Reliability and Construct Validity of the Health-Promoting Lifestyle Profile II in an Adult Turkish Population

Gut microbiome and metabolome alterations in traditional Chinese medicine damp-heat constitution following treatment with a Chinese patent medicine and lifestyle intervention

BACKGROUND

The gut microbiota is crucial in human health and diseases. Traditional Chinese Medicine Constitution (TCMC) divides people into those with a balanced constitution (Ping-he [PH]) and those with an unbalanced constitution. Dampness-heat constitution (Shi-re [SR]) is a common unbalanced constitution in the Chinese population and is susceptible to diseases. However, unbalanced constitutions can be regulated by Chinese medicine and lifestyle interventions in clinical practice. Ermiao Pill (EMP) is a Chinese medicine known for clearing heat and draining dampness and improving SR. However, the efficacy and mechanism of EMP are unclear.

HYPOTHESIS/PURPOSE

To determine alterations in the gut microbiota and metabolome in SR and any changes after EMP treatment combined with lifestyle intervention.

STUDY DESIGN

Randomized clinical trial.

METHODS

We enrolled 112 healthy SR individuals and evaluated the efficacy of EMP along with lifestyle interventions. We further assessed serum cytokine levels, serum and urinary metabolomes, and the gut microbiota by 16S rRNA gene sequencing analysis before and after the EMP and lifestyle interventions.

RESULTS

107 SR individuals (55 in the intervention group and 52 in the control group) completed the 1-month-intervention and 1-year-follow-up. The intervention group significantly improved their health status within 1 month, with a reduced SR symptom score, and the efficacy lasted to the 1-year follow-up. The control group needed a further 6 months to reduce the SR symptom score. The gut microbiota of PH individuals was more diverse and had significantly higher proportions of many bacterial species than the SR. Microbiota co-occurrence network analysis showed that SR enriches metabolites correlating with microbial community structure, consistent with traits of healthy SR-enriched microbiota.

CONCLUSION

EMP combined with lifestyle intervention produced health benefits in SR individuals. Our study indicates a pivotal role of gut microbiota and metabolome alterations in distinguishing between healthy SR and PH. Furthermore, the study reveals structural changes of gut microbiota and metabolites induced by EMP and lifestyle intervention. The treatment enriched the number of beneficial bacteria, such as Akkermansia muciniphila and Lactobacillus in the gut. Our findings provide a strong indication that several metabolite factors are associated with the gut microbiota. Moreover, the gut microbiome and metabolome might be powerful tools for TCMC diagnosis and personalized therapy.

Reliability and Validity of the Health-Promoting Lifestyle Profile II Spanish Version in University Students

AIM

The purpose of this study was to assess the reliability and validity of the Spanish version of the Health Promoting Lifestyle Profile II (HPLP-II) scale in Colombian university students.

METHODS

This was a methodological study to verify reliability and construct validity. A total of 763 undergraduate university students in Cali, Colombia, agreed to participate in the study by filling out a form that included information on sociodemographic characteristics and the HPLP-II scale Spanish version. Data were collected between February and June 2021. To determine construct validity, a confirmatory factor analysis was performed, and internal consistency was determined through Cronbach's alpha.

RESULTS

The confirmatory factor analysis of the proposed theoretical model showed that the goodness-of-fit indices of the scale demonstrated an acceptable level of validity nearing an excellent level of fit (χ2 = 7168.98; gl = 1268; p < 0.001; root mean square error of approximation = 0.08; normed fit index, adjusted goodness-of-fit index = 0.95). Cronbach's alpha coefficient of the scale was 0.94, and the subscales ranged from 0.68 to 0.89.

CONCLUSIONS

The HPLP-II Spanish version is a valid and reliable instrument to assess the health-promoting lifestyle profile of university students.

Physical Activity Behavior and Measurement in Arab American Women: An Integrative Review

Physical activity (PA) is associated with cardiovascular health; however, in the U.S., only 20% of women are physically active, compared to 28% of men. Arab American women (AAW) experience unique barriers to engaging in the recommended PA. This review examines quantitative PA studies conducted with AAW with a specific focus on how PA outcomes were assessed. Studies were analyzed to explore: (a) types of PA behavior, (b) components of PA interventions/interest (if conducted), (c) PA measurement, and (d) translation of PA tools. After screening titles, abstracts, and a full-text review of articles from five different databases, 12 studies met the inclusion criteria. Leisure-time PA was the most readily used PA measure. Only two out of the 12 studies included women-only participants. There was a total of 10 cross-sectional studies and two quasi-experimental studies. All the studies used a self-report PA questionnaire; one study used a pedometer to measure PA. Six PA questionnaires were translated into Arabic. Future studies must explore the use of reliable and valid translated instruments, objective PA measures, and randomized controlled trial designs.

Investigation of the relationship between rational drug use and healthy lifestyle behaviours of university students

AIM

the aim of this research is to investigate the relationship between rational drug use and healthy lifestyle behaviours of university students.

METHOD

this descriptive and cross-sectional study consisted of 1115 students from a university in the Southeast-East Anatolia Region in the autumn semester of the 2019-2020 academic year. In the collection of data, 'Student Introduction Form', 'The Rational Drug Use Scale' and 'The Health-Promoting Lifestyle Profile II' were used. Ethical approval was obtained from the Batman University Ethics Committee. In addition, necessary legal permissions were obtained from the institution where the study was conducted and from the students. Descriptive statistics, number, percentage, independent t-test, ANOVA test and Spearman's rank correlation were used in the Statistical Package for Social Science (SPSS) 22.0 package software to analyse the data.

RESULTS

the average age of the students was 21.31 ± 2.37 years, and their monthly drug expenditure was 142.63 ± 157.200 Turkish Lira. Some 28.1% of them were third-year students, 59% had graduated from Anatolian high school, 59.6% were living with their nuclear family, 49.1% had an equal level of income and expenditure, 7.7% had no chronic disease, and 9% had regular medication. Some 57.8% of them had health insurance. The Health-Promoting Lifestyle Profile II scale mean score of the students was 124.12 ± 21.37 and the Rational Drug Use Scale mean score was 33.65 ± 6.75. A statistically significant difference was found between the students' class, income, and the total mean scores of the health-promoting lifestyle profile II scale (p < 0.05). A statistically significant difference was found between the school type, family type and income status of the students and the total mean scores of the rational drug use scale (p < 0.05).

CONCLUSION

a strong positive correlation was found between rational drug use scale and the health-promoting lifestyle profile II scales.

[Reliability and validity of the Acquired healthy lifestyle assessment scale (E-VEVSA) in adults from Albacete and Murcia (Spain)]

BACKGROUND

Lifestyle is a theoretical construct that is formed by the life habits of a subject. The analysis and objective quantification of lifestyle can have a great impact on people's health, as well as on the evolution of its status over the years. The objective of this research has been the validation of the Acquired Healthy Lifestyle Assessment Scale (E-VEVSA) in Spanish adults.

METHOD

On an initial sample for the exploratory tests of 248 subjects and a final sample for the confirmatory tests of 780 subjects, aged between 22 and 72 years of age. Exploratory and confirmatory psychometric tests were carried out based on the Cronbach's alpha statistic (reliability) and exploratory factorial analysis with oblique rotation (oblimin) and confirmatory with varimax rotation (construct validity), which resulted in an instrument made up of 52 items and structured in 7 dimensions: individual responsibility in health care (9 items), habits of physical-sports practice (6 items), health habits in social relationships (10 items), habit of tobacco and alcohol consumption (9 items), habit of healthy eating (7 items), psychological health habits (6 items) and daily rest and sleep habits (5 items).

RESULTS

All the items explained a total variance of 66.87% and a Cronbach's alpha of .894, with the partial alpha of each dimension or factor being above .700.

CONCLUSIONS

The results show psychometric tests that confirm the validity of the E-VEVSA scale as a useful instrument to measure the healthy lifestyle acquired among adults.

Evaluation of Health Promoting Lifestyle Habits During Pandemic Period: A cross-sectional study

Objective: The COVID-19 pandemic imposed lifestyle changes. The aim of this study was to evaluate the health-promoting lifestyle habits of individuals who applied to a primary care center during the pandemic period. Methods: This descriptive and cross-sectional study was conducted with the voluntary participation of 524 individuals. The data was collected through a research questionnaire form and the Health Promoting Lifestyle Scale (HPLS). Results: Women accounted for 58.2% (n=305) of all participants, 45.2% of them (n=237) had chronic disease and 32.1% (n=168) were smoking. Mean age was 41.26±14.28 (min:18, max:75) years old. Among these participants, %53.2 had equal income to their expenses (n=279), 52.3% experienced sleep pattern changes (n=274), 35.7% had COVID-19 disease and 66.6% vaccinated for COVID-19. The mean HPLS score was 162.75±8.10 points. Interpersonal relationships, stress management and total HPLS scores were higher in women (p

Development and validation of the geriatrics health behavior questionnaire (GHBQ)

BACKGROUND

Considering the importance of health behaviors in health outcomes, it is necessary to assess health behaviors precisely. This study aimed to develop and validate The Geriatrics Health Behavior Questionnaire among Iranian older adults.

METHODS

This cross-sectional and methodological study was conducted on 420 community older adults (age ≥ 60) through random multi-stage sampling. The initial questionnaire has been developed with 22 items and seven subscales based on an extensive literature review, evaluation of related questionnaires, and experts' opinions. Face and content validity were evaluated by interviewing 10 older adults and 18 specialists. The construct validity was evaluated via Known-groups validity and convergent validity. The reliability of the questionnaire was calculated by internal consistency, test-retest, and absolute reliability.

RESULTS

The face validity was conducted by using interviews with older adults and gathering the specialists' opinions. The items were grammatically and lexically corrected accordingly. Two items were deleted due to CVR < 0.44. Modified Kappa statistic (K*) and I-CVI for all items were higher than 0.88. The average content validity index (S-CVI/Ave) value was 0.94. Three items were deleted to improve the internal consistency; the final GHBQ consisted of 17 items with Cronbach α = 0.72. Acceptable convergent validity was approved by a significant correlation between GHBQ and SF8™ health survey (r = 0.613, P value< 0.001). Independent t-test showed that older adults with education level ≥ high school have significantly higher health behavior scores than those with education level < high school (11.93 ± 2.27 vs. 9.87 ± 2.35, t = - 9.08, p < 0.001). Intra-class correlation coefficient (ICC) for the total questionnaire was 0.92 (95% CI =0.84 to 0.96). Standard Error Measurement (SEM) and Minimal Detectable Change (MDC₉₅) were 0.71 and 1.98, respectively.

CONCLUSION

The present study results showed that the Geriatrics Health Behavior Questionnaire had suitable validity and reliability among Iranian older adults. It is recommended to consider its comprehensiveness and yet its briefness in other populations after passing validation.

The Relationship of Lifestyle with Disease Activity among Patients with Systemic Lupus Erythematosus: A Descriptive-Correlational Study

Objective:

The objective of this study was to evaluate the relationship of lifestyle with disease activity among patients with systemic lupus erythematosus.

Methods:

This cross-sectional descriptive-correlational study was conducted in 2019 on 209 patients with systemic lupus erythematosus. Data were collected using a demographic and clinical characteristics questionnaire, the Health-Promoting Lifestyle Profile II, and the systemic lupus erythematosus disease activity Index. The data were analysed through the mixed model and the logistic regression analyses.

Results:

In total, 67.5% of participants had active disease. The mean score of lifestyle was 2.49±0.30 and the lowest and the highest lifestyle dimensional mean scores were respectively related to the physical activity and the health responsibility dimensions (1.55±0.60 and 3.25±0.45). The analysis showed that each one point increase in the mean score of lifestyle was associated with 0.79 point decrease in the odds of disease activity (P = 0.006). Moreover, disease activity had significant positive relationship with body mass index (P = 0.015).

Conclusion:

Interventions for promoting lifestyle among these patients and improving healthcare providers’ knowledge about Systemic lupus erythematosus and lifestyle modification are recommended to reduce disease activity.

Gut Microbiota and Urine Metabonomics Alterations in Constitution after Chinese Medicine and Lifestyle Intervention

Traditional Chinese Medicine Constitution (TCMC) divides human beings into balanced (ping-he) constitution (PH) and unbalanced constitution. Yang-deficiency (yang-xu) constitution (YAX) is one of the most common unbalanced constitutions in Chinese general population, and it causes susceptibility to particular diseases. However, unbalanced constitutions can be regulated by Chinese medicine and lifestyle intervention in clinical practice. Gui-fu-di-huang-wan (GFDHW) is a well-known Chinese medicine with yang-invigorating activity and is regarded as improving YAX. In this study, 60 healthy YAX students selected from a prospective population of 5185 were enrolled in a randomized clinical trial and completed the study. We compared the gut microbiota and urinary metabolome between individuals with PH and those with YAX before and after one-month-intervention. Compared with the control group, the health status of the intervention group improved significantly, the YAX symptom score was reduced, and the efficacy remained high at the one-year follow-up. The gut microbiota of the healthy PH exhibited greater diversity, and significantly higher species were identified. Compared to PH group, YAX individuals showed increased abundance of Bacteroidetes and Bacteroides, also had higher levels of gut microbial-derived urinary metabolites. After one-month-intervention, both GFDHW treatment and lifestyle intervention enriched the diversity and modulated the structure in YAX. The intervention group also partially restored the microbiome and metabolome to healthy PH-like levels. Further, a microbiota co-occurrence network analysis showed that the metabolites enriched in YAX were correlated with microbial community structure. Taken together, our results suggest that Chinese medicine combined with lifestyle intervention benefits YAX individuals. Gut microbiota/metabolite crosstalk might be involved in the Chinese medicine-mediated effects.

Determinants of Health Promotion Behaviors among Family Caregivers of Stroke Survivors

Purpose:To record the health promotion behaviors of family caregivers of stroke survivors, as well as potential determinants that could affect these behaviors. Methods: A cross-sectional study was carried out through home visits in the Attica region using the convenience sampling method. The studied population included 109 survivors who had suffered a stroke and experienced functional problems, and their 109 primary caregivers, who were family members, lived in the same house and were fully responsible for their care. The dependent variables were the caregivers’ health promotion behaviors, while the independent variables were the survivors and caregivers’ demographic characteristics, survivors’ functional capacity, depression, social support and changes in caregivers’ lives from caring. Results: Better health promotional behaviors were associated with the following: patient having advanced age and a high level of functionality, caregivers assessing their own state of health as “good”, greater social support, a higher educational level and a higher income level. In addition, more hours of patient care were associated with a less healthy lifestyle for caregivers. Conclusions: Promoting the health of family caregivers of stroke survivors is crucial for both survivors and caregivers. For this reason, it is of great importance to detect factors that affect the health promotion behaviors of caregivers in order to carry out appropriate interventions and improve their quality of life.

Determining The Relationship Between Smoking Habits and Healthy Lifestyle Behaviors of Health Workers: Smoke-Free Hospital, Healthy Life

Aim: Using tobacco and tobacco products is an important public health issue. This study aims to determine the smoking status of hospital staff and to examine the relationship between their smoking habits and healthy lifestyle behaviors. Methods: This cross-sectional study was carried out between March and September 2018 with 387 health workers in Izzet Baysal Training and Research Hospital affiliated to Bolu Abant Izzet Baysal University. Data were collected using the Healthy Lifestyle Behaviors Scale II and the Fagerstrom Test for Nicotine Dependence, which were applied via face-to-face interview technique to health workers who accepted to participate in the study. Results: The study sample consisted of 387 health workers. Of them, 58.7% of the participants were exposed to smoking in the workplace, and 75.9% of the nonsmokers were exposed to smoking environment, which was statistically significantly high. A statistically significant difference was found between the health workers’ Healthy Lifestyle Behaviors Scale mean scores with respect to gender, smoking status, being in a smoking environment, and duration of smoking. Conclusion: Determining the relationship between smoking habits and healthy lifestyle behaviors of health workers, identifying their negative or incomplete behaviors in this regard, and developing training and support programs for their relevant needs are considered to positively affect the images of health workers in society, and thus to increase healthcare quality and satisfaction. Keywords: health personnel, smoking cessation, healthy lifestyle

Relationships among parenting stress, health-promoting behaviors, and health-related quality of life in Korean mothers of children with cerebral palsy

Health-promoting behaviors have been shown to enhance the quality of life across diverse populations. In this study, we examined the indirect effects of several health-promoting behaviors on the relationship between parenting stress and health-related quality of life in mothers of children with cerebral palsy (CP). A convenience sample of Korean mothers (N = 180) of children aged 10 months to 12 years with CP was recruited from clinical and school settings. Health-promoting behaviors were measured using the health-promoting lifestyle profile II, which is comprised of six subscales: health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, and stress management. Multiple mediation analyses were conducted to examine the mediating role of these behavioral categories. Spiritual growth (β = .56, p < .05) had an indirect effect on the relationship between parenting stress and physical health-related quality of life while spiritual growth (β = -1.00, p < .01) and stress management (β = -.80, p < .05) were found to mediate the association between parenting stress and mental health-related quality of life. The findings of multiple mediation analyses provide evidence of the influence of specific health-promoting behaviors on health-related quality of life, thereby informing the development of intervention programs for mothers of children with disabilities.

Inpatient Suicide Second Victim Experience and Support Tool: Psychometric properties of a scale for nurses who experienced inpatient suicide at Chinese general hospitals

This study describes a psychometric scale, the Inpatient Suicide Second Victim Experience and Support Tool, for evaluating physical and psychological distress with a focus on resources for supporting the needs of nursing professionals. Our study defines "second victim" as a nurse who experiences inpatient suicide while on shift. We conducted a cross-sectional study among non-psychiatric nurses to examine the psychometrics of the scale. A total of 731 participants were recruited from eight Chinese general hospitals for this research. Data were analyzed by exploratory factor analysis and confirmatory factor analysis to examine the reliability and validity of the scale. The results indicated adequate indices resulting in 21 items. The final structure for the scale was categorized into five domains: psychosomatic distress, support from family and friends, work-related support, organizational support, and professional self-efficacy. The total variance explained was 69.06%. Cronbach's alpha was 0.869 overall, and ranged from 0.626 to 0.914 for the five dimensions. The test-retest reliability of 0.792 for the entire scale was also acceptable. The scale shows promise for use by healthcare organizations to identify second victims and promote necessary organizational support interventions in Chinese hospitals.

The impact of pregnant women's health literacy on their health-promoting lifestyle and teratogenic risk perception

This study was conducted to determine pregnant women's health literacy level and its effect on health-promoting lifestyle and perception of teratogenic risk related to medicine. The sample of the study consisted of 326 pregnant women. Women with high health literacy have more health-promoting lifestyles and lower teratogenic risk perceptions toward using antidepressants and influenza immunization during pregnancy. This study gives baseline data on health literacy and teratogenic risk perception of medicine usage during pregnancy in Turkish women.

Applicability of health promoting lifestyle profile-II for postmenopausal women in Sri Lanka; a validation study

BACKGROUND AND OBJECTIVE

Health Promoting Lifestyle Profile-II (HPLP-II), developed in the West, evaluates 52 health promoting behaviors (HPB) under six subscales. In this study we evaluated the applicability of HPLP-II to assess the HPB of postmenopausal women (PMW) conversant in the Sinhala language in Sri Lanka.

METHODS

The Sinhala version of HPLP-II was adapted following standard methodology of cross cultural adaptation. It included forward and backward translations, review by an expert group, focus group discussion and pre-testing. It was self-administered among randomly selected healthy, Sinhalese, community-dwelling PMW (n = 245, aged 55.9 ± 3.4 years), along with the Short Form 36 (SF-36) survey. The Sinhala version of HPLP-II was re-administered among a subsample (n = 105) after two weeks of first administration. Psychometric properties - reliability and validity, were evaluated.

RESULTS

In the Sinhala version of HPLP-II, both internal consistency (Cronbach's alpha = 0.98) and test-retest reliability (intra class correlation / ICC = 0.98, 95%CI = 0.97-0.99) were high. Structural validity assessment with Factor analysis using Principal Component Analysis extracted seven factors explaining 80.65% cumulative variance with few exceptions from the original version. Health responsibility (HR) and spiritual growth (SG) subscales of HPLP-II and physical and psychological health dimensions scores of SF-36 scores correlated significantly (r > 0.63, p < 0.001) ensuring strong concurrent validity.

CONCLUSIONS

The Sinhala version of HPLP-II adapted by us is a tool with high reliability and validity.

Psychometric properties of the health-promoting lifestyle profile II: cross-cultural validation of the Malay language version

BACKGROUND

Health-promoting behaviour is an important concept for health education. Unfortunately, there is a dearth of validated instruments to measure levels of health-promoting behaviour in the Malaysian context. The purpose of this study was to validate a Malay-language version of the Health-Promoting Lifestyle Profile II (HPLP-II) using a confirmatory approach.

METHODS

Participants were 997 university undergraduate students, with a mean age of 21 years (SD = 1.58). The majority of the participants (80.4%) were female. Health-promoting behaviour was assessed using the 52-item HPLP-II, which measures six components of health-promoting behaviour outcomes. HPLP-II was translated into the Malay language using standard forward and backward translation procedures. Participants then completed the HPLP-II Malay version (HPLP-II-M). Confirmatory factor analysis (CFA) was conducted using Mplus 8.0 software on the six domains of HPLP-II-M model.

RESULTS

The CFA result based on the hypothesised measurement model of six factors was aligned with the original HPLP-II, except for two low loading items which were subsequently removed from the CFA analysis. The final CFA measurement model with 50 items resulted in a good fit to the data based on RMSEA and SRMR fit indices (RMSEA = 0.046, 90%CI = 0.045, 0.048, SRMR = 0.062). The construct reliabilities for the HPLP-II-M subscales were acceptable, ranging from 0.737 to 0.878.

CONCLUSION

The HPLP-II-M with six components of health-promoting behaviour outcomes and 50 items was considered valid and reliable for the present Malaysian sample.

Chronotype: implications for sleep quality in medical students

Medical students who suffer from poor sleep quality may be afflicted by distress. While the change of chronotype may improve sleep quality, few studies have focused on this association. The objective of this study is to analyze the effects of chronotype on sleep quality in medical students while controlling for confounding covariate factors. A cross-sectional survey on sleep quality was conducted among 5497 medical students. Sleep quality, chronotype, and lifestyle were measured according to the Pittsburgh Sleep Quality Index, Morningness-eveningness Questionnaire and Health-promoting Lifestyle Profile. Hierarchical logistic regression was conducted to analyze the influence of various factors, especially chronotype effect on sleep quality. Our results showed that the total score of sleep quality in evening-types was 5.43 ± 2.66, which was significantly higher than that in morning-types (3.88 ± 2.20, P < .001). Morning-type students (OR = 0.40, 95%CI = 0.29-0.55) and intermediate-type students (OR = 0.53, 95%CI = 0.41-0.69) had a lower risk of poor sleep quality compared to evening-types. The strongest predictor of sleep quality was chronotype while controlling for covariates (grade, gender, father's educational level, mother's educational level, internet addiction, mood state, midnight snack frequency, and health-promoting lifestyle profile). Based on the results, we believe that sleep quality among evening-type students may be improved by shifting to keep early hours.

Health-Associated Nutrition and Exercise Behaviors in Relation to Metabolic Risk Factors Stratified by Body Mass Index

This study aimed to investigate the relationships of nutrition and exercise behaviors on metabolic risk factors (MRF) when body mass index (BMI) was considered. Health-associated nutrition and exercise behaviors were assessed by a questionnaire, anthropometric values, blood pressure and biochemical determinations that were obtained from 4017 workers. The nutrition score was negatively associated with triglycerides in the overweight subgroup and with systolic blood pressure (SBP) in the obese subgroup. The exercise score was negatively associated with triglycerides and waist circumference (WC) and positively associated with SBP and high-density lipoprotein cholesterol (HDL-C) in the ideal weight subgroup as well as being negatively associated with WC and positively associated with HDL-C in the overweight subgroup. Similarly, the exercise score was negatively associated with WC and positively associated with SBP in the obese subgroup. However, no significant association was found between nutrition or exercise behavior and MRF in the underweight subgroup. In conclusion, the relationships of exercise and nutrition behaviors on MRF varied for different levels of BMI. Exercise showed a significant association with lower WC. Moreover, its effect showed a gradient trend in accordance with the levels of BMI. For ameliorating MRF, exercise seemed to have better effects than nutrition behavior, especially in the ideal weight subgroup.

Psychometric Characteristics of the Turkish Version of Adolescent Lifestyle Profile R2

Background and Purpose:

The purpose of this study was to adapt and assess cultural and psychometric properties of the Adolescent Life Style Profile (ALP-R2) in Turkish adolescents.

Methods:

The sample of the study consisted of 945 students aged 12–18 years. Data were collected using the Turkish translation of the ALP-R2. Psychometric testing of the ALP-R2 included internal consistency, item-total correlation, test–retest correlation, and construct validity with confirmatory factor analysis (CFA).

Results:

The total Cronbach’s α coefficient was .88, and the subscales ranged from .55 to .76. The CFA results showed that the structure of the model/scale has an acceptable goodness of fit.

Conclusion:

The study shows that the Turkish version of the ALP-R2 is a reliable and valid scale that can be used to assess healthy lifestyle domains in Turkish adolescents.

The relationship between attitudes toward aging and health-promoting behaviours in older adults

BACKGROUND

Identifying the factors that are associated with health-promoting behaviours in older adults is necessary to increase their willingness and motivation to participate in health-promotion activities. Understanding context-specific attitudes in relation to their influence on health-promoting behaviours is crucial in designing efficient interventions that foster health-promoting behaviours among older adults.

AIM

This study aimed to examine the relationships between attitudes towards aging and health-promoting behaviours in older adults in Turkey.

METHODS

The study used a descriptive-correlational design. A convenience sample of 448 community-dwelling older adults who were 65 years and older and cognitively intact were selected from 6 family health centres in the city of Denizli in Turkey. The data were collected between March and June of 2014 using the Attitudes to Aging Questionnaire and the Health-Promoting Lifestyle Profile II. Multiple linear regression analysis was performed to explore the predictors of health-promoting behaviours.

FINDINGS

Attitudes toward aging, the psychosocial loss subscale, and education were statistically significant predictors of health-promoting behaviours. Attitudes toward aging were the strongest predictor of health-promoting behaviours in older adults.

CONCLUSION

Attitude towards aging is a factor that affects health-promoting behaviours, and it should be considered during interventions for improving health promoting behaviours.

Do socio-cultural factors influence college students' self-rated health status and health-promoting lifestyles? A cross-sectional multicenter study in Dalian, China

Background

An unhealthy lifestyle of college students is an important public health concern, but few studies have been undertaken to examine the role of socio-cultural differences.

Methods

For this cross-sectional comparative study, data on college students’ health-promoting lifestyles (HPL), as measured using the Health-Promoting Lifestyle Profile (HPLP-II) scale, and self-rated health status (SRH) as measured by Sub-Optimal Health Measurement Scale (SHMS V1.0) were collected from 829 college students.

Results

The sample of 829 college students included 504 (60.8%) Chinese and 325 (39.2%) international students. Chinese students had higher scores in overall health-promoting lifestyle (HPL) (P < 0.001, eta squared =0.113) and in all the six subclasses than their international counterparts. In relation to health status evaluation, the two groups varied in physiological health (P < 0.001, eta squared = 0.095) and social health (P = 0.020, eta squared = 0.007) but there was no significant difference in psychological health subscale (P = 0.156, eta squared = 0.002). HPL was predicted by financial status among the Chinese group and by student’s major, age and level of education in the international group. Body mass index (BMI) and financial status emerged as predictors of the three subscales of SHMS V1.0 in the Chinese group and also of physiological and psychological subscales in the international group. Gender was associated with psychological health in both groups. Smoking status was a predictor of psychological health in both groups and also of social health in the international group. The level of education emerged as a predictor of social health in the international group.

Regression analyses revealed a significant association between health status and healthy lifestyle (P < 0.001). In reference to participants with “excellent” lifestyle, participants with moderate lifestyle were at a 4.5 times higher risk of developing suboptimal health status (SHS) (OR: 4.5,95% CI:2.2-9.99) and those with a ‘general’ lifestyle were at a 3.2 times higher risk SHS (OR: 3.2, 95% CI: 1.5-7.18). Good and moderate HPLP-II levels of nutrition are associated with low risk of suboptimal health status (OR: 0,41 and 0,25, respectively). Participants in good and moderate HPLP-II levels of interpersonal relations are associated with higher risk of suboptimal health (OR:2,7 and 3,01 respectively) than those in excellent levels of HPLP-II.

Conclusion

Collectively, these findings provide a convincing body of evidence to support the role of socio-cultural factors as key determinants of the HPL and SRH of college students.

The Role of Healthy Lifestyle in the Implementation of Regressing Suboptimal Health Status among College Students in China: A Nested Case-Control Study

BACKGROUND

Suboptimal health status (SHS) is the intermediate health state between health and disease, it is medically undiagnosed and is also termed functional somatic syndrome. Although its clinical manifestations are complicated and various, SHS has not reached the disease status. Unhealthy lifestyle is associated with many chronic diseases and mortality. In accordance with the impact of lifestyle on health, it is intriguing to determine the association between unhealthy lifestyle and SHS risk.

METHODS

We conducted a nested case-control study among healthy Chinese college students from March 2012 to September 2013, which was nested in a prospective cohort of 5676 students. We performed 1:1 incidence density sampling with matched controls for birth year, sex, grade, specialty and individual character. SHS was evaluated using the medical examination report and Sub-health Measurement Scale V1.0 (SHMS V1.0). Exposure was defined as an unhealthy lifestyle per the frequency of six behavioral dimensions from the Health-promoting Lifestyle Profile (HPLP-II).

RESULTS

We matched 543 cases of SHS (42.66%) in a cohort of 1273 students during the 1.5 years mean follow-up time with controls. A significant difference (t = 9.79, p < 0.001) and a reduction in HPLP-II total score was present at 1.5 years follow-up (135.93 ± 17.65) compared to baseline (144.48 ± 18.66). A level-response effect was recorded with an increase of the total HPLP-II (every dimension was correlated with a decreased SHS risk). Compared to respondents with the least exposure (excellent level), those reporting a general HPLP-II level were approximately 2.3 times more likely to develop SHS (odd ratio = 2.333, 95% CI = 1.471 to 3.700); and those with less HPLP-II level (good level) were approximately 1.6 times more likely (1.644, 1.119-2.414) to develop SHS (p < 0.05). Our data indicated that unhealthy lifestyle behavior with respect to behavioral dimensions significantly affected SHS likelihood. Further analyses revealed a marked increase (average increased 14.73 points) in lifestyle level among those SHS regression to health after 1.5 years, with respect to the HPLP-II behavioral dimensions, in addition to the total score (t = -15.34, p < 0.001).

CONCLUSIONS

SHS is highly attributable to unhealthy lifestyles, and the Int. J. Environ. Res. Public Health 2017, 14, 240 2 of 17 mitigation of modifiable lifestyle risk factors may lead to SHS regression. Increased efforts to modify unhealthy lifestyles are necessary to prevent SHS.

The factor structure of the Health-Promoting Lifestyle Profile II among a South African student sample

This study aimed to determine the factor structure of the Health-Promoting Lifestyle Profile II scale in a South African sample. The sample consisted of 211 students at a university. Students completed an online survey that included the 52-item Health-Promoting Lifestyle Profile II. Confirmatory factor analysis, items analysis, and exploratory factor analysis were used to determine the factor structure of the Health-Promoting Lifestyle Profile II and reduce the number of items. Confirmatory factor analysis did not confirm the original six-factor structure for the Health-Promoting Lifestyle Profile II. The measure produced high internal consistency value (Cronbach’s alpha = .92) indicating over-redundancy of items. Item analysis was conducted in order to reduce the number of items. A subsequent exploratory factor analysis yielded a six-factor model for the Health-Promoting Lifestyle Profile II in the current sample. The final 24-item measure demonstrated good reliability (Cronbach’s alpha = .87) and can be used as an alternative to the original measure within the current sample.

Health Promoting Lifestyle Behaviors in Menopausal Women: A Cross-Sectional Study

BACKGROUND

Determining health promoting lifestyle behaviors of age-specific groups of women provides valuable information for designing health promotion intervention programs. Hence the present study was conducted to assess health promoting lifestyle behaviors in menopausal women.

METHODS

The present descriptive cross-sectional study examined health promoting lifestyle behaviors in 400 menopausal women admitted to health care centers in Neka city-north of Iran-from March 2015 to July 2015. Health promoting lifestyle behaviors were evaluated using a demographic characteristics form and the Health Promoting Lifestyle Profile II (HPLP II) through simple convenience sampling. Data were analyzed in SPSS version 18 using descriptive and inferential statistics at the significance level of P<0.05.

RESULTS

The mean score of participants' health promoting lifestyle behaviors was 136.43±19.61, ranging from 88 to 194. The logistic regression test revealed women's health promoting lifestyle behaviors to be significantly related to their place of residence (P=0.009, odds ratio=1.73) and their spouse's level of education (P=0.027, odds ratio=0.58). The Pearson correlation test showed significant relationships between mean score of the six sub-scale of health promoting lifestyle behaviors with each other (P<0.001).

CONCLUSION

These findings have implications for addressing the role of men to promote health promoting lifestyle behaviors among rural menopausal women.

Development and validation of the Humanitarian Aid Difficulty Scale for Japanese healthcare workers

Few studies have investigated deployment-related experiences of healthcare workers dispatched for medical humanitarian aid or attempted to assess their difficult living and working environments. This is the first study to develop and validate a scale to measure these kinds of difficulties, in 264 Japanese healthcare workers. The Humanitarian Aid Difficulty Scale was developed in three stages. First, an item pool was generated based on literature and expert reviews. The scale was then tested in a pilot study. Reliability and validity were identified through exploratory and confirmatory factor analysis and Cronbach's alpha. The scale consisted of 23 items across five factors based on exploratory factor analysis (cooperation, health status, infrastructure, culture and customs, and supplies and equipment). The total variance explained was 60.7%. Reliability of the five factors was acceptable and validity was supported by confirmatory factor analysis. Cronbach's alpha for the scale was 0.87. The scale may enable evaluation of the level of difficulty of the living and working environments of Japanese healthcare workers in medical humanitarian aid who are at a greater risk of distress.

Validity and Reliability of Health Promoting Lifestyle Profile II in the Iranian Elderly

Background:

With increasing age, the prevalence of chronic diseases increases. Since health-promoting behaviors (HPB) are considered a basic way of preventing diseases, especially chronic diseases, it is important to assess HPB. This study examines the validity and reliability of the Health Promoting Lifestyle Profile II (HPLP-II).

Methods:

This is a cross-sectional study which is conducted on 502 elderly individuals aged 60 and over in Tehran, Iran. In order to determine the validity, content and construct validity were used. The content validity index (CVI) was used to assess the content validity and to assess construct validity, confirmatory factor analysis (CFA), and item-total correlations were employed. For reliability, test-retest analysis was used, and the internal consistency of the HPLP-II was confirmed by Cronbach's alpha. For data analysis, SPSS-18 and Amos-7 software was used.

Results:

The mean age of the subjects was 66.3 ± 5.3 years. The CVI for the revised HPLP-II and all its subscales was higher than 0.82. The CFA confirmed a six-factor model aligned with the original HPLP-II. Pearson correlation coefficients between the revised HPLP-II and their items were in range of 0.27–0.65. Cronbach's alpha of the revised HPLP-II was obtained as 0.78 and for their subscales were in the range of 0.67–0.84. Intraclass correlation coefficient was obtained 0.79 (95% confidence interval: 0.59–0.86, P < 0.001).

Conclusions:

The Iranian HPLP-II scale is an appropriate tool for assessing HPBs of the Iranian elderly.

Work-Recreation Balance, Health-Promoting Lifestyles and Suboptimal Health Status in Southern China: A Cross-Sectional Study

Suboptimal health status (SHS)—an intermediate state between health and illness—refers to functional somatic symptoms that are medically undiagnosed. Although SHS has become a great challenge for global public health, very little about its etiology and mechanisms are known. Work-recreation balance is a part of work−life balance, and is related to stress which greatly influences health status. We therefore carried out a cross-sectional investigation between 2012 and 2013 within a clustered sample of 24,475 individuals aged 15−60 years from a population in southern China. In so doing, we hoped to illuminate the associations between work-recreation balance conditions, healthy lifestyles, and SHS. Work-recreation balance conditions were categorically defined by frequency (“rarely, sometimes, or always”). Health-Promoting Lifestyle Profile (HPLP-II) was used to evaluate the level of healthy lifestyles, and the medical examination report and Sub-Health Measurement Scale V1.0 (SHMS V1.0) were both used to evaluate health status. The ratio of SHS (46.3%) is higher than health status (18.4%) or disease status (35.3%). Overall, 4.9% of respondents reported the lowest level of work-recreation balance, and they scored lower on both the HPLP-II and SHMS V1.0 compared with those who frequently maintained a work-recreation balance. Significant association was found between work-recreation balance behaviors and healthy lifestyles (p < 0.001) after demographic adjustment. In comparison with those reporting a frequent work-recreation balance, individuals whose work-recreation balance was categorically “rare” were 1.69 times as likely to develop SHS (odds ratio (OR): 1.69, 95% confidence interval (CI): 1.49–1.92), and those with infrequent work-recreation balance (“sometimes”) were 1.71 times more likely to develop SHS (OR: 1.71, 95% CI: 1.62–1.81). These findings suggest that work-recreation balance conditions are significantly associated with, and seem to be accurate behavioral indicia of a healthy lifestyle. Poor work-recreation balance is associated with increased risk for SHS; thus, a healthier lifestyle that maintains a work-recreation balance should be promoted in order to reduce the development of SHS or disease in southern China.

[Effect of health-promoting lifestyle on outcomes of suboptimal health status]

OBJECTIVE

To determine evaluate the effect of health-promoting lifestyle on the outcomes of suboptimal health status (SHS).

METHODS

A prospective population cohort was conducted by consecutively enrolling 5676 college students who took routine health examination from March to May 2013. The participants were assessed for baseline health status and lifestyle and 2972 participants with SHS were followed up for 1.5 years. Exposure was defined as an unhealthy lifestyle. The health-promoting lifestyle was assessed via the Health-promoting Lifestyle Profile (HPLP-II). SHS was evaluated using the medical examination report and Sub-health Measurement Scale V1.0 (SHMS V1.0).

RESULTS

Among the 2972 students with SHS, 422 showed recovery of the healthy status at 1.5 year follow-up, 579 showed progression into disease conditions, and 1971 remained in SHS. The participants with recovered health status presented with significant increase of SHMS V1.0 scores by 8.75∓6.95 points compared to the baseline assessment (t=-2.14, P=0.000) in physiological, psychological and social dimensions; they also showed a marked improvement of HPLP-II scores by 14.73 points in 6 dimensions (t=-15.34, P=0.000). Multivariable regression analyses with adjusted demographic variables revealed a significant association between health status and health-promoting lifestyle (P<0.05). Compared with a healthy lifestyle (minimal exposure), a 'poor' lifestyle (the highest level of exposure) was associated with a 30 times higher risk of developing SHS (OR: 30.598, 95% CI: 3.928-238.331), while a 'moderate' lifestyle (a relatively high-level exposure) had a 24 times higher risk of SHS (OR: 23.988, 95%CI: 14.695-39.158), and a suboptimal lifestyle had a nearly 4 times higher risk of SHS (OR: 4.306, 95%CI: 2.767-6.702).

CONCLUSION

s SHS may evolve into either a healthy or a disease condition. A unhealthy lifestyle is the important risk factor contributing to the progression of SHS into a disease condition, suggesting the importance of intervention of unhealthy lifestyles in promoting good health.

Health promoting behaviors in adolescence: validation of the Portuguese version of the Adolescent Lifestyle Profile

OBJECTIVE

Reliable and valid instruments are essential for understanding health-promoting behaviors in adolescents. This study analyzed the psychometric properties of the Portuguese version of the Adolescent Lifestyle Profile (ALP).

METHODS

A linguistic and cultural translation of the ALP was conducted with 236 adolescents from two different settings: a community (n=141) and a clinical setting (n=95). Internal consistency reliability and confirmatory factor analysis were performed.

RESULTS

Results showed an adequate fit to data, yielding a 36-item, seven-factor structure (CMIN/DF=1.667, CFI=0.807, GFI=0.822, RMR=0.051, RMSEA=0.053, PNFI=0.575, PCFI=0.731). The ALP presented a high internal consistency (α=0.866), with the subscales presenting moderate reliability values (from 0.492 to 0.747). The highest values were in Interpersonal Relations (3.059±0.523) and Positive Life Perspective (2.985±0.588). Some gender differences were found. Findings showed that adolescents from the clinic reported an overall healthier lifestyle than those from the community setting (2.598±0.379 vs. 2.504±0.346; t=1.976, p=0.049).

CONCLUSION

The ALP Portuguese version is a psychometrically reliable, valid, and useful measurement instrument for assessing health-promoting lifestyles in adolescence. The ALP is cross-culturally validated and can decisively contribute to a better understanding of adolescent health promotion needs. Additional research is needed to evaluate the instrument's predictive validity, as well as its clinical relevance for practice and research.

Associations between breakfast eating habits and health-promoting lifestyle, suboptimal health status in Southern China: a population based, cross sectional study

Background

Suboptimal health status (SHS) is the intermediate health state between health and disease, refers to medically undiagnosed or functional somatic syndromes, and has been a major global public health challenge. However, both the etiology and mechanisms associated with SHS are still unclear. Breakfast eating behavior is a dietary pattern marker and previous studies have presented evidence of associations between failure to consume breakfast and increased diseases. Accordingly, in view of the significance of breakfast eating behaviors with respect to health status, the associations between breakfast eating habits and healthy lifestyle, SHS require further elucidation.

Methods

A cross-sectional survey was conducted within a clustered sample of 24,159 individuals aged 12–80 years in 2012–13 within the population of Southern China. Breakfast eating habits were categorically defined by consumption frequency (‘scarcely, sometimes or always’). Health-promoting lifestyle was assessed via the health-promoting lifestyle profile (HPLP-II). SHS was evaluated using the medical examination report and Sub-health Measurement Scale V1.0 (SHMS V1.0).

Results

Of the 24,159 participants, the prevalence rates for the ‘health’ , ‘SHS’ , and ‘disease’ were 18.8%, 46.0%, and 35.2%, respectively. Overall, 19.6% of participants reported ‘scarce’ breakfast eating habits, with frequent breakfast eaters scoring higher on both HPLP-II and SHMS V1.0. After demographic adjustment, regression analyses revealed a significant association between breakfast eating habits and healthy lifestyle (p <0.001). There were lower levels of breakfast consumption regularity amongst individuals with SHS than those with disease. Categorically ‘scarce’ breakfast eaters were approximately three times more likely to be assigned SHS (OR: 2.745, 95% CI: 2.468-3.053), while infrequent breakfast eaters (‘sometimes’) were just less than twice as likely to be assessed as being of SHS (OR: 1.731, 95% CI: 1.595-1.879).

Conclusions

Breakfast eating habits are significantly associated with a healthy lifestyle, and appear to be a useful predictor of a healthy lifestyle. Irregular breakfast eating habits are related to an increased risk of SHS; increased breakfast eating frequency may contribute to lowering the prevalence of SHS in Southern China.

Electronic supplementary material

The online version of this article (doi:10.1186/s12967-014-0348-1) contains supplementary material, which is available to authorized users.

Measuring health-promoting behaviors: cross-cultural validation of the Health-Promoting Lifestyle Profile-II

PURPOSE

Individual lifestyles have emerged as valuable health constructs. This study aims to psychometrically test the Portuguese (European) version of the Health-Promoting Lifestyle Profile-II.

METHODS

After an adequate linguistic and cultural adaptation of the Health-Promoting Lifestyle Profile-II scale, their psychometric properties were assessed (N = 889) by Cronbach's alpha and confirmatory factor analysis.

FINDINGS

Results showed an adequate fit to a 52-item, six-factor structure. A global alpha of .925 was obtained.

CONCLUSIONS

The Portuguese version demonstrated good validity and reliability in a wide adult sample, and can thus be applied to the Portuguese population.

IMPLICATIONS FOR NURSING PRACTICE

This instrument is useful as an evaluation tool for health-promoting lifestyles and as an instrument for testing the effectiveness of health-promoting programs.

Psychometric properties of the Spanish version of the Health-Promoting Lifestyle Profile II

The Health-Promoting Lifestyle Profile II (HPLPII) has been psychometrically validated across several linguistic and cultural groups; however the Spanish version has not been psychometrically tested for the Spanish population. The purpose of this research was to evaluate the reliability and factor structure of the Spanish version of the HPLPII for Spanish people. Principal component analysis (PCA) revealed that a six-component model for 44 items accounted for 40% of the variance, and the scale had an internal consistency of .87. Confirmatory factor analysis demonstrated that a better fit of the six-component structure emerged from the PCA than from the model proposed in the original version of the HPLPII, suggesting that the health-promoting lifestyle might be sensitive to context and culture.

Health promotion behaviors of residents with hypertension in Iwate, Japan and North Carolina, USA

AIM

The aim of this study was to compare the health promotion practises of rural residents in northern Japan (n = 212) to those in south-eastern North Carolina, USA (n = 105), using the Health Promotion Lifestyle II (HPLP) scale.

METHODS

A comparative and descriptive design examined the relationships between health-related behaviors and demographic and physiological variables, and compared cross-cultural patterns.

RESULTS

The Japanese participants scored significantly higher on the total HPLP II score, as well as on the subscales of health responsibility, nutrition, interpersonal support, and stress management. No significant differences were found in the HPLP II subscales for spiritual growth or physical activity between the groups. The subscale scores for both the participants from Japan and the participants from North Carolina were lowest for physical activity. For the participants from North Carolina, the HPLP II subscale scores were highest for spirituality and interpersonal relationships. The predictive factors of variation in the scores of the HPLP II for the participants from North Carolina included being married and not working. No significant demographic predictor was found for the HPLP II scores of the Japanese participants.

CONCLUSIONS

The study's findings add to an increased understanding of the cultural variations in the health-promoting behaviors of persons with hypertension. Providing health promotion strategies for hypertension remains an urgent issue for nurses and other health-care providers in both Japan and North Carolina, USA.