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Tong LK, Li YY, Liu YB, Zheng MR, Fu GL, Au ML. Social determinants of health and their relation to suboptimal health status in the context of 3PM: a latent profile analysis. EPMA J 2024; 15:221-232. [PMID: 38841621 PMCID: PMC11147970 DOI: 10.1007/s13167-024-00365-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 05/03/2024] [Indexed: 06/07/2024]
Abstract
Background Suboptimal health is identified as a reversible phase occurring before chronic diseases manifest, emphasizing the significance of early detection and intervention in predictive, preventive, and personalized medicine (PPPM/3PM). While the biological and genetic factors associated with suboptimal health have received considerable attention, the influence of social determinants of health (SDH) remains relatively understudied. By comprehensively understanding the SDH influencing suboptimal health, healthcare providers can tailor interventions to address individual needs, improving health outcomes and facilitating the transition to optimal well-being. This study aimed to identify distinct profiles within SDH indicators and examine their association with suboptimal health status. Method This cross-sectional study was conducted from June 16 to September 23, 2023, in five regions of China. Various SDH indicators, such as family health, economic status, eHealth literacy, mental disorder, social support, health behavior, and sleep quality, were examined in this study. Latent profile analysis was employed to identify distinct profiles based on these SDH indicators. Logistic regression analysis by profile was used to investigate the association between these profiles and suboptimal health status. Results The analysis included 4918 individuals. Latent profile analysis revealed three distinct profiles (prevalence): the Adversely Burdened Vulnerability Group (37.6%), the Adversity-Driven Struggle Group (11.7%), and the Advantaged Resilience Group (50.7%). These profiles exhibited significant differences in suboptimal health status (p < 0.001). The Adversely Burdened Vulnerability Group had the highest risk of suboptimal health, followed by the Adversity-Driven Struggle Group, while the Advantaged Resilience Group had the lowest risk. Conclusions and relevance Distinct profiles based on SDH indicators are associated with suboptimal health status. Healthcare providers should integrate SDH assessment into routine clinical practice to customize interventions and address specific needs. This study reveals that the group with the highest risk of suboptimal health stands out as the youngest among all the groups, underscoring the critical importance of early intervention and targeted prevention strategies within the framework of 3PM. Tailored interventions for the Adversely Burdened Vulnerability Group should focus on economic opportunities, healthcare access, healthy food options, and social support. Leveraging their higher eHealth literacy and resourcefulness, interventions empower the Adversity-Driven Struggle Group. By addressing healthcare utilization, substance use, and social support, targeted interventions effectively reduce suboptimal health risks and improve well-being in vulnerable populations. Supplementary Information The online version contains supplementary material available at 10.1007/s13167-024-00365-5.
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Affiliation(s)
- Lai Kun Tong
- Research Management and Development Department, Kiang Wu Nursing College of Macau, Macao, China
| | - Yue Yi Li
- Education Department, Kiang Wu Nursing College of Macau, Macao, China
| | - Yong Bing Liu
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Mu Rui Zheng
- Faculty of Health Sciences, University of Macau, Macao, China
| | - Guang Lei Fu
- Infectious Disease Department, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Mio Leng Au
- Education Department, Kiang Wu Nursing College of Macau, Macao, China
- Avenida Do Hospital, Complexo de Cuidados de Saúde das Ilhas – Edifício do Instituto de Enfermagem Kiang Wu de Macau, das Ilhas No.447, Coloane, RAEM, Macao, China
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Alzain MA, Asweto CO, Hassan SUN, Saeed ME, Kassar A, Ali KEM, Ghorbel M, Zrieq R, Alsaif B, Wang W. Assessing suboptimal health status in the Saudi population: Translation and validation of the SHSQ-25 questionnaire. J Glob Health 2024; 14:04030. [PMID: 38305242 PMCID: PMC10836270 DOI: 10.7189/jogh.14.04030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Background Suboptimal Health Status (SHS) is realised as a vital feature for improving global health. However, the Arabian world does not have a validated instrument for screening SHS in their population. Therefore, the study aimed to evaluate the psychometric properties of Arabic-translated SHS (ASHSQ-25) in the Saudi Arabian population. Methods We conducted a cross-sectional study among the conveniently sampled 1590 participants from the Saudi population (with a 97.4% response rate). The data was gathered through an online survey and then exported into SPSS and AMOS version 26.0 for analysis. Mann-Whitney and Kruskal-Wallis tests were used to identify the median difference between demographic groups. The one-tailed 90% upper limit of SHS scores was chosen as the cut-off criteria for SHS. Reliability and confirmatory analysis were performed for the psychometric evaluation of ASHSQ-25 in the Saudi Arabian context. Results This study demonstrates that the ASHSQ-25 has good internal consistency, interclass correlation coefficient (ICC) = 0.92; 95% confidence interval (CI) = 0.91-0.93) and reliability (Cronbach's α = 0.92). The confirmatory factor analysis (CFA) results indicated a good fit of the databased on the CMIN/degrees of freedom (df) = 4.461, comparative fit index (CFI) = 0.94, Tucker Lewis index (TLI) = 0.93, and Root Mean Square Error of Approximation (RMSEA) = 0.05. The result factor loadings for each item were high (≥ 0.55), except for one item from the immune system subscale. The SHS cut-off point for ASHSQ-25 was 33, leading to a 23.7% prevalence of SHS. Conclusions This study reveals that ASHSQ-25 has appropriate internal consistency and structural validity to assess SHS in an Arabic-speaking population; therefore, it is recommended.
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Affiliation(s)
- Mohamed Ali Alzain
- Department of Public Health, College of Public Health and Health Informatics, University of Ha'il, Ha'il City, Saudi Arabia
- Department of Community Medicine, Faculty of Medicine and Health Sciences, University of Dongola, Dongola, Sudan
| | | | - Sehar-Un-Nisa Hassan
- Department of Public Health, College of Public Health and Health Informatics, University of Ha'il, Ha'il City, Saudi Arabia
| | - Mohammed Elshiekh Saeed
- Faculty of Medicine, National University-Sudan, Khartoum, Sudan
- Department of Physiology, Faculty of Medicine, University of Dongola, Dongola, Sudan
| | - Ahmed Kassar
- Department of Public Health, College of Public Health and Health Informatics, University of Ha'il, Ha'il City, Saudi Arabia
| | - Kamal Elbssir Mohammed Ali
- Department of Community Health, Occupation Health and Safety Program, Northern Boarder University, Arar, Saudi Arabia
| | - Mouna Ghorbel
- Department of Biology, College of Sciences, University of Hail, P.O., Ha'il City, Saudi Arabia
| | - Rafat Zrieq
- Department of Public Health, College of Public Health and Health Informatics, University of Ha'il, Ha'il City, Saudi Arabia
- Applied Science Research Centre, Applied Science Private University, Amman, Jordan
| | - Bandar Alsaif
- Department of Public Health, College of Public Health and Health Informatics, University of Ha'il, Ha'il City, Saudi Arabia
| | - Wei Wang
- Clinical Research Center, First Affiliated Hospital, Shantou University Medical College, Shantou, China
- Centre for Precision Health, Edith Cowan University, Joondalup, Western Australia, Australia
- On behalf of Global Health Epidemiology Research Group (GHERG) & Global Suboptimal Health Consortium (GSHC)
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Ayubi E, Khazaei S, Borzouei S, Soltanian AR, Ghelichkhani S, Karbin F, Yan Y, Song M, Tian C, Zhang W, Sun J, Wang W. Validity and reliability of the Persian version of the Suboptimal Health Status Questionnaire among university staff in Iran. J Glob Health 2023; 13:04162. [PMID: 38098436 PMCID: PMC10722246 DOI: 10.7189/jogh.13.04162] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2023] Open
Abstract
Background Suboptimal Health Status Questionnaire-25 (SHSQ-25) is an established tool for measuring a precision health state between health and illness. The present study aims to assess the validity and reliability of a Persian version of SHSQ-25 (P-SHSQ-25) in a university staff Iranian population. Methods A sample of 316 academic and supporting staff (163 males, age range from 23 to 64 years old) from Hamadan University of Medical Sciences, Hamadan, Iran was recruited in this population-based cross-sectional study with a questionnaire validation from Apri1 to October 2022. Forward-backward translation method was performed for the SHSQ-25 translation from English to Persian. Internal reliability, content, convergence, discriminative and construct validity of the P-SHSQ-25 were examined. The factorial structure of the P-SHSQ-25 across groups was examined using measurement invariant test. Results In the translation process, the conceptual equivalence of the P-SHSQ-25 with the English version was confirmed. The item-content validity index and content validity ratio of all P-SHSQ-25 items were higher than the cut-off values of 0.70 and 0.62, respectively. Cronbach's α was higher than 0.70 for all P-SHSQ-25 domains. The confirmatory factor analysis (CFA) showed the fitness of five factors on the data set (comparative fit index = 0.88, and root mean square error of approximation = 0.07). The CFA model fit did not change substantially across sex, age, occupation, economic status, and body mass index (Δ comparative fit index (CFI)<0.01). Conclusions The P-SHSQ-25 can be used as a reliable and valid tool to measure health status for screening pre-chronic disease conditions in a primary care setting among Iranian population.
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Affiliation(s)
- Erfan Ayubi
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Salman Khazaei
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Shiva Borzouei
- Department of Endocrinology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Reza Soltanian
- Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Samereh Ghelichkhani
- Mother and Child Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Fatemeh Karbin
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Yuxiang Yan
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Manshu Song
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Cuihong Tian
- Clinical Research Center, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Center for Precision Health, Edith Cowan University, Joondalup, WA, Australia
| | - Wei Zhang
- Centre for Cognitive Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jing Sun
- School of Medicine and Dentistry, and Institute for Integrated and Intelligent Systems, Griffith University, Gold Coast, Australia
| | - Wei Wang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Clinical Research Center, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Center for Precision Health, Edith Cowan University, Joondalup, WA, Australia
| | - Global Health Epidemiology Research Group (GHERG)
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Endocrinology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
- Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Mother and Child Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Clinical Research Center, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Centre for Cognitive Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- School of Medicine and Dentistry, and Institute for Integrated and Intelligent Systems, Griffith University, Gold Coast, Australia
- Center for Precision Health, Edith Cowan University, Joondalup, WA, Australia
| | - Global Suboptimal Health Consortium (GSHC)
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Endocrinology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
- Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Mother and Child Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Clinical Research Center, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Centre for Cognitive Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- School of Medicine and Dentistry, and Institute for Integrated and Intelligent Systems, Griffith University, Gold Coast, Australia
- Center for Precision Health, Edith Cowan University, Joondalup, WA, Australia
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Liu Y, Wan C, Xi X. Measurement properties of the EQ-5D-5L in sub-health: evidence based on primary health care workers in China. Health Qual Life Outcomes 2023; 21:22. [PMID: 36890491 PMCID: PMC9996950 DOI: 10.1186/s12955-023-02105-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 02/21/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Sub-health which is the state between health and disease is a major global public health challenge. As a reversible stage, sub-health can work as a effective tool for the early detection or prevention of chronic disease. The EQ-5D-5L (5L) is a widely used, generic preference-based instrument while its validity in measuring sub-health is not clear. The aim of the study was thus to assess its measurement properties in individuals with sub-health in China. METHODS The data used were from a nationwide cross-sectional survey conducted among primary health care workers who were selected on the basis of convenience and voluntariness. The questionnaire was composited of 5L, Sub-Health Measurement Scale V1.0 (SHMS V1.0), social-demographic characteristics and a question assessing the presence of disease. Missing values and ceiling effects of 5L were calculated. The convergent validity of 5L utility and VAS scores was tested by assessing their correlations with SHMS V1.0 using Spearman's correlation coefficient. The known-groups validity of 5L utility and VAS scores was assessed by comparing their values between subgroups defined by SHMS V1.0 scores using the Kruskal-Wallis test. We also did an analysis in subgroups according to different regions of China. RESULTS A total of 2063 respondents were included in the analysis. No missing data were observed for the 5L dimensions and only one missing value was for the VAS score. 5L showed strong overall ceiling effects (71.1%). The ceiling effects were slightly weaker on the "pain/discomfort" (82.3%) and "anxiety/depression" (79.5%) dimensions compared with the other three dimensions (nearly 100%). The 5L weakly correlated with SHMS V1.0: the correlation coefficients were mainly between 0.2 and 0.3 for the two scores. 5L was yet not sensitive in distinguishing subgroups of respondents with different levels of sub-health, especially the subgroups with adjacent health status (p > 0.05). The results of subgroup analysis were generally consistent with those of the full sample. CONCLUSIONS It appears that the measurement properties of EQ-5D-5L in individuals with sub-health are not satisfactory in China. We thus should be cautious to use it in the population.
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Affiliation(s)
- Yueyue Liu
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, No.639 Longmian Avenue, Jiangning District, Nanjing, Jiangsu Province, China
| | - Chuchuan Wan
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, No.639 Longmian Avenue, Jiangning District, Nanjing, Jiangsu Province, China
| | - Xiaoyu Xi
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, No.639 Longmian Avenue, Jiangning District, Nanjing, Jiangsu Province, China.
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Psychometric Properties of Suboptimal Health Status Instruments: A Systematic Review. J Pers Med 2023; 13:jpm13020299. [PMID: 36836533 PMCID: PMC9967625 DOI: 10.3390/jpm13020299] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/01/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Suboptimal health status (SHS) measurement has now been recognized as an essential construct in predictive, preventive, and personalized medicine. Currently, there are limited tools, and an ongoing debate about appropriate tools. Therefore, it is crucial to evaluate and generate conclusive evidence about the psychometric properties of available SHS tools. OBJECTIVE This research aimed to identify and critically assess the psychometric properties of available SHS instruments and provide recommendations for their future use. METHODS Articles were retrieved by following the guidelines of the PRISMA checklist, and the robustness of methods and evidence about the measurement properties was assessed using the adapted COSMIN checklist. The review was registered in PROSPERO. RESULTS The systematic review identified 14 publications describing four subjective SHS measures with established psychometric properties; these included the Suboptimal Health Status Questionnaire-25 (SHSQ-25), Sub-health Measurement Scale Version 1.0 (SHMS V1.0), Multidimensional Sub-health Questionnaire of Adolescents (MSQA), and the Sub-Health Self-Rating Scale (SSS). Most studies were conducted in China and reported three reliability indices: (1) the internal consistency measured by Cronbach's α value ranged between 0.70 and 0.96; (2) the test-retest reliability; and (3) the split-half reliability coefficient values ranged between 0.64 and 0.98, and between 0.83 and 0.96, respectively. For the values of validity coefficients in the case of SHSQ-25 > 0.71, the SHMS-1.0 ranged from 0.64 to 0.87, and the SSS ranged from 0.74 to 0.96. Using these existing and well-characterized tools rather than constructing original tools is beneficial, given that the existing choice demonstrated sound psychometric properties and established norms. CONCLUSIONS The SHSQ-25 stood out as being more suitable for the general population and routine health surveys, because it is short and easy to complete. Therefore, there is a need to adapt this tool by translating it into other languages, including Arabic, and establishing norms based on populations from other regions of the world.
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