Development of a questionnaire measuring student attitudes to working and living in rural areas

Introduction: Student attachments in rural locations have been instigated, in part to foster positive attitudes to rural practice and encourage rural recruitment. Based on medical and allied health literature, it was hypothesised that students’ attitudes to rural practice and rural life encompasses the following three dimensions: (1) community and social issues; (2) family and personal issues; and (3) professional issues. However, there are limited studies assessing attitudinal change before and after rural placement and no valid and reliable tools which examine change across all three dimensions. This article reports on the development, reliability and validity of such a tool to fill this gap in the rural health research literature. Methods: Students who undertook a rural placement in South Australia or a rural placement organised by the Mt Isa Centre for Rural and Remote Health in Queensland, Australia, during 2001 were invited to complete a pre- and post-placement questionnaire (n = 243). The response rate for the pre-placement questionnaire was 74.9% (n = 182) and 50.2% (n = 122) for the post-placement questionnaire. A literature review informed the content of the initial questionnaire, which consisted of a series of statements to which respondents were instructed to indicate how strongly they agreed or disagreed on a Likert scale of one to six. The assessment of validity and reliability of the questionnaire involved three main processes. Content validity was assessed by discussion and rating by academics and students, resulting in 18 questionnaire items. Exploratory factor analysis was used to provide evidence of construct validity. The internal consistency reliability of the questionnaire was assessed using Cronbach’s alpha. Results: The Cronbach’s alpha coefficient for the post-questionnaire was 0.68, acceptable for newly developed scales. Exploratory factor analysis and varimax rotation was conducted for pre- and post-placement (n = 110) questionnaires. The pre-placement questionnaire did not lend itself to logical interpretation, probably due to the diverse attitudes students may have pre-rural placement. However the factors on the post-placement questionnaire were interpretable. The Scree Plot indicated four factors, explaining 60.82% of the total variance. The factors were rotated using the normalised varimax rotation method. The factors extracted were: (1) friendliness and support in rural areas; (2) isolation and socialisation problems associated with living and working in rural areas; (3) enjoyable aspects of living in a rural area; and (4) opportunities that working in a rural area provides. Conclusions: Analysis of the Student Attitudes to Rural Practice and Life Questionnaire provides evidence of validity. The study identified four factors associated with student attitudes to living and working in rural areas, which differ from those hypothesised. The main deviation was Factor 2, grouping all the negative aspects of isolation and socialisation in a rural area. The resulting factors provide a more integrated reflection of the rural experience, rather than the rigid categorisation of professional, social and personal issues. Reliability was found to be adequate. The questionnaire is able to measure student attitudes to rural practice and rural life, and may be used to evaluate the impact of rural placement on student attitudes