Healthcare Profession Students' Intentions to Work with Older Adults: A Structural Equation Modeling Analysis

Background and Purpose: The Current Population Reports (Vespa et al., 2020) estimated that the population aged 85 years and over would double in 2035 (11.8 million), compared to the aging population in 2020 (6.5 million). Meanwhile, the US is experiencing a shortage of healthcare workers to provide services and support for older adults. Students in healthcare professions often report a limited interest in working with this demographic. The reasons for students’ lack of interest are varied and inconclusive. Guided by the Theory of Planned Behavior, this study investigated healthcare profession students' attitudes toward older adults, perceived behavioral control, subjective norms, and the level of perceived self-efficacy associated with their intention to work with older adults.

Methods: Data were collected using a cross-sectional survey design. The Working with Older Adults Scale (Graham & King, 2022) measured students' intention, attitude, subjective norm, and perceived behavioral control. The New General Self-Efficacy Scale (Chen et al., 2012) was utilized to assess students' self-efficacy. Surveys were sent to 1348 health profession students from disciplines including Physical Therapy, Occupational Therapy, Nursing, Counseling, Physician Assistant, Social Work, and Speech Therapy at a mid-size comprehensive public university in southwest Virginia. A total of 244 complete responses were collected (response rate: 18%). The majority of respondents identified as White or Caucasian (76.2%), 8.2% as Black or African American, 3.3% as Hispanic or Latino, 2.9% as Asian, and 9.4% as a mix of these and other racial identities. Two hundred eleven respondents self-identified as Female (86.8%), 22 as Male (9.1%), 5 as Transgender Male (2.1%), and 2.0% as Non-Binary or preferring not to answer. Structural equation modeling was used to test the overall model fit and the direct and indirect relationships among variables based on the theory of planned behavior.

Results: The structural equation model shows a reasonably good fit to the observed data, as indicated by key fit indices (CFI, TLI, RMSEA, SRMR). Attitude (estimate = 0.930, p < 0.001) and subjective norm (estimate = 0.864, p < 0.001) significantly predict intention. The effects of Perceived Behavioral Control on Intention (estimate = 0.169, p = 0.118) and Self-efficacy on Intention (estimate = 0.008, p = 0.976) are not statistically significant.

Conclusions and Implications: These results support the Theory of Planned Behavior in the context of healthcare profession students' career intentions. Multicollinearity might affect the observed relationships between perceived behavioral control and self-efficacy. Thus, the results do not support the theory's expansion to include self-efficacy, as it may conceptually overlaps with perceived behavioral control. The findings have implications for gerontology education. Interventions to improve students' perceptions towards aging care could be crucial in addressing the healthcare workforce shortage. Educational programs should focus on enhancing positive attitudes and confidence in working with older adults.