The Research Of Health Quotient For Postpartum Women

ObjectiveHealth quotient(HQ) is a reflection of health consciousness, health knowledge and health ability level for one person or an area resident. HQ is a new human health culture in the 21 st century which is important for improving health consciousness and maintaining physical and mental health. Postpartum women are a high-risk population who are subject to many health-related issues. Their health is directly related to the newborn’s growth and development as well as the whole family’s harmony. The study combines the concept of health quotient with health management in puerperium. It aims to develop the Postpartum Women Health Quotient Scale(PWHQS) and form puerperium health quotient management strategy, thus provide suitable tool and theoretical guidance for health quotient practice.Methods1.The pilot instrument was developed in the following steps: health quotient theory research,literature review,semi-structured interviews,two rounds of Delphi expert consultation and pilot study.2.Cross-sectional survey and measurement examination:A total of 395 postpartum women were recruited for survey from two inpatient clinics in Jiangsu Province,China. The general information questionnaire,PWHQS pilot instrument,HADS,SSRS were used to interview. Database was managed using Epidata 3.1,and data analyses were conducted using SPSS18.0 and Mplus7.3. The items were screened according to item distribution,coefficient of variation(CV),Pearson correlation coefficients and extreme-group method. The factors structures of the PWHQS scales were examined by exploratory factor analysis(EFA) and confirmatory factor analysis(CFA). And then, the finalized PWHQS was developed..3.The puerperium health quotient management strategy was formulated by the perspectives of postpartum women and the results of covariate effects.Results1.Items and factors analysis:The PWHQS instrument was developed with a total of 31 items and 5 underlying factors:health consciousness(HC), maternal health knowledge(MHK), infant health knowledge(IHK), maternal health ability(MHA), and infant health ability(IHA).2.Reliability test:The Cronbach’s α, split reliability, and model-estimated scale reliability ρ of the HQ scale were 0.908,0.847,and 0.946, respectively.The corresponding figures for the five specific factors were between 0.662~0.821, 0.656~0.826, and 0.697~0.848. Again,using the results of bifactor model, the general factor’s coefficient omega hierarchical(ωh)and explained common variance(ECV)are 0.84 and 60.5%, respectively. The results confirmed the scale has a relatively strong degree of unidimensionality.3.Validity test:①Content validity:The content validity index(CVI)of whole scale was 0.939;CVI ranges from 0.8 to 1.0 for specific factors,and from 0.90 to 0.98 for the items;②Convergent validity and discriminant validity:The correlation coefficients between items and their underlying factors range from 0.563 to 0.769.The correlation coefficients between items and other common factors range from 0.179 to 0.553. The correlation coefficients among factors range from 0.326 to 0.647. The correlation coefficients between factors and the total scale range from 0.646 to 0.846. All the correlation coefficients were statistically significant(P<0.01). ③ Construct validity:The 5 factors were extracted by EFA which explained for 63.794% variances. The factor loadings of items were between 0.552 to 0.839, and the difference between an item’s factor loading and its cross loadings was about 0.15. CFA results show that the domain specific single factors CFA models, 5-factor CFA, and bifactor model of PWHQS fit data very well, and bifactor model was preferred, in which five group factors and a general HQ factor were identified. The 31 PWHQS items measure not only their underlying specific group factors, respectively, but also a general HQ factor.4.Testing covariate effects:Both the 5-factor and bifactor MIMIC models fit data very well. Age and education had no significant effect on any of the PWHQS factors; multipara had a positive effect on MHA and IHA(P<0.05,P<0.01);perinatal education had a significant positive effect on IHK and MHA(P<0.01,P<0.05);depression had a significant negative effect on HC and MHK(P<0.01,P<0.05)while anxiety had a negative effect on MHK(P<0.05);social support had a significant positive effect on all the PWHQS subscales and HQ(P<0.01).5. Testing differential item functioning(DIF):To test measurement invariance, all covariates were also specified to affect all items directly in the MIMIC models. The covariates under study did not directly influence the items except that “age” directly influences item 8 and item 11. This indicates that the response values of the items do not vary by the covariates, holding the constant. I can, therefore, claim that the PWHQS has a property of measurement invariance.ConclusionThe PWHQS can be used as a health screening tool for postpartum women in regard to their health quotient. PWHQS is a valid and reliable instrument and it has a statistical property of measurement invariance. The puerperium health quotient management strategy developed in the study would provide useful guidance for health quotient practices.