Development of a well-dying awareness scale for middle-aged adults in Korea: a mixed-methods study

Purpose: This study aimed to develop a valid and reliable tool to measure awareness of well-dying among middle-aged adults. Methods: A mixed-methods approach was adopted, consisting of a qualitative phase to identify the characteristics of well-dying and a quantitative phase to validate the instrument with middle-aged participants. Initially, 76 items were generated through a literature review and in-depth interviews, and these were reduced to 35 items through expert validation. A pilot survey was conducted with 112 individuals aged 40-65, selected via quota sampling from 17 administrative regions in South Korea. Based on the pilot survey results, the instrument was refined to 32 items for the main survey. The main survey included 314 participants recruited through quota sampling in Busan and Ulsan Metropolitan Cities and Gyeongsang Region. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and reliability testing were performed to validate the instrument. Results: The final scale comprised 23 items across six factors. EFA demonstrated an explanatory power of 69.1%, with factor loadings ranging from .53 to .88 CFA confirmed the instrument's validity, and reliability was established with a Cronbach's alpha of .93. Conclusion: This instrument is a validated and reliable tool for measuring middle-aged individuals' awareness of well-dying. It can serve as an effective resource for evaluating and assessing well-dying awareness in the middle-aged population.