Test-Retest Reliability and Validity of the Malay Version Life Habits Assessment (LIFE-H 3.1) to Measure Social Participation in Adults With Physical Disabilities

Social Participation Determines Quality of Life Among Urban-Dwelling Older Adults With Stroke in a Developing Country

BACKGROUND AND PURPOSE

Poor quality of life (QoL) is a well-recognized consequence after stroke. Quality of life is influenced by a complex interaction between personal and environmental factors. Most previous investigations of the QoL after stroke have focused on personal factors, for example, physical deficits directly resulting from stroke. The influence of environmental factors, including social participation, is relatively understudied partly due to its high variation across different sociocultural contexts. The purpose of this study was to investigate the determinants of QoL among older adults with stroke living in an urban area of a developing country.

METHODS

This cross-sectional observational study included 75 older adults who were at least 3 months poststroke and 50 age-matched healthy controls. Depressive symptoms were quantified using the World Health Organization Quality of Life Brief version (WHOQoL-BREF). Physical function was examined using Functional Ambulation Category, grip strength, 5 times Sit-to-Stand test, and Box and Block tests. The Montreal Cognitive Assessment and visual-manual reaction time were used to index cognitive function. Depressive symptom was quantified using the Patient Health Questionnaire-9. The Barthel Index and Fatigue Severity Scale were used to quantify activity limitation. Social participation and environmental participation were assessed using the Assessment of Life Habit and Craig Hospital Inventory of Environment Factors, respectively. Linear stepwise regression models were used to determine explanators for WHOQoL-BREF domain scores.

RESULTS

Individuals with stroke demonstrated significantly worse QoL on all WHOQoL-BREF domains compared with healthy controls. Stroke was a strong determinant for QoL and explained 16% to 43% of variances. Adding other outcome measures significantly improved the robustness of the models (R change = 12%-32%). The physical, psychological, social, and environmental domains of WHOQoL-BREF were all explained by the LIFE-H scores (β = -10.58, -3.37, 4.24, -5.35, respectively), while psychological, social, and environmental domains were explained by Montreal Cognitive Assessment scores (β = .47, 0.78, 0.54, respectively).

CONCLUSION

Social participation and cognition were strong determinants of QoL among urban-dwelling older adults with stroke. Social and recreational activities and cognitive rehabilitation should therefore be evaluated as potential strategies to improve the well-being of older adults affected by stroke.

Health protective behavior scale: Development and psychometric evaluation

Objective

A healthy lifestyle includes health protective and health promoting behaviors. Health promoting lifestyle profiles have been developed, but measures of health protective behavior are still lacking. This study sought to develop a health protecting behavior scale.

Methods

An initial item pool for the Health Protective Behavior Scale (HPBS) was generated based on read and referred literature and a single-item open-ended survey. An expert group screened this initial item pool using an item-level content validity index. Pilot testing was conducted. The degree of variation, the response rate, the item-total correlation coefficient, and the factor loading in factor analysis and item analysis were used to screen items using data of pilot testing. 454 subjects were recruited evaluate the psychometric properties of the HPBS. Analyses included internal consistency, test-retest reliability, factor analysis, parallel analysis, correlation analysis and criterion validity analysis.

Results

The final iteration of the HPBS was developed with 32 items and five dimensions: interpersonal support, general behavior, self-knowledge, nutrition behavior and health care. Cronbach’s alpha coefficient, and test-retest reliability were 0.89 and 0.89 respectively. Correlation coefficients of the five dimensions ranged from 0.28 to 0.55. The Spearman correlation coefficient between the total scores on the WHOQOL-BREF and on the HPBS was 0.34.

Conclusions

HPBS has sufficient validity and reliability to measure health protective behaviors in adults.