \u0026gt; 0.97 and acceptable fit \u0026gt; 0.95), and root mean square error of approximation (RMSEA) (good fit \u0026lt; 0.05 and acceptable fit \u0026lt; 0.08) (Bentler, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e1990\u003c/span\u003e; Hooper et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Schermelleh-Engel et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2003\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eKnown-Group Validity\u003c/b\u003e\u003c/p\u003e\u003cp\u003eKnown-group validity was assessed using independent samples t-tests (p \u0026lt; 0.05) to compare groups based on their knowledge of PCC, as the ADQ was developed based on the PCC concept (Lintern, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2001\u003c/span\u003e). We hypothesized that the mean ADQ scores would differ between the two groups, with participants who were familiar with PCC expected to have significantly higher scores compared to those who were not. Additionally, we hypothesized that participants who had received training in dementia care, were satisfied with their job, intended to continue working in the field of dementia care, and took pride in their work would have higher ADQ scores.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConvergent and Divergent Validity\u003c/b\u003e\u003c/p\u003e\u003cp\u003eConvergent and divergent validity were assessed by calculating Pearson correlation coefficients (\u003cem\u003er\u003c/em\u003e) between the total scale of the Indonesian ADQ and the subscales of the Indonesian P-CAT, which measure related or separate constructs. We expected a higher correlation between the total scale of the Indonesian ADQ and the \u003cem\u003eExtent of Personalizing Care\u003c/em\u003e subscale of the Indonesian P-CAT, indicating convergent validity.\u003c/p\u003e\u003cp\u003eConversely, lower or no correlations were expected between the total scale of the Indonesian ADQ and the \u003cem\u003eDegree of Flexibility in Caring Activity\u003c/em\u003e and \u003cem\u003eAmount of Environmental Support\u003c/em\u003e subscales, indicating divergent validity. A correlation (\u003cem\u003er\u003c/em\u003e) above 0.30 was considered acceptable, and a value below 0.30 was interpreted as low or no correlation (Polit \u0026amp; Beck, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eInternal Consistency\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFor reliability testing, we conducted statistical analyses of internal consistency (Cronbach’s α) (0.6–0.7 is considered acceptable, and ≥ 0.8 is very good) (Ursachi et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) and corrected item-total correlation (\u0026gt; 0.3) (Nunnally \u0026amp; Bernstein, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e1994\u003c/span\u003e). Paired t-tests were also conducted to compare test-retest means (\u003cem\u003ep\u003c/em\u003e ≤ 0.05).\u003c/p\u003e\u003cp\u003e\u003cb\u003eTest-retest Reliability\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTest-retest reliability was examined through a single-rater, absolute agreement, two-way mixed-effect model of the Intraclass Correlation Coefficient (ICC) (Koo \u0026amp; Li, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), those with an ICC of \u0026lt; 0.5 is considered poor, 0.5–0.75 is moderate, 0.75–0.90 is good, and 0.90-1 is considered excellent (Koo \u0026amp; Li, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cb\u003eIndonesian Translation of ADQ\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWe contacted the original author of the ADQ via email and received feedback on our translations. The author specifically commented on the translation of \"ordinary people\" in item 19 relates to approaching people with dementia with the same respect and normalcy as ordinary people. We had not used the literal translation (\"orang biasa\") for \"ordinary people.\" In the context of the item, the literal translation would not have been culturally appropriate, as \"orang biasa\" is typically used to express humility. Therefore, we opted for a more culturally suitable synonym, \"orang pada umumnya\" (meaning \"people in general\"), which more accurately conveys the idea that people with dementia are equal to those without dementia.\u003c/p\u003e\u003cp\u003e\u003cb\u003eDemographic Characteristics of the Participants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA total of 218 participants completed the questionnaire, with no missing data recorded. The online survey platform required responses for all items before submission, ensuring that only fully completed questionnaires were accepted. Skewness and kurtosis values indicated a normal distribution of the data (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eADQ Two-factor structure of scale content with factor loading, total variance explained, and Cronbach`s α of Indonesian ADQ (n\u0026thinsp;=\u0026thinsp;218).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eItem\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean (SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSkewness\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eKurtosis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSubscale 1\u003c/span\u003e\u003csup\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eb\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eHope\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSubscale 2\u003c/span\u003e\u003csup\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eb\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003ePerson-centred\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eCommunalities\u003c/span\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eADQ 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.24 (0.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.45\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-0.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eADQ 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.63 (1.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.35\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-0.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eADQ 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4.06 (0.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.62\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.41\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eADQ4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.20 (0.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.46\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eADQ 6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.99 (1.01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.42\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-0.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eADQ 7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.95 (1.01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e-0.38\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eADQ 8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.59 (0.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.63\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eADQ 13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.36 (0.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.53\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.29\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eADQ 14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.95 (0.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.50\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eADQ 5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.94 (0.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.76\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.58\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eADQ 9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.58 (0.82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.66\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.47\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eADQ 10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.35 (0.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e-0.69\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.51\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eADQ 11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.99 (0.82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.90\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.79\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eADQ 12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.84 (0.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.86\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.73\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eADQ 15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.33 (0.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.45\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eADQ 16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.05 (0.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.36\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eADQ 17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.81 (0.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.78\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.61\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eADQ 18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.46 (0.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.59\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.36\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eADQ 19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.75 (0.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.75\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.58\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExplained variance (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e45.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e14.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e30.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cem\u003eNote.\u003c/em\u003e ADQ, Approaches to Dementia Questionnaire; SD, Standard Deviation.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003ea\u003c/sup\u003eItem numbers are based on the original final version of the P-CAT questionnaire.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003eb\u003c/sup\u003eFactor loading\u0026thinsp;\u0026gt;\u0026thinsp;0.3 is in bold print.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eMost participants were female (n\u0026thinsp;=\u0026thinsp;142, 65.1%), with a mean age of 28.86\u0026thinsp;\u0026plusmn;\u0026thinsp;2.94 years (range: 20\u0026ndash;40 years). Only one participant held an advanced Japanese Language Proficiency qualification. The majority had less than four years of work experience (n\u0026thinsp;=\u0026thinsp;111, 50.9%). Among the participants, 27 (12.4%) were Indonesian nurses with a Japanese-certified nurse qualification, 67 (30.7%) had a Japanese-certified care worker qualification, and 124 (56.9%) held no Japanese qualifications. The demographic characteristics of the study participants are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eExploratory Factor Analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe Kaiser-Meyer-Olkin test (0.87) and Bartlett\u0026rsquo;s test of sphericity (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were satisfactory. The EFA suggested a three-factor model as two factors had eigenvalues above one. Factor loadings, communalities, and total variance explained by the Indonesian version of ADQ items are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConfirmatory Factor Analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe CFA results for models derived from EFA and the original ADQ are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. While the two-factor model extracted from EFA demonstrated a poor fit, it still exhibited better fit indices compared to other models, with a CMIN/DF of 2.73, CFI of 0.83, and RMSEA of 0.09. To further explore the structure, we tested a bifactor model, comprising one general factor and two specialized factors, based on the EFA-derived two-factor model, as it showed the best performance among the tested models.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eComparison of CFA indices between different versions and 1, 2, 3-factor structures of Indonesian ADQ (n\u0026thinsp;=\u0026thinsp;218).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModel\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003edf\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eΔχ\u003csup\u003e2\u003c/sup\u003e/df\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCMIN/df\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCFI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRMSEA\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1-factor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e585.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e152\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2-factor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e412.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e151\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e172.5(1)***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBifactor model\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e273.68\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e133\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e138.92(18) ***\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e2.06\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.91\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.07\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3-factor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e408.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e149\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.12(2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLintern`s 2-factor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e545.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e171\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-132.83(20)***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cem\u003eNote.\u003c/em\u003e CFA, Confirmatory Factor Analysis; ADQ, Approaches to Dementia Questionnaire.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003edf, degree of freedom; CMIN, qui-square statistics; CFI, Comparative Fit Index; RMSA, Root Mean Square Error of Approximation.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cb\u003e***\u003c/b\u003e \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe bifactor model demonstrated fully acceptable fit indices and significantly outperformed the EFA two-factor model, with a CMIN/DF of 2.06, CFI of 0.91, and RMSEA of 0.07. The bifactor model of the Indonesian ADQ is illustrated in Fig.\u0026nbsp;1. Subscale 1: \u003cem\u003eHope\u003c/em\u003e includes items 1, 2, 3, 4, 6, 7, 8, 13, and 14, while Subscale 2: \u003cem\u003ePerson-Centred\u003c/em\u003e comprises items 5, 9, 10, 11, 12, 15, 16, 17, 18, and 19. These findings suggest that the Indonesian ADQ has a different structural composition compared to the original version, indicating cultural and contextual adaptations.\u003c/p\u003e\u003cp\u003e\u003cb\u003eKnown-group Validity\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe results revealed a significant difference in ADQ scores between participants who were familiar with PCC (n\u0026thinsp;=\u0026thinsp;85, M\u0026thinsp;=\u0026thinsp;66.44\u0026thinsp;\u0026plusmn;\u0026thinsp;5.46) and those who were not (n\u0026thinsp;=\u0026thinsp;133, M\u0026thinsp;=\u0026thinsp;64.20\u0026thinsp;\u0026plusmn;\u0026thinsp;5.97), with \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.006. However, no significant differences were found in ADQ scores based on whether participants had received dementia care training, were satisfied or unsatisfied with their job, intended or did not intend to continue working in dementia care, or felt proud or not proud of their work.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConvergent and Divergent Validity\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFor convergent validity, the total scale of the Indonesian ADQ demonstrated a significant positive correlation with the \u003cem\u003eExtent of Personalizing Care\u003c/em\u003e subscale of the P-CAT (r\u0026thinsp;=\u0026thinsp;0.44, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, 95% CI [0.33, 0.54], N\u0026thinsp;=\u0026thinsp;218). Regarding divergent validity, the total Indonesian ADQ showed a smaller but significant positive correlation with the \u003cem\u003eAmount of Environmental Support\u003c/em\u003e subscale (r\u0026thinsp;=\u0026thinsp;0.22, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, 95% CI [0.09, 0.34], N\u0026thinsp;=\u0026thinsp;218) and no significant correlation with the \u003cem\u003eDegree of Flexibility in Caring Activity\u003c/em\u003e subscale (r\u0026thinsp;=\u0026thinsp;0.10, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.149, 95% CI [-0.04, 0.23], N\u0026thinsp;=\u0026thinsp;218). The detailed results for convergent and divergent validity are presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eCorrelation of the Indonesian Version of the ADQ and P-CAT (n\u0026thinsp;=\u0026thinsp;218)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e\u003cem\u003eTotal ADQ\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003er\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003cp\u003e(Lower-Upper)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP-CAT Subscale 1: Extent of Personalizing Care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.33\u0026ndash;0.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP-CAT Subscale 2: Amount of Environmental Support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.09\u0026ndash;0.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP-CAT Subscale 3: Degree of Flexibility in Caring Activity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.04\u0026ndash; 0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.149\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal P-CAT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.34\u0026ndash;0.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003eNote\u003c/em\u003e. ADQ, Approaches to Dementia Questionnaire; P-CAT, Person-centered Care Assessment Tool; CI, confidence interval.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003er\u003c/em\u003e values were calculated using Pearson r correlation.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eConvergent validity measurement: P-CAT subscale \u003cem\u003eExtent of Personalizing Care\u003c/em\u003e.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eDivergent validity measurement: P-CAT subscale \u003cem\u003eAmount of Environmental Support\u003c/em\u003e and P-CAT subscale \u003cem\u003eDegree of Flexibility in Caring Activity.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eInternal Consistency\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe internal consistency analysis showed a Cronbach\u0026rsquo;s α of 0.63 for the total scale, 0.58 for Subscale 1, and 0.80 for Subscale 2. The Cronbach\u0026rsquo;s α values if an item was deleted ranged from 0.57 to 0.69, while the corrected item-total correlations ranged from \u0026minus;\u0026thinsp;0.02 to 0.58. Detailed internal consistency results for individual items, subscales, and the total scale are presented in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eItem performance for Indonesian ADQ (n\u0026thinsp;=\u0026thinsp;218).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eItem\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean (SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCronbach`s α if Item Deleted\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCorrected Item-Total Correlation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCronbach`s α\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eSubscale 1: Hope\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.58\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.24 (0.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.63 (1.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4.06 (0.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.20 (0.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.99 (1.01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.95 (1.01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.59 (0.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.36 (0.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.95 (0.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSubscale 2: Person-centred\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.80\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.94 (0.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.58 (0.82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.35 (0.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.99 (0.82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.84 (0.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.33 (0.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.05 (0.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.81 (0.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.46 (0.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.75 (0.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal score\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.63\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eNote.\u003c/em\u003e ADQ, Approaches to Dementia Questionnaire; SD, Standard Deviation.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eTest-retest Reliability\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe test-retest reliability analysis revealed significant positive correlations between scores on the initial and follow-up assessments. Subscale 1: Hope showed a Pearson correlation of 0.62 (p\u0026thinsp;\u0026lt;\u0026thinsp;.001, N\u0026thinsp;=\u0026thinsp;75), Subscale 2: Person-centred had a correlation of 0.49 (p\u0026thinsp;\u0026lt;\u0026thinsp;.001, N\u0026thinsp;=\u0026thinsp;75), and the ADQ total scale demonstrated a correlation of 0.70 (p\u0026thinsp;\u0026lt;\u0026thinsp;.001, N\u0026thinsp;=\u0026thinsp;75). The Intraclass Correlation Coefficient (ICC) was 0.53 for the total scale, 0.62 for Subscale 1, and 0.47 for Subscale 2. Detailed test-retest reliability results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eTest and Retest Reliability of Indonesian ADQ (n\u0026thinsp;=\u0026thinsp;75).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTest\u003c/p\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRetest\u003c/p\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePearson Correlation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eICC\u003c/p\u003e\u003cp\u003e(95% CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubscale 1: Hope\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30.36 (3.97))\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35.87 (4.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.732\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.62***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.62 (0.46\u0026ndash;0.74)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubscale 2: Person-centred\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30.49 (3.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36.57 (3.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.136\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.49***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.47 (0.27\u0026ndash;0.63)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eADQ Total scale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e62.89 (5.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e67.07 (5.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.70***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.53 (0.01\u0026ndash;0.77)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003eNote.\u003c/em\u003e ADQ, Approaches to Dementia Questionnaire; SD, standard deviation; CI, confidence interval.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003ea\u003c/sup\u003e \u003cem\u003ep-\u003c/em\u003evalue was two-tailed p-value obtained from Paired t-test.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003e*\u003c/b\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05; **\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01; ***\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of our study support the translation and psychometric evaluation of the ADQ for use among migrant Indonesian care staff providing dementia care in Japanese LTC facilities. The attitudes of migrant Indonesian care staff toward persons with dementia are effectively reflected in the content, structure, and attributes of the Indonesian version of the ADQ. The development of this version is expected to serve as a valuable tool for researchers in assessing the attitudes of Indonesian care staff toward individuals with dementia. Indonesian ADQ has a two-factor model, different from the original version.\u003c/p\u003e\u003cp\u003eThe Indonesian version of subscale 1: \u003cem\u003eHope\u003c/em\u003e comprised items 1, 2, 3, 4, 6, 7, 8, 13, and 14, while the original version comprises items 1, 2, 3, 4, 6, 8, 10, and 13. In the Indonesian version, item 10, which relates to how dementia causes a person to decline in function, is no longer associated with items in the original subscale of \u003cem\u003eHope\u003c/em\u003e. Within their everyday lives and in the social context of grief and loss, stress, exhaustion, and ongoing management of the behaviors of the person with dementia, hope is the potential for a positive future (Duggleby et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Considering the overall positive attitude toward persons with dementia, a large number of participants agree with item 10, implying that they think a decline in the function of people with dementia is bound to happen. Presumably, participants perceived dementia as a part of the natural decline in function of aging.\u003c/p\u003e\u003cp\u003eThe Indonesian version of subscale 2: \u003cem\u003ePerson-centred\u003c/em\u003e comprised items 5, 9, 10, 11, 12, 15, 16, 17, 18, and 19, while the original version is comprised of items 5, 7, 9, 11, 12, 14, 15, 16, 17, 18, and 19. In the Indonesian version, item 7 (related to providing choices) and 14 (related to responding to declining memory function) are not related to items in the original subscale but related to items in subscale 1: \u003cem\u003eHope.\u003c/em\u003e This phenomenon may suggest that by offering choices and treating persons with dementia respectfully\u0026mdash;despite their declining memory\u0026mdash;migrant Indonesian care staff demonstrate a sense of hope in the individuals they care for.\u003c/p\u003e\u003cp\u003eThe results of CFA on the 2-factor model derived from EFA suggested that the bifactor model shows a better fit compared with the simple structure correlated factors model. These results indicate that Indonesian ADQ has a single general factor that influences all items while there are two distinct dimensions within. It also means that Indonesian ADQ reflects a complex interplay of a general construct and specific dimensions of attitude toward persons with dementia. Attitude is a complex concept in psychology that involves affective (emotion), cognitive (belief and thoughts), and behavior (Breckler, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e1984\u003c/span\u003e; Ostrom, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e1969\u003c/span\u003e). This phenomenon is captured in Indonesian ADQ as each item and dimension constructing attitude in ADQ intricates with each other under one general concept of attitude.\u003c/p\u003e\u003cp\u003eRegarding validity testing, we examine the known group validity and convergent/divergent validity of Indonesian ADQ. For known group validity, those who knew about PCC had significantly higher scores on Indonesian ADQ. Therefore, Indonesian ADQ appears to be able to distinguish scores for groups that have been shown to vary in the variables being assessed (Polit \u0026amp; Beck, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRegarding convergent/divergent validity, the correlation between Indonesian ADQ and P-CAT subscale was acceptable with subscale 1: \u003cem\u003eExtent of Personalizing Care\u003c/em\u003e, low or no correlation with subscale 2: \u003cem\u003eAmount of Environmental Support\u003c/em\u003e, and subscale 3: \u003cem\u003eDegree of Flexibility in Caring Activity\u003c/em\u003e. As expected, acceptable positive relationship was found between ADQ and subscale \u003cem\u003eExtent of Personalizing Care\u003c/em\u003e, as it reflects how care staff individualize everyday activities for residents. Low to no correlation was predicted between ADQ and subscale Amount of Environmental Support and Degree of Flexibility in Caring Activity, as they measure environmental aspects of PCC, which is a distinct concept from attitude.\u003c/p\u003e\u003cp\u003eThe overall Indonesian ADQ shows acceptable internal consistency; however, it is lower than the original version. Presumably, this is due to study participants had different age, education, work experience, and qualifications, which led to different interpretations of the questionnaire items. Regarding test-retest reliability, the overall ICC of the Indonesian ADQ was considered moderate, possibly due to inconsistencies in participants' interpretations. For example, item 2\u0026mdash;which compares a person with dementia to a child\u0026mdash;may be understood differently depending on cultural background, life experience, or personal values. In the first survey, some participants may have associated children with negative traits such as emotional instability or dependency, leading to less favorable responses. By the second survey, however, they might have reflected more deeply and associated children with positive qualities like innocence, sincerity, or living in the moment, resulting in more favorable responses. Such shifts in interpretation over time could contribute to variability in item responses. Nevertheless, our version has higher internal consistency compared to the Indonesian version tested among health students in Indonesia (Mulyani et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOur study has limitations, first regarding the utilization of two sampling methods: purposive and snowball sampling. We used snowball sampling as the number of participants recruited from purposive sampling was small. Using snowball sampling might lead to selection bias, as participants recruited in the study are more socially connected. Those who are not well-connected are possibly excluded from the study, which leads to under-representation of certain groups. We used snowball sampling after purposive sampling failed to gather study participants. Snowball sampling is effective as it can reach study participants who are difficult to identify (Polit \u0026amp; Beck, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) since not all Japanese LTC facilities employ migrant Indonesian care staff. However, no significant difference between the characteristics of participants in both sampling methods, except for years of working experience in Japan.\u003c/p\u003e\u003cp\u003eSecondly, since the Indonesian ADQ was tested on migrant Indonesian care staff working in LTC facilities in Japan, its generalizability to care staff in Indonesia may be limited. The influence of Japanese culture and workplace practices may have shaped participants\u0026rsquo; responses, making them different from those of care staff in Indonesia. However, testing the Indonesian ADQ in this context could enhance its validity and reliability, as the participants have direct, daily experience in providing care for individuals with dementia\u0026mdash;unlike many health-related students or care workers in Indonesia, who may have limited or no practical experience in dementia care.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eSimilar to the original version, the Indonesian ADQ is conceptualized around two core dimensions: Hope and Person-centredness. However, the specific items that correlate within each subscale differ somewhat from the original. We tested three models: the original structure, a correlated factors model derived from EFA, and a bifactor model. The bifactor model\u0026mdash;with two specific factors loading onto a general overarching factor\u0026mdash;provided the best fit. These findings suggest that the Indonesian ADQ is a valid and reliable tool for measuring attitudes toward persons with dementia among Indonesian care staff working in long-term care facilities in Japan.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all study participants and those who participated in the translation of the Indonesian version of ADQ.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no external funds, grants, or other support were received for conducting this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets are not publicly available due to ongoing studies, but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eEthic approval: Ethical approvals were sought and granted by the Ethics Committee of the authors\u0026rsquo; affiliation.\u003c/p\u003e\n\u003cp\u003eConsent to participants: All participants provided fully informed consent by answering the questionnaire survey.\u003c/p\u003e\n\u003cp\u003eConsent for publication: All participants consented for anonymised data to be used in future publications: The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003eConflict of interest: The authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBeaton, D. 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Development and Psychometric Validation of the Dementia Attitudes Scale. \u003cem\u003eInternational Journal of Alzheimer\u0026rsquo;s Disease\u003c/em\u003e, \u003cem\u003e2010\u003c/em\u003e, 1\u0026ndash;10. https://doi.org/10.4061/2010/454218\u003c/li\u003e\n \u003cli\u003eOstrom, T. M. (1969). The relationship between the affective, behavioral, and cognitive components of attitude. \u003cem\u003eJournal of Experimental Social Psychology\u003c/em\u003e, \u003cem\u003e5\u003c/em\u003e(1), 12\u0026ndash;30. https://doi.org/10.1016/0022-1031(69)90003-1\u003c/li\u003e\n \u003cli\u003ePolit, D. F., \u0026amp; Beck, C. T. (2017). \u003cem\u003eNursing Research, Generating and Assessing Evidence for Nursing Practice\u003c/em\u003e (C. Burns, Ed.; 10th ed.). Wolters Kluwer.\u003c/li\u003e\n \u003cli\u003eSchermelleh-Engel, K., Moosbrugger, H., \u0026amp; M\u0026uuml;ller, H. (2003). Evaluating the Fit of Structural Equation Models: Tests of Significance and Descriptive Goodness-of-Fit Measures. In \u003cem\u003eMethods of Psychological Research Online\u003c/em\u003e (Vol. 8, Issue 2).\u003c/li\u003e\n \u003cli\u003eSuzuki, M., Asai, Y., Uchiyama, Y., Abe, Y., Abe, K., Sawaki, K., \u0026amp; Tajima, A. (2021). Application of dementia care mapping (DCM) for one year in a geriatric health services facility: Effects of developmental evaluation based on collaboration by medical and welfare staff aimed at person-centred care. \u003cem\u003eNippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics\u003c/em\u003e, \u003cem\u003e58\u003c/em\u003e(1), 70\u0026ndash;80. https://doi.org/10.3143/geriatrics.58.70\u003c/li\u003e\n \u003cli\u003eTullo, E. S., \u0026amp; Young, T. J. (2014). 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Psychometric evaluation of the Indonesian version of the Person‐centered Care Assessment Tool. \u003cem\u003eInternational Journal of Older People Nursing\u003c/em\u003e. https://doi.org/10.1111/opn.12565\u003c/li\u003e\n \u003cli\u003eWeni, W. M., Shimizu, M., Ando-Ohmura, C., \u0026amp; Ozaki, A. (2024).\u0026nbsp;Factor Structure of the Indonesian Version of the Approaches to Dementia Questionnaire. \u003cem\u003eGeriatric Nursing Journal\u003c/em\u003e, \u003cem\u003eManuscript under review\u003c/em\u003e.\u003c/li\u003e\n \u003cli\u003eYong, A. G., \u0026amp; Pearce, S. (2013). A Beginner\u0026rsquo;s Guide to Factor Analysis: Focusing on Exploratory Factor Analysis. \u003cem\u003eTutorials in Quantitative Methods for Psychology\u003c/em\u003e, \u003cem\u003e9\u003c/em\u003e(2), 79\u0026ndash;94. https://doi.org/10.20982/tqmp.09.2.p079\u003c/li\u003e\n \u003cli\u003eZhao, Y., Liu, L., Ding, Y., Shan, Y., \u0026amp; Chan, H. Y. L. (2022). Translation and validation of Chinese version of sense of competence in dementia care staff scale in healthcare providers: a cross-sectional study. \u003cem\u003eBMC Nursing\u003c/em\u003e, \u003cem\u003e21\u003c/em\u003e(1), 35. https://doi.org/10.1186/s12912-022-00815-3\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Dementia, Attitude, Translation, Reliability and Validity","lastPublishedDoi":"10.21203/rs.3.rs-6949948/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6949948/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eMany migrant Indonesian care staff first encounter dementia care while working in long-term care facilities in Japan. Their perspectives may be influenced by Japanese cultural values, potentially shaping their attitudes toward individuals with dementia differently from those in Indonesia. This study aimed to translate, culturally adapt, and assess the validity and reliability of the Approaches to Dementia Questionnaire (ADQ) among migrant Indonesian nurses and care workers in Japanese long-term care facilities.\u003c/p\u003e\n\u003cp\u003eThe ADQ was translated into Indonesian and administered to 218 migrant Indonesian care staff. A retest was conducted 1–2 weeks later with 75 participants. The psychometric evaluation included exploratory and confirmatory factor analyses, known-group validity, convergent-divergent validity, internal consistency, and test-retest reliability.\u003c/p\u003e\n\u003cp\u003eExploratory factor analysis identified a two-factor model for the Indonesian ADQ, conceptualized as \u003cem\u003eHope\u003c/em\u003e and \u003cem\u003ePerson-Centered\u003c/em\u003e. Confirmatory factor analysis indicated that a bifactor model with two factors grouped under one general factor provided the best fit. Known-group validity analysis showed significantly higher ADQ scores among those familiar with person-centered care (p \u0026lt; 0.05). Convergent and divergent validity were supported through correlations with three subscales of the Person-Centered Care Assessment Tool. The Indonesian ADQ demonstrated acceptable internal consistency (α = 0.63) and moderate test-retest reliability (ICC = 0.53).\u003c/p\u003e\n\u003cp\u003eOverall, the Indonesian ADQ demonstrated sound validity and reliability for assessing the attitudes of Indonesian care staff toward individuals with dementia in Japanese long-term care facilities.\u003c/p\u003e","manuscriptTitle":"Validity and Reliability of the Indonesian version of Approaches to Dementia Questionnaire among Migrant Indonesian Care Staff Caring for Persons with Dementia in Japanese Long Term Care Facilities","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-24 16:16:04","doi":"10.21203/rs.3.rs-6949948/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5973aac3-189a-4f46-994d-cd4c00876ccf","owner":[],"postedDate":"October 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-13T16:13:25+00:00","versionOfRecord":{"articleIdentity":"rs-6949948","link":"https://doi.org/10.1007/s10823-026-09568-x","journal":{"identity":"journal-of-cross-cultural-gerontology","isVorOnly":false,"title":"Journal of Cross-Cultural Gerontology"},"publishedOn":"2026-04-06 15:59:22","publishedOnDateReadable":"April 6th, 2026"},"versionCreatedAt":"2025-10-24 16:16:04","video":"","vorDoi":"10.1007/s10823-026-09568-x","vorDoiUrl":"https://doi.org/10.1007/s10823-026-09568-x","workflowStages":[]},"version":"v1","identity":"rs-6949948","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6949948","identity":"rs-6949948","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}