Validity and reliability testing of a Buddhist death acceptance scale among healthy Thai older persons (BDAS-O)

Death acceptance is a key component of psychological well-being in later life, influencing emotional adjustment, quality of life, and end-of-life preparedness. However, culturally appropriate and psychometrically sound instruments to assess death acceptance among older adults in Thailand remain limited. This study aimed to examine the validity and reliability of an instrument designed to assess death acceptance among healthy older Thai individuals. The study involved modifying an existing instrument and evaluating its validity and reliability. Seven hundred eighty healthy Buddhist Thai individuals aged 60 or older were recruited through multi-stage random sampling from community centers in four Thai regions. The instrument's quality was assessed using content validity, exploratory and confirmatory factor analyses, discriminant analysis, and internal consistency reliability. The results show that the Buddhist Death Acceptance Scale for Older Adults (BDAS-O) consists of 10 items with a good content validity index. It encompasses two dimensions that explain 48.1% and 77.6% of the variance in the construct. The scale's structure fits the empirical data well (χ2 (31, N = 480) = 42.716, p = .078 χ²/df = 1.378 CFI = 0.994, TLI = 0.992, SRMR = 0.021, RMSEA = 0.028). The discriminant analysis also demonstrated good power. Additionally, the scale shows strong internal consistency, with a Cronbach's alpha coefficient of 0.831 and McDonald's omega of 0.632. The BDAS-O is a valid and reliable tool for measuring death acceptance among healthy older Thai individuals. Nurses and healthcare providers can use this instrument to assess death acceptance, supporting efforts to promote greater acceptance of death among this population.