Development And Psychometric Properties Of Quality Of Life Scale For Residents In Long-Term Care Facilities

Objectives:1. To describe connotation of quality of life as reported by residents in long-term care facilities through a qualitative method to provide theoretical evidence for the development of quality of life instruments for residents in long-term care facilities.2. Based on the results of the qualitative method, the review of the literature on quality of life, consulting relevant experts, and reference of current instruments, we aim to develop and validate a scale, quality of life scale for residents in long-term care facilities, to assess the quality of life of residents in long-term care facilities and then provide standard instruments for research about quality of life of residents in long-term care facilities.MethodsThe current study apply qualitative and quantitative method to reveal the understanding of quality of life among residents in long-term care facilities in China and develop a quality of life scale suitable for residents in long-term care facilities in China1. In-depth interviews were carried out with a sample of 6 residents who lived in nursing home for at least 6 months in Jinan and whose cognition was intact. The interviews were audiotaped and transcribed into verbatim. The transcripts were analyzed using the phenomenological analysis method devised by Colaizzi in order to extract themes about the understanding of quality of life among residents in long-term care facilities.2. The quality of life scale for residents in long-term care facilities was developed according to the results of the qualitative method, the review of the literature on quality of life, consulting relevant experts, and reference of current instruments.3. Experts were invited to assess the scale’s content validity for two rounds. The items were deleted, added, and modified based on the experts’suggestions and finally, a 74-item scale consisting of nine dimensions was formed after a preliminary test among a small sample.4. One hundred and seventy six residents in 14 nursing homes in Jinan were surveyed by quality of life scale for residents in long-term care facilities using convenient sampling. SPSS 19.0 was used to analyze the data. Descriptive analysis was used to describe social-demographic data of the participants. Exploratory analysis was used to simplify the items, establish the dimensions, and assess construct validity. Cronbach’s a coefficient, split-half reliability, test-retest reliability were applied to test reliability of the final scale. Independent sample t-test was used to assess the criterion-related validity of the final scale.Results1. Nine core themes were extracted from the data. They were physical health, food satisfaction, security, comfortable environment, autonomy, recreational activities, relationships, dignity, and emotional health.2. Content validity analysis demonstrated that the initial scale had good content validity. The item content validity indexes of all items were above0.83, except item 4 and item 64 which were 0.80 with five experts completing the assessment. The two scale content validity indexes valued 0.92 and 0.99 respectively.3. Item analysis and exploratory factor analysis showed that the scale was composed of 41 items, belonging to nine dimensions. The item factor loadings of corresponding dimension were within 0.462-0.818, and the nine dimensions explained 61.252% of the variance.4. The Cronbach’s alpha coefficient of the total scale was 0.90 with those of nine dimensions being 0.8506,0.83,0.87,0.80,0.72,0.67,0.63,0.62, and 0.65, respectively. The corrected split-half reliability of the total scale was 0.93, with those of nine dimensions being 0.86,0.83,0.86,0.84,0.71,0.70,0.69,0.68, and 0.61. The test-retested reliability of the scale was 0.76. All these results indicated that the scale had good internal consistency and stability.5. Construct validity analysis showed that all item factor loadings were above 0.40 with loading on only one factor and common factors explained 61.252% of the variance. Except dememsion eight and nine, the correlation coefficients among all dimensions ranged from 0.123 to 0.594, while the correlation coefficients between scale and other seven dimensions were between 0.483 and 0.766. All the result represented the acceptable construct validity of the scaleConclusions1. The quality of life scale for residents in long-term care facilities is composed of 33items belonging to seven dimensions as follows:psychological health (six items), food satisfaction (six items), harmony of the relationship (six items), environmental comfort (five items), activity involvement (four items), physical comfort (four items), security (four items), family cohesion (three items), and autonomy (three items), which contains physical domain, psychological domain, social dimaion, and environmental domain.2. The quality of life scale for residents in long-term care facilities has satisfying psychometric assessment indexes and can be applied to test quality of life of residents in long-term care facilities.