According to the data released by the United Nations Population Division, the percentage of the global population aged ≥65 will almost double over the next 30 years, increasing from 9.1–15.9% of the global population [1]. This implies that the average patient will have more comorbidities in the future. In addition to having more than one systemic disease, the patient may also experience psychological, spiritual, and social difficulties.
The provision of so-called whole person care (WPC) is crucial to meet the needs of these patients because it attends to the patient’s full spectrum of needs, including medical, behavioral, and socioeconomic [2-4]. WPC yields improved clinical outcomes, increased care quality, reduced cost of care, and greater consumer satisfaction [5-7].
WPC has been an objective of healthcare reform and medical education in the recent 20 years [8-10], but it is difficult to put into practice despite having theoretical principles that are easy to understand [11]. Transformative education was proposed to propagate WPC [12]. Because every decision is based on a person’s beliefs, attitudes, and values, whether held consciously or unconsciously [13], convincing healthcare workers (HCWs) to adopt WPC is crucial to encouraging them to reflect on the meaning of life to shape a positive attitude and empathy for life [14,15]. Several studies have demonstrated that the attitudes, beliefs, values, and norms of HCWs play an essential role in the health care experiences and treatment outcomes of patients [16, 17]. In addition to affecting their interaction with patients, the attitudes and beliefs of HCWs can also influence their motivation to alter their own practices and behaviors at work [18-25]. HCWs in teaching hospitals often observe birth, senility, sickness, and death and accompany people through momentous life events. The effect of these experiences on HCW attitudes has not been explored, and no reliable instrument exists to measure it.
Measuring Attitude Toward Life: Short-form Life Attitude Inventory
Life attitude refers to a person’s perceptions of the purpose of one’s life, control over one’s life, presence of an existential vacuum, acceptance of death, will to find meaning in life, and the pursuit of one’s goals [26]. The more positive one's life attitude is, the more one can accept frustrations and experience being loved and cared for [27]. In 1981, Reker and Peacock developed the self-reported Life Attitude Profile (LAP) to assess meaning in life (MiL) from logotherapeutic assumptions [26]. Originally, it contained 7 factors and 56 items. In 1992, Reker proposed the revised version, Life Attitude Profile-Revised, LAP-R [28], which contains 48 items for assessing 6 dimensions of MiL: purpose (having life goals and a sense of direction from the past, in the present, and toward the future), coherence (having a sense of order, a reason for existence, and a clear sense of personal identity), choice or responsibility (perception of freedom to make all life choices for oneself and take responsibility), acceptance of death (fearlessness of death and acceptance as a natural aspect of life), existential vacuum (lack of sense and orientation in life), and goal seeking (desire to search for new and diverse experiences). Several studies have analyzed the psychometric properties of the LAP-R when applied to individuals from various countries and populations, including adolescents, college students, and patients with cancer [29-32]. These studies have reported varying results, and the proposed factorial structures have ranged from three to six. Some LAP-R scales have exhibited satisfactory internal consistency, and others did not. The results have suggested that implementing LAP necessitates a consideration of cross-cultural elements and the particularities of a given population. Some life attitude scales have been formulated for the Taiwanese population [33-36]; however, most are person-centered and focus on psychotherapy. In 2010, Hsieh and Pan developed a Life Attitude Inventory (LAI) in traditional Chinese to assess university students’ attitude toward life; the LAI is based on the concepts of life formulated by Jean-Paul Sartre, Viktor Frankl, Rollo May, and Carl Rogers [37]. The LAI comprises 70 items in 6 dimensions: ideals of life (having meaningful life goals and worthy of effort to fulfill), autonomy (perception of freedom to make life choices for oneself and take responsibility), love and care (perception of others’ existence and being altruistic), feeling of existence (being sure of the meaning and value of their existence), attitude toward death (expectations, attitudes, and behaviors toward death), and life experience (attitude and reactions toward life’s setbacks and sufferings). The six dimensions can be categorized into three relationships: with oneself, with others, and with their situation. The ideals of life, autonomy, and feeling of existence were included in the relationships with self and love and care in the relationships with others, attitude toward death, and life experience in one’s relationship with their situation. Because the work of HCWs is almost entirely about others and their life situations, the LAI is more suited to measuring HCWs’ attitudes toward life than other scales are. In 2015, Hsieh and Pan proposed the simplified version, the Short-Form LAI (SF-LAI) [38]. For each dimension, they selected four items with improved reliability. The SF-LAI had a Cronbach’s alpha of 0.93 in a psychometric analysis. The reliability estimates for all factors ranged from 0.68–0.80. A confirmatory factor analysis (CFA) indicated that the six-factor model had a good fit, at χ² (237) = 1078.58, χ²/df = 4.55, GFI = 0.93, CFI = 0.93, and RMSEA = 0.053 [38]. Although this Taiwanese version of LAI had cross-cultural validity and suited the requirements for measuring the life attitudes of HCWs, the structural validity and internal consistency among HCWs has yet to be determined.
We conducted this study to (1) analyze the applicability of the SF-LAI to the HCWs of a teaching medical center, (2) explore the validity and internal reliability of the revised version of the SF-LAI, and (3) examine the extent of measurement invariance across genders and professions.