This instrument is usually used to assess the students in Year 1 and again in year 4.
Each COCOA item is scored on a 1-5 Likert-type agreement scale (see attached COCOA items with wording for 1-5 response choices).
Single item responses can be compared across survey respondents over time with multiple administrations using a pretest-posttest format. Comparisons across comparison or alternative treatment/intervention groups can be conducted on single items as well.
The COCOA items can be summed to produce a composite score for the entire instrument or for subscale combinations of items. However, if this procedure is taken, the following items must be reverse-scored to preserve common orientation of attitudes across items:
Items 1, 5, 7, 8, 9, 11, 12, 13, 18, 24, 25, 26, 27, 29, 30, 32, 33, 34, 36, 37, 39, 40, and 42 are reverse-scored (see attached table of COCOA items).
Potential subscales (for the reduced 24-item COCOA instrument) are as follows:
Geriatrics as a Career (Items 2, 4, 10, 16, 21, 31, 38, 41 in Factor 1 on Table 1)
Cost Effectiveness of Caring for Older Adults (Items 11, 13, 24, 25, 27, 32, 33 in Factor 2 on Table 1)
Value of Older Adults (Items 15, 17, and 20 in Factor 4 on Table 1)
Experience in Caring for Older Adults (Items 6 and 19 in Factor 5 on Table 1)
Perception of Older Adults being Helpless (Items 1, 5, 18, and 39 in Factor 6 on Table 1)
A study was performed on the effectiveness of this instrument. The objective of this study was to test the reliability and validity of the Carolina Opinions on Care of Older Adults (COCOA) survey compared with the Geriatric Assessment Survey (GAS). Participants were first year medical students (n=160). A Linear Structural Relations (LISREL) measurement model for COCOA had a moderately strong fit that was significantly better than the null model (GFI = 0.81, TLI = 0.90) and the GAS (GFI = 0.76). A reduced, 24-item COCOA performed well (GFI = 0.90, TLI = 1.00) with R2 = 0.595 on five factors. The COCOA and GAS represent complementary instruments for assessing attitudes toward older adults.
The Factor Loadings for all 42 items are included in the attached table.