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 Table of Contents  
Year : 2021  |  Volume : 8  |  Issue : 3  |  Page : 209-216

Validity and reliability studies of the psycho-political safety scale

1 Department of Psychology, Institute of Social Sciences, Üsküdar University, Istanbul, Turkey
2 Political Psychology Research Center, Faculty of Humanities and Social Sciences, Üsküdar University, Istanbul, Turkey
3 Department of Psychology, Faculty of Medicine, Üsküdar University, Istanbul, Turkey

Date of Submission27-Sep-2021
Date of Acceptance18-Nov-2021
Date of Web Publication27-Dec-2021

Correspondence Address:
Gökben Hizl Sayar
Uskudar University, Institute of Social Sciences, Uskudar, İstanbul
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jnbs.jnbs_39_21

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Aim: The psychological effects of political approaches in our country together with political developments in the world, affect the mental health of society and the individuals who hold it together. When the literature was examined, it became clear that a Psycho-political Safety Scale (PSS) was needed to address the mental health and sense of safety of the individual from a psycho-political perspective. Materials and Methods: This research aims to conduct a validity and reliability study in a wide sample of the PSS. The sample consists of 6420 people from all over Turkey. Results: Analysis revealed that the scale consists of four factors. The first factor “Economy” alone explains 43.7% of the variance, the second factor “Homeland Security” 7.9% of the variance, the third factor “Education” 6.5% of the variance, the fourth factor “Domestic Policy” 6.3% of the variance. These four factors, consisting of a total of 16 items, together explained 64.5% of the total variance. In addition, four factors confirmed PSS in the validating factor analysis. (Chi-square/degree of freedom value: 3.15; Root mean square error of approximation: 0.069; Normed fit index: 0.93; Nonnormed fit index: 0.93; Comparative fix index: 0.96; Goodness of Fit Index: 0.93; Adjusted goodness of fit index: 0.91). The internal consistency coefficient of the scale Cronbach Alpha (α) was found to be, 91. As a result of the studies, it is understood that the scale is valid and reliable. Conclusion: A valid and reliable scale called PSS, which measures the psycho-political safety of individuals psychometrically has emerged.

Keywords: Politic psychology, psycho-political safety, psycho-politics, scale development

How to cite this article:
Sayar GH, Ünal AT, Ünübol H, Aribogan DÜ, Tarhan N. Validity and reliability studies of the psycho-political safety scale. J Neurobehav Sci 2021;8:209-16

How to cite this URL:
Sayar GH, Ünal AT, Ünübol H, Aribogan DÜ, Tarhan N. Validity and reliability studies of the psycho-political safety scale. J Neurobehav Sci [serial online] 2021 [cited 2023 Mar 24];8:209-16. Available from: http://www.jnbsjournal.com/text.asp?2021/8/3/209/333762

  Introduction Top

As in the field of psychology, it is extremely important to study “human” oriented behaviors in politics. Verbal or behavioral political content, together with people's reactions to events, facts, has the power to direct individuals and audiences unswervingly. Therefore, the field of political psychology, where political science and psychology meet in common, is becoming increasingly important.

For individuals who have a direct or indirect relationship with politics, political psychology; is defined as a discipline that addresses their behavior in a personal, social, emotional, and mass sense on many developmental grounds, especially lifestyles.[1] So much so that it is clear that the lifestyles and behavioral effects of individuals in a mass sense will differ from culture to culture. In this context, different cultural values and political understandings will vary from country to country, so psycho-political effects will diversify in the mosaic range, affecting individuals at the micro-level and societies at the macro level. Given this situation, there is a need for domestic studies that will contribute “culturally.”

The concept in our country of politics is mentioned together with the concept of policy. In this context, whether the concept of political psychology can be called political psychology is debating, and every day this discipline continues to develop by covering unique concepts such as Psycho-politics and political self-sufficiency, as in other fields. Nowadays, the concept of “Psycho-politics” meets these two disciplines, as in this study.

Hence, political self-sufficiency has become one of the concepts that political psychology has frequently discussed in recent years, expressing people's self-sufficiency perception levels, political competence, and safety levels. In other words, it is about investigating how individuals, situations, and events are perceived and interpreted and the relationships between this perception and the interpretation.[2]

Hence, psycho-political safety concept is another concept where people's perceptions of feeling safe find themselves in the field of politics. Accordingly, the country's domestic policy, foreign policy, economy, education, and homeland security policies are vital as parameters that will affect citizens' perceptions of security. The attitude of the country's leadership, the characteristics of the political leader, and some of his administrative skills directly affect the public's perception of safety. According to Tarhan, the sociopsychological code of social conflicts in Turkey is not a right-left or a lifestyle fight but is a resounding feature of the class struggle. Managing class struggle and achieving fair balance are essential skills for strong management. If it cannot be managed, it can become a crisis and have a trauma effect on society.[3]

According to Arıboğan, some walls in people's minds are collapse much harder than been thought. It is clear from many examples that collective traumas in the past can shape today's psychology and social behaviors, even though centuries have been passed. Accordingly, the criticism and emphasis on the preconceived notion that human behavior is rational in the political psychology discipline, which focuses on solving the connection between the psychology of societies and individuals and political processes, has been an important element that differentiates it from other disciplines.[4]

On the other hand, when the literature is examined, it is seen that the relationships between leadership characteristics and social context are frequently curious by researchers. In researches, three models of the leader's personality are widely deliberated. These are the ones that are going to be the “Leader characteristics model,” “Leader-State mapping model” and “Leader-Monitor match model.” Accordingly, the leading characteristics model set forth that successful leaders have certain personality traits. In the leader-state matchmaking model, it is suggested that successful leaders have personality traits, that are most suitable for the political situation. In the leader-monitor matchmaking model, it is stated that successful leaders have similar characteristics to society.[5]

Although political psychology has become a voice in the world since the 1970s, it was possible to talk about it in Turkey in the early 1980s with a limited environment. However, the definition of political self-sufficiency, which paved the way for the emergence of the field of political psychology, is associated with the concept of safety, with Campbell et al., feeling that the political actions or political stance of the individual have an impact on processes.[6]

According to Bingol (2015), Political competence is a sense of one's confidence in one's ability to participate effectively in democratic processes.[7] Accordingly, individuals with high political competence do not hesitate to participate in activities such as voting, participating in social protests, writing in newspapers, collecting signatures, while individuals may be more prone to alienation, and political inaction when their political competence is low.[8]

As well as the political context, political behaviors and leadership properties have been carried out with a focus on business life,[9] organizational structures,[10],[11] and managers[12] with many studies since previous years.[13],[14]

It is stated that the influencing tactics put forward by Kipnis et al. shed light on many of the research and these tactics developed in the following years.[15] These tactics took place in studies as; applied pressure, putting the senior management behind it, mutual interest, coalition, trying to stand out, trying to convince by sense, sanctions, and obstruction.[16],[17] Accordingly, measurement and sizing studies in previous years show that political behavior within the scope of institutions is measured by taking the subordinate-upper context into account.

When the literature is examined, it is found that a study has improved the scale of political behavior, which includes the dimensions of political behavior aimed at revealing what political behaviors are encountered in the institution.[18] The scale obtained by the dimensions of “Being Compromising,” “Being Hypocritical,” “Trying to Stand Out,” “Forming a Coalition,” “Mutual Interest,” “Trying to Benefit Senior Management” and these dimensions as “Horizontal Political Behaviors” and “Vertical Political Behaviors” under two basic groups was consistent with previous political behavior dimensions.

More recently, it was developed a “Perceived Political Self-Sufficiency Scale.”[8] The scale of type 5 rated Likert consists of 10 items and one dimension, and the high score from the scale shows a high level of political self-sufficiency. The internal consistency reliability of the scale was found to be, 92 in the Cronbach Alpha value. It is also aimed to determine the political effectiveness levels of health workers on another scale developed by Kuşçu-Karatepe and Atik.[19] The 26-point scale called the “General Political Activity Scale,” is seen to consist of two-dimensional structures as “internal” and “external.” As a result of validity and reliability studies, the Cronbach Alpha value was found to be, 96.

On an up-to-date scale on political leadership characteristics, participants' perceptions of leadership can be determined. Developed by Tarhan and Tutgun-Ünal, the “Üsküdar Democratic Leadership Scale (USDELID)” is a five-type Likert psychometric scale consisting of 25 items and four factors. People's perceptions of leadership can be measured in four dimensions called libertarianism/pluralism, justice-orientation, participation, and accountability. With the scale that allows double-sided evaluation, people can evaluate themselves as well as the opposite side.[20]

In the field of political psychology, the lack of psychometric scales that can measure these contexts and reveal the relationship between the existing political situation and its psychological effects on the person is noted. The lack of measurement tools for psychopolitical safety indicates that the scale developed in this study will be the first in the literature and will meet the need in this regard. In this study, it is aimed to develop a scale of psychopolitical safety that is thought to contribute to the field of political psychology.

  Materials and Methods Top

This study was performed in line with the principles of the Declaration of Helsinki, as revised in 2013. The ethics committee approval has been obtained from the Uskudar University Noninterventional Research Ethics Committee on the date of 23/09/2019, with the number of 61351342 /2019 404.

The validity and reliability studies of PSS were carried out with 6420 participants throughout Turkey. When the literature is examined, various opinions about the sample size to be reached are found in the multivariate analyses to be carried out for the development of a scale.[21],[22] When these opinions are examined, it is stated that the minimum sample size should be between 100 and 250, and it should be at least five times or even ten times, the number of substances on the scale. The sample size in this study is more than 100 times the number of items. Thus, it was found to be sufficient due to it was well above the minimum number of samples required.

The sample of the study consisted of 3419 women (53.3%) and 3001 male (46.7%) participants in various regions of Turkey. When the participant characteristics were examined, it was determined that 42.2% of their education level was university and 30% was high school. In addition, when the marital status was questioned, it was determined that 46.2% of the participants were married, 48.1% were single and 5% were separated.

Measurement instrument

Psycho-political Safety Scale

Psycho-political Safety Scale (PSS) validity and reliability studies were carried out with scope content validity, structure validity, discriminant validity, confirmatory validity, and internal consistency reliability studies. Accordingly, the substance pool of the scale in the scope validity studies was formed from 33 items in the first stage. There was a 3-rated Likert type prepared as a scale and participation in each item is designated as “I do not feel safe,” “I am undecided” and “I feel safe” to determine how safe the person feels for the relevant item. The high score from the draft scale indicates that the person feels safe from a psycho-political point of view, while the low score indicates that the person does not feel safe.

After the expressions and contents of the items were edited by taking expert opinions, the draft scale was applied to a pilot group of 10 experts. To evaluate draft scales, the expert opinion inventory includes the options “The item is appropriate to remain on the scale,” “The item may remain on the scale but is unnecessary” and “The item is not appropriate to remain on the scale.” After that, the adaptation rates of the items were calculated using the formula proposed by Tavşancıl and Aslan.[23]

Interrater reliability rates are calculated using the ratings contained in the inventory for each item. Accordingly, it was noted that the relevant item does not stay below 80, scoring between 0 and 1. Furthermore, according to the opinions of experts, the items have been revised and arranged in terms of spelling and grammar. After this stage, the data obtaining phase and the explanatory factor analysis (EFA) phase have been started.

In the EFA studies, the items that entered each dimension were examined in terms of item-total analysis and contribution to internal consistency, and items were eliminated in cases where low relationship values were present or where the removal of the items increased internal consistency. However, EFA was applied with the Varimax Rotation technique to determine the structure validity of the dimensions. In the first stage, several trial tests were performed with the Varimax Rotation technique, and then the Promax Rotation technique was applied due to the size of the data set. It is stated that the Promax Rotation technique, which is indicated to work better in big data sets, is one of the closest techniques to the Varimax Technique.[24] In this research, it was seen to work better either.

Bartlett Sphericity test was performed with Kaiser Meyer Olkin (KMO) coefficient to determine the suitability of the data for factor analysis.[25] There are some opinions regarding the evaluation of the KMO value. It describes having a KMO value of. 90 and above as “excellent,” being in the range of 0.80–0.89 as “very good,” being in the 0.70–0.79 range as “good,” being in the 0.60–0.69 range as “moderate,” “weak” and “unacceptable” being below 0.50.[26] In general, 0.70 and above is considered “good” in terms of providing sample size, and. 80 and above are considered “excellent.”[27],[28] In addition, Bartlett Sphericity is expected to be P < 0.05 for factor analysis with the data set.

In addition, the variance rate explained by the scale of factor analysis is ideal in social sciences when it varies in the range of 40%–60%.[29] The found ratio of 65% in the study is considered fairly well in social sciences.

Correlation values have been reviewed in the relations of the scale within the scope of structural validity studies. In the interpretation of correlation values, it is taken into account that the relationship values between 0.30 and 0.70 indicate the medium and the values >0.70 indicate a high relationship.[29]

Within the scope of validity studies, the volume of each item for the discriminant validity of the scale was viewed to the total volume of the scale and the lower scales. The item discriminant index (D) shows how many of the items are measured, in particular, relevant to their contacts. In other words, this is the power to distinguish between individuals who have a high level of the feature that the scale aims to measure, and individuals who have a low level. The item discriminant index can vary from −1 to +1. The fact that this value is negative indicates that the item inversely distinguishes individuals in terms of the measured feature. Therefore, such items should be removed from the test.[30] After the scale was scored, the scores were sorted and the lower and upper groups were separated by the 27% sub-quarter and the upper quarter, and the independent group t-test was applied.

In the confirmatory factor analysis studies, the scale structure that consisted of dimensions was verified in terms of structural equation modeling. In this stage, the goodness of fit index (GFI) values of PSS were verified (Chi-square/degrees of freedom value, Root mean square error of approximation [RMSEA], Normed fit index [NFI], Nonnormed fit index [NNFI], Comparative fix index [CFI], GFI, Adjusted goodness of fit index [AGFI]).

Within the scope of the reliability studies of the scale, the coefficients of internal consistency Cronbach Alpha (α) were calculated by item analysis. Cronbach Alpha value is considered reliable in cases of. 70 and above. In this study, this criterion was accepted when interpreting the internal consistency value of Cronbach Alpha.


The data obtaining was carried out according to the principle of volunteerism through an face to face survey between January 1 and 30, 2020. The study group consisted of people aged 18 and elder through randomly selected sampling. Attendees were given a questionnaire consisting of the PSS questions. An average of 12 min to complete the applied survey was enough.

Data analysis

EFA was applied to 5920 participants for PSS structure validity studies. Twenty-seven percent slices were taken from the upper group and the lower group in the discrimination validity studies, and the difference between the two groups was looked at with an independent group t-test. Confirmatory factor analysis was applied to 500 participants for PSS confirmatory validity and was calculated GFI values (Chi-square/degrees of freedom value, RMSEA, NFI, NNFI, CFI, GFI, AGFI). The reliability coefficient of the scales was determined by the Cronbach alpha value. SPSS 26.0 (IBM Corp. Released. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.) and AMOS (These statistical programs by IBM were used for all validity and reliability analyses) statistical program was used for all validity and reliability analyses.

  Results Top

Validity and reliability studies of the psycho-political safety scale

In this part of the study, evaluations were made for the PSS. Content validity, structure validity, discrimination validity, confirmatory validity, and internal consistency reliability studies.

Content validity

The PSS item pool was formed 33 items in the first stage and presented to expert opinions. To include interdisciplinary views, the items were examined by ten experts accompanied by an expert opinion inventory. A content validity study was conducted with data provided from opinions received from each expert through the expert opinion inventory, and interrater reliability was calculated. Accordingly, in the study, the compliance rates of. 80 were sought and 23 items were found to remain on the draft scale. Thus, EFA was applied to the data obtained by applying the 23-item draft scale to 5920 participants.

Structure validity-explanatory factor analysis

To determine the factor structure of PSS, EFA was first studied with KMO coefficient and Bartlett Sphericity Analyses. Accordingly, KMO value was found to be 0.931 at this stage where it was decided whether the data set was suitable for factor analysis. This test demonstrates the suitability of the data set for factor analysis. In addition, the Bartlett test applied to the data set was found to be significant (χ2 = 45,405,749, sd: 120, P = 0,000). These results showed a high correlation between the variables and the appropriateness of the data set for factor analysis was decided.

Since in factor building after factor analysis is made, eigenvalues for PSS > 1 are accepted, it is obtained that it is four-factor structure. In [Table 1], the eigenvalue of the factors obtained as a result of factor analysis and the variance amounts, they explain are given.
Table 1: Factor structure and explained variance rate

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As shown in [Table 1], the variance rate explained by the first factor with equity of 7,001 is 43.757%; the variance rate explained by the second factor with equity of 1.265 is 7.905%; the variance rate explained by the third factor with eigenvalue of 1.045 is 6.530%; the variance rate explained by the fourth factor with eigenvalue of 1.012 is 6.326%. The total variance rate explained was 64.517%.

Another method used to determine the number of factors is the scree plot test. Accordingly, the factor analysis scree plot test determines the number of factors indicated by the point at which the slope begins to disappear. The scree plot for dimensions is given in [Figure 1].
Figure 1: Scree Plot of Psycho-political Safety Scale

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When the line chart in [Figure 1] is examined, a fracture is observed around the fourth factor. Accordingly, high acceleration and rapid decreases in the graph were effective in determining the number of factors.

In the next stage, the rotation of the factors was made with the Promax Rotation technique to associate the substances with the factors. Accordingly, the factors under which the items are under the four factors obtained in the study and the factor loads of the items are given in [Table 2].
Table 2: Factor load values of Psycho-Political Safety Scale items

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The factor load values seen in [Table 2] are sorted from large to small in each dimension. The load values here are coefficients that describe the relationship between dimensions and factors and items and are decisive in the emergence of the factor structure. In the study, the lower cutting point was considered, 55. Accordingly, items that exhibit a load value below this value have been removed from the scale. Thus, 7 items were eliminated and it was observed that the measuring tool, which was 23 items before the factor analysis, was reduced to 16 items at this stage.

When [Table 2] is examined, it is seen that the load values of the first factor consisting of 5 items range from 0.886 to 0.694, the load values of the second factor consisting of 4 items range from 0.833 to 0.597, and the load values of the third factor consisting of 3 items range from 0.932 to 0.608, and the load values of the fourth factor consisting of 4 items range from 0.916 to 0.510.

After the factor load values were found, the dimensions were named according to the variance ratio described before the item discriminant validity studies were started and the contents of the items were taken into account when naming the dimensions.

Accordingly, items 12, 13, 14, 15, 16 in the measuring instrument constituted the first dimension and it was seen that this dimension was related to “economy.” The dimension of the economy is related to one's confidence in the country's economic policies. When the items in this dimension are examined, it is seen that “About the future of my livelihoods and my economic situation,” “About that I can protect the work I am still working in, in the near future,” “About that Turkey's economy will get better,” “About that the economic bureaucracy is doing its job well,” “About that the Turkish currency can maintain its value against foreign currencies such as dollars/euros.” are taking there their place.

It is seen that the 6th, 10th, 18th, and 19th items in the measuring instrument constitute the second dimension called “homeland security.” This dimension is about whether one feels safe against domestic security policies. When the contents of the items are examined, it is seen that “About to live my beliefs freely,” “Whether we can succeed in defending our country in the event of an attack,” “About the adequacy of the fight against terrorist organizations,” “The Turkish armed forces have been completely purged from terrorist organizations and gangs” are taking there their place.

Items 23, 25, 26 in the measuring instrument constitute the third dimension and are called “education.” The training dimension is about safety in training policies. When the contents of the items are examined, it is seen that “About the current state of the education system in our country,” “Our universities provide adequate education,” “Our universities produce objective scientific studies” are taking their place.

Items 1, 2, 3, 4 in the measuring instrument constitute the fourth dimension and are called “domestic policy.” The domestic policy dimension is about the person feeling safe from domestic policies. The person responds to the expressions in the substances that make up this dimension by considering whether they feel safe. Accordingly, it is seen that the items; “When I have a job with the judicial authorities, I will be judged fairly,” “About the fact that the mainstream media impartially conveys the news,” “About being able to express my thoughts freely,” “About the reality of the agenda produced on social media” are taking place.

The final form of the scale consisting of 16 items and 4 factors obtained by reordering the substances after the descriptive factor analysis studies carried out within the scope of the structure validity is included in [Annexure 1]. Thus, the PSS factor structure was determined, and the relationship of each factor was determined. Accordingly, the results are in [Table 3].
Table 3: Psycho-Political Safety Scale and its dimensions related to each other

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When [Table 3] is examined, the PSS total and subscales are associated with each other at the level of 0.001 signation. Accordingly, it is understood that the relationship of dimensions with the sum varies between medium and high (r: 0,502 ve r: 0,878).

Discriminant validity

At this stage, item discriminant validity studies were carried out to determine whether the items on the scale measured the desired property. Data collected from 1730 participants were sorted from large to small and independent group t-test was applied to data in the upper 27% and subgroups of 27%.

When [Table 4] is examined, the results were significant, it was concluded that PSS is a scale that measures the desired properties. Thus, it was observed that the highest score taken from the PSS of 3-rank Likert type, which consisted of 16 items and 4 factors, was 48, the lowest score was 16, and the arithmetic average obtained from the sum of the scale (n = 5920) was 26.56.
Table 4: PSS and total score differentiations of dimensions

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Confirmatory validity-confirmatory factor analysis

Validation factor analysis was also applied in the AMOS program with 500 participants to test whether the scale resulting from the structure validity of PSS, the relationship of factors with each other and the validity of items and factors was verified in terms of items and factors. Accordingly, the resulting structural equation model is given in [Figure 2].
Figure 2: Confirmatory factor analysis of Psycho-political Safety Scale

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When [Figure 1] is examined, it is seen that the structure revealed in the confirmatory validity studies is verified by the confirmatory factor analysis. Accordingly, the dimensions revealed by EFA are statistically verified and the results are given in [Table 5].
Table 5: Goodness of fit index values of Psycho-Political Safety Scale

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[Table 5] shows the GFI values of PSS. As a result of confirmatory factor analysis, it was found that Chi-square/freeness value is: 3.15; RMSEA is: 0.069; NFI is: 0.93; NNFI is: 0.93; CFI is: 0.96; GFI is: 0.93 and AGFI is: 0.91. Thus, these values are considered to meet the GFI values reasonably. It has been concluded that PSS is verified by four factors.

Reliability studies

The Cronbach Alpha (α) internal consistency coefficient of PSS and dimensions were determined within the scope of reliability studies. Cronbach Alpha internal consistency coefficients calculated based on the variance of items are included in [Table 6].
Table 6: Psycho-Political Safety Scale and the reliability of dimensions

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As shown in [Table 6], the 0.911 Cronbach α found in the sum of the PSS revealed a high degree of reliability. When the scale was examined, the Cronbach α value was found to be the lowest with 0.757 (domestic policy) and the highest with 0.845 (economy). It has been concluded that PSS total and dimensions provide reliability.

  Conclusion Top

The PSS is a measuring tool developed by researchers to measure whether people feel safe on a political level. After validity and reliability studies, it reveals that PSS is a structure consisting of 16 items and four factors.

PSS is a three-type Likert scale rated as “I don't feel safe,” “I am undecided,” “I feel safe,” the highest score from the entire scale is 48 and the lowest score is 16. Thus, the increase of PSS means an increase in confidence. To interpret the scores to be obtained from PSS, the highest and lowest score range that can be taken from the scale was determined and the range coefficients were calculated according to the triple Likert scale. The total score from the scale means “Unsafe” in the range of 16–29, “Undecided” in the range of 30–38, and “Safe” in the range of 39–48.

PSS's explanation of 64.5% of the total variance is considered quite high in terms of social sciences. In addition, the internal coefficient of consistency of the scale, Cronbach α value was found to be. 91. Dimensions have also been found acceptable in themselves, providing internal consistency. As a result of the confirmatory factor analysis, the goodness of fit values of the factors and the scale were found to be acceptable. Studies have shown that PSS is a valid and reliable scale. Thus, it is thought that the scale developed will contribute to addressing the lack of measuring instruments in measuring psycho-political safety in Turkey.

Dimensional examinations can also be carried out with the factorial structure of PSS, which will allow measurements to be made to reveal the relationship of people's feelings of safety with the country's policies and what their perceptions of security are. Accordingly, the perception of security to sustain the work achieved by livelihoods can be examined with the dimension of “economy,” the perception of security that beliefs can be lived freely, the perception of security in the case of an attack can be examined with the dimension of “homeland security,” the perception of security regarding the adequacy and objectivity of the education system can be examined with the dimension of “education,” and the perception of security regarding the impartiality of the judicial authorities, the mainstream media, and the security perception of freedom of thought can be examined with the dimension of “domestic policy.”

The validity and reliability studies of the scale developed in this study were carried out with a wide-ranging sample of Turkey. It is thought that the results of new studies with smaller focus groups will contribute to the literature in the future.

Patient informed consent

Informed consent was obtained.

Ethics committee approval

The ethics committee approval has been obtained from the Uskudar University Noninterventional Research Ethics Committee on the date of 23/09/2019, with number of 61351342-/2019-404.

Financial support and sponsorship

No funding was received.

Conflicts of interest

There are no conflicts of interest.

Author contribution subject and rate

  • Gökben Hızlı Sayar (%20) contributed with scale items, theoretical background, and data collect.
  • Aylin Tutgun Ünal (%20) contributed with scale development process, data analysis and wrote the whole manuscript.
  • Hüseyin Ünübol (%20) contributed with scale items, theoretical background, and data collect.
  • Nevzat Tarhan (%20) contributed with scale items revision and theoretical background.
  • Deniz Ülke Arıboğan (%20) contributed with scale items revision and theoretical background.

  References Top

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  [Figure 1], [Figure 2]

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


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