Development and Validation of the Attitudes Toward Healthcare Providers (ATHP) Scale: A Three-Study Investigation of Perceived Interpersonal and Institutional Ageism in Clinical Care

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ID: 328991
2026
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Abstract
BACKGROUND AND OBJECTIVES: Ageism in healthcare contributes to undertreatment, dismissive communication, and age-based exclusions from care, yet no psychometrically validated, patient-reported measure captures older adults' perceptions of age-based bias during clinical encounters. We developed and validated the Attitudes Toward Healthcare Providers (ATHP) scale. RESEARCH DESIGN AND METHODS: Items adapted from four validated discrimination measures plus two new items were administered to community-dwelling adults aged 65 and older in three independent, predominantly non-Hispanic White samples (Ns = 223, 349, 361) recruited through Prolific within the United States. Study 1 examined latent structure with exploratory factor analysis; Study 2 tested and refined the structure with confirmatory factor analysis; Study 3 confirmed the refined model and evaluated reliability, measurement invariance across gender, and construct validity. RESULTS: Study 1 identified two correlated factors, Interpersonal and Institutional Ageism, corroborated by parallel analysis and Velicer's MAP test. Study 2 indicated that a 20-item model fit poorly and that removing three items produced a refined 17-item model. Study 3 confirmed this model (CFI = .926, RMSEA = .058, SRMR = .057), with excellent reliability for Interpersonal Ageism and the total scale, good reliability for Institutional Ageism, full scalar invariance across gender, and coherent discriminant and convergent validity. DISCUSSION AND IMPLICATIONS: The 17-item ATHP is a psychometrically sound, healthcare-specific measure distinguishing interpersonal from institutional ageism, equipping researchers, health systems, and policymakers to monitor age-based bias and evaluate interventions.
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Authors Elizabeth Foster, Robert C. Intrieri
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Journal the gerontologist
Year 2026
DOI
10.1093/geront/gnag223
URL
https://doi.org/10.1093/geront/gnag223
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