Development And Application Of A Comprehensive Health Self-assessment Scale(CHSAS) For People’s Liberation Army

ObjectiveThe health status of our military personnel is not just a matter of individual well-being but a crucial factor in maintaining combat effectiveness.Till today,a comprehensive health assessment tool with adequate reliability,validity,and discrimination for officers and soldiers in the People’s Liberation Army（PLA）is lacked.This project is of utmost importance as it aims to fill this gap and develop a comprehensive health self-assessment Scale（CHSAS）tailored explicitly for PLA officers and soldiers based on Classical Test Theory（CTT）.The study will also delve into the reliability,validity,and discriminative power of the CHSAS.The latent profile analysis method is used to explore classification of the health status,determine the demarcation norms of each classification,and analyze the factors affecting the health status of our military personnel.To summarize,this research provided a standardized assessment tool for early detection and daily management of health status in military personnel,as well as a reference for the formulation of individualized intervention programs to promote health maintenance of military personnel and improvement of military combat effectiveness.Methods1.The development of CHSAS（1）Establishment of the Conceptual Model for the Comprehensive Health Assessment of PLAOur research is based on a comprehensive review of domestic and international advances in comprehensive health assessment.Through a qualitative interview,we have meticulously summarized the definition and connotation of comprehensive health for the PLA.By combining the PLA’s health characteristics and influential factors,we have determined the overall framework of the extensive health assessment tool for officers and soldiers and built its conceptual model.（2）Creation of the Initial Draft of the Comprehensive Health Self-Assessment Scale for PLADuring the creation of the initial draft of the comprehensive health self-assessment scale,we meticulously adhered to the conceptual model for the extensive health assessment of military personnel.We proposed dimensions for the health assessment scale,considering advances in China and foreign countries and the characteristics of comprehensive health for our military personnel.We then completed the preliminary construction of an item pool.Through consultation with relevant experts and exploratory surveys conducted with the target population,we ensured the thoroughness of our process.Items with ceiling effect or floor effect were eliminated,resulting in the initial draft of the comprehensive health assessment Scale for military personnel.We used the Likert-5 scale to score the item,and the dimensionality was scored with the mean score of items.The total score of all dimensionalities expressed the score of CHSAS,ensuring its reliability and validity.（3）Development of the Trial Version of the Comprehensive Health Self-Assessment Scale for PLAWe employed a convenience sampling method to recruit 280 officers and soldiers from the Army,Navy,and Air Force across 6 provinces nationwide to conduct a survey utilizing the initial draft of CHSAS.The results from the Scale were analyzed using trend analysis,discrimination analysis,correlation coefficient method,Cronbach’sαcoefficient method,and factor analysis,all based on CTT,to screen items from the initial draft.（4）Finalization of the CHSAS for PLAUsing convenience sampling in 18 provinces across the Army,Navy,Air,Joint Logistic Support,and Strategic Support Force,we selected 1,100 military personnel to test the trial version of the comprehensive health assessment Scale.Upon completion of the testing,we continued to use item selection methods based on Classical Test Theory to screen items further,and we applied exploratory factor analysis（EFA）to validate and name the dimensions of the Scale.This is the final version of CHSAS for officers and soldiers in PLA.2.Evaluation of the CHSAS for officers and soldiers in the PLAUtilizing the CHSAS,a third round of large-scale sampling survey was conducted on a convenience sample of 5000 soldiers from 32 provinces and cities nationwide,encompassing all five war zones and military branches.A total of 4,799 valid Scales were gathered.After two weeks,720 individuals（15%retest rate）were randomly selected from participants who validly confirmed the CHSAS to retake the CHSAS.Based on the data from this survey,reliability,validity,and discriminative ability assessments were conducted for the CHSAS.The statistical methods,including Cronbach’sαcoefficient,split-half reliability coefficient,and test-retest reliability coefficient,were applied to evaluate the reliability of CHSAS.Content validity was assessed using expert judgment and statistical analysis;the latter refers to evaluating the correlation coefficients between the scores of each dimension of the Scale and the total score.Moreover,EFA and confirmatory factor analyses were used to assess structural validity,and convergent validity and discriminative validity were also calculated.EFA was then performed on each scale dimension to verify the structural validity.Differentiation analysis was conducted using a t-test or ANOVA to compare the scores of different dimension scales among different characteristic groups.3.Exploration the potential comprehensive health categories of PLA and Norm Establishment for the CHSASBased on the data collected from the third round of surveys using the CHSAS,the standard latent profile analysis procedure was first used to determine the observed indicators/manifest variables:the scores of the eight dimensions.On this basis,we started with the assumption of a single class.We incrementally added the number of latent terms to fulfill the latent profile model of the comprehensive health status of military personnel,identifying the optimal number of classifications.The classes were named in consultation with relevant literature and expert opinions.Finally,quantification was performed based on the results of the manifest variables across different courses,leading to establishing norms for the CHSAS,which was expressed with the method of percentiles.4.Analysis of Potential Predictive Factors Affecting Comprehensive Health among PLA PersonnelTaking the total score and the latent categories of comprehensive health assessment for military personnel as outcome variables,we included characteristics of gender,ethnicity,age,marital status,number of children,education level,BMI,professional title,the origin of military recruitment,a branch of the military,military service years,nature of work,category of identity,smoking habits,alcohol consumption,exercise,allergenic foods,allergenic drugs,geographical features of the stationed area,distribution of the stationed area,the climate of the stationed area,working environment,dietary habits,and exposure to harmful factors as independent variables.Variable selection,multiple linear regression for total score,and Logistic regression analysis for potential categories were performed to comprehensively examine the complex factors affecting the health status of military personnel in PLA.Results1.Using methods such as qualitative interviews and expert consultations,a pool of229 items was established.After conducting a preliminary test with 24 experts in related fields and 40 military officers and soldiers,177 items were retained to form the first draft of the CHSAS.Based on the survey data from 268 military personnel,a trial version of CHSAS consisting of 31 dimensions and 128 items was formed after content evaluation and item screening.Based on the survey data from the second round completed by 1,001 military personnel using the trial Scale,the draft CHSAS was further refined through item selection.Items of draft CHSAS resulted in the deletion of 73 items and the retention of 55 items to establish a formal Scale.A total of 8 common factors were finally extracted from EFA results,and the cumulative variance contribution rate was 69.92%.According to the referenced literature and the professional significance of the items,the corresponding eight common factors were defined as follows:physiological fitness（12 items）,daily activities（10 items）,occupational satisfaction（14 items）,otolaryngological health（4 items）,skin health（4 items）,visual health（4 items）,sleep health（4 items）,and physical fitness（3 items）,which were formed as the final version of CHSAS with 55 items.2.The validity,reliability,and discrimination of CHSAS were assessed using 4,799valid Scales from the third round of the survey.（1）The reliability evaluation results were shown as follows:The Cronbach’sαcoefficient for homogeneity reliability is 0.970,and Cronbach’sαcoefficient for each dimension is between 0.781 and 0.944;the Guttman split-half reliability coefficient is 0.937,and the Guttman split-half reliability coefficients for each dimension were between 0.797and 0.936.The retest reliability coefficient of 720 officers and soldiers after 2 weeks was0.902,and the retest reliability of each dimension was between 0.630 and 0.960.（2）The results of content validity,the correlation coefficient between the scores of each dimension,and the scale’s total score are between 0.69～0.88,both of which are positively correlated.The content validity ratio is 0.62.Half of the samples were randomly selected for EFA analysis,and the results showed that all 8 factors need to be extracted,which is consistent with the theoretical concept dimensions.The cumulative variance contribution rate is 64.66%.Using the remaining half of the sample data for CFA of the 8-factor model,the results indicated that except for NFI,it was 0.880 and CFI was 0.893（close to 0.90）,respectively,χ²/df,GFI,AGFI,NNFI,and RMSEA all meet statistical requirements.Only one common factor with eigenvalues greater than 1 could be extracted from each dimension,and the variance contribution rate ranges from 58.40%to 80.25%.The loadings of each item in their respective dimensions are all greater than 0.51,indicating that this Scale has a reliable structural validity.（3）The results of discrimination.There were statistically significant differences in the total score of the scale and the scores of each dimension among different genders,ages,educational levels,BMI,length of military service,Nature of work,Work area,Geographical distribution,Work environment,and Harmful factors（P<0.05）,these indicated the good discrimination level of CHSAS.3.The results of the latent cross-sectional analysis showed that the 3-category model had the highest Entropy index,suggesting that this model provided the most precise classification.From the results of the latent profile analysis,three categories of comprehensive health assessment for military personnel can be named as follows:Poor Health Level(below P_18.13,i.e.,the score is less than 28 points),General Health Level(P_18.13～P_60.39,the score is between 28 and 33 points),and Good Health Level(above P_60.39,i.e.,the score is more than 33 points).The scores for occupational satisfaction,psychological fitness,daily activities,physical fitness,otolaryngological health,skin system health,sleep health,and visual health among military personnel of different health categories were statistically significant（P<0.001）.Post-hoc tests revealed that scores on all dimensions for those with a Good Health evaluation were significantly higher than those for the General and Poor Health evaluations,and scores on all dimensions for the General Health evaluation were considerably higher than those for the Poor Health evaluation.4.The results of the multifactorial Logistic regression analysis showed that gender,educational level,military source,military service,nature of work,status category,smoking,drinking,exercise,landform,distribution of the site,working environment,eating habits,high noise,electromagnetic radiation,toxic and harmful substances,and other damaging factors are influential prediction factors for the potential classification of the evaluation of comprehensive health for PLA（P<0.05）.Conclusions1.This study attempted to compile a self-assessed questionnaire for the comprehensive health status of PLA personnel from eight aspects:psychological fitness,daily activities,occupational satisfaction,otolaryngological health,skin health,visual health,sleep health,and physical fitness.The scale developed by this project is reliable,valid,and discriminable.It could be widely used as an effective tool for the comprehensive health evaluation of our military personnel and provided a reliable theoretical and practical tool for the future assessment of the extensive health of the PLA.2.The results of the latent profile analysis showed that comprehensive health for servicemen could be divided into three categories:"good,""general,"and"poor."accounted for 39.61%,42.26%,and 18.13%,respectively,indicating that the overall health of our soldiers was in good.3.Among health influential factors,gender,educational level,military source,military service,nature of work,status category,smoking,drinking,exercise,landform,distribution of the site,working environment,eating habits,high noise,electromagnetic radiation,toxic and harmful substances,and other harmful factor are all determinants which would affect the comprehensive health status of military personnel.Innovations1.Following the standard scale development process,we developed a comprehensive health self-rating tool with good reliability,validity,and discriminability—the"Comprehensive Health Self-Assessment Scale,"which includes 8 dimensions and 55 items and could be applied to assess the PLA’s comprehensive health status.2.Using the potential profile analysis model,we confirmed the health status classification in PLA officers and soldiers.Based on this finding,a norm model was also constructed,as the first one in China,as we know.This could be used to evaluate the health status of the PLA personnel.3.After conducting a comprehensive analysis of the main factors impacting,specific factors affecting overall health and various dimensions of the health of officers and soldiers were identified.The data supports updating military health management concepts and developing a more scientific health evaluation model.It also provided a basis for the PLA to create personalized health promotion strategies and implement targeted health management methods.