| ObjectiveDeep aging process is fast in China,especially in megacities such as Beijing.Timely and effective detection of health problems and health risks of the elderly is the basis for formulating policies for disease prevention and control,maintaining the physical functions of the elderly and reducing the burden of disease.The health assessment scale for the elderly has become one of the indispensable tools to evaluate the health status of the community elderly.This study built indicators pool of community elderly health comprehensive assessment by analysis of the previous nationwide nutrition and health survey results about the older population and the abroad related research involving in chronic disease prevention,nutrition,exercise and psychological health.In addition,this study developed and verified the Comprehensive Health Status Assessment Scale for the Elderly in Beijing by the methods of Delphi expert consultation,preliminary experiment and the evaluation of reliability,validity of the scale.The purpose of this study is to build big city community elderly health status evaluation index system,compile comprehensive health in the elderly is applicable to big city community comprehensive evaluation scale,evaluation of the comprehensive scale is suitable for Beijing community elderly reliability,validity,sensitivity and the degree of acceptable,provides the comprehensive assessment of city community elderly health can use reference tool,and provides policy advice to perfect our country basic public health services,for our country healthy aging.MethodsThis study is to develop a simple scale for the comprehensive assessment of the health status of the elderly in the community.The scale is developed by combining qualitative and quantitative methods.Based on the theoretical framework of "China Healthy Elderly Standards" and supplemented by literature research,the scale item pool was constructed and the Delphi expert consultation table was compiled.On this basis,the Delphi expert consultation method was used to screen and revise the items and contents of the scale to form the initial scale.Through the population pre-test,the expression validity of the scale was evaluated,the existing problems were modified,and the scale to be tested was formed.Finally,the reliability and validity of the scale were verified and evaluated in the population.The main content includes the following parts:(1)Constructing evaluation index system of elderly scale pool with "biological-psychological-social medical model" as the basis,the framework of "Chinese old people health standards",literature retrieval in November 2020-January 1973 published about the document of elderly health assessment tool(including journals,dissertations,books,papers and other forms),literature exclusion criteria:repetitive reports and literature evaluation index to describe is not clear;At the same time,by referring to the mature scales at home and abroad and the scale compilation process,combined with the discussion of the research group,the dimensions of the questionnaire and specific item indicators were determined,the specific questions and question options of the items were designed,and the scale item pool was prepared.The subject team prepared the Delphi expert consultation table according to the content of the scale pool.(2)Delphi expert consultation:50 experts with associate senior titles in clinical medicine,public health,nutrition,psychology,nursing,sports rehabilitation,etc.,who are familiar with scale construction,and who are interested and have time to complete the consultation,will be invited to send to each expert via WeChat or email.Experts are required to score the importance of each item,and fill in the judgment basis of each dimension and the degree of familiarity,so as to evaluate the professionalism of experts.Experts’ suggestions and supplements on dimensions and items can be annotated after the items.After the first round of Delphi,according to the statistical analysis results of scores and expert opinions,the second round of expert consultation form was developed and returned to the experts.The second round of letter consultation was continued.After at least two rounds of Delphi expert consultation,the comprehensive assessment scale for elderly health in the community was determined.(3)Pre-test:convenience sampling was adopted to conduct face-to-face questionnaire pre-survey among 30 elderly people in the service center of Jinsong Community,Chaoyang District,Beijing,to determine whether there was ambiguity in the expression of the scale content,whether the respondents could understand it,and to adjust the scale content.(4)Population verification of the scale to be tested:A total of 1978 elderly people were selected from three districts of Beijing for scale population verification.Inclusion criteria of respondents were:aged 65 or above,coming to a community hospital for treatment,or having a file in a community hospital,and voluntarily participating in this study.Exclusion criteria:caregivers with mental disorders,inability to communicate normally,and inability to complete the scale.Face-to-face questionnaires were used to conduct the survey,and body measurements were taken.The reliability,validity,sensitivity and acceptability of the scale were evaluated by using the field survey data of the population.The validity of the scale was evaluated by surface validity,content validity and structure validity.The internal consistency reliability and split reliability were used to evaluate the reliability of the scale,in which the internal consistency reliability was reflected by Cronbach a coefficient.The sensitivity of the scale was evaluated by the difference of scores in each dimension and total scale between the high and low groups.The acceptability of the scale was evaluated by the scale recovery rate and response time.Results(1)Scale pool construction:urban community elderly health state comprehensive assessment scale includes disorders and physical function,cognitive status,social status,daily activities and life self-care ability,diet and lifestyle of five dimensions,and increases reflect the status of the muscles of the four body measurement index,containing 40 core entries,62 issue of the initial inventory pool.(2)Delphi expert consultation:50 experts were invited to conduct two rounds of Delphi expert consultation.The effective recovery rates of the two rounds of expert consultation questionnaires were 98.0%and 100%.The expert authority coefficients of the two rounds of consultation were 0.84 and 0.86.The mean value of dimensions and items in the second round of consultation was 4.45～5.00,the full mark ratio was 0.51～1.00,and the coefficient of variation was less than or equal to 0.20.The Kendall coordination coefficients were 0.116 and 0.110(P<0.01),respectively.The experts’enthusiasm and authority were good,the experts’ opinions were consistent,and the results of letter consultation were reliable.The final comprehensive health assessment scale for the elderly includes 5 dimensions(disease status,physical function,cognitive status,social support and psychology,diet and nutrition and lifestyle),30 items and 4 measurement indexes.(3)Pre-test:modify 5 questions in the dimension of physical function,add question requirements in the dimension of cognitive status,replace 2 questions in the dimension of social support,add time setting for physical activity in the dimension of diet,nutrition and lifestyle,and modify 1 question.(4)Population verification of the scale to be tested:the average filling time of the scale was(12.8±4.8)minutes.The Cronbach’s a of the scale was 0.849,and the Cronbach’s a coefficient of each dimension was 0.358-0.845.The total retest reliability was 0.837,and the retest reliability of each dimension was 0.579-0.910.The intra-group correlation coefficients for the overall rating were 0.899,and the intra-group correlation coefficients for each dimension were 0.280-0.860.A total of 15 common factors were extracted from the scale,and the cumulative variance contribution rate was 55.65%.Results of scale confirmatory factor analysis:GFI and AGFI were 0.961 and 0.951,both greater than 0.9;CFI and IFI were 0.926 and 0.927,respectively more than 0.90,RMSEA is 0.039,less than 0.080.Theoretical models of all dimensions fit well with real data,and the structural validity is good.The t-test showed statistical difference between the scores of high group respondents and the scores of each dimension of low group,indicating a good degree of differentiation between the total scale and the scale of each dimension.ConclusionThrough the Delphi method,a scientific and reliable comprehensive health assessment scale for the elderly in Beijing communities was preliminarily formed in this study.The population verification showed that the scale and various dimensions had good internal consistency,retest-reliability and evaluator reliability.The content validity,structure validity and calibration correlation validity have all been verified,and the sensitivity and acceptability of the scale are good.And the practical application value of this scale is high. |
