Development and Evaluation of a Questionnaire for Measuring Suboptimal Health Status in Urban Chinese

Abstract

BackgroundSuboptimal health status (SHS) is characterized by ambiguous health complaints, general weakness, and lack of vitality, and has become a new public health challenge in China. It is believed to be a subclinical, reversible stage of chronic disease. Studies of intervention and prognosis for SHS are expected to become increasingly important. Consequently, a reliable and valid instrument to assess SHS is essential. We developed and evaluated a questionnaire for measuring SHS in urban Chinese.MethodsFocus group discussions and a literature review provided the basis for the development of the questionnaire. Questionnaire validity and reliability were evaluated in a small pilot study and in a larger cross-sectional study of 3000 individuals. Analyses included tests for reliability and internal consistency, exploratory and confirmatory factor analysis, and tests for discriminative ability and convergent validity.ResultsThe final questionnaire included 25 items on SHS (SHSQ-25), and encompassed 5 subscales: fatigue, the cardiovascular system, the digestive tract, the immune system, and mental status. Overall, 2799 of 3000 participants completed the questionnaire (93.3%). Test-retest reliability coefficients of individual items ranged from 0.89 to 0.98. Item-subscale correlations ranged from 0.51 to 0.72, and Cronbach’s α was 0.70 or higher for all subscales. Factor analysis established 5 distinct domains, as conceptualized in our model. One-way ANOVA showed statistically significant differences in scale scores between 3 occupation groups; these included total scores and subscores (P < 0.01). The correlation between the SHS scores and experienced stress was statistically significant (r = 0.57, P < 0.001).ConclusionsThe SHSQ-25 is a reliable and valid instrument for measuring sub-health status in urban Chinese.

Association of Suboptimal Health Status and Cardiovascular Risk Factors in Urban Chinese Workers

“…In our study, a newly created instrument, SHSQ-25, was used for measurement of SHS. 2 The SHSQ-25 is a self-rated questionnaire of perceived health complaints. SHS is more prevalent in women than in men and more in white-collar workers than in blue-collar workers.…”

“…The SHSQ-25 is short and easy to be completed, and therefore, suitable for use in general population and primary care service. 2 In many developed counties, much attention has been paid on perceived poor health "somatization" and "medically unexplained symptoms" in community and primary care system. 32,33 Somatic symptom is one of the main reasons for patients seeking health care.…”

“…2 Each subject was asked to rate a specific statement on a five-point Likert-type scale, based on how often they suffered various specific complaints in the preceding 3 months: (1) never or almost never, (2) occasionally, (3) often, (4) very often, and (5) always. The raw scores of 1 to 5 on the questionnaire were recoded as 0 to 4.…”

“…1,2 SHS is characterized by ambiguous health complaints, general weakness, and lack of vitality. It is deemed that SHS may be associated with progression or development of chronic disease.…”

“…[4][5][6] We have established a previously proposed instrument (suboptimal health status questionnaire-25, SHSQ-25) for investigating suboptimal health status. 2 In our recent data analysis, work stress was among the most mentioned factors influencing general health. The multiple linear regression analyses revealed that competition, high job demands, poor relationship with colleagues, and lack of physical activities were the main factors associated with SHS (adjusted R 2 =0.573), independent of sex, age, education, smoking, and drinking.…”