Sub-health And Associated Factors Of Guangdong Town Dweller

Objective:The study aims at survey the sub-health state of town dweller in Guangdong by Sub-Health Measurement Scale Version1.0(SHMS V1.0). To explore the diagnosis threshold of sub-health state basing on total score of SHMS V1.0, and to find out incidence and associated factors of sub-health state to give some suggestions for department of Health.Methods:1SubjectsStratified sampling was carried on in2567town dweller in Guangdong during the year2012.2Methods(1) Operational definitionSub-health is the dropping state appears in physical, mental, or social health when there isn’t any diagnosis disease in physical or mental health. It shows declining in physical health, physical symptom, organic function, physical mobility function and vitality included. It shows bad statement in mental health, positive emotion, psychosocial symptom and cognitive function included. It shows declining in social health too, social interaction and social support included. (2) InstrumentDesigned questionnaire of sub-health state for town dweller that included factors like demography, life way, event, SHMS V1.0and SF-36.SHMS V1.0is a quantitative measurement scale about sub-health state which is developed by Jun Xu and his teammates. Based on WHO’s definition of health, Chinese social culture and lifestyle, they developed the scale by rigorous process including Delphi expert consultation, item analysis, item selection. Large sample population test showed that SHMS V1.0had good reliability and validity.SF-36is an international popular scale about health-related quality of life, which is widely used by measurement about quality of life, evaluation of clinical trial effect, assessment of civil health policy and similar field. As it was proved to be well in reliability and validity, in this study we make it the criterion to evaluate criterion validity of SHMS V1.0.(3) Data processing and statistics①Data management and statistical analysisBuild up the database by Epidata3.02and process the data by SPSS15.0and AMOS18.0.②Evaluation methods of SHMS V1.0Reliability reflects the precision, stability, consistence that means the degree of variation caused by random error in the test. Common indicators of reliability include test-retest reliability, internal consistency reliability and split-half reliability. In this study, we evaluate the reliability of SHMS V1.0for Guangdong town dweller by internal consistency reliability and split-half reliability.Validity reflects accuracy of the test result, that is whether the scale can tell the subject’s health or not. Common indicators include construct validity, content validity, and criterion validity. In this study we evaluate the validity of SHMS V1.0for Guangdong town dweller by construct validity and criterion validity.Reactivity reflects the chang of objective which means measure the sensitivity of objective. In this study we evaluate the reactivity of SHMS V1.0for Guangdong town dweller by ceiling effect/floor effect. ③StatisticsDescribe sub-health state of Guangdong town dweller by Descriptive and Frequency module. Compare converted score of SHMS V1.0among group with different social demographic factors or lifestyle by two independent t-test and one way ANOVA.Explore norm of sub-health state in town dweller by mean and normal distribution method. Find out the main associated factors with sub-health state of Guangdong town dweller by ordinal regression and binary logistic regression.(4) Quality controlThis study is a part of the National Natural Science Fund (NO:81172775). Therefore we hold a scientific and reasonable plan for the investigation.Screen the questionnaires recovered, filter the ones which finished less than80%of the whole questionnaires or bad-complete-one. Build up a database by Epidata3.02, double entry and validation to minimize the deviation caused by entry.Result:1. We have surveyed2640town dweller and the valid questionnaires are2567, the valid rate is97.65%.2. Reliability and validity of SHMS V1.02.1Reliability(1) Internal consistency reliabilityCronbach’s a coefficient of SHMS V1.0is0.919, and the Cronbach’s a of Physical, Mental and Social subscale were match the qualification.(2) Split-half reliabilityThe Spearman-Brown coefficient is0.866which means SHMS V1.0has a good split-half reliability.2.2Validity(1) Construct validity①Correlation coefficient between each dimension and its affiliated items were bigger than that between the dimension and other items. Correlation coefficient between each subscale and its affiliated dimensions were higher than that between the dimension and other subscale.②Factor analysisThe first-order model and the second-order model of Confirmatory factor analysis shows that x2/df, GFI, AGFI, RMSEA are match the qualification. The model was good at fitting and the divided of dimensions and subscale was reasonable.(2) Criterion validityAs there isn’t any accepted evaluation criterion of sub-health, this study made SF-36of SHMS V1.0criterion. Results show that correlation between SHMS V1.0score and SF-36score is good.2.3ReactivityThe highest score of Physical subscale, Mental subscale, Social subscale, and SHMS V1.0were all100; the lowest scores were0.00,0.00and10.71. That shows the reactivity is good.3. Norm of SHMS V1.0in Guangdong town dweller(1) Mean normBy means of analysing the scores of SHMS V1.0the study found that there is no statistical difference between gender. Thus base on the converted score of SHMS V1.0mean norm for different age group has been computed. SHMS V1.0’s converted score for younger than25is63.99±13.52, for25between54is61.37±14.62, for55and older than55is57.24±12.66.(2) Cut-off normCut the converted score of SHMS V1.0into several parts by normal distribution method. Compare the distributing correlation between cutting plans and converted score of SHMS V1.0, choose the one with the highest degree, which is cut point by x±s and x±0.5s into disease, severe sub-health, moderate sub-health, mild sub-health and health state by ascending order, and privde specific value for each age group.4. Score of SHMS V1.0in Guangdong town dwellerThe study shows that the total score of SHMS V1.0was61.05±14.19; the score of physical subscale was60.90±19.21; the score of mental subscale was60.16±15.96; the score of social subscale was62.46±15.38.Among9dimensions of SHMS V1.0,"vitality" got the highest score and "organic mobility function" got the lowest.5. Sub-health incidence of Guangdong town dwellerAccording to norm above, there are65.5%town dweller are at sub-health state in Guangdong. This rate is63.1%at younger than25,65.7%between25to54,67.1%at55and older.6. Analysis factors affecting sub-health among Guangdong town dweller(1) Univariate analysis of the factors affecting sub-health among town dweller in GuangdongThe one way ANOVA shows that social demography factors such as age, marital status, education, in work, monthly income, room mate, residence and life style include drinking preferences, having breakfast, sleeping time, sit up, sport or entertainment and sedentariness were the factors associated with sub-health among Guangdong town dweller. The people who aged, divorced or bereft of one’s spouse, lived alone, worked a long time, hard-drinking, do not eat breakfast, sleep less or oversleep, sit up, less or never participate in physical exercise and entertainment, sedentary had a worse health status.(2) Logistic regression analysis of the factors associated with sub-health in Guangdong town dwellerOrdinal logistic regression shows that the factors affecting the different state of sub-health include age, monthly income, daily work time, sedentary, and sport or entertainment.Binary regression analysis shows that factors such as gender, age, monthly income, residence, room mate, smoke, drink, breakfast, sleep time, sit up, sport or entertainment, and negative events affected the sub-health among Guangdong town dweller.7. SuggestionsGive some countermeasure and suggestion based on factors that affected sub-health among Guangdong town dweller (1) Health educationHealth education could reduce the dangerous factors that affected health, and to impel people change the unhealthy life or behaviors habit to recuperate. Ultimately, reduce the burden of disease effectively. We advocate of reasonable dietary habit, change the unhealthy behaviors habit and develop a healthy life habit.(2) Monitor, diagnose and treatProposed treat method based on different sub-health state of town dweller. We could chose musical therapy, mental therapeutic and convalesce for medium or mild sub-health to prevent from disease; we could chose traditional Chinese medical science such as traditional Chinese medicine, acupuncture and massage.(3) Improve the basic health service and dynamic monitoring and trackingWe should monitor the sub-health, chronic and mental disease on town dweller. Establish archives about person and family health to grasp of town dweller’s lifestyle and healthy development; intensify construct the information network about public health to collect the sub-health data more comprehensive and systematic, and to analysis the main affected factors in order to provide advice for relevant departments to making policy.Conclusions:1. SHMS V1.0shows good reliability and validity in test sub-health of Guangdong town dweller.2. Established norm for Guangdong town dweller base on converted score of SHMS V1.0. It has provided a epidemiology standard for assess sub-health that divided health status into disease, severe sub-health, medium sub-health, mild sub-health, and health, in addition, give a specific value for each age group.3. Sub-health incidence of Guangdong town dweller reached65.5%. This rate is63.1%at younger than25,65.7%between25to54,67.1%at55and older.4. Main factors such as social demography, life way and negative events were associated with sub-health of Guangdong town dweller.5. We give some countermeasure and suggestion according to the main factors affecting sub-health state of town dweller.