| Objective: The objective of this study was:1) to construct a conceptualframework for developing lifestyle questionnaire in health management, and define itsdimensions, sub-dimensions, and core data elements, and provide the theory forstandardizing the lifestyle questionnaire of physical examination;2) to develop alifestyle questionnaire base on the conceptual framework and data elements, andevaluate the goodness of fitting for the questionnaire structure with conceptualframework by data coming from survey administrated in population consuming healthexamination, and refine a minimum data set by confirmatory factor analysis (CFA) forthe final aim of expressing information in the lifestyle questionnaire of healthexamination by using least data elements.Methods: We combined top-down with bottom-up methods to establish theconceptual framework, which involved incorporating data from lifestyle questionnaires conducted as part of large-scale studies by Chinese health-management organizations aswell as data from paper-based health records. We included data relating to Chinese andinternational health information standards and made reference to health risk factorsidentified by the World Health Organization as well as those recognized by otherstudies in this area. Through an analysis of the significance and the collection facility ofthe information and whether the information exists in the current lifestyle questionnaireas well as following the experts’ advice, we defined the core data elements.We took the conceptual framework as the bases and referred to27kinds oflifestyle questionnaire items at home and abroad. Then we constructed the lifestylequestionnaire to survey the people who went to medical examination center. Throughanalysis of the data from survey, we evaluate the reliability and validity of thequestionnaire. Finally, the model was updated by CFA and cutting the items with factorsloading lower than0.4to constructed a minimum data set.Results: The conceptual framework, which was established for developinglifestyle questionnaire, included8dimensions (smoking, alcohol consumption, diet,employment, exercise, daily living habits, sleep, toxic exposure) and28sub-dimensions.For instance, smoking included4sub-dimensions such as smoking status, intensity ofsmoking, continuance time of smoking, kinds of tobacco. Further,24core data elementswere extracted from48general data elements, and value codes were defined for the partof these data elements.Results of the evaluation of the reliability showed that the Cronbach’α coefficientof the questionnaire was greater than0.6. The ceiling effect and floor effect of thequestionnaire was respectively11.46and37.18. CFA results showed that the modelstructure was good fitted. The results showed that the exposure ratio of risk factors inmen were higher than women (P<0.05), and the average standardized scored of somedimensions (e.g. smoking, diet, sleep, toxic exposure) were significantly higher inpeople with chronic illnesses (e.g. high blood pressure) than healthy people. The logicalregression showed that risk factors of neck atherosclerosis included smoking, alcoholconsumption, and overmuch dairy products, and ORs of them were respectively1.46, 3.51and0.51). The risk factors of high blood pressure included less fruit, lesserphysical strength and occupational exposure, and ORs of them were respectively1.24,0.55and1.74. The standardized overall score was negatively correlated with theself-rating score of EQ-5D (r=-0.17, p=0.002), and positively correlated with the scoreof anxiety/depression dimension in EQ-5D. The positive rate of blood pressure,dyslipidemia and artery atherosclerosis in physical examination population were about50percent. The analysis of lifestyle questionnaire showed that the rate of people withthe healthiest (the most reasonable) lifestyle were about below10percent, in addition,the rates of smoking and alcohol consumption dimensions were respectively42.4percent and31.4percent.The minimum data set, including33data elements, could be divided into2components in which demographic and socioeconomic characteristic componentincluded14data elements and lifestyle component included19data elements. We havedefined13of the33data elements and the others were referenced to health dataelement dictionary.Conclusion: We concluded that the conceptual framework could serve as thereferences for the development of lifestyle questionnaire, and the standardized dataelements we extracted could be used as the standard for data elements in informationexchanging involved differently structured questionnaires among different institutions.Most of the participants should be got rid of the unhealthy living habits. A minimumdata set of health management lifestyle questionnaire have been refined to restricted theminimum measurements set of lifestyle. The minimum data set provided the standardsof the data elements, and further more medical examination center could refer theminimum data set to establish the healthy lifestyle questionnaire. It was helpful for thestandardization of physical examination questionnaire, the process of data collectionand management as well as analysis. However, standardization of the data elementsshould be further improved. |
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