The Developments Of The Social Health Scale For The Elderly And Its Norms In Hangzhou,China

Background and ObjectivesPopulation ageing is happening quickly around the world.In China,the proportion of people aged 60 years and older was 16.15%in 2015,which was larger than the average of global.In 2050,the predicted percentage of people aged 65 years and older was almost 26.90%in China.If the percentage of the elderly keeps rising,then the ratio of unhealthy people may increase and health status of general population may be worse.To reduce the negative influence of population ageing to general health,the concept of healthy ageing was put forward.Health contained three fields,that is,physical health,mental health and social health.In China,the assessment tools for physical and mental health of the elderly were developed,but that of social health was urgent to be developed.This study was aim at developing a Social Health Scale for the Elderly(SHSE),and then social health status of the Chinese elderly can be assessed.Materials and MethodsThe Social Health Scale for the Elderly was developed over 4 phases.Firstly,the item pool and original scale was developed through literature review and expert consultation.Secondly,a pilot test was carried out.All of subjects came from representative communities/villages.The target population was the relatively healthy population aged 60 years and above,among which person who was bed-ridden for a long time,had serious physiological,psychological illness would be excluded.Multistage sampling was conducted,firstly some representative communities/villages were selected,and then stratified random sampling by age and gender was used.Test-retest reliability analysis,Cronbach's alpha analysis,correlation analysis,distinguishability analysis and factor analysis were conducted for items selection,and then the final versions of the SHSE were generated.Thirdly,field test was conducted.The target population and exclusion criteria were the same as the pilot test.When multistage sampling was conducted,after selecting the representative communities/villages,the population was stratified by age and gender,and then non-random sampling was used.The test-retest reliability,internal consistency reliability,inter-rater reliability,split-half reliability,construct validity,criterion validity,convergent validity and discriminant validity of SHSE were analyzed.Finally,confirmatory factor analysis was carried out to estimate the structure of the SHSE,and then the norms of the SHSE were calculated.The factors may influence social health status of the Chinese elderly were explored by correlation analysis and regression analysis.ResultsThe item pool contained 3 dimensions,9 sub-dimensions and 40 items.The pilot test was carried out from Dec.14,2015 to Jan.08,2016,the interval of retest was nearly two weeks,and 430 subjects were included in statistical analysis.Fifteen items were excluded after conducting five kinds of statistical analyses.The field test was begun on Nov.6,2016 and finished on Jan.20,2017,the interval of retest was also nearly two weeks,and a total of 2404 subjects were included in statistical analysis.The correlations of scales were 0.77 in test-retest reliability analyses.In internal consistency reliability analysis,the standardized Cronbach's a coefficient of scale was 0.79.The McNemar-Bowker tests indicated the disagreement between interviewers,the weighted KAPPA were 0.44.The split-half reliability coefficient was 0.82,which was calculated by Rulon's formula.Variables would be extracted when the factor loading was larger than 0.50,and finally 76.44%variances could be explained by extracted variables.As criterion,the correlation between the score of Social Support Rating Scale and that of dimension named social support were 0.64.In convergent validity and discriminant validity analyses,the average variance extracted(AVE)of the SHSE was 0.54,and AVEs of every two factors were larger than related squared inter-factor correlation.As the above result shows,the test-retest reliability,internal consistency reliability,split-half reliability,construct validity,convergent validity and discriminant validity of the SHSE were desirable,butinter-rater reliability was not satisfactory.In addition,criterion validity of the SHSE could not be analyzed because a perfect criterion was absent,but the validity of the dimension named social support was satisfactory.The goodness of fit index,adjusted goodness of fit index and root mean square error of approximation in confirmatory factor analysis were 0.95,0.91 and 0.09,which indicated that the structure of SHSE was rational.Finally,the percentile rank norms and standard norms of the total and two age groups were generated.The protective factors of social health of the elderly might include woman,living in countryside,younger age,Christian,better educated,married,better quality of sleep,better mobility,more severe pain or discomfort,and lower level of anxiety and depression.The household called agricultural might have negative effect on social health of the elderly.But only married and better mobility might play positively influence on social health of the oldest-old.ConclusionsThe findings of this study were as follows:(1)After item selection,the SHSE was including 3 dimensions,8 sub-dimensions and 25 items.(2)The test-retest reliability,internal consistency reliability,split-half reliability,construct validity,convergent validity and discriminant validity of the SHSE were good enough,but inter-rater reliability was not good.In addition,criterion validity of the SHSE could not be analyzed because of lacking for a perfect criterion,but the validity of the dimension named social support was good.(3)The model based on the structure of the SHSE had good fitting degree of data,so the structure of the SHSE was good.(4)Selecting the most suitable norms based on the age and gender of subjects was an effective means' to avoid overestimating and underestimating the social health status of the elderly.(5)Many factors might have influence on the social health of the elderly.Some factors had effect on the social health status of people aged 60?79 years might have no effect among the oldest old.