Development of the Rural Perception Scale (RPS-18)

Abstract

Background: People living in rural areas often experience limited access to health resources, slow knowledge diffusion, and geographical isolation, and tend to be at higher risk for poor physical and mental health outcomes compared with nonrural populations. It is unclear, yet, how the concept of "rural" shapes observed differences from nonrural populations. We aim to develop a psychometrically sound scale to assess key dimensions that constitute individual-level perceived rurality.

Methods: We first conducted a broad literature review to identify a priori concepts related to rurality and adapted survey items measuring relevant constructs, such as loneliness, attitudes toward people living in rural areas, and perceived social membership. We used these conceptual constructs and measures to develop a survey questionnaire focused on rural perceptions. We recruit residents in 3 rural states: Kentucky, New Hampshire, and Vermont. Using the explorative factor analysis and second-order measurement model in the structural equation model framework, we developed a rural perception scale consisting of 18 items.

Results: We recruited 1,384 participants (n = 686 from KY; n = 698 from NH/VT) using Amazon Mechanical Turk (n = 897, 64.8%) and social media paid ads (n = 487, 35.2%). The average age of participants was 41 years old (SD = 15); 54.7% of respondents had less than college graduate education, and 94.2% reported their race as non-Hispanic White. Majority of the participants were from Rural Urban Commuting Area (RUCA)-designated urban areas (n = 798, 57.7%), followed by RUCA-designated large rural areas (257, 18.6%), RUCA-designated rural areas (n = 174, 12.6%) and RUCA-designated isolated areas (n = 133, 9.6%). Our final model revealed 4 latent constructs: "belonging" (Cronbach's α = 0.896), "attitudes toward rural life" (Cronbach's α = 0.807), "loneliness" (Cronbach's α = 0.898), and "community social ties to people in their community" (Cronbach's α = 0.846).

Conclusions: We identified 4 subfactors of the umbrella concept of rurality that explain how people in rural regions may perceive being in rural environments and having rural lifestyles.

Keywords: health equity; rural health; rural perception; scale development.

FIGURE 1

Factor loading scores for 4 rural perception factors by overall, New Hampshire/Vermont, and Kentucky. Note: Items with an asterisk character were removed for further analysis. [R] = reverse-coded items.

FIGURE 2

The second-order measurement model with latent constructs and 18 items. Note: CFI=0.94, RMSEA=0.065,SRMR=0.065. All path coefficients are significant. Numbers in the boxes indicate item ID numbers listed in Appendix 1. Items in the model include: Belonging (Cronbach’s α = 0.896) 63 Fitting into this community is important to me. 73 I feel hopeful about the future of this community. 68 This community has good leaders. 54 Being a member of this community makes me feel good. 62 Being a member of this community is a part of my identity. 52 Community members and I value the same things. 74 Members of this community care about each other. Attitudes (Cronbach’s α = 0.807) 43 I would say, living in a rural area is… Unpleasant: Pleasant 42 I would say, living in a rural area is… Harmful: Beneficial 50 I would say, living in a rural area is… Preferred: Not preferred [R] 48 I would say, living in a rural area is… Acceptable: Unacceptable [R] 45 I would say, living in a rural area is… Boring: Stimulating Loneliness (Cronbach’s α = 0.898) 95 How often do you feel that you lack companionship? 96 How often do you feel left out? 97 How often do you feel isolated from others? Community Social Ties (Cronbach’s α = 0.846) 16 Most of the people in my community know me. 15 I know most of the people who live around me. 58 I can recognize most of the members of this community. Use of a 5-point or 7-point likert scale is recommended for response options.