A cross-cultural comparative study of attitudes towards people with epilepsy in Japan and Germany

The Japanese version of the Scales of the Attitudes towards People with Epilepsy (SAPE-J) has been developed based on the German SAPE to assess attitudes towards people with epilepsy (PWE). This study aims to verify the invariance of the measurement models between the SAPE and SAPE-J and investigate scale-level differences in attitudes towards PWE between Japan and Germany. We administered the SAPE-J to members of the Japanese public via an online survey (n = 985) and used previously collected data of 1001 participants from Germany for comparison. Sampling weights based on German and Japanese population characteristics were included to mitigate sampling bias. We conducted multigroup measurement invariance tests to compare the measurement models. After adding demographic characteristics, epilepsy knowledge and personal experiences with PWE as covariates, we investigated SAPE factor differences between the German and Japanese data while controlling for these covariates, and assessed group differences in how covariates impact SAPE factors. Results support partial strong measurement invariance and reveal that members of the Japanese public show higher Social Distance, Concerns, and Anger, and less Pity. Differences in attitudes and their associations to demographic characteristics, experiences and knowledge underscore the importance of considering the cultural context when developing strategies to reduce stigma and improve attitudes towards PWE. While increasing knowledge and promoting positive experiences are generally beneficial, tailored approaches that address specific cultural factors may be necessary to effectively reduce social distance and negative attitudes in different societies.