Development Of Health Scale Of Emergency Medical Rescuers Fighting Epidemic

Objective:To develop the Health Scale of Emergency Medical Rescuers Fighting Epidemic(hereinafter referred to as Health Scale)and provide an effective tool for dynamic assessment of the physical and mental health problems of emergency medical rescuers,which also provides references for the targeted actions to protect their physical and mental health.Methods(scale development process):1.From October to December 2020,an interview outline was developed based on the review of the literatures,and 31 emergency medical rescuers who involved in fighting Corona Virus Diseases 19(COVID-19)in Hubei province from February to April 2020 were selected for qualitative interviews through purpose sampling.Text analysis was conducted using the Colaizzi seven-step analysis method to provide reference for constructing an item pool for the Health Scale.2.From December 2020 to January 2021,based on the results of the review of literatures and qualitative interviews,the item pool of the Health Scale was constructed.These items were modified through focus group discussion to compile the initial version of the Health Scale.3.From February to March 2021,20 experts in clinical medicine,clinical nursing,or psychometrics were invited to participate in the expert consultation,and these items of initial version of the Health Scale were screened and modified to form the Health Scale trial version I.4.From March to April 2021,360 emergency medical rescuers who were involved in fighting COVID-19 in Hubei province during the epidemic were surveyed by convenience sampling method using the Health Scale trial version I.The Health Scale trial version I was analyzed by item analysis and exploratory factor analysis using SPSS 26.0 to form the Health Scale trial version II.5.From May to July 2021,the trial version II of the Health Scale was used to survey 287 emergency medical rescuers who involved in fighting COVID-19 in Hubei province by convenience sampling method.And confirmatory factor analysis,convergent,discriminant,criterion validity and reliability test were performed on the trial version II of the Health Scale using SPSS 26.0 and Amos 23.0.Finally,the formal version of the Health Scale was developed.Results:1.The Health Scale included three subscales:Health Before Medical Rescue Subscale,Health During Medical Rescue Subscale and Health After Medical Rescue Subscale.2.The Health Before Medical Rescue Subscale contained 1 dimension named anxiety and 4 items.Exploratory factor analysis extracted 1 factor with cumulative variance explained of 52.07%;confirmatory factor model fit was good(χ2/df=0.007,P=0.993,RMSEA=0.000,CFI=1.000,TLI=1.000,IFI=1.000)with standardized factor loadings from 0.57 to 0.74.The Cronbach’s a for this scale was 0.748.The AVE of this scale was 0.543,the CR was greater than 0.70.The scale was significantly correlated(P<0.01)with the calibration scales of quality of life,posttraumatic stress disorder,and physical symptom with correlation coefficients of-0.166,0.176,and 0.250 respectively.3.The Health During Medical Rescue Subscale included 6 dimensions and 21 items.Specifically,"fear of infection,compulsion,and grief’ constitute mental health problems integrated dimensions;"physical exhaustion,gastrointestinal disorders and basic physiological disorders" constitute physical health problems integrated dimensions.Exploratory factor analysis extracted 6 factors with cumulative variance explained of 68.51%.The confirmatory factor model found that the second-order factor model fitted acceptably(χ2/df=6.034,P<0.001,RMSEA=0.008,CFI=0.865,TLI=0.894,IFI=0.909).The standardized factor loadings ranged from 0.62 to 0.91.The Cronbach’s α for all dimensions was greater than 0.70,and the Cronbach’s a for this subscale was 0.924.The AVE of scale was greater than 0.50 for all dimensions and CR was greater than 0.70.The square root of the AVE for each dimension was greater than the correlation coefficient with other dimensions.The scale was significantly correlated(P<0.01)with the calibrated scales of quality of life,posttraumatic stress disorder,and physical symptom with correlation coefficients of-0.260,0.412 and 0.442 respectively.4.The Health After Medical Rescue Subscale consisted of 4 dimensions and 14 items.Specifically,"altered cognition,poor mood,and behavioral dysregulation"constitute mental health problems integrated dimension.Exploratory factor analysis extracted 2 factors with cumulative variance explained of 52.07%.The confirmatory factor model found that the second-order factor model fitted acceptably(χ2/df=3.468,P<0.001,RMSEA=0.090,CFI=0.895,TLI=0.912,IFI=0.931).The standardized factor loadings ranged from 0.67 to 0.91.The Cronbach’s a for all dimensions of the scale was greater than 0.70,and the Cronbach’s α for this subscale was 0.921.The AVE for each dimension of the scale was greater than 0.50,and the CR was greater than 0.70.The square root of AVE for each dimension was greater than the correlation coefficient with other dimensions.This scale was significantly correlated(P<0.01)with the calibrated scales of quality of life,posttraumatic stress disorder,and physical symptom with correlation coefficients of-0.246,0.584,and 0.514 respectively.Conclusion:The Health Scale has good reliability and validity,which can be used as an assessment tool for the health problems of emergency medical rescuers fighting epidemic in China.