Modeling the Relationships between Attributed Dignity and Health

Attributed dignity is a unique concept that refers to an internal state affected by both the environment and interpersonal interactions. Given these interactions, this state can change depending on the meaning one infers from any given situation. Attributed dignity has been shown to be related to improvement in physical function and health. In previous research, attributed dignity was measured using the 18-item Jacelon Attributed Dignity Scale (JADS). The JADS has been validated for use in community-dwelling older adults. The JADS consists of four subscales: behavior with respect to others (BRO), self-value (SV), perceived value from others (PVO), and self in relation to others (SRO) (Jacelon & Choi, 2014).

Purpose:   The aim of the current study is to evaluate the four characteristics of attributed dignity and mental and physical health using structural equation modeling (SEM; Lisrel 9.1). 

Methods: The study sample consisted of 289 older adults (mean age = 77.4; range = 65 – 99) recruited from senior centers in western Massachusetts. Data were cleaned so that only cases that had responses for all items of interest were included in the modeling analysis; the sample size for the model included 229 cases. Relationships among the four identified characteristics of attributed dignity as measured by the JADS and the outcomes were entered as outlined in the theoretical model and further refined guided by the modification indices. Alternative models were also tested to ensure that a better fit between theoretical components and outcomes did not exist based on these data. A path diagram of the final model and its corresponding coefficients was identified; only significant paths were included in the final model. Indirect effects were also evaluated.  

Results: The overall model fit the data very well (χ² = 388.46, df = 325, RMSEA = 0.029, p = 0.009, CFI = 0.99, NFI = 0.92). The SEM revealed that PVO directly affected both SRO and BRO, but SV was only influenced by BRO. An individual’s self-value was positively impacted mental health, which in turn positively affected physical health. There was also a direct path from gender to SV. Females reported lower self-value scores than males. There were significant indirect paths from PVO to SV, PVO to mental health, and PVO to physical health. Gender also indirectly influenced mental and physical health. Age only influenced living status and physical health; older participants had lower physical health scores and were more likely to live alone.  

Implications: PVO, the value an individual perceives he or she is attributed from other people is critical in the process of maintaining dignity. In the model, based on PVO, an individual adjusted how they saw their own behavior in relation others (SRO) and their behavior toward others (BRO). An individual’s self-value was affected by the perception of how their behavior influenced others, not directly from the influence of other’s behavior.  Thus, attributed dignity affected mental health and physical health in this sample of older adults.

Conclusion: Interventions that support and enhance an older individual’s attributed dignity have the potential to improve health outcomes.