The Development Of Sub-health Self-rating Scale And Study On TCM Construction Among Sub-healthy Undergraduate Students

ObjectiveAt home,sub-health is currently a hot topic in the research area.Meanwhile,the diagnosis of sub-health is the important question,which is basis and prerequisite for developing sub-health.The development of scale is the diagnosis method.Based on the dominant role of "evaluation of quality of life" and the subsidiary role of "common symptom of sub-health",we put forward the theory of assumptions,and introduce the ideas of developing sub-health scale.According to the theory of "Preventive Treatment of Disease" of Nei Jing,it has deep effect on the research of sub-health.It is the people's result of congenital and acquired factors that TCM construction is formed,which has great influence on development and evolution of sub-health.The purpose of this study:To develop Sub-health Self-rating Scale(SSS);to examine the reliability and validity of the scale;to initially establish the evaluation model of sub-health among undergraduate students;to study TCM construction of Sub-heahthy undergraduate students;to explore the correlation between sub-health and TCM construction.Methods (1) The development of Sub-health Self-rating Scale(SSS) was divided into three stages.The first stage was Construction of the scale samples.Through cluster sampling, 5599 undergraduate students were selected and studied.The reliability and validity of the Second-generation Sub-health Questionnaire(Draft of SSS) were examined.The reliability verification applied generalizability coefficient;the validity verification included the factor analysis to verify the validity,criteria validity and discriminant validity.Five methods based on dispersion,correlation coefficient,factor analysis, t-test and Cronbach'sαwere employed to analyze the items,and the preliminary samples composed of the 10 factors,3 subscales were generated.The second stage was scientific evaluation of SSS.Thought cluster sampling, the paper was filled in by investigator.6205 undergraduate students were selected and studied.The scale was conducted feasibility analysis.Exploratory and confirmatory factor analysis of 1-order Factor and 2-order Factor were used to evaluate the infra-structure of the scale.The reliability analysis included Cronbach'sα,split-half reliability and the mean inter-item correlation.The validity analysis included content and construct validity.The third stage was initial establishment of the sub-health evaluation model among undergraduate students.The clinical sub-health reference value tablelet, including original score,transformed score and T score,was made out by percentile method,according to the dividing line of the prevalence rate of sub-health among undergraduate students.Meanwhile,1000 valid questionnaires by random sampling were used to evaluate the goodness of fit between expert evaluation method and score value method.According to our assumption,we initially established the triadic evaluation model of sub-health among undergraduate students.(2) Study on TCM construction among sub-healthy undergraduate students included four aspects.Thought field survey,6205 undergraduate students were surveyed by Sub-health Self-rating Scale(SSS) and the Constitution in Chinese Medicine Questionnaire (CCMQ),and were divided into 9 TCM constitutions.The data were analyzed with Frequencies and Chi-square test.The first aspect was to distribute and analyze sub-health of undergraduate students.The second aspect was to distribute and analyze TCM constitution of undergraduate students.The third aspect was to distribute and analyze TCM constitution of sub-healthy undergraduate students.The fourth aspect was to explore the correlation between and TCM construction sub-health among undergraduate students.4 logistic regression models were set up and analyzed.Results(1) The development of Sub-health Self-rating Scale(SSS)In the first stage was the scale construction.①Validity analysis:The method of construct validity was factor analysis.There were 16 factors that the Eigenvalue was above 1.The Cumulative Proportion was 52.29%.The result of the criterion validity was showed that the correlation of the questionnaire total score with the score of WHOQOL-BREF was high(r>0.60),which were statistically significant (P<0.001).The result of distinguish validity was showed that there were notability difference in mean scores between the undergraduate students of health and Sub-health in the dimensions(t>35.00,P<0.000).②Reliability Analysis:The Cronbach's alpha of the total questionnaire was 0.949,the dimensions of body,mood, and society had high reliability,0.906,0.881,0.865 respectively,but only 8 factors were up to 0.7.③Item analysis:It indicated that 63 items kept in the Second-generation Sub-health Questionnaire had satisfactory sensibility, representation,independence,significance and internal consistency.From a professional perspective,we deleted 9 items,maintained 54 items,and added 4 item of skin factor.The scale was consisted of 58 items.The second stage was evaluation scale.①Feasibility analysis:Acceptance rate and finish rate were 89.03%and 99.67%respectively.Answer time of SSS was in 10 minutes.②Reliability Analysis:Internal consistency analysis showed that the Cronbach's alpha of the total scale was 0.942,the dimensions of body,mood,society had high reliability,0.915,0.856,0.850 respectively,each factor was up to 0.7. Split-half reliability of the total scale was 0.938,that of the dimensions of body, mood,society was 0.933,0.890,0.881 respectively,that of each factor was from0.73 to 0.90.③Validity analysis:The method of construct validity was exploratory factor analysis 1-order Factor(Varimax).There were 12 factors that the Eigenvalue was above 1.The cumulative proportion was 60.53%.Based on screen plot and related theories,there were 10 factors that be extracted.The cumulative proportion was 56.63%.10 factors were labeled as follows:F1:negative emotion,F2:positive emotion,F3:body discomfort,F4:capability,F5:sleep,F6:digestive function,F7: social relationship,F8:fatigue,F9:skin,F10:urine.The result of 2-order Factor exploratory factor analysis(Promax) was showed that there were 2 factors that the Eigenvalue was above 1,the cumulative proportion was 56.55%.FⅠwas included 6 factors of physiological dimension;FⅡwas included 4 factors of psychological and social relationship dimensions.From a professional perspective,Sub-health Self-rating Scale was composed of 3 dimensions.The indexes of confirmatory factor analysis(2-order Factor of 3- dimensions and 10- factors) met the requirement of Sub-health Self-rating Scale(SSS) measurement(GFI=0.86,CFI=0.96,AGFI=0.85, RMSEA=0.055,NFI=0.961,IFI=0.963,TLI=0.961).The correlation coefficient between each item and factor was 0.51-0.88.The correlation coefficient between each factor and it's own domain was 0.52-0.89,and lowly correlated to other domains.The correlation coefficient between subscale and total scale was 0.77-0.93,which were statistically significant(P<0.01).The third stage was initially established the evaluation model of sub-health among colledge students.①The clinical sub-health reference value tablelet: Percentile divided line of the total score of SSS was 60%,Percentile divided line of physiological field was 50%,Percentile divided line of psychological field was 35%, Percentile divided line of social relationship field was 35%.The original score, transformed score and T score of the total scale were 224,72,52 respectively.The original score,transformed score and T score of each subscale were 128,72,50 (physiological sub-health subtype);48,60,46(psychological sub-health subtype);26, 56,45(social relationship sub-health subtype).The lower score indicated that the worst of the health condition.②The goodness of fit between expert evaluation method and score value method were up to 0.70.③The results of the triadic evaluation model prediction showed that regression model had good prediction rate and interpreting ability(χ~2=0.188,P=0.664,Nagelkerke R~2=0.772,total of prediction rate 93.0%).(2) Study on TCM Construction among Sub-healthy Undergraduate studentsFirstly,the result showed that the total prevalence rate of mental sub-health among undergraduate students was 62.51%.The prevalence rate of sub-health in female was higher than that in male,in non-only-child than that in only-child,there were of statistical significance(P<0.05).A decreasing trend among different grades, the prevalence rate of sub-health decreased with the increase of grades(χ~2=17.440, P=0.002).Compared among various professional undergraduate students,health status of humanities and social sciences and foreign language specialty students were poor(χ~2=20.987,P=0.000).Secondly,the result showed that biased constitution among undergraduate students was in the minority.The proportion of normal constitution in male were higher than that in female,there were of statistical significance(P<0.05).The proportion of yin deficiency constitution and dampness-heat constitution in minority were higher than that in Han nationality,there were of statistical significance (P<0.05).The proportion of yin deficiency constitution among undergraduate students born in Northwest China was relatively higher.The proportion of blood Stasis constitution among undergraduate students born in Northeast China was relatively higher. Thirdly,①the result showed that sub-healthy undergraduate students were easier to tend of biased constitution than healthy undergraduate students.In order of decreasing percentage,the range was blood stasis constitution(48.10%),qi deficiency constitution(41.50%),qi depression constitution(35.60%),yin deficiency constitution(31.90%),phlegm-dampness constitution(29.20%),dampness-heat constitution(28.80%),yang deficiency constitution(22.80%),the specific endowment constitution(15.60%).②1849 students were biased constitution.38.90% were single constitution,61.10%were multiple constitution.③The proportion of blood Stasis constitution and yin deficiency constitution in female were higher than that in male,there were of statistical significance(P<0.05).The proportion of qi depression constitution,qi deficiency constitution,phlegm-dampness constitution and the specific endowment constitution in male were higher than that in female,there were of statistical significance(P<0.05).④The proportion of yin deficiency constitution and dampness-heat constitution in minority were higher than that in Han nationality,there were of statistical significance(P<0.05).⑤The proportion of yin deficiency constitution among undergraduate students born in Northwest China was relatively higher.The proportion of blood Stasis constitution among undergraduate students born in Northeast China was relatively higher.Fourthly,①Hypothesis Testing of the models:4 logistic regression models had statistical significance(P<0.01).②Goodness of fit test:Nagelkerke R~2 of the regression model of TCM Constitution and Sub-health,the regression model of TCM Constitution and Physiological Sub-health Subtype,the regression model of TCM Constitution and Psychological Sub-health Subtype and the regression model of TCM Constitution and Social Relationship Sub-health Subtype was 0.671,0.744,0.452 and 0.388 respectively. Total of prediction rate was 86.00%,87.40%,78.80%and 78.00%respectively. Goodness-of-fit index of Hosmer-Lemeshow model showed the regression model of TCM Constitution and Psychological Sub-health Subtype was good(χ~2 =3.971,P=0.860), which of another 3 logistic regression models were not ideal,χ~2(46.0-20.0),P<0.000.Conclusion (1) To develop Sub-health Self-rating Scale(SSS).Item analysis indicated that the items of SSS had satisfactory sensibility,representation,independence, significance and internal consistency.Feasibility analysis showed acceptance rate, finish rate and answer time of SSS achieved the demand of psychometrics.The index of reliability included the Cronbach;s alpha and Split-half reliability,achieved the demand of psychometrics.The structure validity achieved excellent levels of content, construct,and criterion-related validity.SSS can reflect the status and characteristic of sub-health in China and verified with the theory model and can be used to evaluate sub-health among undergraduate students.However,there were some deficiency,the cumulative proportion was not high enough,and the models of SSS need to be revised and reduced.(2) To initially the evaluation model of sub-health among undergraduate students.The clinical sub-health reference value tablelet,including original score, transformed score and T score,was made out by percentile method,according to the dividing line of the prevalence rate of sub-health among undergraduate students.The result showed that the evaluation model had good prediction rate and interpreting ability.To some extent,the model was scientific and rational to be the framework of SSS.(3) To elementarily prove TCM constitution has major influence on sub-health.Sub-healthy undergraduate students were easier to have tendency of biased constitution than healthy undergraduate students,which means the evolution law of biased constitution may change with the development from health to disease, and may finally form each kind of TCM syndrome types of disease.The more frequent constitutions among sub-healthy undergraduate students were blood stasis constitution and qi deficiency constitution,while the specific endowment constitution was rare.A large proportion of TCM constitution among sub-healthy undergraduate students was multiple constitutions,which suggested that distribution of TCM constitution was extremely complicated and a single constitution classification was rare.Distribution of TCM constitution among sub-healthy undergraduate students was different in gender,in birthplace and in nation,which accorded with the theory of "abidance by triple pathogens".TCM construction had high correlation with sub-health,especially with physiological sub-health subtype.