Understanding social perceptions of epilepsy: The Japanese version of the attitudes and beliefs about living with epilepsy (ABLE) scale development and validation study

Abstract

This study aimed to develop and validate the Japanese version of the Attitudes and Beliefs about Living with Epilepsy scale (ABLE-J), a multidimensional instrument to assess public stigma toward epilepsy in Japan. A cross-sectional online survey was conducted with 400 Japanese adults. The ABLE scale was translated and culturally adapted into Japanese. Confirmatory factor analysis (CFA) tested a four-factor model: Negative Stereotypes, Risk and Safety Concerns, Work and Role Expectations, and Personal Fear and Social Avoidance. Internal consistency was assessed with Cronbach's alpha. Validity was examined via correlations with the Public Attitudes Toward Epilepsy Scale (PATE-J), epilepsy knowledge, and cultural stigma. CFA showed marginal fit for the original 29-item model (Comparative Fit Index: CFI = 0.867, Tucker-Lewis Index: TLI = 0.853, Root Mean Square Error of Approximation: RMSEA = 0.091), while the revised 27-item model showed improved fit (CFI = 0.893, TLI = 0.880, RMSEA = 0.087). All subscales showed high internal consistency (Cronbach's alpha = 0.81-0.92 for the 29-item version; up to 0.94 for the 27-item version). The ABLE-J score correlated positively with the PATE-J (r = 0.617) and cultural stigma (r = 0.489), and negatively with epilepsy knowledge (r = -0.326). No significant differences in stigma were found across demographic groups. The ABLE-J is a reliable, valid tool for measuring public stigma toward epilepsy in Japan. It is suitable for public health research, stigma-reduction interventions, and international comparison.

Keywords: Cross-cultural adaptation; Discriminant validity; Epilepsy knowledge; Measurement tool. construct validity; Psychometrics; Public health.