The Attitudes and Beliefs of Nursing Students Towards the Childhood Overweight Scale<\/strong> is a specialized psychometric inventory developed and validated by Semerci, \u00c7elik, and Kudube\u015f (2023)<\/a> to evaluate implicit and explicit cognitive appraisals, stereotypical perceptions, and causal attributions concerning pediatric obesity among undergraduate nursing students. Adapted from the pediatric adaptation by Tsai et al. (2018), which evolved from the seminal work of David B. Allison (1995) on the Attitudes Toward Obese Persons (ATOP)<\/a> and Beliefs About Obese Persons (BAOP)<\/a> scales, this 19-item measurement tool operationalizes weight bias specifically in pediatric nursing contexts. The instrument is partitioned into two major conceptual components: the Attitudes Towards Obese Persons children’s adaptation (comprising two distinct latent dimensions: Self-Concept<\/em> and Social Relations<\/em>) and the Beliefs About Obese Persons children’s adaptation (a unidimensional construct evaluating locus of control and controllability attributions). The adaptation into Turkish followed formal cross-cultural translation protocols with explicit authorization from Dr. Lauretta Luck.<\/p>\n Psychometric evaluation of the instrument across third- and fourth-year nursing students revealed outstanding content validity, with an item-level content validity index (I-CVI) ranging from 0.91 to 0.99 and a scale-level content validity index (S-CVI) of 0.97. Construct validity was corroborated via exploratory factor analysis<\/a> (EFA), which isolated a two-factor solution for the ATOP component explaining 49.3% of the variance and a unidimensional structure for the BAOP component accounting for 55.92% of the variance. Confirmatory factor analysis<\/a> (CFA) demonstrated good model fit indices for both subscales (ATOP: χ²\/df = 2.151, RMSEA = 0.073, GFI = 0.932, CFI = 0.924; BAOP: χ²\/df = 2.190, RMSEA = 0.074, GFI = 0.969, CFI = 0.976). Internal consistency reliability was confirmed with Cronbach’s α coefficients exceeding 0.70 across all subscales. The scale serves as a diagnostic, educational, and empirical instrument designed to illuminate implicit bias, refine pediatric nursing curricula, and mitigate weight stigma in pediatric healthcare environments<\/span>.<\/p>\n Attitudes Toward Childhood Obesity, Nursing Students, Pediatric Weight Stigma, Attitudes Toward Obese Persons, Beliefs About Obese Persons, Self-Concept, Social Relations, Psychometrics, Nursing Education, Weight Bias<\/p>\n The Turkish adaptation and psychometric validation of the Attitudes and Beliefs of Nursing Students Towards the Childhood Overweight Scale<\/strong> was conducted by a team of nursing scholars specialized in pediatric health and psychiatric nursing:<\/p>\n The scale traces its conceptual lineage to the pediatric adaptation by Tsai et al. (2018) and the foundational work of David B. Allison (1995), with cross-cultural translation permissions formally authorized by Dr. Lauretta Luck.<\/p>\n Pediatric obesity is globally recognized by the World Health Organization (WHO)<\/a> as one of the most pressing public health challenges of the 21st century. Beyond the physiological sequelae—including metabolic syndrome, type 2 diabetes mellitus, non-alcoholic fatty liver disease, and orthopedic complications—children with overweight and obesity navigate pervasive weight stigma<\/a>, social exclusion, teasing, and emotional distress. Crucially, empirical literature indicates that healthcare environments are not immune to weight bias; healthcare professionals, including registered nurses and nursing students, often harbor implicit and explicit negative attitudes toward individuals with obesity, frequently stereotyping them as unmotivated, undisciplined, or non-compliant.<\/p>\n When directed toward children, healthcare-associated weight bias can have catastrophic clinical consequences. Children experiencing bias from healthcare providers report heightened medical avoidance, avoidance of preventative screenings, decreased physical activity, exacerbation of depressive symptoms, and elevated risks for developing disordered eating behaviors. In nursing education, students frequently receive robust didactic training regarding nutritional requirements and energy balance calculations, but rarely undergo formal self-reflection regarding their implicit prejudices, sociocultural stereotypes, or causal attributions regarding body weight.<\/p>\n The Attitudes and Beliefs of Nursing Students Towards the Childhood Overweight Scale<\/strong> was established precisely to fulfill this critical diagnostic and pedagogical void. The primary purposes of the instrument encompass:<\/p>\n The instrument operationalizes two foundational, interdependent psychological constructs drawn from social psychology and behavioral medicine: attitudes<\/em> and beliefs<\/em> regarding obesity, contextualized specifically to pediatric populations.<\/p>\n In accordance with Gordon Allport’s classical framework, an attitude<\/a> represents a learned predisposition to respond in a consistently favorable or unfavorable manner with respect to a given object or group. Within this instrument, attitudes reflect evaluative, affective, and cognitive stereotyping directed toward children with overweight and obesity. The factor analysis of the adapted instrument isolates two sub-dimensions:<\/p>\n The belief construct captures cognitive attributions regarding the etiology, controllability, and modifiability of pediatric obesity. Anchored in attribution theory<\/a>, this dimension measures the degree to which respondents attribute body weight to internal, controllable behavioral factors (e.g., lack of self-discipline, poor personal willpower, laziness, overeating, poor parental oversight) versus external, uncontrollable physiological and structural factors (e.g., genetic predisposition, metabolic dysregulation, endocrine pathology, neighborhood food insecurity, medication side effects).<\/p>\n In healthcare providers, a strong belief in individual controllability is consistently linked with heightened moral condemnation, diminished clinical empathy, and victim-blaming attitudes. Conversely, recognizing the multi-factorial, polygenic, and systemic nature of pediatric adiposity promotes supportive, evidence-based clinical partnerships.<\/p>\n The scale rests upon a confluence of three foundational theoretical models in social and health psychology:<\/p>\n Weiner’s Attribution Theory<\/a> posits that individuals act as naive psychologists, constantly seeking to understand the causes behind behaviors and physical states. These attributions fall along three primary dimensions: locus of control<\/em> (internal vs. external), stability<\/em> (stable vs. unstable), and controllability<\/em> (controllable vs. uncontrollable). When health conditions are appraised as internal and controllable (such as an individual simply ‘choosing’ not to exercise or a parent ‘allowing’ poor nutrition), observers experience affective reactions of anger, blame, and disgust, resulting in discriminatory behavioral inclinations.<\/p>\n Conversely, when a condition is appraised as external and uncontrollable (e.g., genetic vulnerability, neurochemical appetite dysregulation, socioeconomic barriers to nutritious food), observers experience empathy and prosocial helping motivations. The BAOP subscale operates directly on this framework, identifying whether nursing students evaluate childhood overweight through a punitive lens of personal volition or through a comprehensive biopsychosocial etiology.<\/p>\n Erving Goffman’s seminal conceptualization of stigma<\/a> characterizes it as an attribute that is deeply discrediting, reducing the bearer from a whole and usual person to a tainted, discounted one. Goffman classified stigma into three typologies: abominations of the body (physical deformities or deviations from physical norms), blemishes of individual character (perceived weak will, unnatural passions, or dishonesty), and tribal stigma of race, nation, or religion.<\/p>\n Obesity occupies a uniquely damaging intersection between physical deviations and characterological blemishes; society frequently interprets visible adiposity as an external manifestation of underlying moral and psychological failure. In the context of nursing education, Goffman’s model illuminates how healthcare trainees unconsciously extend negative physical stereotypes into global assessments of a child’s character, intelligence, and social viability, as measured by the ATOP Self-Concept and Social Relations subscales.<\/p>\n The Stereotype Content Model<\/a> posits that social perceptions of outgroups are organized along two fundamental dimensions: warmth<\/em> (intentions: friendly, sincere, trustworthy) and competence<\/em> (capability: skillful, confident, intelligent). Individuals with obesity are frequently stereotyped as low in competence and moderate-to-low in warmth. When pediatric nurses perceive children with obesity through this lens, they may provide less educational depth, deliver less thorough physical assessments, or demonstrate reduced therapeutic patience, directly impairing pediatric health outcomes.<\/p>\n The validation protocol executed by Semerci, \u00c7elik, and Kudube\u015f (2023) followed rigorous psychometric standards to establish content, construct, and structural validity within a target cohort of undergraduate nursing students.<\/p>\n Cross-cultural translation and linguistic adaptation were executed following standard back-translation methodologies. Subsequently, content validity was formally evaluated by a multidisciplinary panel of academic experts in pediatric nursing, psychiatric nursing, and psychometrics. Experts evaluated each item for linguistic clarity, cultural relevance, and theoretical alignment with pediatric weight bias:<\/p>\n Construct validity was established through structural verification using factor analysis. In scale validation, explained variance serves as a core benchmark for construct adequacy; accounted variance exceeding 40% is widely recognized as indicating robust construct representation. For the ATOP children’s version, the two extracted factors collectively accounted for 49.3% of the total variance<\/strong>. For the BAOP children’s version, the unidimensional construct explained 55.92% of the total variance<\/strong>. These findings confirm that the scale captures substantial structural variance in nursing students’ implicit and explicit appraisals.<\/p>\n The internal consistency and precision of the Turkish adaptation were evaluated using classical test theory metrics:<\/p>\n To substantiate the latent architecture of the instrument, Semerci et al. (2023) conducted both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) on empirical data collected from undergraduate nursing students.<\/p>\n Confirmatory factor analysis was conducted to assess the structural fit of the empirically derived models. Multiple fit indices were evaluated against established psychometric benchmarks:<\/p>\n2. Keywords<\/h2>\n
3. Authors<\/h2>\n
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4. Purpose<\/h2>\n
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5. Psychological Construct<\/h2>\n
1. Attitudes Toward Obese Persons (ATOP – Children’s Version)<\/h3>\n
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2. Beliefs About Obese Persons (BAOP – Children’s Version)<\/h3>\n
6. Theoretical Framework<\/h2>\n
1. Attribution Theory (Bernard Weiner)<\/h3>\n
2. Social Stigma Theory (Erving Goffman)<\/h3>\n
3. The Stereotype Content Model (Susan Fiske et al.)<\/h3>\n
7. Validity<\/h2>\n
1. Content Validity<\/h3>\n
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2. Construct Validity<\/h3>\n
8. Reliability<\/h2>\n
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9. Factor Analysis<\/h2>\n
1. Exploratory Factor Analysis (EFA)<\/h3>\n
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2. Confirmatory Factor Analysis (CFA)<\/h3>\n