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Factor Structure of the Multidimensional Orientation toward Dying and Death Inventory among Hong Kong College Students: A Preliminary Study

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Title: Factor Structure of the Multidimensional Orientation toward Dying and Death Inventory among Hong Kong College Students: A Preliminary Study
Language: English
Authors: Wittkowski, Joachim, Ho, Samuel M. Y., Chan, Wallace C. H.
Source: Death Studies. 2011 35(1):59-72.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 325 Chestnut Street Suite 800, Philadelphia, PA 19106. Tel: 800-354-1420; Fax: 215-625-2940; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 14
Publication Date: 2011
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Descriptors: College Students, Factor Structure, Factor Analysis, Foreign Countries, Fear, Death, Psychological Patterns, Cultural Differences, German, Surveys, Psychometrics
Geographic Terms: Hong Kong
DOI: 10.1080/07481187.2010.502612
ISSN: 0748-1187
Abstract: This study examines the factor structures of the Chinese version of the Multidimensional Orientation Toward Dying and Death Inventory (MODDI-F/chin), originally established in German language, in a sample of Hong Kong college students (n = 256). Both confirmatory factor analysis and exploratory factor analysis were performed to examine the factor structures of the MODDI-F/chin. The results showed that, identical to the German version, the MODDI-F/chin consisted of a 5-factor Fear domain and a 3-factor Acceptance domain. The fear of another person's dying was the weakest of the four factors in the Hong Kong sample but represented the first and strongest factor in the German sample of the original study. Although preliminary and not representative of mainland China, our results show that the factor structure of attitudes toward dying and death that had been established empirically with German people can be replicated with Chinese students of Hong Kong. (Contains 3 tables.)
Abstractor: As Provided
Number of References: 34
Entry Date: 2011
Accession Number: EJ910813
Database: ERIC
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  Value: <anid>AN0057225642;dea01jan.11;2019Mar28.13:33;v2.2.500</anid> <title id="AN0057225642-1">Factor Structure of the Multidimensional Orientation Toward Dying and Death Inventory Among Hong Kong College Students: A Preliminary Study. </title> <p>This study examines the factor structures of the Chinese version of the Multidimensional Orientation Toward Dying and Death Inventory (MODDI-F/chin), originally established in German language, in a sample of Hong Kong college students (n = 256). Both confirmatory factor analysis and exploratory factor analysis were performed to examine the factor structures of the MODDI-F/chin. The results showed that, identical to the German version, the MODDI-F/chin consisted of a 5-factor Fear domain and a 3-factor Acceptance domain. The fear of another person's dying was the weakest of the four factors in the Hong Kong sample but represented the first and strongest factor in the German sample of the original study. Although preliminary and not representative of mainland China, our results show that the factor structure of attitudes toward dying and death that had been established empirically with German people can be replicated with Chinese students of Hong Kong.</p> <p>Attitudes toward dying and death are core issues in thanatology, beginning with Feifel's ([<reflink idref="bib8" id="ref1">8</reflink>], [<reflink idref="bib9" id="ref2">9</reflink>]) pioneering studies on geriatric and mentally ill populations (see Neimeyer, Wittkowski, & Moser, [<reflink idref="bib22" id="ref3">22</reflink>], for a review). A comprehensive description of the main features of this area following Schulz ([<reflink idref="bib24" id="ref4">24</reflink>]) reveals a host of fears and concerns with respect to dying and death: fear of physical suffering, fear of humiliation, fear of loss of personal dignity, fear of loneliness, fear of no longer being able to pursue important goals, fear of the impact of one's own death on significant others, fear of punishment, fear of the unknown, fear of the annihilation of one's own body, fear of other persons' dying (i.e., witnessing suffering without being able to provide relief), fear of the death (i.e., the loss) of other persons, and fear of either the dead or features of a corpse.</p> <p>This overview of dimensions of the fear of dying and death results contains ambiguities, fails to consider an attitude of acceptance toward dying and death, and lacks a conceptual framework. Schulz's scheme was the starting point for the development of the Collett-Lester Fear of Death Scale (Collett & Lester, [<reflink idref="bib5" id="ref5">5</reflink>]), which was rationally constructed to distinguish between fears associated with the state of being dead and with the process of dying, and fears as they apply to not only the self but also to others. Although not included in the above structure, aspects of an accepting attitude toward dying and death too can find their place within this structure.</p> <p>On an empirical basis, factor analytic studies using mainly Templer's Death Anxiety Scale with college students partly found the above mentioned dimensions (Conte, Weiner, & Plutchik, [<reflink idref="bib6" id="ref6">6</reflink>]) and partly disclosed new ones including death as courage; death as failure; death as reward in the hereafter; fear of separation; concern with escape; sarcasm; fear of catastrophic death, pain, and operations (Durlak & Kass, 1981–1982; Martin, 1982–1983). Lonetto and Templer ([<reflink idref="bib18" id="ref7">18</reflink>]) concluded from their review of the literature and their own research that there are four higher dimensions that describe the fear of dying and death, namely cognitive and affective reactions to death, the physical changes that may accompany dying and serious illness, an awareness of the unstoppable flow of time, and the pain and stress brought about by chronic illness and personal fears.</p> <p>Moreover, the construction of multidimensional questionnaires for the assessment of attitudes toward dying and death as well as the examination of their construct validity revealed a variety of additional dimensions: uncertainty, fatalism, and threat to well-being (Threat Index; Krieger, Epting, & Leitner, [<reflink idref="bib16" id="ref8">16</reflink>]; Moore & Neimeyer, [<reflink idref="bib21" id="ref9">21</reflink>]); fear of premature death (Multidimensional Fear of Death Scale; Hoelter, [<reflink idref="bib13" id="ref10">13</reflink>]); death despair, death loneliness, death dread, death sadness, death depression, and death finality (Templer et al., [<reflink idref="bib29" id="ref11">29</reflink>]); loss of self-fulfillment, loss of social identity, and transcendental consequences (Fear of Personal Death Scale; Florian & Kravetz, [<reflink idref="bib10" id="ref12">10</reflink>]); fear of dead people and tombs, fear of postmortem events, fear of lethal disease, and death preoccupation (Arabic Scale of Death Anxiety; Abdel-Khalek, [<reflink idref="bib1" id="ref13">1</reflink>]); and externally generated death anxiety and brevity of life (Spanish Death Anxiety Inventory; Tomás-Sábado & Gómez-Benito, [<reflink idref="bib3" id="ref14">3</reflink>]).</p> <p>Only a few multidimensional assessment tools in addition to the fear of dying and death also tap acceptance of dying and death. Some proposed acceptance dimensions are neutral acceptance, approach acceptance, and escape acceptance (revised Death Attitude Profile; Wong, Reker, & Gesser, [<reflink idref="bib34" id="ref15">34</reflink>]); meaning and acceptance of death (Spanish Death Anxiety Inventory; Tomás-Sábado & Gómez-Benito, [<reflink idref="bib30" id="ref16">30</reflink>]); and acceptance of one's own dying and death, acceptance of another person's death (Multidimensional Orientation Toward Dying and Death Inventory [MODDI-F]; Wittkowski, [<reflink idref="bib32" id="ref17">32</reflink>]). Among these multidimensional assessment inventories, the MODDI-F is largely free of implicit assumptions (Slife, [<reflink idref="bib25" id="ref18">25</reflink>], [<reflink idref="bib26" id="ref19">26</reflink>]). Specifically, no Christian notions are part of any item. Rather, a clear conceptual and verbal distinction of the various aspects of the attitudes toward dying and death was the guideline in formulating the items. To avoid ambiguity, each item addresses only one aspect. This characteristic makes the MODDI-F viable to be transferred to another culture. As a result, the MODDI-F was the focus of this study.</p> <p>The original 47-item MODDI-F was developed in German and then adapted to English (Wittkowski, [<reflink idref="bib31" id="ref20">31</reflink>], [<reflink idref="bib32" id="ref21">32</reflink>]). Based on a structure proposed by Collett and Lester ([<reflink idref="bib5" id="ref22">5</reflink>]) with respect to the fear of dying and death, the MODDI-F adds a new component: acceptance. Factor analyses shows the MODDI-F to have eight subscales: (a) Fear of One's Own Dying (FODy); (b) Fear of One's Own Death (FODe); (c) Fear of Another Person's Dying (FAPDy); (d) Fear of Another Person's Death (FAPDe); (e) Fear of Corpses (FC); (f) Acceptance of One's Own Dying and Death (AODD); and (g) Acceptance of Another Person's Death (AAPDe); (h) Rejection of One's Own Death (RODe). Each item is rated on a 4-point Likert scale from 0 (<emph>agree not at all</emph>) to 3 (<emph>agree almost totally</emph>). For the German version of the MODDI-F, the internal consistency among a community sample ranged from.82 to.92, and the pattern of correlations between the subscales was in line with the conceptual premises (Wittkowski, [<reflink idref="bib31" id="ref23">31</reflink>], [<reflink idref="bib32" id="ref24">32</reflink>]).</p> <p>Note that experts disagree about whether there are universal attitudes toward death and dying across cultures. Abdel-Khalek, Beshai, and Templer ([<reflink idref="bib2" id="ref25">2</reflink>]) argued for a universal structure of the fear of dying and death, referring to data from Egypt as well as data from other cultures. Further, besides philosophical speculations about the nature of mankind, one might argue that during the past decades a significant mixing of various cultural influences took place all over the world, resulting in a kind of cultural <emph>g</emph>-factor with global impact. It is necessary to examine if the factors derived from the German version of the MODDI-F can be generalized to another culture, like the Chinese.</p> <p>Cross-cultural comparisons of attitudes toward dying and death mainly contrast Arab to the English-speaking Western samples, especially the United States. Examining the factor structure of fear of death among Saudi-Arabians, Long (1985–1986) found nearly no correspondence with Americans. Abdel-Khalek et al. ([<reflink idref="bib2" id="ref26">2</reflink>]) reported a factorial structure of fear of death among Egyptians that was similar to those in other cultures. However, this factor pattern corresponded in only two of four factors with results from a sample of Filipino undergraduate nursing students (Lester, [<reflink idref="bib17" id="ref27">17</reflink>]). In another study, Abdel-Khalek and Tómas-Sábado ([<reflink idref="bib3" id="ref28">3</reflink>]) compared the structure of the fear of death in Egyptian and Spanish samples and found two broad dimensions—death anxiety and general anxiety—in both cultures. Although not based on factor analysis, Huang Lin ([<reflink idref="bib14" id="ref29">14</reflink>]) found that attitudes toward death among American and Chinese older adults included an inverse correlation between spirituality and fear of death. Furthermore, in both samples there was a positive correlation between religiosity and an attitude of approach acceptance toward death.</p> <p>In sum, the issue of uniformity versus diversity of attitudes toward dying and death in cross-cultural perspective is restricted to very few research instruments, mainly Templer's ([<reflink idref="bib28" id="ref30">28</reflink>]) Death Anxiety Scale that was devised as a global measure of the fear of death. Multidimensional questionnaires have rarely, if ever, been used in cross-cultural research on attitudes toward dying and death. Moreover, only a few cultures have been considered, namely the Arab world and the Western world (United States, Spain). There is a paucity of data with respect to the Far East. The present study is an attempt to extend our knowledge in this field by applying a multidimensional questionnaire that was developed in Germany to participants from Hong Kong/China.</p> <p>Specific features of contemporary Chinese culture that may influence individual attitudes toward dying and death are the traditional belief system on one hand and a naturalistic world view on the other. The traditional belief system is a blend of Taoism, Buddhism, and Confucianism in which the Christian notion of an individual spiritual life after death plays no major role. Taoism encourages people to maintain a harmonic relationship with the universe and thereby fosters acceptance of death as a natural part of life. Buddhism teaches people not to struggle against the inevitable finitude of life and invites them to reach a peace of mind in consequence of acceptance. The central concern of Confucianism is the incorporation of the individual into the state, the family and society's moral code of behavior (Penson, [<reflink idref="bib23" id="ref31">23</reflink>]). Thus, the traditional Chinese belief system strongly emphasizes the acceptance of life and death as well as harmonious interdependence among family members and others. Because of this emphasis, the prospect of the loss of the emotional bond to significant others by death may be especially threatening to Chinese people. Besides close social relationships, what worries Chinese people the most about mortality is the pain and suffering associated with the dying process.</p> <p>With respect to Hong Kong, decades under British administration combined with rapid socioeconomic change may have impacted attitudes toward dying and death. Nevertheless, family relationships are still dominant. Thus, when thinking about health-related issues, Hong Kong Chinese people are especially concerned about the reactions of their loved ones and separation from their significant others. In a similar vein, Hong Kong Chinese tend to express more concern about the reactions of others in the grieving process (Ho, Chow, Chan, & Tsui, [<reflink idref="bib11" id="ref32">11</reflink>]), as well as in making important health-related decisions (Ho, Ho, Chan, Kwan, & Tsui, 2003), than the reaction of self. In another study, the psychosocial well-being of Chinese palliative care patients was positively associated with family members' support and acceptance, and negatively associated with family members' level of anxiety (Chan, Epstein, Reese, & Chan, [<reflink idref="bib4" id="ref33">4</reflink>]).</p> <p>Specific features of modern West European culture that may impact on attitudes toward dying and death are Christianity on the one hand and a secularized and individualized way of life on the other. For Christians, God has power over life and death. Therefore, the individual can lay all responsibility into His hands. Moreover, in Christianity the notion of an individual spiritual life in the hereafter as well as the forgiving of one's sins is of eminent importance. However, for some Catholics there may be uncertainty whether the Day of Judgment will sentence the soul of the deceased to Heaven or to Hell (Wittkowski & Baumgartner, [<reflink idref="bib33" id="ref34">33</reflink>]). Autonomy and self-actualization are the key values. This individualism is closely linked to the notion of responsibility for one's unique life, which in turn increases the subjective value of life.</p> <p>The purpose of the present article is to examine the multidimensionality of attitudes toward dying and death among a group of college students in Hong Kong/China. The question was whether the factor structure of a set of items that has been established empirically with German participants could be replicated with Chinese students of Hong Kong.</p> <hd id="AN0057225642-2">Method</hd> <p></p> <hd id="AN0057225642-3">Participants and Procedure</hd> <p>Originally, participants were 260 college students from The University of Hong Kong who completed the MODDI-F/chin. Students completed a package of questionnaires in groups of approximately 10 after giving their informed consent. A research assistant was available to answer queries. They received credit as part of the requirements of an introduction to psychology course. Four participants were excluded because of missing data, leaving 256 participants (161 men, 93 women, three who did not report gender). The age range was from 16 to 23 years (median = 19 years, <emph>M</emph> = 19.3 years, <emph>SD</emph> = 1.12 years). None was married. Most (<emph>n</emph> = 234 students) reported no religious commitment, 17 participants indicated Buddhism, and five indicated other religious affiliations.</p> <p>The adaptation of the MODDI-F to the Chinese language was performed in three steps, First, the German items were translated into Chinese and then back into German independently by two different specialists. Discrepancies were discussed among the two translators and resolved. Second, the same process occurred with the English version of the MODDI-F; and third, discrepancies in the two Chinese versions were discussed extensively and resolved under the direction of the first author (Joachim Wittkowski). A central goal was to preserve the conceptual distinction between the process of dying and the state of being dead.</p> <hd id="AN0057225642-4">Results</hd> <p>Within the present sample, missing data (0.15%) were substituted by the rounded mean of the corresponding scale. Confirmatory factor analyses (CFA) using maximum-likelihood estimation was performed to examine whether the original factor structure of the MODDI-F fit the present sample.</p> <p>Two CFAs were conducted, one for the Fear domain and another for the Acceptance domain, separately. The hypothesized model for the Fear domain was a first-order model with five factors: (a) FODy, (b) FODe, (c) FAPDy, (d) FAPDe, and (e) FC. Similarly, the hypothesized model for Acceptance domain was a first-order model with three factors: (a) AODD, (b) RODe, and (c) AAPDe. The five-factor model of fear and the three-factor model of acceptance did not fit current data (see Table 1).</p> <p>TABLE 1 Goodness-of-Fit Indices of the MODDI-F/chin</p> <p> <ephtml> <table><thead valign="bottom"><tr><td>Domain</td><td><italic>χ²</italic></td><td><italic>df</italic></td><td><italic>p</italic></td><td>GFI</td><td>CFI</td><td>TLI</td><td>RMESA</td></tr></thead><tbody><tr><td>Fear domain: 5-factor first order model from original German version</td><td char="." charoff="50">754.468</td><td>341</td><td char="." charoff="50">< .000</td><td char="." charoff="50">.819</td><td char="." charoff="50">.882</td><td char="." charoff="50">.869</td><td char="." charoff="50">.068</td></tr><tr><td>Acceptance domain: 3-factor first order model from original German version</td><td char="." charoff="50">373.514</td><td>150</td><td char="." charoff="50">< .000</td><td char="." charoff="50">.868</td><td char="." charoff="50">.894</td><td char="." charoff="50">.880</td><td char="." charoff="50">.076</td></tr><tr><td /></tr></tbody></table> </ephtml> </p> <p>As a result, exploratory factor analyses (EFA) were conducted to establish the factor structure of the MODDI-F/chin. It resulted in a 26-item 5-factor fear solution that explained 61.1% of the variance (see Table 2). Factor 1 consisted of six items from the FODy; Factor 2 of four items from FC and two items of the FAPDe; Factor 3 of seven items from FODe; Factor 4 of the four items from FAPDe; and Factor 5 of three items from FAPDy.</p> <p>TABLE 2 EFA Result of the Fear Domain of MODDI-F/chin (Total Sample, N = 256)</p> <p> <ephtml> <table><thead valign="bottom"><tr><td /><td /><td>Factor</td></tr><tr><td>Factors/Items</td><td /><td>I</td><td>II</td><td>III</td><td>IV</td><td>V</td></tr></thead><tbody><tr><td>Fear of One's Own Death (16.99% of variance)</td><td /><td /><td /><td /><td /><td /></tr><tr><td> 28.<xref ref-type="fn" rid="fn3" /> The idea that I will never be able to think [...] disturbs me.</td><td>(FODe)<xref ref-type="fn" rid="fn4" /></td><td char="." charoff="50">.822</td><td /><td /><td /><td /></tr><tr><td> 20. The very idea that my entire personality will disappear forever with my death appals me.</td><td>(FODe)</td><td char="." charoff="50">.820</td><td /><td /><td /><td /></tr><tr><td> 13. Thinking beyond the threshold of my death makes me feel afraid.</td><td>(FODe)</td><td char="." charoff="50">.796</td><td /><td /><td /><td /></tr><tr><td> 5. I am frightened by the idea that all my thoughts and feelings will stop when I am dead.</td><td>(FODe)</td><td char="." charoff="50">.750</td><td /><td /><td /><td /></tr><tr><td> 35. The thought that I will be dead someday makes me apprehensive.</td><td>(FODe)</td><td char="." charoff="50">.733</td><td /><td /><td /><td /></tr><tr><td> 42. The idea that my body will disappear after my death disturbs me.</td><td>(FODe)</td><td char="." charoff="50">.676</td><td /><td /><td /><td /></tr><tr><td>Fear of Corpses (15.18% of variance)</td><td /><td /><td /><td /><td /><td /></tr><tr><td> 27. The thought of the stiffness of a corpse fills me with fear.</td><td>(FC)</td><td /><td char="." charoff="50">.828</td><td /><td /><td /></tr><tr><td> 41. When I think of how pale a corpse is, I feel panic.</td><td>(FC)</td><td /><td char="." charoff="50">.822</td><td /><td /><td /></tr><tr><td> 45. The sight of a dead body would be appalling to me.</td><td>(FC)</td><td /><td char="." charoff="50">.817</td><td /><td /><td /></tr><tr><td> 12. The thought of the coldness of a corpse terrifies me.</td><td>(FC)</td><td /><td char="." charoff="50">.813</td><td /><td /><td /></tr><tr><td> 25. The idea of being in the presence of a dying person appals me.</td><td>(FAPDy)</td><td /><td char="." charoff="50">.637</td><td /><td /><td /></tr><tr><td> 10. I am afraid if seeing another person dying.</td><td>(FAPDy)</td><td /><td char="." charoff="50">.569</td><td /><td /><td /></tr><tr><td>Fear of One's Own Dying (11.46% of variance)</td><td /><td /><td /><td /><td /><td /></tr><tr><td> 37. I am afraid of dying a painful death one day.</td><td>(FODy)</td><td /><td /><td char="." charoff="50">.685</td><td /><td /></tr><tr><td> 23. I am afraid of my dying being prolonged by medical equipment.</td><td>(FODy)</td><td /><td /><td char="." charoff="50">.661</td><td /><td /></tr><tr><td> 46. The possibility of losing my personal dignity when I am dying appals me.</td><td>(FODy)</td><td /><td /><td char="." charoff="50">.613</td><td /><td /></tr><tr><td> 1. The thought that my dying could be long and painful is unbearable to me.</td><td>(FODy)</td><td /><td /><td char="." charoff="50">.605</td><td /><td /></tr><tr><td> 8. I feel fear at the very idea of dying slowly and in agony someday.</td><td>(FODy)</td><td /><td /><td char="." charoff="50">.600</td><td /><td /></tr><tr><td> 16. The physical decline that accompanies a slow dying process disturbs me.</td><td>(FODy)</td><td /><td /><td char="." charoff="50">.580</td><td /><td /></tr><tr><td> 43. I am afraid of being treated as a mere object when I lie dying.</td><td>(FODy)</td><td /><td /><td char="." charoff="50">.577</td><td /><td /></tr><tr><td>Fear of Another Person's Death (9.52% of variance)</td><td /><td /><td /><td /><td /><td /></tr><tr><td> 22. The thought of losing people close to me forever through death frightens me.</td><td>(FAPDe)</td><td /><td /><td /><td char="." charoff="50">.757</td><td /></tr><tr><td> 7. I am afraid of losing loved ones through death.</td><td>(FAPDe)</td><td /><td /><td /><td char="." charoff="50">.719</td><td /></tr><tr><td> 30. The possibility of losing another person forever through death disturbs me.</td><td>(FAPDe)</td><td /><td /><td /><td char="." charoff="50">.629</td><td /></tr><tr><td> 15. The thought that a person close to me will simply disappear due to death appals me.</td><td>(FAPDe)</td><td /><td /><td /><td char="." charoff="50">.619</td><td /></tr><tr><td>Fear of Another Person's Dying (7.94% of variance)</td><td /><td /><td /><td /><td /><td /></tr><tr><td> 39. The idea of a dying person asking me for comfort and support disturbs me.</td><td>(FAPDy)</td><td /><td /><td /><td /><td char="." charoff="50">.715</td></tr><tr><td> 33. I am afraid of having to support another person in his/her last hours.</td><td>(FAPDy)</td><td /><td /><td /><td /><td char="." charoff="50">.713</td></tr><tr><td> 3. I am afraid of having to support another person someday when he/she is dying.</td><td>(FAPDy)</td><td /><td /><td /><td /><td char="." charoff="50">.659</td></tr><tr><td /></tr><tr><td /></tr><tr><td /></tr></tbody></table> </ephtml> </p> <p>An EFA with the total sample resulted in a 19-item three-factor acceptance solution explaining 57.3% of the variance. These three dimensions are exactly the subscales in the original German MODDI-F, except that some items were loaded onto a different subscale in the Hong Kong sample as compared to the Germany sample. Table 3 depicts these results.</p> <p>TABLE 3 EFA Result of the Acceptance Domain of MODDI-F/chin (Total Sample, N = 256)</p> <p> <ephtml> <table><thead valign="bottom"><tr><td /><td /><td>Factor</td></tr><tr><td>Factors/Items</td><td /><td>I</td><td>II</td><td>III</td></tr></thead><tbody><tr><td>Acceptance of One's Own Dying and Death (37.81% of variance)</td><td /><td /><td /><td /></tr><tr><td> 26.<xref ref-type="fn" rid="fn6" /> I have a positive attitude to the process of dying as part of my life.</td><td>(AODD)<xref ref-type="fn" rid="fn7" /></td><td char="." charoff="50">.774</td><td /><td /></tr><tr><td> 34. Basically, I am ready to accept that I have to die one day.</td><td>(AODD)</td><td char="." charoff="50">.762</td><td /><td /></tr><tr><td> 44. My death is a part of a wider scheme of things that I treat positively.</td><td>(AODD)</td><td char="." charoff="50">.737</td><td /><td /></tr><tr><td> 19. The fact that I will die some day is something absolutely natural for me.</td><td>(AODD)</td><td char="." charoff="50">.733</td><td /><td /></tr><tr><td> 47. The dying process contributes toward rounding off my life.</td><td>(AODD)</td><td char="." charoff="50">.729</td><td /><td /></tr><tr><td> 4. I have a positive attitude to the process of dying as a necessary stage in my life.</td><td>(AODD)</td><td char="." charoff="50">.679</td><td /><td /></tr><tr><td> 40. Somehow, the knowledge of my death is a part of my life that I view positively.</td><td>(AODD)</td><td char="." charoff="50">.596</td><td /><td /></tr><tr><td> 11. To me, the dying process means the completion of my life.</td><td>(AODD)</td><td>589</td><td /><td /></tr><tr><td> 2. As painful as it is, I have a positive attitude toward the fact that people who are important to me will be dead one day.</td><td>(AAPDe)</td><td char="." charoff="50">.487</td><td /><td /></tr><tr><td>Rejection of One's Own Death (11.61% of variance)</td><td /><td /><td /><td /></tr><tr><td> 21. Inwardly, I protest against the fact that I will be dead one day.</td><td>(RODe)</td><td /><td char="." charoff="50">.788</td><td /></tr><tr><td> 14. Inwardly, I rebel against the fact that my life on earth is limited.</td><td>(RODe)</td><td /><td char="." charoff="50">.733</td><td /></tr><tr><td> 29. I view the fact that I will be dead one day as a violent intrusion in my life.</td><td>(RODe)</td><td /><td char="." charoff="50">.714</td><td /></tr><tr><td> 36. Knowledge of my death is like a foreign element in my life.</td><td>(RODe)</td><td /><td char="." charoff="50">.619</td><td /></tr><tr><td> 6. Inwardly, I resist the thought of my own death.</td><td>(RODe)</td><td /><td char="." charoff="50">.597</td><td /></tr><tr><td> 9.<xref ref-type="fn" rid="fn8" /> I find it unjust that even people who are close to me will be dead one day.</td><td>(AAPDe)</td><td /><td char="." charoff="50">−.532</td><td /></tr><tr><td>Acceptance of Another Person's Death (7.90% of variance)</td><td /><td /><td /><td /></tr><tr><td> 17. I accept the death of people who are close to me.</td><td>(AAPDe)</td><td /><td /><td char="." charoff="50">.795</td></tr><tr><td> 32. Ultimately, I am at peace with the fact that even people who are close to me have to die.</td><td>(AAPDe)</td><td /><td /><td char="." charoff="50">.730</td></tr><tr><td> 24. Basically, I am ready to accept that even people who are close to me will be dead one day.</td><td>(AAPDe)</td><td /><td /><td char="." charoff="50">.728</td></tr><tr><td> 38.<xref ref-type="fn" rid="fn8" /> Inwardly, I resist the thought that people who are dear to me will be dead one day.</td><td>(AAPDe)</td><td /><td /><td char="." charoff="50">.635</td></tr><tr><td /></tr><tr><td /></tr><tr><td /></tr><tr><td /></tr></tbody></table> </ephtml> </p> <hd id="AN0057225642-5">Discussion</hd> <p>The factor structure of the MODDI-F/chin was established in the present study. Similar to the original German version of the scale, the MODDI-F/chin consists of a 26-item fear of death and dying domain and a 19-item acceptance of death and dying domain.</p> <p>The dimensions of the domain Fear, however, show both consistencies and discrepancies between the two cultures. Discrepancies mainly concern the weight of Fear of Another Person's Dying, which was the weakest of the four factors in the Hong Kong sample. In contrast, among Germans this dimension was the first and strongest factor. This finding was not expected because the traditional Chinese belief system with its emphasis on Confucianism highlights the importance of interpersonal relationships and thereby may encourage fears of other persons' dying and death. In fact, the pain and suffering associated with the dying process belong to those visions that worry Chinese people the most about mortality (Hui & Fung, [<reflink idref="bib15" id="ref35">15</reflink>]).</p> <p>Present results indicate that both the German sample in the original study and the present Hong Kong sample share the same three dimensions of acceptance toward death and dying (i.e., Acceptance of One's Own Dying and Death, Rejection of One's Own Death, and Acceptance of Another Person's Death). However, it should be noted that some items load onto a different subscale in the Hong Kong sample as compared to the Germany sample. One reason for this similarity may be a naturalistic world view of the young students from Hong Kong in which the traditional Chinese belief system that may foster an attitude of acceptance toward dying and death plays a minor role. Hong Kong is a place where its people have been exposed to Western influences for over a century. In fact, nearly all participants indicated no religious affiliation. The questionnaire used, in turn, does not refer to any Christian notion or to other implicit assumptions. The kind of neutral acceptance that is assessed by the MODDI-F/chin seems well suited to depict Hong Kong Chinese students' acceptance of dying and death.</p> <p>The main limitation of the study reported here is with the sample. The number of women participants may be too small to allow for a meaningful factor analysis specifically with women. More important, however, the sample is representative of Hong Kong students and may not be representative of the Chinese population in general because it has been influenced by Western culture for more than a century (Tang, Wu, & Yan, [<reflink idref="bib27" id="ref36">27</reflink>]). For this reason the study reported here is merely a first step in cross-cultural exploration of the multidimensionality of attitudes toward dying and death in China and Germany/Western Europe. Replications of the present study with larger samples from mainland China would enhance generalizability.</p> <ref id="AN0057225642-6"> <title> References </title> <blist> <bibl id="bib1" idref="ref13" type="bt">1</bibl> <bibtext> Abdel-Khalek, A. M. (2004). The Arabic Scale of Death Anxiety (ASDA): Its development, validation, and results in three Arab countries. Death Studies, 28, 435–457.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref25" type="bt">2</bibl> <bibtext> Abdel-Khalek, A., Beshai, J. A., & Templer, D. I. (1993). The structure of Templer's Death Anxiety Scale among Egyptian students. Psychological Reports, 72, 920–922.</bibtext> </blist> <blist> <bibl id="bib3" idref="ref14" type="bt">3</bibl> <bibtext> Abdel-Khalek, A. M., & Tomás-Sábado, J. (2005). Anxiety and death anxiety in Egyptian and Spanish nursing students. Death Studies, 29, 157–169.</bibtext> </blist> <blist> <bibl id="bib4" idref="ref33" type="bt">4</bibl> <bibtext> Chan, W. C. H., Epstein, I., Reese, D., & Chan, C. L. W. (2009). Family predictors of psychosocial outcomes among Hong Kong Chinese cancer patients in palliative care: Living and dying with the "support paradox."Social Work in Health Care, 48, 519–532.</bibtext> </blist> <blist> <bibl id="bib5" idref="ref5" type="bt">5</bibl> <bibtext> Collett, L. J., & Lester, D. (1969). The fear of death and the fear of dying. Journal of Psychology, 72, 179–181.</bibtext> </blist> <blist> <bibl id="bib6" idref="ref6" type="bt">6</bibl> <bibtext> Conte, H. R., Weiner, M., & Plutchik, R. (1982). Measuring death anxiety: Conceptual, psychometric, and factor analytical aspects. Journal of Personality and Social Psychology, 43, 775–785.</bibtext> </blist> <blist> <bibl id="bib7" type="bt">7</bibl> <bibtext> Durlak, J. A., & Kass, R. A. (1981–1982). Clarifying the measurement of death attitudes: A factor analytic evaluation of fifteen self report death scales. Omega: The Journal of Death and Dying, 12, 129–141.</bibtext> </blist> <blist> <bibl id="bib8" idref="ref1" type="bt">8</bibl> <bibtext> Feifel, H. (1956). Older persons look at death. Geriatrics, 11, 127–130.</bibtext> </blist> <blist> <bibl id="bib9" idref="ref2" type="bt">9</bibl> <bibtext> Feifel, H. (1959). Attitudes toward death in some normal and mentally ill populations. In H.Feifel (Ed.), The meaning of death (pp. 114–130). New York, NY: McGraw-Hill.</bibtext> </blist> <blist> <bibtext> Florian, V., & Kravetz, S. (1983). Fear of personal death: Attribution, structure and relation to religious belief. Journal of Personality and Social Psychology, 44, 600–607.</bibtext> </blist> <blist> <bibtext> Ho, S. M. Y., Chow, A. Y. M., Chan, C. L. W., & Tsui, Y. K. Y. (2002). The assessment of grief among Hong Kong Chinese: A preliminary report. Death Studies, 26, 91–98.</bibtext> </blist> <blist> <bibtext> Ho, S. M. Y., Ho, J. W. C., Chan, C. L. W., Kwan, K., & Tsui, Y. K. Y. (2003). Decisional consideration of hereditary colon cancer genetic test results among Hong Kong Chinese adults. Cancer Epidemiology, Biomarkers & Prevention, 12, 426–432.</bibtext> </blist> <blist> <bibtext> Hoelter, J. W. (1979). Multidimensional treatment of fear of death. Journal of Consulting and Clinical Psychology, 47, 996–999.</bibtext> </blist> <blist> <bibtext> Huang Lin, A. H.-M. (2003). Factors related to attitudes toward death among American and Chinese older adults. Omega: The Journal of Death and Dying, 47, 3–24.</bibtext> </blist> <blist> <bibtext> Hui, V. K.-Y., & Fung, H. H. (2009). Mortality anxiety as a function of intrinsic religiosity and perceived purpose in life. Death Studies, 33, 30–50.</bibtext> </blist> <blist> <bibtext> Krieger, S. R., Epting, F. R., & Leitner, L. M. (1974). Personal constructs, threat and attitudes toward death. Omega: The Journal of Death and Dying, 5, 299–310.</bibtext> </blist> <blist> <bibtext> Lester, D. (1993). The structure of Templer's Death Anxiety Scale among Egyptian students: A comment. Psychological Reports, 72, 1378.</bibtext> </blist> <blist> <bibtext> Lonetto, R., & Templer, D. I. (1986). Death anxiety. New York, NY: Hemisphere.</bibtext> </blist> <blist> <bibtext> Long, D. D. (1985–1986). A cross-cultural examination of fears of death among Saudi Arabians. Omega: The Journal of Death and Dying, 16, 43–50.</bibtext> </blist> <blist> <bibtext> Martin, T. O. (1982–1983). Death anxiety and social desirability among nurses. Omega: The Journal of Death and Dying, 13, 51–58.</bibtext> </blist> <blist> <bibtext> Moore, M. K., & Neimeyer, R. A. (1991). A confirmatory factor analysis of the Threat Index. Journal of Personality and Social Psychology, 60, 122–129.</bibtext> </blist> <blist> <bibtext> Neimeyer, R. A., Wittkowski, J., & Moser, R. (2004). Psychological research on death attitudes: An overview and evaluation. Death Studies, 28, 309–340.</bibtext> </blist> <blist> <bibtext> Penson, R. T. (2004). Bereavement across culture. In R. J.Moore & D.Spiegal (Eds.), Cancer, culture, and communication (pp. 241–279). New York, NY: Kluwer Academic/Plenum Publication.</bibtext> </blist> <blist> <bibtext> Schulz, R. (1978). The psychology of death, dying, and bereavement. Reading, MA: Addison-Wesley.</bibtext> </blist> <blist> <bibtext> Slife, B. D. (1995). What's behind the research? Discovering hidden assumptions in the behavioral sciences. Thousand Oaks, CA: Sage.</bibtext> </blist> <blist> <bibtext> Slife, B. D. (2005). Critical thinking about psychological assumptions and plausible alternatives. Washington, DC: APA Books.</bibtext> </blist> <blist> <bibtext> Tang, C. S.-K., Wu, A. M. S., & Yan, E. C. W. (2002). Psychosocial correlates of death anxiety among Chinese college students. Death Studies, 26, 491–499.</bibtext> </blist> <blist> <bibtext> Templer, D. I. (1970). The construction and validation of a death anxiety scale. Journal of General Psychology, 82, 165–177.</bibtext> </blist> <blist> <bibtext> Templer, D. I., Harville, M., Hutton, S., Underwood, R., Tomeo, M., Russell, M., & Mitroff, D. (2002). Death Depression Scale–Revised. Omega: The Journal of Death and Dying, 44, 105–112.</bibtext> </blist> <blist> <bibtext> Tomás-Sábado, J., & Gómez-Benito, J. (2005). Construction and validation of the Spanish Death Anxiety Inventory. European Journal of Psychological Assessment, 21, 108–114.</bibtext> </blist> <blist> <bibtext> Wittkowski, J. (1996). Fragebogeninventar zur mehrdimensionalen Erfassung des Erlebens gegenüber Sterben und Tod (FIMEST) [Inventory for the Multidimensional Assessment of the Experiencing Toward Dying and Death]. Goettingen, Germany: Hogrefe.</bibtext> </blist> <blist> <bibtext> Wittkowski, J. (2001). The construction of the Multidimensional Orientation Toward Dying and Death Inventory (MODDI-F). Death Studies, 25, 479–495.</bibtext> </blist> <blist> <bibtext> Wittkowski, J., & Baumgartner, I. (1977). Religiosität und Einstellung zu Tod und Sterben bei alten Menschen [Religiosity and attitude toward death and dying in old persons]. Zeitschrift für Gerontologie, 10, 61–68.</bibtext> </blist> <blist> <bibtext> Wong, P. T. P., Reker, G. T., & Gesser, G. (1994). Death Attitude Profile–Revised: A multidimensional measure of attitudes toward death. In R. A.Neimeyer (Ed.), Death anxiety handbook: Research, instrumentation, and application (pp. 121–148). Washington, DC: Taylor & Francis.</bibtext> </blist> </ref> <ref id="AN0057225642-7"> <title> Footnotes </title> <blist> <bibtext> <emph>Note</emph>: MODDI-F/chin = Chinese version of the Multidimensional Orientation Toward Dying and Death Inventory; GFI = goodness-of-fit index; CFI = comparative fit index; TLI = Tucker-Lewis index; RMSEA = root mean square error of approximation.</bibtext> </blist> <blist> <bibtext> <emph>Note</emph>. EFA = exploratory factor analyses; MODDI-F/chin = Chinese version of the Multidimensional Orientation Toward Dying and Death Inventory.</bibtext> </blist> <blist> <bibtext> <sups> <emph>a</emph> </sups>Item number in the Chinese version of the MODDI-F (MODDI-F/chin).</bibtext> </blist> <blist> <bibtext> <sups> <emph>b</emph> </sups>Abbreviations for the original MODDI-F/chin subscales: FODy = Fear of One's Own Dying; FODe = Fear of One's Own Death; FAPDy = Fear of Another Person's Dying; FAPDe = Fear of Another Person's Death; FC = Fear of Corpses.</bibtext> </blist> <blist> <bibtext> <emph>Note</emph>. EFA = exploratory factor analyses; MODDI-F/chin = Chinese version of the Multidimensional Orientation Toward Dying and Death Inventory.</bibtext> </blist> <blist> <bibtext> <sups> <emph>a</emph> </sups>Item number in the Chinese version of the MODDI-F (MODDI-F/chin).</bibtext> </blist> <blist> <bibtext> <sups> <emph>b</emph> </sups>Abbreviations for the original MODDI-F/chin subscales: AODD = Acceptance of One's Own Dying and Death; AAPDe = Acceptance of Another Person's Death; RODe = Rejection of One's Own Death.</bibtext> </blist> <blist> <bibtext> <sups> <emph>c</emph> </sups>Item has to be inverted.</bibtext> </blist> </ref> <aug> <p>By Joachim Wittkowski; SamuelM. Y. Ho and WallaceC. H. Chan</p> <p>Reported by Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib22" firstref="ref3"></nolink> <nolink nlid="nl2" bibid="bib24" firstref="ref4"></nolink> <nolink nlid="nl3" bibid="bib18" firstref="ref7"></nolink> <nolink nlid="nl4" bibid="bib16" firstref="ref8"></nolink> <nolink nlid="nl5" bibid="bib21" firstref="ref9"></nolink> <nolink nlid="nl6" bibid="bib13" firstref="ref10"></nolink> <nolink nlid="nl7" bibid="bib29" firstref="ref11"></nolink> <nolink nlid="nl8" bibid="bib10" firstref="ref12"></nolink> <nolink nlid="nl9" bibid="bib34" firstref="ref15"></nolink> <nolink nlid="nl10" bibid="bib30" firstref="ref16"></nolink> <nolink nlid="nl11" bibid="bib32" firstref="ref17"></nolink> <nolink nlid="nl12" bibid="bib25" firstref="ref18"></nolink> <nolink nlid="nl13" bibid="bib26" firstref="ref19"></nolink> <nolink nlid="nl14" bibid="bib31" firstref="ref20"></nolink> <nolink nlid="nl15" bibid="bib17" firstref="ref27"></nolink> <nolink nlid="nl16" bibid="bib14" firstref="ref29"></nolink> <nolink nlid="nl17" bibid="bib28" firstref="ref30"></nolink> <nolink nlid="nl18" bibid="bib23" firstref="ref31"></nolink> <nolink nlid="nl19" bibid="bib11" firstref="ref32"></nolink> <nolink nlid="nl20" bibid="bib33" firstref="ref34"></nolink> <nolink nlid="nl21" bibid="bib15" firstref="ref35"></nolink> <nolink nlid="nl22" bibid="bib27" firstref="ref36"></nolink>
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  Data: Factor Structure of the Multidimensional Orientation toward Dying and Death Inventory among Hong Kong College Students: A Preliminary Study
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  Data: <searchLink fieldCode="AR" term="%22Wittkowski%2C+Joachim%22">Wittkowski, Joachim</searchLink><br /><searchLink fieldCode="AR" term="%22Ho%2C+Samuel+M%2E+Y%2E%22">Ho, Samuel M. Y.</searchLink><br /><searchLink fieldCode="AR" term="%22Chan%2C+Wallace+C%2E+H%2E%22">Chan, Wallace C. H.</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Death+Studies%22"><i>Death Studies</i></searchLink>. 2011 35(1):59-72.
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  Data: Routledge. Available from: Taylor & Francis, Ltd. 325 Chestnut Street Suite 800, Philadelphia, PA 19106. Tel: 800-354-1420; Fax: 215-625-2940; Web site: http://www.tandf.co.uk/journals
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  Data: 14
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  Data: 2011
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  Data: Journal Articles<br />Reports - Research
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  Label: Descriptors
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  Data: <searchLink fieldCode="DE" term="%22College+Students%22">College Students</searchLink><br /><searchLink fieldCode="DE" term="%22Factor+Structure%22">Factor Structure</searchLink><br /><searchLink fieldCode="DE" term="%22Factor+Analysis%22">Factor Analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Fear%22">Fear</searchLink><br /><searchLink fieldCode="DE" term="%22Death%22">Death</searchLink><br /><searchLink fieldCode="DE" term="%22Psychological+Patterns%22">Psychological Patterns</searchLink><br /><searchLink fieldCode="DE" term="%22Cultural+Differences%22">Cultural Differences</searchLink><br /><searchLink fieldCode="DE" term="%22German%22">German</searchLink><br /><searchLink fieldCode="DE" term="%22Surveys%22">Surveys</searchLink><br /><searchLink fieldCode="DE" term="%22Psychometrics%22">Psychometrics</searchLink>
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  Data: 10.1080/07481187.2010.502612
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  Data: 0748-1187
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  Data: This study examines the factor structures of the Chinese version of the Multidimensional Orientation Toward Dying and Death Inventory (MODDI-F/chin), originally established in German language, in a sample of Hong Kong college students (n = 256). Both confirmatory factor analysis and exploratory factor analysis were performed to examine the factor structures of the MODDI-F/chin. The results showed that, identical to the German version, the MODDI-F/chin consisted of a 5-factor Fear domain and a 3-factor Acceptance domain. The fear of another person's dying was the weakest of the four factors in the Hong Kong sample but represented the first and strongest factor in the German sample of the original study. Although preliminary and not representative of mainland China, our results show that the factor structure of attitudes toward dying and death that had been established empirically with German people can be replicated with Chinese students of Hong Kong. (Contains 3 tables.)
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        Value: 10.1080/07481187.2010.502612
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      – Text: English
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        PageCount: 14
        StartPage: 59
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      – SubjectFull: College Students
        Type: general
      – SubjectFull: Factor Structure
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      – SubjectFull: Factor Analysis
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      – SubjectFull: Foreign Countries
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      – SubjectFull: Fear
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      – SubjectFull: Death
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      – SubjectFull: Psychological Patterns
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      – SubjectFull: Cultural Differences
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      – SubjectFull: German
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      – SubjectFull: Psychometrics
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      – SubjectFull: Hong Kong
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      – TitleFull: Factor Structure of the Multidimensional Orientation toward Dying and Death Inventory among Hong Kong College Students: A Preliminary Study
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