Journal of Studies in Social Sciences and Humanities

http://www.jssshonline.com/
Volume 6, No. 3, 2020, 100-115
ISSN: 2413-9270

Development and content validity of the readiness for Filial Responsibility

Scale

Huemer O. Uy, MSN, RN

Cebu Normal University, Philippines.
E-Mail: [email protected]

Abstract
Ageing brings physical limitations which gradually hamper people’s ability to do self-care and activities
of daily living. Changes in social roles, financial stability, cognitive functions, emotional needs and
spirituality could steer ageing parents toward partial or total dependence on their children. This study
aims to develop a scale which measures the adult children’s readiness to assume filial responsibility.
Using inductive approach and literature reviews, various ways of assuming filial responsibility have
been explored and classified into five themes- physical support, financial support, psychological support,
emotional support and spiritual support. 25 questions were formulated in relation to the identified
themes and were evaluated by five gerontology experts based on each items’ relevance to the scale.
Content validity was measured at both item and scale level. Item-level content validity was identified
through content validity ratio (CVR) and Content Validity Index (I-CVI). 22 items rated as “essential”
had a perfect agreement between all experts (CVR=+1.00; I-CVI=1.00); three items did not meet the
recommended level of agreement proportion (CVRcritical≥ +0.99; I-CVI=1.00). Overall, the scale has an
average scale-level content validity index (S-CVI/Ave) of 0.952, with a scale-level content validity
index for universal agreement (S-CVI/UA) of 0.88.

Keywords: Filial Responsibility, Filial Piety, Filial Responsibility Scale, Content Validity, Readiness
Scale

Introduction
Following the traditional family dynamics, parents normally provide the needs of their growing children.
With the inherent and implicit responsibility of providing a nurturing environment conducive for growth
and healthy development, these parents become the primary source of family support. Treas and Cohen
(2007) defined family support as social, emotional, instrumental, and economic exchanges between
family members. However, in time, these parents who used to be the primary provider and care giver
of the family grow old and develop needs that they can no longer independently meet because of the
limitations brought about by ageing. Aside from the physical limitations that can gradually hamper their
ability for self-care and activities of daily living, changes in their social role, financial stability,
cognitive function, emotional needs and spirituality become imminent. Associated with changes in
health and social status, the once independent parents can end up seeking assistance from their
significant others such as close kin, able peers and mostly, from family members.
During the early phase of late adulthood, spousal obligations normally develop wherein the
couple mutually meet their own needs independently without their children’s aide. However, their
independence may not last long if a spouse dies or both partners start developing the same needs that
cannot be met by the other (example, physical and sensory limitations on both partners). In most Asian
families, it is not uncommon for ageing parents to start reaching out seeking help from their own
children (Kim, et al., 2015, Waheed et al. 2020). Also in some cultures, where having close family ties
is the norm, the children may start to reach out to their parents once some parental needs are perceived.
At this point, the burden of taking care, and meeting the needs and expectations of the family starts to
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reciprocate. The children who were once dependent on their parents’ provision and care, are now the
functional adults who are responsible for taking care and meeting the needs of their elderly family
members. Now having the added responsibility of caring for and looking out for their elderly parents’
needs, this becomes a stressful period for functional adult children (Stephens, & Townsend, 1997;
Szinovacz, & Davey, 2013, Gilani et al., 2020) for playing the role of a “sandwich” generation.
Filial responsibility (also known as filial piety or filial obligation) refers to one’s caring duty to
one’s parents (Coalson, 1999; Polenick et al., 2017). Such support may come in various forms such as
physical, financial, psychological, emotional or spiritual support. When the children’s ability to meet
their filial responsibility is perceived to be poor, their parents experience despair over their children’s
unreliability and become distressed about being abandoned upon reaching old age (Liu, & Huang, 2009).
To address that, developing readiness among adult children in assuming the responsibility to provide
support to ageing parents becomes a need.
Due to the lack of conceptual clarity in literature on adult children’s responsibility for ageing
parents, the Filial Values Index was developed in order to predict association of filial care-giving, filial
values, and caregiver health outcomes (Jones, et al., 2011). In developing the index, 119 questionnaire
item s were assessed for clarity by 20 individuals representing different cultural groups. Every cultural
group is represented by two females and two males who rate each item on a 4-point rating scale. At this
point, ten cultural experts (one male and one female from each cultural group) examined the content
validity. Such process then reduced the questionnaire into 59-item with seven themes, with seven
questionnaire items per theme. The said tool was then pretested twice involving 34 and 30 individuals
respectively. The final questionnaire had all the 59 items rated on nine point Likert scales. (Jones, et al.,
2011).
Fingerman, et al., (2010) established the Intergenerational Support Scale in order to assess an
adult child’s parental support. In developing the tool, five questions were derived from other tools that
assess Social Support (Vaux, 1988; Vaux & Harrison, 1985), and one question pertaining to daily
interactions was derived from Fingerman (2001). Each item was scored based on the frequency of its
occurrence. To come up with the score, the mean of the six items are calculated.
Multiple scales have been developed to measure filial piety among adult children. Ho and Lee
(1974) created a filial piety scale that assesses the traditional filial attitudes that rooted from
Confucianism and overemphasizes some aspects of authoritarianism which implies the children’s
absolute submission to parents’ wishes, duties to repay parents’ sacrifices, preserve family honor, and
continue the ancestral line (Hwang, 1999; Gilani et al., 2020). Such authoritative elements were
criticized in Yang et al. (1989) by emphasizing that filial piety should also include emotional connection
and affection between parents and children (reciprocity), thus developing the Formal Filial Piety Scale.
In order to measure two integrated concepts—1. authority and obedience, 2. and emotion and
reciprocity-- Yeh and Bedford (2003) designed the nine-item Dual Filial Piety Scale (DFPS), wherein
few items relating to reciprocal and authoritarian form of filial piety were modified from the formal
filial piety scale of Yang et al. (1989).
Lum et al, (2016) developed the Contemporary Filial Piety Scale (CFPS) by compiling 42 items
through concept analysis on current literature. Using principal component analysis, a three-factor model
was generated: pragmatic obligation, compassionate reverence, and family continuity. The third factor
(family continuity) was removed after a confirmatory factor analysis. The remaining two-factor model
with a total of 10 items was then adopted as an efficient instrument with psychometric capabilities of
assessing contemporary filial piety.
Cicirelli (1988) originated the concept of filial anxiety to explain the state of distress about the
anticipated decline and death of an ageing parent, as well as one’s apprehension about one’s ability to
meet a foreseen parental care-giving needs and in preparation for further parental decline and needs for
supplementary care. To measure such anxiety, Cicirelli (1988) designed the filial anxiety scale (FAS)
and was administered to 71 adult children. The scale, which was narrowed down to 13-items, generated
two themes which relate to the cause of filial anxiety- foreseen care-giving role and anticipated parental
decline. The tool validity was proven as anxiety caused by an expected care-giving role turned out to
be significantly related to level of adult children’s resources; while the anxiety caused by parental
declines was related to their parental attachment.

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Bergelson, et al., (2015) studied the phenomenon called “post-migration filial responsibility”
which retrospectively explored the emotional reactions of immigrant children towards their
family’s traditional practices of filial responsibility and their respective psychological adaptation. The
emotional reaction to filial responsibility scale (ERFR) was created and was tested on immigrant adults
who migrated when they were 16 to 55 years old. Along with ERFR, four other proxy measures of
adjustment were used such as an adapted version of the Brief Symptom Inventory, the Satisfaction with
Life Scale, the General Self-Efficacy Scale, and selected items from the General Life Functioning
Inventory (Bergelson, et al., 2015). In this study, resilience factors were examined which included
individual characteristics of sense of coherence, optimism, and perceived social support, which in
general, diminished the relationship between filial responsibility and some of the adjustment indicators.
The results contribute to an understanding of interrelations between post-migration filial responsibility
and adjustment (Bergelson, et al., 2015).
Various research tools have been developed to measure filial piety/responsibility (Ho & Lee,
1974; Lum, et al., 2016; Yang, et al., 1989; Yeh & Bedford, 2003), filial anxiety (Cicirelli, 1988),
expectations of filial piety/responsibility (Kao & Travis, 2005; van der Pas, et al., 2005), attitudes
toward filial responsibility (Brody et al., 1983; Hamon, & Blieszner, 1990; Seelbach, & Sauer, 1977)
and the willingness for filial responsibility (Zhan, 2004). However, most of the previously constructed
scales pertaining to filial responsibility attitude lacks reliability and validity estimates (Coalson, 1999).
Furthermore, there has been no known tool developed to assess the adult children’s readiness to assume
filial responsibility. Thus, this paper aims to develop a measurement that gauges an adult child’s self-
perceived level of readiness to support their ageing parents.

Theoretical Framework
The Bowen Family Systems Theory (1974), which conceptualizes human behavior and human
relationships, provides an important framework that makes the assessment of an adult child’s readiness
to assume filial responsibility pertinent. The family systems theory posits that “all important people in
the family unit play a part in the way family members function in relation to each other” (Bowen, 1974).
This theory considers family as a system where a functional change in one family member leads to a
compensatory change and reciprocal impact with other family members (Bowen, 1974). Families acting
as systems explain why people tend to seek his family’s attention, approval and support and respond to
each others’ needs, expectations and disappointments. Such connection makes family members function
interdependently and is presumed to promote cohesiveness and cooperation among family members in
terms of providing protection, shelter, provision towards other family members (Kerr, 2000). However,
increased pressure can lead to anxiety and other problems. Should this anxiety be left unresolved, the
emotional connection among family members may lead to more stress, thereby making one or more
family members feel overwhelmed, isolated and out of control (Kerr, 2000). These people are mostly
the ones who absorb most of the tension and the system “anxiety”, and thus become more inclined to
depression, alcoholism, affairs and physical illness.
The family systems theory has eight interlocking concepts-- triangles, emotional fusion and
self-differentiation, nuclear family emotional process, family projection process, emotional cutoff,
multi-generational transmission process, sibling positions, and societal emotional process (Bowen,
1974; Brown, 1999; Kerr, 2000).
First, the triangle refers to the three-person relationship system which can contain much more
tension, as the tension can shift around three relationships. Triangling (otherwise known as triangulation)
takes place when an inevitable anxiety between two persons is alleviated by accommodating a third
person who can take sides, or temporarily reroute the anxiety (Brown, 1999). This can be observed in
the filial responsibility taking place in some families, as a response to failing spousal obligations
between ageing parents.
Second, the concept of emotional fusion and self-differentiation refer to a family member’s
tendency to independently or dependently function within family relationships. ‘Fusion’ happens when
independent preferences are ignored for the purpose of creating harmony inside the system and is
conveyed either by assuming responsibility over the others reactions, or by emotional ‘cut-off’ within
the relationship (Brown, 1999). ‘Differentiation’, on the other hand, refers to one’s ability to
independently make decisions, while maintaining emotional bond to relationship (Brown, 1999). This
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can be observed in the decision making of some adult children pertaining to their assumption of filial
responsibility as some adult children may be obliged to assume certain roles to achieve harmony and
minimize parental anxiety, yet others may choose otherwise, while maintaining emotional connection
to the family.
Third, the emotional dynamics of nuclear family pertains to four patterns that govern
complications in a relationship - marital conflict, a spouse’s inability to perform individual roles,
disability of any of the children, and emotional detachment. This concept assumes that tension
increases the activity of one or more relationship patterns; and that the greater the tension, there is an
increasing tendency of the manifestations to be serious, and more relationships will be symptomatic
(Kerr, 2000).
Fourth, the family projection process refers to a concept of communicating tension and
emotional problems to a child. This in turn can lead to anxiety to the child, as it is assumed that children
with the weakest emotional independence are most prone to developing anxiety. Through this reciprocal
anxiety, children become more impaired as they inherit the tension from their parents (Brown, 1999).
Kerr (2000) summarizes this projection into three steps—the parent pays special attention to the child
because of a perceived abnormality, the parent validates the said perceived abnormality by translating
the child’s manifestations, and the parents provides special treatment to the child by assuming that the
child is dysfunctional. In the concept of filial responsibility, a parental anxiety on the adult child’s level
of preparedness to assume such responsibility may be directly or indirectly communicated to the child,
which may cause the adult child to inherit the anxiety. When such anxiety is manifested on the adult
child’s behavior, the parents may interpret it as confirming their adult child’s lack of preparedness.
Fifth, the emotional cutoff refers to the concept where children emotionally dissociates from
their parents and other family members to alleviate emotional conflict. This may be attained by
physical detachment, or by maintaining physical connection while avoiding issues that may lead to
tension (Kerr, 2000). A main proposition of Bowen’s family system theory is that “the more people
maintain emotional contact with the previous generation, the less reactive they will be in current
relationships” (Brown, 1999).
Sixth, the muti-generational process describes how patterns and roles in a triangle are passed
down to the next generations. This concept assumes that each generation promotes lowered levels of
differentiation to family members of the next generation (Kolhepp, 1998). However, it is also possible
for the succeeding generations to differentiation by having family members that are minimally focused
on the family projection process, or by having a spouse with a higher level of differentiation (although
Bowen (1979) believes that most people select mates with similar levels of differentiation (Kolhepp,
1998).
Seventh, the concept of sibling position assumes that people who grew up in the same sibling
position most likely have common characteristics (Kerr, 2000). As an example, the eldest child are more
likely to be responsible and manifest leadership characteristics, the middle child tends to be the mediator
and may shift between both leader/follower roles, while the youngest of the siblings are often the
followers. Though the characteristics of these sibling positions are not necessarily opposites but are
complementary to each other- as in a leader-follower relationship (Kerr, 2000). Although, Bowen (1979)
never really concluded that these generalized traits are universal, such that the youngest child may even
act as ‘functional eldest’ (Brown, 1999).
And lastly, the societal emotional process which refers to the extension of the family patterns
to the larger emotional systems of the society. This idea outlines how the emotional system dictates
behaviors on a societal level, affecting both progressive and regressive impact to a society (Kerr, 2000;
Kolhepp, 1998). Just as in the dynamics of family relationships to its individual members, the societal
emotional process has reciprocal influence on the emotional processes in families (Kolhepp, 1998).
The family systems theory has also guided family therapies through the use of family systems
approach which is based on assumptions that consider each family unique as shaped by personal
characteristics of its members, cultural influence and ideological upbringing; families are interlinked
systems with parts whose boundaries are constantly shifting and resistance to change varies; families
need to fulfill varying roles for each member, individually and collectively as a family, in order for its
members to grow and develop; and families pass through developmental and non-developmental
changes that stress all members, at varying degrees (Missouri Department of Social Services, n.d).
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Figure 1. The Family Systems

(Illustrated by the Missouri Department of Social Services).

Filial responsibility invokes changes in family dynamics and roles. Since the family, as a system,
is composed of individual members that play important roles to one another, it is necessary to assess
each family member’s readiness to the changes and the assumption of new roles. Pelletiere (2006)
proposed that the change process in a system usually fails because a lack of readiness for change.
Individual’s readiness for change consists of beliefs and attitudes towards a change initiative; a state of
unfreezing; and a collection of thoughts toward a change initiative (Armenakis, & Harris. 2002;
Bernerth, 2004). In the context of filial responsibility, this translates to an adult child’s readiness to let
go of being the recipient of parental support into being the provider of support to ageing parents.
Furthermore, to ensure individual readiness to embrace changes in the family roles, each member must
be able to perceive a demonstrable need for change, have a sense of one’s ability to accomplish change
(or assume the new role), and an opportunity to participate in the change process (Armenakis, et al.,
1993).

Research Methodology
The study started with an inductive approach as its aim is to capture various ways filial
responsibility is assumed in order to develop a tool that measures an adult child’s readiness to assume
filial responsibility. This process was done through focused group discussions and individual interviews
in order to illicit as much data that could be used to generate the questionnaire. In choosing the
participants, inclusion criteria were set to ensure that the interviews and focused group discussions yield
useful and realistic data. The criteria in choosing the participants include a.) adult, b.) with at least one
living parent who is perceived to fall under the participant’s care in the future, or with at least one parent
who is currently under the participant’s care, or with any parent (deceased or living) who was previously
under the participant’s care.
Thirteen respondents joined two separate focused-group discussions; and three respondents
were interviewed individually to gather their experiences and perceptions on filial responsibility.
Participants were classified into three groups- Group A are adults with an anticipated responsibility to
take care of an ageing parent(s) soon; Group B are adults who are currently taking care and providing
support to at least one living parent; and Group C are adults who have previously taken care and
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provided support to at least one parent. Of the sixteen total respondents, eight were classified under
group A (with mean age of 23), five are classified under group B (with mean age of 28); and three are
classified under group C (with mean age of 37). A total of 23 significant statements led to data saturation.
Group A participants were asked about what they expect filial responsibility will involve, and
what needed preparations are perceived. Group B participants were asked about what their current
responsibilities toward their ageing parents are, and the ways in which their current responsibilities are
accomplished. Group C participants were requested to recall how they provided support to ageing
parent(s) who was/were previously under the participant’s care. By involving the three group of
participants, the interviews and informal focused group discussions were able to gather data based on
perceived responsibilities from Group A participants, and the actual responsibilities experienced by
participants from Group B and C.
After gathering enough information, the interview data were then transcribed, read and
analyzed in order to illicit their formulated meanings. The formulated meanings were classified
according to their thematic ideas. Five themes emerged as to how filial responsibility is perceived and
assumed—physical support, financial support, psychological support, emotional support, and spiritual
support. Literature review was also done in order to consider the compositions and methods of
previously developed questionnaires, and to consider how filial responsibility is practiced across
different cultures.
After identifying the themes from the data, the questions were liberally formulated into
questionnaire items that represent these themes. The questions were read multiple times and analyzed
until the contextual similarities were identified, then the items were integrated to narrow down the
questionnaire into more generalized statements that can be applied in varying situations. After
integrating pertinent information from literature reviews and participant’s statements according to their
contextual similarities, interview questions were formulated and grouped into five clusters, representing
each of the five themes.

Method Verification
Twenty-five questions were formulated and arranged into clusters, according to their themes.
An evaluation sheet containing a table with three columns was created to test the content validity of
these questions. The first column contained all the 25 questions, while the second and third columns
were left blank as they were intended for the rating of each item and for the expert’s comments,
respectively.
The evaluation sheets were sent via email to five experts. All five experts are gerontology
practitioners and educators, who have already earned a doctorate degree in gerontology nursing. On the
email sent to them, the purpose of the evaluation was explained, including the instructions on how to
use the evaluation sheet and how each item should be evaluated.
All 25 items were evaluated based on their relevance using a 4-point scale. While Lynn (1986)
advised that item evaluation should be rated using a 3- or 5-point rating scale, a 4-point rating scale
may be preferred in order to avoid having a neutral or ambivalent midpoint (Polit, & Beck, 2006). Davis
(1992), as cited in Polit and Beck (2006), supported the most frequently used label for the 4-point scale:
1= not relevant, 2= somewhat relevant, 3= quite relevant, and 4=highly relevant. The scoring and its
labels are shown on the evaluation sheet used by all five experts in rating the relevance of each item in
the proposed questionnaire.
After receiving the feedback from each expert, the data was processed on a spreadsheet to
calculate for the Content Validity Ratio (CVR) and the Content Validity Index (CVI), which will reflect
the item-level content validity. The comments from the experts were also considered in order to enhance
the formulation of the questions, making them more inclusive and applicable to adult children with
various backgrounds.

The Tool
Prior to proceeding to the readiness for filial responsibility (RFR) scale, the tool (see appendix
A) begins with a questionnaire asking for the participant’s age, gender, marital status, nationality, and
country of origin. These questions are not part of the scale, but they yield important information that
can be used in profiling the participant. The age, gender, and marital status are included in the tool as
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such information may justify the level of participant’s readiness in various clusters. Nationality and the
country of origin may also be used to determine the participant’s cultural background which may
influence the participant’s perception and behavior toward filial responsibility.
Apart from the profiling information, the tool also includes few questions that assesses the
participant’s current status (if the participant is supporting a parent at the moment, and if the
participant’s current finances are enough), the participant’s current responsibilities (such as having
dependent children, and having a full-time job), and the participant’s perception of future filial
responsibility. The answers to these questions may justify the participant’s level of readiness and may
be used to test the tool’s reliability in future studies. Furthermore, questions 1 and 2 function as
qualifiers to ensure that the participant is either a.) currently supporting a parent, or b.) anticipating an
ageing parent as dependent. In order to identify if a participant is qualified for this tool, at least one of
the questions 1 and 2 should be answered with a “YES”. If both questions 1 and 2 are answered with a
“NO”, this tool may not be applicable as there is no reason to assess the participant’s RFR.
The main part of the initial tool is the RFR scale composed of 25-item questions classified into
five clusters. The first cluster which measures readiness for physical support (RPS) contained five items
(items 1 to 5); the second cluster which measures readiness for financial support (RFS) contained five
items (items 6 to 10); the third cluster which measures readiness for psychological support (RPsS)
contained six items (items 11 to 16); the fourth cluster contained five items that measure readiness for
emotional support (RES) (items 17 to 21); and lastly, the fifth cluster contained four items that measure
readiness for spiritual support (RSS) (items 22 to 25). Each question is to be rated by a participant using
a 5-point scale with the following label: 1- Fully unprepared, 2- slightly prepared, 3- Moderately
prepared, 4- Highly prepared, and 5- Fully Prepared.
To use the tool, the researcher will compute the average rating of all items belonging to the
same cluster. The average rating will represent the cluster score. For example, to determine the
participant’s RPS, the average ratings of items 1 to 5 will be computed. The average rating (cluster
score) will represent the participants’ readiness level for that cluster.
The same procedure of averaging will be applied to all five clusters. Recognizing that filial
responsibility involves a balance of physical, financial, emotional, psychological and emotional support,
the researcher assumes that each cluster in this tool should have an equal weightage in determining a
participant’s total RFR score. Considering that not all clusters have an equal number of items (three
clusters have five items each, one cluster have four items, and one cluster have six items), computing
for a participants’ level of readiness should not be done by calculating the average of all 25 items
altogether. Instead, computing for a participant’s overall RFR shall be done by calculating the readiness
level for each cluster first and obtaining the average of 5 cluster scores to a generate the overall RFR
score.

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Each of the five cluster’s score and the RFR score will yield a minimum value of 1.0 and a
maximum value of 5.0. The cluster scores and the RFR score will be interpreted based on three
classifications- Poorly Prepared, Moderately Prepared, and Highly Prepared. This will help identify the
level of the participant’s readiness at each category. The ranges of scores and their interpretations are
shown in table 3.

Results and Discussion

For the CVR and the CVI to be computed, it is necessary to classify each item using a
dichotomized nominal data-- relevant and non-relevant (Polit, & Beck, 2006), or essential and non-
essential (Ayre, & Scally, 2014). The experts’ evaluations sheets rated each item with values ranging
from 1 to 4. These ratings were dichotomized by considering those items rated 3 or 4 as
‘relevant/essential’, while those items rated as 1 or 2 were considered as ‘non-relevant/non-essential’.

Content Validity Ratio (CVR)

Lawshe (1975), as cited in Ayre and Scally (2014), proposed CVR to calculate the proportional
level (ratio) of agreement between experts who rated an item as “essential” (or relevant). Lawshe
(1975) also argued that computing the CVR is useful in order to easily identify which item is considered
“essential” by more than 50% of the panelists, assuring its content validity (Ayre & Scally, 2014).
CVR is computed using the Lawshe’s formula shown below:

Lawshe’s formula computes CVR by considering ne (which is the number of experts indicating
an item is “essential”), and N (which is the total number of experts rating the item). CVR can be
expressed in values ranging from +1 to -1, wherein +1 is interpreted as perfect agreement and -1 as
perfect disagreement. Any item with a CVR above zero means more than 50% of the experts agree that
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the item is essential, while a CVR below zero means that less than 50% of the experts consider the item
essential.
However, using 50% agreement (represented by a CVR of 0) as the basis for finally considering
the item as essential may not be enough as it is important to consider the possibility that the agreement
may have occurred by chance (Ayre & Scally, 2014). In order to exceed the level of agreement by
chance for a given number of experts, Lawshe provided a table of critical CVR values (CVRcritical).
For this study, a panel size of 5 experts have a CVRcritical of +0.99, which means that almost all
5 experts are required to agree that the item is “essential” in order to meet the CVRcritical. Even if 3 out
of 5 experts (CVR=0.2) would already mean that more than 50% of the experts agree that the item is
“essential”, this study would apply Lawshe’s CVRcritical as the basis for retaining an item in the
questionnaire in order to get rid of a possible agreement by chance.

Of the 25-items rated by the experts, 22 items have a CVR above the +0.99 CVRcritical value.
The three items that did not reach the critical limit have CVR values of +0.2, -0.2, and +0.6, respectively.
Basing on each item’s CVR and Lawshe’s table of Critical CVR Values, only 22 “essential” items of
the questionnaire pass the minimum level of agreement of all five experts.

Content Validity Index (CVI)

Like CVR, CVI is an index that conveys the proportion of agreement between raters (experts).
Lynn (1986), as cited in Polit and Beck (2006), noted two types of CVI. The first type computes the
content validity of individual items (I-CVI), while the second type computes the content validity of the
entire scale (S-CVI).
I-CVI is computed as the number of experts considering an item as “relevant” (rating of 3 or
4), divided by the total number of experts (Polit & Beck, 2006). Like CVR, I-CVI also has the
possibilities that the agreement between raters happened by chance. To resolve this, Lynn (1986)
utilized the standard error of proportion to develop the criteria for item acceptability (Polit & Beck,
2006). Basing on Lynn’s criteria, a panel composed of five experts (or less) must have all experts agree
on the item’s content validity (I-CVI=1); while a panel of six or more experts has a recommended I-
CVI of not less than 0.78 (Polit, & Beck, 2006). For this study, 22 items achieved an I-CVI of 1.00,
while the three other items have an I-CVI of 0.6, 0.4, and 0.8, respectively.
Polit and Beck (2006) cited two definitions of S-CVI coming from two sources -- “The
proportion of items given a rating of quite/very relevant by both raters involved’’ (Waltz et al., 2005);
and “the proportion of items given a rating of 3 or 4 by both raters involved’’ (Waltz, & Bausell, 1981).
However, both definitions emphasized the use of the word “both”, which suggest that S-CVI is the
proportion of agreement between two experts. Considering that more than two experts are usually
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involved in evaluating the content validity, Polit and Beck (2006) provided an extension to the original
definitions of a two-rater S-CVI. To account for the rating of “all” content experts who evaluated
each item, in cases where multiple raters are involved (N>2), Polit and Beck (2006) coined the concept
of S-CVI/UA to represent the scale-level content validity index by universal agreement. Hence, S-
CVI/UA is defined as “the proportion of items on a scale that achieves a relevance rating of 3 or 4 by
all the experts” (Polit, & Beck, 2006).
Polit and Beck (2006) also coined the concept of S-CVI/Ave (average) which serves as a “more
liberal interpretation” to the original definitions of S-CVI. S-CVI/Ave is defined as the “average of the
I-CVIs for all items on the scale”, and is recommended to be 0.90 or higher, for a scale to be considered
as having excellent content validity (Polit & Beck, 2006).
For this study, the S-CVI/UA is at 0.88, while the S-CVI/Ave is at 0.952.

Validation Findings
The tool’s S-CVI/Ave of 0.952 can classify the 25-item scale as having an excellent overall
content validity. However, three items did not meet the recommended agreement proportion
(CVRcritical≥ +0.9 and I-CVI=1.00) of five experts.
Experts suggested that encouraging friends and younger family members to visit an ageing
parent may not be feasible in most scenarios, especially if the friends and relatives are living in a distant
location (ie, the relatives are from abroad). The experts recommended an integration of questionnaire
items which will suggest the use of technology (ie, video calls) to maintain communication with friends
and relatives from distant places. However, the researcher’s reason for not integrating some items is
not all relatives/friends are coming from distant places, and the item could mean encouraging visits
from friends/relatives nearby. Having a CVR of 0.2 and an I-CVI of 0.6, item #12 of the original
questionnaire was removed from the final questionnaire and is now integrated to item #11.
Furthermore, the original item #16 with a CVR of -0.2 and an I-CVI of 0.4, experts suggested
that constantly providing resources to promote learning may not be necessary or applicable in most
scenarios. However, the experts recommend having item #16 integrated with item #15 by carefully
rephrasing the statement in order to classify “learning” as a hobby or a mode of self-discovery. This is
now reflecting as item # 14 in the validated questionnaire.
For the original item #18 with a CVR of 0.6 and an I-CVI of 0.8, the expert who rated the
item as non-essential recommend having item #18 integrated with the original item #19, as involving
ageing parents in important family occasions is similar to involving them in making family decisions.
However, all the other four experts agree that item #18 is essential on its own. By following Lawshe’s
critical CVR values and Lynn’s criteria, the original item#18 shall be removed from the questionnaire,
but shall be integrated to the original item #19. In the validated questionnaire, it is shown as item #16.
All experts who rated most items of this tool as “essential” recommend that some items can
be improved by carefully rephrasing them to be more inclusive, and not appearing as “too ideal”. It was
recommended that the items be rephrased in a way that they do not appear to hinder the participant’s
personal growth in the pursuit of providing support to their ageing parent(s). Furthermore, in rephrasing
the questions, experts suggested to avoid the usage of certain words, such as the word “permanently”,
which may suggest a perpetual responsibility. Rather, it is recommended to use the word “sustainably”
as an alternative, which suggests consistency in providing support.
Most of the experts also recommend using statements and examples that are inclusive, which
participants from any origin or culture can relate to. For instance, the usage of the term “church services”
is exclusive to Christians, while “praying the rosary” is exclusively Catholic in nature. Furthermore, it
was recommended to have the term “church services” replaced with religiously inclusive terms such as
“worship activities” or “religious gatherings”. For the same reason, “providing a quiet place for worship”
is more inclusive than the usage of “praying the rosary”. The 22-item final version of this validated tool,
applying the validation criteria and integrating the experts’ recommendations, is shown on aappendix
A.
Conclusions and Recommendations
Despite having three items not meeting the recommended agreement proportion between five
experts, this scale can already be considered a valid tool in measuring an adult child’s readiness to
assume filial responsibility. The reliability (consistency) of this tool, however, has not been established.
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The researcher recommends having this tool tested on multiple participants with various backgrounds,
in order to ascertain the tool’s reliability.
Overall, the content of this tool is already considered valid. After applying minor
improvements on the sentence construction, the final version version of the validated tool can already
be used as an instrument or reference for future research studies in family dynamics and gerontology.

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Appendix A
The Validated 22-Item Version of the
Readiness for Filial Responsibility (RFR) Scale

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