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Theory-Based Study of the Basic Values of 565 Physical Therapists

LJ Nosse, PT, PhD, is Associate Professor, Department of Physical Therapy, College of Health Sciences, Marquette University, Room 346, Schroeder Health Science Complex, Milwaukee WI 53201-1881 (USA) (larry.nosse{at}marquette.edu)
L Sagiv, PhD, is Assistant Professor, School of Business Administration, The Hebrew University, Jerusalem, Israel

Address all correspondence to Dr Nosse

Submitted April 23, 2004; Accepted March 3, 2005

	Abstract

 
Background and Purpose. There is a prevailing belief expressed in the physical therapy literature that values influence behavioral choices. There is, however, meager research on physical therapists' values. A values theory was used to study the organization of physical therapists' basic values and to generate hypotheses about age-related value priority differences. Subjects. Participants were volunteers from the Wisconsin Physical Therapy Association (N=565). Methods. Values importance ratings were gathered using a modified Schwartz Values Survey. Demographic data were obtained with an investigator-developed questionnaire. Analyses included descriptive and nonparametric statistics and nonmetric multidimensional scaling. Results. The organizational structure of therapists' values was similar to the theoretical model. Physical therapists rated values associated with benevolence as most important and values associated with power as least important. Three of 7 age-related hypotheses were supported. Discussion and Conclusion. The theory adequately explained the organization of physical therapists' values and provided rational explanations for age-based value priority differences. Compared with occupationally heterogeneous samples, the results suggest that physical therapists highly prize values that benefit others and give remarkably little importance to values associated with power.

Key Words: Personal values • Social values • Values

	Introduction

Top Abstract Introduction A Values Theory Purposes and Hypotheses Method Results Discussion Summary and Conclusions Appendix References

 
The belief that values are important determinants of human behavior is long-standing and multidisciplinary.^1–12 It is generally accepted that human behavior is influenced by what people value. What people value is based on enduring personal beliefs⁹ about what is important⁴ and what action is likely to bring about a desired outcome^6,13 or fulfill a personal need¹⁴ or goal.¹⁵ Values are intertwined with a sense of oneself^9,13 or self-concept.³ Scheibe¹¹ captured the essence of these attributes of values when he wrote that what people do (behavior) depends on what they want (value) and what they consider to be true (beliefs) about themselves.

The beliefs that values are important in guiding behavior of physical therapists and that specific values are important to the profession as a whole have been expressed several ways. In national addresses, eminent physical therapists have repeatedly noted that caring and its synonyms is an important value for members of this profession.^16–18 Philosophical papers have offered reasoned arguments for physical therapists to honor the values of reciprocity,¹⁹ caring,²⁰ helping, honesty, fairness, and respect.²¹ A recent consensus report identified accountability, altruism, caring/compassion, excellence, integrity, professional duty, and social responsibility as the critical values that define physical therapist professionalism.² Albeit sparse, there have been empirical studies that have given attention to physical therapists and their values. Roush,²² for example, studied attitudes and values of physical therapists and occupational therapists as they related to patient satisfaction. One purpose of Roush's study was to determine whether therapists' attitudes or their general life values were the better predictor of patient satisfaction. Seventy-eight therapist-patient pairs were surveyed. The therapists' mean experience level was 12 years (SD=9), and the patients' age range was 22 to 79 years (SD=12). General life values were measured with the Survey of Interpersonal Values,²³ an instrument with reliability and validity for this purpose.³ The only remarkable finding about values was the low importance female therapists gave to conformity compared with sex-specific adult norms. Roush concluded that patients were well satisfied with their therapists' services and that therapists' attitudes predicted patient satisfaction better than their general life values.

Qualitative studies also have drawn attention to physical therapists' values. In such studies, inductive reasoning and creative insight are used to interpret interviews and other sources of data. Raz et al²⁴ and Stiller²⁵ conducted qualitative studies of predominantly female physical therapists. Raz and colleagues were interested in developing a framework to describe professional development of physical therapists. Values, perceptions, and experiences were extracted from interviews of 10 experienced female physical therapists (mean age >40 years). Values identified as important to the professional development of the interviewees were caring, relationship, context, and empowerment. Stiller was interested in developing a different framework, one that would describe the evolution of physical therapy culture (ethos). Data were obtained from a review of historical American Physical Therapy Association (APTA) literature and interviews with 14 members of the APTA Prime Timers (APTA members 55 years of age). The author chose this population under the assumption that longevity and a breadth of experiences were important to understand the culture of physical therapy. The resultant framework included value terms that the investigator classified as enduring traits: "positive attitude," "caring and helping," "hard work and dedication," and "warmth and openness."

A third qualitative study was reported by Jensen et al.²⁶ This study's purpose was to develop a theoretical model of expert practice. Multiple means were used to study physical therapists who were deemed clinical experts by their peers. Twelve study subjects were chosen for their specific expertise. There were 3 experts in each of 4 domains: geriatric, neurological, orthopedic, and pediatric physical therapy. Subjects had from 10 to more than 30 years of experience. Data were gathered from interviews, observations, videotapes, and written documents. The data coding system included the identification of the values and beliefs that supported each therapist's actions. The model of expert practice that emerged contained 4 interlinked core dimensions: clinical reasoning, knowledge, movement, and virtues. Examples of the virtues dimension were caring and commitment. The authors summarized expert physical therapists as individuals who were committed to continual learning, providing excellent care, showing patients and their families that they care, and treating patients respectfully.

The findings of the preceding studies are interesting because of their variety. However, the variety makes it a challenge to summarize what is believed, understood, and applicable to other physical therapists. For example, each study had a different purpose, used a different conceptualization of values, and involved different size groups. In most cases, the study subjects differed in age and practiced in distinct settings. Furthermore, one study used a measurement tool that produced rating data and the data were interpreted in terms of sex-specific norms. The qualitative studies gathered different types of observational data that were converted to analyzable forms via unique investigator-developed coding schemas. Missing from all of these reports was a connection between the constructs the authors called values and the general body of knowledge on values and values theory.

	A Values Theory

Top Abstract Introduction A Values Theory Purposes and Hypotheses Method Results Discussion Summary and Conclusions Appendix References

 
Our study used the Theory of Basic Human Values (TBHV).²⁷ This theory was developed to investigate basic human values worldwide.¹⁵ Its development and validation, the psychometric properties of the measurement instrument, and the analysis method have been discussed in multiple publications.^28–36

Value Definition and TBHV Propositions

In the TBHV, basic values are operationally defined as desirable goals that transcend situations, vary in importance, and serve as guiding principles throughout a person's life.²⁹ Basic values represent important consciously chosen goals that serve to meet biological needs, societal needs, and social interaction needs.²⁸ The essential propositions of the theory are:

1. There are many basic human values that reflect goals that fulfill biological, social, and societal needs.
   
2. Almost universally some basic value terms have similar meaning in that they reflect the same goals.
   
3. Value terms that are recognized in most cultures are useful for identifying sets of values with the same goal.
   
4. The focus of analysis should be on the common goals that sets of basic values reflect rather than on individual value items.
   
5. There is an organizational structure of value goals (ie, value goals are systematically related such that there is a predictable pattern or continuum of relationships between sets of values, each of which are associated with the fulfillment of different value goals).
   
6. The organizational structure of basic human values is based on the compatibility and incompatibility of concurrently prioritized value goals.
   
7. Although the same value goals are recognized nearly universally, their relative importance is personal and varies from person to person and across cultures.
   

Organizational Structure: 10 Types of Value Goals

The organizational structure of values is a continuum of relationships among 10 distinct types of value goals (Tab. 1, Fig. 1). The organizing logic is that certain value goals can be pursued harmoniously, whereas others cannot.^28–31 This means that actions taken to fulfill some types of value goals have psychological, practical, and social consequences that are compatible and complementary, while at the same time they can be in conflict with and in opposition to one or more other types of value goals. In the continuum depicted as a ship's steering wheel in Figure 1, the compatible value goals (ie, goals that can be pursued simultaneously) are located adjacent to or near one another any place within the wheel. Universalism and benevolence are examples of adjacent and compatible value goals. Using these value goals as examples, and moving in either direction around the wheel from universalism or benevolence, the value goals become increasingly less compatible and even antagonistic. In terms of individual values, loyalty (a benevolence value goal) is compatible with equality (a universalism value goal). However, to pursue these values concurrently is in conflict with ambition (an achievement value goal) and wealth (a power value goal) (Tab. 1).

View larger version (39K): [in this window] [in a new window] Figure 1. Organizational structure of values according to the Schwartz Theory of Basic Human Values. Permission granted by British Journal of Social Psychology to modify and publish Figure 1 (page 8) of Schwartz SH, Verkasalo M, Antonovsky A, Sagiv L. Value priorities and social desirability: much substance, some style. Br J Soc Psychol. 1997;36:3–18.

SVS Data Analyses

The main analysis used in the development of the TBHV has been a nonmetric multidimensional scaling procedure called "similarity structure analysis" (SSA).^28,30,36 The output of SSA is a visual image that is used to identify the locations of the theory-related groupings of value terms. This is a descriptive analysis rather than a hypothesis testing procedure. Based on ordinal data, the SSA produces a figure called a "map." This map is a spatial representation of the relationships among the importance ratings given to the value terms. Typically, a 2-dimensional map is produced. The SSA uses a data matrix based on Pearson correlation coefficients of values importance ratings. The general process to go from a values importance rating to a point on a graph is as follows:

• Respondents assign a relative importance rating to each value term.
  
• The SSA program forms a Pearson correlation data matrix of importance ratings.
  
• The intercorrelation matrix is then mathematically transformed into measures of distance and location called "proximities."
  
• An output map that depicts the unique location of every value term is produced for interpretation.
  

The proximity of a point on the map reflects the similarity as well as the dissimilarity between value terms. Points close in space to one another are interpreted as having similar meaning. They are said to be compatible or complementary. Points progressively more distant in space are interpreted as having dissimilar meaning, and, as the space between items increases, the items become progressively more dissimilar or antagonistic. Thus, the SSA procedure produces a visual representation of the relationships among importance ratings as points on a map. As in any map, location and distance are important for interpretation. Figure 2A is a hypothetical output map. The points close together (eg, 5, 56) are similarly correlated to all of the other points on the map. According to the TBHV, value items close by have the same meaning in the sense that they reflect the same value goal. Conversely, points at increasing distances from each other (eg, 5, 27) are progressively less well correlated. Points most distant from each other reflect values with goals that are not easily pursued simultaneously because the respective goals are not compatible.

View larger version (8K): [in this window] [in a new window] Figure 2. (A) Example of a similarity structure analysis (SSA) output map. The numbers represent example marker value terms. (B) An SSA output map with example marker values partitioned into value goal regions.

Empirical studies involving samples (88) representing 40 countries have demonstrated that 44 of the SVS value terms (Tab. 1) emerged in their predicted locations 75% of the time.³³ These value terms, therefore, had similar value goal meaning in most samples studied. The high frequency of finding these 44 value terms in their predicted locations makes them ideal indicators or markers to identify the presence of the TBHV value goal regions (Tab. 1) and to examine organizational relationships in terms of the continuum of value goals.

Consistency

Consistency of the locations of all 56 SVS value terms was determined for an occupationally diverse sample of Israeli Jewish adults that included nearly equal numbers of men and women. The SVS was administered twice with approximately 6 weeks between exposures. Five of the 56 SVS values, approximately 10%, were found outside of their TBHV-predicted value goal locations. The misplacements were most often among values with compatible goals. These deviations were attributed to measurement instability, chance variability, or possible culturally unique meanings.³³ The frequency of finding the value goal regions on SSA graphs was determined from data from 88 samples.³³ In the majority of these samples (70%), value goal regions emerged in their expected locations or were intermixed with the marker values of a compatible value region. Specifically, all 10 value goal regions were found in 26% of the samples. In 44% of the samples, 8 distinct value goal regions were found along with another region containing marker values that were intermixed so that partitioning was not possible.

Characteristics of the SVS

Several psychometric characteristics of the SVS have been reported. Reliability was tested by administering the SVS twice at approximately 6-week intervals to an occupationally heterogeneous group of 224 Israeli adults (48% male, 52% female), aged 18 to 73 years (=32 years).³² The internal reliabilities for the 10 value goals ranged from =.70 to =.90 (ie, hedonism [.70], self-direction [.78], achievement [.80], power and stimulation [.84], benevolence and conformity [.86], security and universalism [.88], tradition [.90]). Other studies have investigated response tendencies, sex differences, and the use of the SVS rating scale. The SVS has been reported to be minimally susceptible to the tendency to respond in a socially desirable manner,³⁴ and no sex differences have been found in the organizational continuum of value goals³⁵ or in values importance ratings.^35,36 Finally, most people associate most of the SVS value terms with positive goals. The SVS value terms have been found to be rated important or highly important 80% of the time.³⁰ Very seldom have they been rated unimportant.

Samples Studied

The TBHV has been tested in more than 200 samples³⁹ involving over 65,000 people from 65 countries, including the United States.⁴⁰ Approximately equal numbers of men and women from many occupations have been surveyed with the SVS. Many samples included teachers and students. Cross-sectional studies involving younger respondents (college-age students) and older respondents (teachers) have shown multiple age-related value priority differences. Nonetheless, the meanings of the value terms and value goal structures were consistent across these 2 types of populations. Findings related specifically to health care professionals' values have not been reported. Finally, regardless of age or culture, values associated with the goals of benevolence and power have been rated most and least important, respectively.⁴¹

	Purposes and Hypotheses

Top Abstract Introduction A Values Theory Purposes and Hypotheses Method Results Discussion Summary and Conclusions Appendix References

 
To our knowledge, no reports on physical therapists' or other health care providers' basic values based on the TBHV or the SSA have appeared in refereed journals. Our intent was to use this theory of values to investigate physical therapists' personal basic values. Our study had 4 purposes: (1) to describe and interpret the organizational structure of physical therapists' personal basic values, (2) to describe and interpret values ascribed in the literature to physical therapists within the context of the TBHV, (3) to identify the personal value goal priorities of physical therapists, and (4) to determine whether there are age-based personal value priority distinctions among physical therapists.

With regard to the first purpose, we expected that the value goal compatibilities and conflicts of this sample would be similar to the general TBHV model. If deviations were found, they would educate us regarding the meaning of values to physical therapists. For the second purpose, we expected that the majority of these values (ie, "caring for others," "empathetic," "just," and "respectful of others") would be found among values that support the value goal of benevolence. Additional relevant values (ie, "accountable," "professionalism," and "pursuit of excellence") were expected to reflect the value goal of achievement. For the third purpose, because of the nature of the work of physical therapists and prior TBHV studies, our expectations were that benevolence value goals would be rated most important and power value goals would be rated least important. With regard to the last purpose, prior TBHV reports have indicated that age is associated with value goal prioritization. To compare value priorities of younger and older therapists, several directional hypotheses were formulated (Tab. 2). We hypothesized that younger therapists would give higher importance ratings to values associated with hedonism, self-direction, and stimulation and that older therapists would give higher importance ratings to values associated with benevolence, conformity, security, and tradition. According to the TBHV model (Fig. 1), these anticipated patterns represent value goal conflicts. The unifying aspect of hedonism, self-direction, and stimulation values is that they all serve individualistic interests. The conflicting unifying aspect of benevolence, conformity, security, and tradition values is that they all serve group interests.²⁹ If these differences are found, the knowledge would be useful to facilitate mutual understanding among physical therapists of different ages, such as senior staff and new graduates, physical therapist managers and their younger subordinates, and physical therapist faculty members and their students.

	Method

Top Abstract Introduction A Values Theory Purposes and Hypotheses Method Results Discussion Summary and Conclusions Appendix References

Procedure

Packets containing an explanatory letter detailing the elements of the study sufficient to obtain informed consent along with a coded 6-page questionnaire, a scannable answer sheet, and a preaddressed, postage-paid envelope in which to return the questionnaire and answer sheet were sent to the physical therapists. Postcard reminders were sent 3 and 6 weeks after the initial mailing. Most responses were received within a month of the initial mailing. A trained assistant who was not aware of the study's hypotheses followed up with nonrespondents. The assistant made up to 3 scripted follow-up contacts with nonrespondents over a 2-month period to encourage participation in the study. A second complete packet was sent to those individuals who indicated that they did not receive or misplaced the initial packet.

Measurement Instruments

An 80-item investigator-developed survey instrument was pretested in a series of pilot studies⁴² that are detailed in the Appendix. The survey instrument was designed to gather demographic, work history, job satisfaction, attitude, and values data. The values measurement component was a modified version of the 57-item 1995 SVS provided by its developer (Shalom H Schwartz, msshasch{at}olive.mscc.huji.ac.il; e-mail; June 28, 1995). Instructions printed on the values questionnaire directed participants to read all value term descriptions before rating them, then to rate value terms that were personally most and least important, and then to rate the remaining terms. This sequence provides a common framework for using the rating scale. It also encourages respondents to make fine incremental decisions about the degree of importance of each value item relative to the extremes. This method facilitates using a variety of the remaining importance ratings.^29,30

The values questionnaire modifications were (1) an increase in the number of value items and (2) changes in the values importance rating scale. The developers of the SVS encouraged investigators to add value items that might represent a unique value goal domain of their sample.^28,29 Accordingly, 7 value terms drawn from the physical therapy and health care literature were added to explore the value goal associations of relevant value terms within the parameters of the TBHV. These terms were "accountable,"⁴³ "caring for others,"^{16–19,24–26} "empathetic,"¹ "just,"^21,44 "professionalism,"⁴⁵ "pursuit of excellence,"^26,46 and "respectful of others"^1,26 (Tab. 1). The second change involved simplifying the 9-increment (–1 to 7) SVS values importance rating scale. Our pilot studies (Appendix) and the literature supported a reduction in the number of values importance ratings, particularly the single negative rating ("values I am opposed to"). Miller⁴⁷ found that the amount of new information to which people can give their immediate attention is limited to 7±2 chunks of information. Cohen and Cohen⁴⁸ cautioned that inequalities among scale increments, such as a single negative rating and several levels of importance ratings, can alter relationships among variables. In addition, in order to use some common tests of significance, negative and zero ratings are best converted to positive numbers. This method increases the possibility of recoding errors. Based on the preceding information, we formed a new rating scale. We eliminated the negative values rating option, retained the remaining SVS rating level descriptors, and renumbered the scale increments 1 through 8 (Tab. 3). Our pilot studies showed that results from the new values rating scale and the 64-item values questionnaire were very similar or identical to results obtained with the original scale and the 57-item SVS (Appendix).

• Identify the points representing the marker values for each of the 10 value goals (Tab. 1).
  
• Draw lines that start near the center of the map out to the edge of the map such that they enclose the marker value points for each value goal.
  
• The center-to-edge boundary lines go outward in any direction, but they cannot intersect.
  
• If points within the bounded region represent marker values of another value goal or goals, see if it is possible to delimit other value goal regions by drawing additional nonintersecting boundaries within the existing bounded region.²⁹
  

A goal region may take any shape as long as the boundaries are continuous and they do not intersect with the boundary lines of another region.

An additional set of criteria were used to confirm the presence of a value goal region. These criteria were:

• The region must include at least 60% of the marker value terms postulated a priori to be in a particular value goal region.
  
• To be a distinct value goal region, the bounded area cannot include more than 33% of the marker values associated with other value goal regions.
  
• At least 70% of the values in a bounded region must reflect or potentially reflect (ie, be compatible with) the value goal of that region.²⁹
  

Partial correlations also were calculated to more discretely examine the interrelationships of the investigator-added value items.

Respondents were assigned to 1 of 3 age groups such that group sizes were as similar as possible. Descriptive statistics were calculated. We used the Kruskal-Wallis one-way analysis of variance for ranks to test for overall differences among the 3 age groups' values importance ratings. Where significant differences were found, 2-group comparisons were made with the Mann-Whitney U test to determine which of the age groups differed. Directional hypotheses were tested using one-tailed values with significance set at P=.05. The Bonferroni correction was used to protect against type I error when multiple comparisons were made.⁴⁹

	Results

Top Abstract Introduction A Values Theory Purposes and Hypotheses Method Results Discussion Summary and Conclusions Appendix References

 
Response Rate and Respondent Demographics

Over a 3-month period, 590 questionnaires were received (48.6% response rate). Five hundred sixty-five questionnaires (45.3% of the target population) were used in the analysis. Questionnaires were excluded for the following reasons: overuse of a single importance rating (n=13), incomplete demographic or work-related information (n=11), and rating of too few value terms (n=1). More than two thirds of the usable questionnaires were from female therapists (n=428) as compared with male therapists (n=137). The median age and years of experience of all respondents were 32 to 37 years and 11 to 15 years, respectively. The youngest age group (n=163) consisted of respondents aged <32 years. The intermediate age group (n=209) consisted of respondents 32 to 43 years of age. Respondents in the oldest age group (n=193) were at least 44 years of age. The most frequently reported work settings were outpatient clinics (27.6%), multiple sites (19.6%), and general hospitals (18.1%). Approximately half of the work sites were in urban and suburban areas, and half were in rural areas. Most respondents (61.3%) classified themselves as staff or senior physical therapists engaged primarily in direct patient care. Manager, supervisor, owner, or other similar organizational titles were held by 31.3% of the respondents. These individuals spent at least half of their typical workday in activities other than direct patient care. The remaining respondents (7.4%) were faculty members, retired, or not currently working.

Organizational Structure of Physical Therapists' Basic Values

The SSA map was configured independently by 2 experts according to the stated rules. To assess the reliability of data for the configuration procedure in the current study, the maps were compared. The 2 experts agreed on the location of all except 2 value items (>96% agreement), thus indicating high interrater reliability.

The configured therapist SSA map (Fig. 3) reflected the prototypical model (Fig. 1), with a few interesting exceptions. Eight distinct regions of values emerged. The regions that contained stimulation and self-direction values were located one above the other rather than side-by-side, as expected. Conformity and tradition values emerged in the ninth region, intermixed, instead of one above the other, as in the SSA model. Finally, the locations of achievement and power values in the continuum were reversed.

View larger version (60K): [in this window] [in a new window] Figure 3. Similarity structure analysis output map based on data from 565 physical therapists configured into Theory of Basic Human Values goal regions. UN (universalism), SD (self-determination), ST (stimulation), HE (hedonism), PO (power), AC (achievement), SE (security), TR (tradition), CO (conformity), and BE (benevolence).

Locations of Values Related to Physical Therapy and Health Care

As expected, the majority of value terms derived from the physical therapy and health care literature (ie, "caring for others" [#19], "just" [#42], "empathetic" [#47], and "respect for others" [#64]) were found among benevolence value goals. Unexpectedly, the value item "accountable" (#34) also was found in the benevolence region and not in the achievement region, as hypothesized. Our expectation that "professionalism" (#4) and "pursuit of excellence" (#13) would be found among achievement value goals also was not realized.

Physical Therapists' Value Priorities

The overall average values importance rating corrected for differences in rating scale use was 5.43 (SD=0.61). As expected, benevolence values were rated most important ( +1 standard deviation) and power values were rated least important ( –3 standard deviations) for the entire sample of physical therapists (Tab. 4). In our sample, the primacy of benevolence values was consistent across groups, as signified by similar averages and the smallest standard deviations. At the other extreme, power values were much less important than the values ranked ninth. The difference between the average rating for power and the value goal ranked just above it (#9) was the largest of all such comparisons. Thus, these findings suggest that physical therapists prize benevolence values and reject power values to a greater degree than values with other goals.

The Kruskal-Wallis analyses of the age group data are summarized in Table 5. Five median rank importance rating differences among the 3 groups were identified. These differences were for the value goal domains hedonism, achievement, universalism, security, and stimulation. Table 6 summarizes the Mann-Whitney 2-group comparisons of importance ratings. Ten age group differences were uncovered and provided support for 3 of our 7 hypotheses (Tab. 2). As hypothesized, the therapists in the youngest age group rated values with hedonism and stimulation goals as more important. Compared with the youngest group, the oldest age group gave higher importance ratings to security values. Not supported were the hypothesized age-associated differences in the importance of self-direction, benevolence, conformity, and tradition. Three unexpected age group differences also were disclosed. The youngest group rated achievement values as more important than both older groups did, whereas the oldest group rated universalism values as more important than the youngest group did and security as more important than the middle age group did.

	Discussion

Top Abstract Introduction A Values Theory Purposes and Hypotheses Method Results Discussion Summary and Conclusions Appendix References

The most distinctive feature of the organization of therapists' values was the transposition of achievement and power values (compare Figs. 1 and 3). This finding reflects the fact that the correlations between the marker values of security and achievement and of power and hedonism were more similar than expected. The practical implication of the observed location of achievement in the continuum suggests that, when thinking of their values in the context of their career, physical therapists associate competence-based personal success with attaining security more so than as a means of attaining personal pleasure, as is inferred in the TBHV model. Social esteem is gained, in part, through clinical competence, and with clinical competence, job security is likely to follow. Therefore, external recognition for having a high level of skill or unique skills is sought more so for social esteem than as a way to elevate oneself above others.

Individual SVS Value Terms

The physical therapist data produced an SVS map that had more of the SVS marker values in their theory-predicted locations than typical nontherapist TBHV samples. More than 90% of the marker value terms and nearly 90% of the 57 SVS value terms were found within their theory-predicted value goal groupings. The misplaced marker values were found in complementary regions. These results are important for future studies of physical therapists. The high percentages of SVS value terms found in their TBHV-predicted locations or in adjacent regions show that the SVS value terms are adequate for testing hypotheses about physical therapists' values and actions and that the results can be compared with those of other TBHV-based studies.

Supplemental Value Terms

Five of the 7 value terms related to physical therapy and health care added to the values measurement instrument were located in the benevolence region, and 2 value terms were in the security region. Although the locations of single values are less important in the TBHV than the locations of the preidentified sets of related value terms, it is instructive to look more closely at these terms because several of them have equivalents among APTA's core values of professionalism.²

Consistent with Schwartz's^29,30 contention that the SVS value terms were sufficiently complete for delimiting the 10 nearly universal basic value goals, the supplemental value terms did not form an additional distinct region on the SSA map. Thus, these values did not reflect a value goal domain unique to physical therapists. The locations of 5 of the 7 values within the benevolence region indicate that they share the basic meaning of benevolence values: concern and care for others. Surprisingly, the expectation that "accountable" (#34), "professionalism" (#4), and "pursuit of excellence" (#13) would be located among values with achievement goals was not realized. Instead, "accountable" was found among values with benevolence goals, and the other 2 values were found among security values adjacent to the achievement region (Fig. 3). These findings mean that accountability was perceived by physical therapists as a means of preserving or enhancing the welfare of people with whom they regularly interact, such as patients and co-workers. The values "professionalism" and "pursuit of excellence" were associated with stable, safe, and harmonious relationships more so than with opportunities for personal success through demonstrated competence. The importance of these observations is that they suggest that respondents gave more importance to what Purtilo called "other regarding"^20(p5) than they did to acting in ways that may "rock the boat" or bring attention to their own distinctiveness. A final thought on the individual values relevant to physical therapy and health care is the question, Did these value terms add new knowledge? The answer is both "yes" and "no." Although these values provided several previously unreported insights into where they fit into therapists' value systems, they failed to form a unique value goal domain. That is, when treated as basic values, these supplemental value terms were found to be redundant. They were dispersed among the existing SVS value goal regions.

Value Priorities

The finding that our sample of physical therapists rated benevolence values most important for guiding their personal behavior was expected because benevolence has been reported to be the most important value goal in other SVS-based studies.⁴¹ However, the relative degree of importance they assigned to benevolence was unique. Compared with samples in pan-cultural studies,⁴¹ our sample's average importance rating was much higher for benevolence than for the second most important value goal (Tab. 4). Benevolence relates to preserving and enhancing the welfare of people with whom a person is in regular contact, or "other regarding."^20(p5) For physical therapists, this includes clients, fellow professionals, friends, and family. The primacy of benevolence found in this study adds empirical support to reports of the importance of caring in the therapist-patient relationship^16–21 and to the qualitative reports that have included caring within frameworks for describing what is remarkable about physical therapy experiences²⁴ and physical therapy culture.²⁵

It is equally important to point out that our sample of physical therapists gave unusually little importance to power values. Again, compared with samples in pan-cultural studies,⁴¹ our sample rated the value goal of power as extraordinarily less important than the next low importance-rated value goal (Tab. 4). Power values emphasize control over other people as well as resources. However, in the TBHV model, the pursuit of power is not compatible with acting benevolently, the value goal held most important by therapists. The incompatibility comes from the likelihood of harming others (financially, status-wise, or psychologically) in order to advance oneself. The pursuit of power can interfere with social and professional relationships. Although benevolence and power values are universally at the upper and lower extremes of personal value hierarchies,⁴¹ the degree of incompatibility of these value goals for physical therapists is remarkable. Together, the benevolence and power findings may be associated with the "us versus them" attitude some direct care staff have toward management personnel. To confirm this assumption, the value priorities and attitudes of staff physical therapists and physical therapist managers need to be compared.

Age and Value Goal Priorities

In this study, we tested 7 age-based value priority predictions (Tab. 2) that were derived from the TBHV literature. Support was found for only 3 of the hypotheses (hedonism and stimulation were more important to the youngest group, and security was more important to the oldest group). These findings suggest that our sample differed from other TBHV study samples. One difference is representation by sex. In most TBHV samples, there were nearly equal numbers of male and female subjects. In 2 of the studies, no sex differences in value goal priorities were found.^35,36 In contrast, our sample consisted of members of a single profession in which the membership is nearly two thirds female. This large difference in the female-to-male ratio, coupled with a skewed distribution of the values importance ratings, precluded the use of analyses that could have separated the influences of age from the influences of sex on value priorities. Other notable differences are that most samples came from countries other than the United States, respondents worked or had worked in a variety of occupations, and students often were included.

Considering age group differences, there was an important and surprising finding about the youngest physical therapists' value hierarchy. Their value priorities were very similar to those reported for US college-age students.⁴¹ For example, the youngest physical therapists in our study and college-age students in the study by Schwartz and Bardi⁴¹ ranked hedonism and achievement 2 and 3 and 3 and 2, respectively. Achievement is considered a means of self-enhancement. Self-enhancement involves motivation to compete in order to excel by demonstrating socially and professionally accepted behaviors.

Having opportunities for achievement is particularly important to younger therapists. Assuming "college age" means 18 to 24 years, our findings suggest that the high importance of hedonism (personal pleasure and sensual gratification) and achievement (success based on demonstrated competence) extends beyond college age, because nearly 75% of the subjects in our youngest physical therapist group were 26 to 31 years of age. In a physical therapy context, people 26 to 31 years of age would include many recent graduates as well as some therapists with a few years of experience. Based on their overall value goal hierarchy, the youngest physical therapist group can be described as giving greatest importance to values associated with caring for people around them and enjoyment and appreciation of activities associated with physical pleasure. Intermediate levels of importance were given to values with goals associated with opportunities to express independent thought, creativity, and attainment of socially secure relationships. Least important were values with goals related to supporting the welfare of strangers, preservation of the environment, novelty, excitement, and control over other people or inanimate resources. These most and least important value goal priorities are very important for young therapists to reflect upon when they sense conflict with older colleagues. Likewise, older staff and managers need to recognize value priority disharmony. Action plans could include providing opportunities to motivate and reward younger staff members in ways congruent with their age group values.

A quite different order of value priorities was expected for the oldest group of physical therapists (Tab. 2). However, only one expectation was supported. Security, even though ranked sixth in importance, was significantly more important to older therapists (Tab. 5). Contrary to our hypotheses, age group differences in the importance of tradition and conformity value goals were not significant. Tradition was rated eighth or ninth in importance by all age groups. Of greater interest was that conformity was rated second or third most important by both older groups and fifth by the youngest group. This high level of importance seems contradictory to the nonsignificant statistical results. We believe there is clinical relevance in this finding. The statistical analyses considered value goal rating differences among age groups for each type of value goal. The analyses did not examine differences in the overall patterns of value priorities for lack of an appropriate nonparametric statistic. A rational interpretation of the general pattern is that security, conformity, and tradition value goals all support social stability.³⁶ Compared with the youngest group, the oldest group's rating for security was significantly higher, conformity was ranked 3 places higher (second versus fifth), and tradition was ranked 1 place higher (eighth versus ninth). Thus, the results suggest that stability in the workplace and other environments is more important to older physical therapists than it is to younger physical therapists. The clinical implication is that a stable environment—one in which there are few changes over time, where social and professional conventions are respected and followed, and where there is organizational continuity³⁵—is more important to therapists 32 years of age and older than to younger therapists.

Another unexpected finding was this group's significantly higher rating of values associated with universalism compared with the youngest group. This finding indicates that older therapists are motivated to act in ways that transcend self-interests more so than younger therapists. In the workplace, this may be expressed as older therapists recognizing that help is needed and stepping in without being asked or by their looking for something job-related to do rather than using free time to do something for themselves.

The overall value goal hierarchy of the oldest group of physical therapists describes them as giving high priority to the welfare of their usual associates. They also prioritize values that preserve the status quo and foster autonomy in thinking and acting. The pursuit of success according to social standards, helping those outside of their in-group, social harmony, and stability all had intermediate levels of importance.

No hypotheses were generated for the middle age group because only dichotomous age group data have been reported. However, an interesting pattern in the mean values importance ratings is apparent in Table 3. The middle age group's mean values were between those of the youngest and oldest age groups in 7 of 10 value goal categories. This observation suggests to us that there is an age-associated pattern of changes in value priorities.

Future Study

There is potential for a wide variety of studies of clinical importance to physical therapists. To test the credence of the interpretation of the findings of this study, it would be desirable to focus on value priorities, sex, and age using a stratified random sample of physical therapists with groups balanced for sex and age. This design would allow examination of these important variables concurrently. An alternative grouping variable could be years of clinical experience in place of age. Subsequent studies could focus on physical therapists' value priorities in specific contexts. Specific hypotheses could be posed regarding value priorities and expertise in clinical practice, management, organizational leadership, teaching, and research. There is also a need for a longitudinal study focusing on value priorities and career development. Such a study could start with individuals when they are students and monitor them at intervals throughout their career. A longitudinal study has the possibility of answering questions about the evolution of value priorities and their connection to career-related actions.

Limitations

The main caveat to consider is that what we have ascribed to age-based value priority differences could be due to other unmeasured variables or combinations of variables. One probable variable is years of clinical experience.

The values importance instrument used in this study was a modified version of the instrument developed to test the TBHV. No remarkable differences were found between the 2 versions in pilot studies involving mostly physical therapist students. It is conceivable that, if the sample sizes had been nearly equal and the respondents had been practicing physical therapists, different conclusions regarding the adequacy of the modified values measurement instrument might have been drawn.

The use of purposely chosen subjects rather than a random sample of physical therapists limits extending the findings to other groups. It would be risky to assume that the findings of this study would apply equally to all physical therapist members of APTA. The sampling method also produced a sex-biased sample. The high percentage of female respondents hindered forming a clear answer to the question, Do the findings represent physical therapists as a group, or do they reflect a female physical therapist perspective?

Our study's design was cross-sectional. The age-related value priority differences and similarities that we identified relate to different age groups of people studied at the same point in time. The design did not allow examination of changes over time (eg, at ages 30 and 35 years).

The decision to treat values importance ratings as if they represented increments with equal intervals is controversial.^48–54 By taking a conservative approach in the selection of analysis methods and avoiding multivariate parametric statistics, possible influences of other variables on basic value prioritization were not determinable.

	Summary and Conclusions

Top Abstract Introduction A Values Theory Purposes and Hypotheses Method Results Discussion Summary and Conclusions Appendix References

 
To our knowledge, this is the first report of the use of a values theory and its associated measurement instrument to study the values structures and priorities of physical therapists. The organizational structure of the basic values of this mostly female sample of physical therapists was interpretable according to the theory. The continuum of value goal relationships for this sample of physical therapists was like that frequently found in more heterogeneous samples, with one remarkable difference. The locations of achievement and power values were transposed. This finding indicates that, when thinking of their values in the context of their lives in general, physical therapists associate personal success based on competence with security more so than as a means of attaining personal pleasure, as is inferred in the theory-related model. The major statistical findings were: (1) respondents in 3 age categories differed significantly in their values importance ratings of 5 of 10 categories of value goals; (2) group-by-group comparisons of these differences identified 10 significant value goal importance differences; and (3) for all age groups, the highest and lowest importance ratings were given to benevolence and power values, respectively. These findings provide a foundation for future values theory-guided investigations of physical therapists.

	Appendix

Top Abstract Introduction A Values Theory Purposes and Hypotheses Method Results Discussion Summary and Conclusions Appendix References

 

View larger version (225K): [in this window] [in a new window] Appendix. Pilot Studies42

	Footnotes

 
Both authors provided concept/idea/research design, writing, data analysis, and consultation (including review of manuscript before submission). Dr Nosse provided data collection, project management, fund procurement, subjects, facilities/equipment, and clerical support. The authors thank Sonia Roccas for reviewing the output and for configuring of the multidimensional scaling analysis. Pilot studies associated with this project were supported by a Geriatric Fellowship Award from the Section on Geriatrics of the American Physical Therapy Association.

This article is an expansion of Dr Nosse's dissertation research directed by Dr Marvin W Berkowitz, who at the time was Professor, Department of Psychology, Marquette University.

The study was approved by the Institutional Review Board of Marquette University.

Partial results of this study were presented in platform presentations at the Combined Sections Meeting of the American Physical Therapy Association, February 4, 1999, New Orleans, La; the Scientific Meeting and Exposition of the American Physical Therapy Association, June 14, 2000, Indianapolis, Ind; and the Section on Health Policy and Administration's LAMP IV Symposium, July 15, 2003, Milwaukee, Wis, and LAMP V Symposium, July 31, 2004, Philadelphia, Pa.

	References

Top Abstract Introduction A Values Theory Purposes and Hypotheses Method Results Discussion Summary and Conclusions Appendix References

 

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