Volume 15, Issue 2 (Summer 2020)
Salmand: Iranian Journal of Ageing 2020, 15(2): 130-143 |
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Esmaeil Zali M, Arab M, Rahimi Foroushani A, Farzianpour F. Construction and Validation the Healthy Lifestyle Questionnaire Among the Iranian Elderly Who Receive Home Care Services. Salmand: Iranian Journal of Ageing 2020; 15 (2) :130-143
URL: http://salmandj.uswr.ac.ir/article-1-1761-en.html
URL: http://salmandj.uswr.ac.ir/article-1-1761-en.html
1- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
2- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
3- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. ,farzianp@sina.tums.ac.ir
2- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
3- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. ,
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Extended Abstract
1. Introduction
The elderly issues have changed into one of the most challenging and essential topics. This is due to the increased life expectancy, decreased fertility, decreased birth rate, healthcare improvement, and increased elderly population. According to the estimations, by 2025, the elderly population will have reached one billion and 200 individuals (14% of the world population) [3]; therefore, pursuing healthy aging, exposure of a high proportion of the population to certain diseases of this period is inevitable and requires extensive health service. Due to aging, the individuals’ health will deteriorate and the number of diseases will rise [4]. Iran, as a developing country, has a young population; soon, this population will move to the upper part of the population pyramid [5]. Lifestyle is a manner by which individuals’ health, welfare, and life quality are provided, maintained, and improved [6]. Furthermore, lifestyle refers to behavior patterns related to health, i.e. according to the individuals’ accessible life opportunities [7, 8]. Based on studies, there is an increase in the effective criteria on lifestyle and the lack of proper and comprehensive scales about the elderly’s healthy lifestyle in Iran.
The present study intended to design and validate a healthy lifestyle questionnaire among the Iranian elderly. This goal was achieved by comprehensively reviewing the previous studies and benefiting from the elderly’s ideas and experiences, as well as the experts of elderly issues.
The present study aimed to develop a comprehensive scale that includes all aspects of lifestyle proportionate to its theoretical concept.
2. Methods & Materials
The present study applied a combined method; consecutive exploratory aiming at generating lifestyle assessment scale among the elderly living in Tehran City, Iran, in 2018. The study was conducted in 4 steps, as follows: reviewing texts and semi-structured interviews (the elderly & experts); extracting domains and items related to lifestyle; performing validity examination, and conducting a final assessment on the target society (reliability check). To evaluate the validity, Content Validity Index (CVI) and Content Validity Ratio (CVR) were implemented by the expert’s panel (n=20 in 8 different specialties related to the elderly’s healthcare issues). Moreover, to assess its reliability, Cronbach’s alpha coefficient (n=40) was implemented. The statistical analysis was conducted by SPSS.
3. Results
The agreed unit for CVR was calculated as 42 according to the experts’ numbers. CVR value was calculated for each question in different fields.
Table 1 presents the achieved CVI and CVR scores of every question for each field. The questions with scores less than the agreed limit were eliminated (CVR≤0.76); accordingly, out of 130 extracted questions, the CVR was above the agreed limit for 69 questions (CVR≥0.42). CVI was calculated to be 0.76 for the whole questionnaire. In 11 fields, CVI exceeded the agreed limit for all questions (CVR≤0.76). Cronbach’s alpha coefficient equaled >0.7 in all defined fields.
4. Conclusion
The designed questionnaire in the present study (EHLSQ), compared with other questionnaires, not only covers more aspects of the elderly’s lifestyle, but it can also be used to assess all the elderly’s lifestyle; it is not limited to the elderly with special conditions. Therefore, it has the necessary comprehensiveness to assess all elderly’s lifestyle. Moreover, the researchers benefited from the elderly’s ideas while interviewing them in designing the EHLSQ. Furthermore, the EHLSQ provided a desirable validity and reliability due to benefiting from more experts’ opinions (20 individuals); diversity in the specialty (8 specialties); CVR and CVI assessment; using the target group opinions (the elderly), and obtaining a high Cronbach’s alpha coefficient (0.974). The researchers attempted to act scientifically and standardly in the field of scale production during the operation procedure; thus, that the method used in designing the EHLSQ could have the adequate assurance to design scales. Besides, the researchers tried to eliminate the previous scales’ faults in assessing lifestyle while designing the EHLSQ.
Ethical Considerations
Compliance with ethical guidelines
All ethical principles were considered in this article. The participants were informed about the purpose of the research and its implementation stages; they were also assured about the confidentiality of their information; Moreover, They were allowed to leave the study whenever they wish, and if desired, the results of the research would be available to them.
Funding
The present paper was extracted from the PhD. thesis the first author, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences.
Authors' contributions
Design and conceptualization: Fereshteh Farzianpour, Morad Esmaeil Zali; Methodology and data analysis: Morad Esmaeil Zali, Abbas Rahimi Foroushani; Supervision and final writing: Morad Esmaeil Zali, Mohammad Arab, Fereshteh Farzianpour.
Conflicts of interest
The authors declared no conflict of interest.
References
Mohammadi M, Mohammadi Shahboulaghi F, Shati M, Khanke HR. [The validity and reliability of the Persian version of the device to identify older people at risk for re-admission in emergency centers (Persian)]. Nursing Journal of Vulnerable. 2016; 3(8):48-58. http://njv.bpums.ac.ir/article-1-740-en.html
Park SH, Han KS, Kang CB. Effects of exercise programs on depressive symptoms, quality of life and self-esteem in older people: A systematic review of randomized controlled trials. Applied Nursing Research. 2014; 27(4):219-26. [DOI:10.1016/j.apnr.2014.01.004] [PMID]
Mohammadzadeh A, Dolatshahy B, Mohammadkhani P. [The effects of integrative reminiscence therapy on signs and symptoms of depression in the elderly (Persian)]. Iranian Journal of Ageing. 2011; 6(1):23-8. http://salmandj.uswr.ac.ir/article-1-373-en.html
Imani ADS, Azizi Zeinalhajlou A. [Population aging and burden of diseases (Persian)]. Depiction of Health. 2015; 6(2):54-61. https://doh.tbzmed.ac.ir/Article/doh-125
Statistical Center of Iran. Selected findings of the 2016 national population and housing census. Tehran: Statistical Center of Iran; 2018. https://www.amar.org.ir/Portals/1/census/2016/Census_2016_Selected_Findings.pdf
Hekmatpou D, Shamsi M, Zamani M. [The effect of healthy lifestyle educational programs on the quality of life of the elderly in Arak (Persian)]. Journal of Arak University of Medical Sciences. 2013; 16(72):1-11. http://jams.arakmu.ac.ir/article-1-2024-en.html
Ghasemi V, Rabani R, Rabbani A, Alizadeh MB. [Structural and capital determinants of health-oriented lifestyle (Persian)]. Journal of Faculty of Literature and Humanities Kharazmi. 2009; 1387(63):181-213. https://jspi.khu.ac.ir/article-1-229-fa.html
Son KY, Park SM, Lee J, Kim CY. Difference in adherence to and influencing factors of a healthy lifestyle between middle-aged and elderly people in Korea: A multilevel analysis. Geriatrics & Gerontology International. 2015; 15(6):778-88. [DOI:10.1111/ggi.12335] [PMID]
Kendig H, Browning CJ, Thomas SA, Wells Y. Health, lifestyle, and gender influences on aging well: An Australian longitudinal analysis to guide health promotion. Frontiers in Public Health. 2014; 2(2):70. [DOI:10.3389/fpubh.2014.00070] [PMID] [PMCID]
Taheri M. The study of life style and demographic characteristics of iranian elderly. Journal of Sports Research. 2014; 1(3):45-8. https://ideas.repec.org/a/pkp/josres/2014p45-48.html
Movahedi M, Khamseh F, Ebadi A, Haji Amin Z, Navidian A. [Assessment of the lifestyle of the elderly in Tehran (Persian)]. Journal of Health Promotion Management. 2016; 5(3):51-9. http://jhpm.ir/article-1-630-en.html
Abbasi M, Daniali SSM, Hazrati M. Lifestyle of fallen elderly patients referred to Isfahan Hospitals. Iran Journal of Nursing. 2017; 30(107):20-31. [DOI:10.29252/ijn.30.107.20]
Anahita Babak SD, Davari S, Aghdak P, Pirhaji O. Assessment of healthy lifestyle among elderly in Isfahan, Iran. Journal of Isfahan Medical School. 2011; 29(149):64-74. https://b2n.ir/578878
Fallah Mehrabadi E PM, Asadi S, Haghani H. [Lifestyle of elderly people with osteoporosis and its related factors (Persian)]. Iranian Journal of Ageing. 2017; 12( 2):132-45. [DOI:10.21859/sija-1202132]
Eshaghi SR, Farajzadegan Z, Babak A. [Healty lifestyle assessment questionnaire in elderly: Translation, reliability and validity (Persian)]. Payesh. 2010; 9(1):91-9. http://payeshjournal.ir/article-1-593-en.html
Shamsadini Lori A, PourMohammadi K, Vida K, Ahmadi Kashkol S, PourAhmad MR. [A survey on the level of the elderly lifestyle in Shiraz (Persian)]. Journal of Health-Based Research. 2015; 1(1):75-84. http://hbrj.kmu.ac.ir/article-1-35-en.html
Mahmudi Gh, Niazazari K, Sanati T. [Evaluation of life style in the elderly (Persian)]. Journal of Health Breeze. 2013; 1(3):45-50. http://jfh.iausari.ac.ir/article_633408.html
Darviri C, Alexopoulos EC, Artemiadis AK, Tigani X, Kraniotou C, Darvyri P, et al. The Healthy Lifestyle and Personal Control Questionnaire (HLPCQ): A novel tool for assessing self-empowerment through a constellation of daily activities. BMC Public Health. 2014; 14(1):995. [DOI:10.1186/1471-2458-14-995] [PMID] [PMCID]
Hwang JE. Promoting healthy lifestyles with aging: Development and validation of the Health Enhancement Lifestyle Profile (HELP) using the Rasch measurement model. American Journal of Occupational Therapy. 2010; 64(5):786-95. [DOI:10.5014/ajot.2010.09088] [PMID]
Aubi E, Shadnoush M, Nazarzadeh M, Bidel Z, Ranaei A, Delpisheh A. [Translation and assessment of validity andreliability of the health-promoting lifestyle questionnaire, using factor analysis (Persian)]. Pejouhandeh. 2012; 17(3):114-20. https://www.academia.edu/21511928/
Hajizadeh E, Asghari M. [Methods and statistical analyzes by looking at the research method in the biological sciences and health sciences (Persian)]. Tehran: University Jihad Publishing Organization; 2011. https://b2n.ir/425749
Mohd Tajudin N, Puteh M, Mazlini A. Guiding principles to foster higher order thinking skills in teaching and learning of mathematics. International Journal of Engineering & Technology. 2018; 7(4.15):195-9. [DOI:10.14419/ijet.v7i4.15.21445]
Rodriguez Añez CR, Reis RS, Petroski EL. Brazilian version of a lifestyle questionnaire: Translation and validation for young adults. Arquivos Brasileiros de Cardiologia. 2008; 91(2):102-9. [DOI:10.1590/S0066-782X2008001400006] [PMID]
Chen MY, Wang EK, Yang RJ, Liou YM. Adolescent health promotion scale: Development and psychometric testing. Public Health Nursing. 2005; 22(2):209-20. [DOI:10.1046/j.1525-1446.2003.20204.x]
Sotos-Prieto M SBG, Bodega P, Pocock S, Mattei J, Peñalvo JL. Validation of a questionnaire to measure overall Mediterranean lifestyle habits for research application: The MEDiterranean LIFEstyle Index (MEDLIFE). Nutricion Hospitalaria. 2015; 32(3):1153-63. http://scielo.isciii.es/scielo.php?pid=S0212-16112015000900026&script=sci_abstract&tlng=en
Walker SN, Sechrist KR, Pender NJ. The health-promoting lifestyle profile: Development and psychometric characteristics. Nursing Research. 1987; 36(2):76-81. [DOI:10.1097/00006199-198703000-00002] [PMID]
Tanjani PT, Azadbakht M, Garmaroudi G, Sahaf R, Fekrizadeh Z. Validity and reliability of health promoting lifestyle profile II in the Iranian elderly. International Journal of Preventive Medicine. 2016; 7:74. [DOI:10.4103/2008-7802.182731] [PMID] [PMCID]
1. Introduction
The elderly issues have changed into one of the most challenging and essential topics. This is due to the increased life expectancy, decreased fertility, decreased birth rate, healthcare improvement, and increased elderly population. According to the estimations, by 2025, the elderly population will have reached one billion and 200 individuals (14% of the world population) [3]; therefore, pursuing healthy aging, exposure of a high proportion of the population to certain diseases of this period is inevitable and requires extensive health service. Due to aging, the individuals’ health will deteriorate and the number of diseases will rise [4]. Iran, as a developing country, has a young population; soon, this population will move to the upper part of the population pyramid [5]. Lifestyle is a manner by which individuals’ health, welfare, and life quality are provided, maintained, and improved [6]. Furthermore, lifestyle refers to behavior patterns related to health, i.e. according to the individuals’ accessible life opportunities [7, 8]. Based on studies, there is an increase in the effective criteria on lifestyle and the lack of proper and comprehensive scales about the elderly’s healthy lifestyle in Iran.
The present study intended to design and validate a healthy lifestyle questionnaire among the Iranian elderly. This goal was achieved by comprehensively reviewing the previous studies and benefiting from the elderly’s ideas and experiences, as well as the experts of elderly issues.
The present study aimed to develop a comprehensive scale that includes all aspects of lifestyle proportionate to its theoretical concept.
2. Methods & Materials
The present study applied a combined method; consecutive exploratory aiming at generating lifestyle assessment scale among the elderly living in Tehran City, Iran, in 2018. The study was conducted in 4 steps, as follows: reviewing texts and semi-structured interviews (the elderly & experts); extracting domains and items related to lifestyle; performing validity examination, and conducting a final assessment on the target society (reliability check). To evaluate the validity, Content Validity Index (CVI) and Content Validity Ratio (CVR) were implemented by the expert’s panel (n=20 in 8 different specialties related to the elderly’s healthcare issues). Moreover, to assess its reliability, Cronbach’s alpha coefficient (n=40) was implemented. The statistical analysis was conducted by SPSS.
3. Results
The agreed unit for CVR was calculated as 42 according to the experts’ numbers. CVR value was calculated for each question in different fields.
Table 1 presents the achieved CVI and CVR scores of every question for each field. The questions with scores less than the agreed limit were eliminated (CVR≤0.76); accordingly, out of 130 extracted questions, the CVR was above the agreed limit for 69 questions (CVR≥0.42). CVI was calculated to be 0.76 for the whole questionnaire. In 11 fields, CVI exceeded the agreed limit for all questions (CVR≤0.76). Cronbach’s alpha coefficient equaled >0.7 in all defined fields.
4. Conclusion
The designed questionnaire in the present study (EHLSQ), compared with other questionnaires, not only covers more aspects of the elderly’s lifestyle, but it can also be used to assess all the elderly’s lifestyle; it is not limited to the elderly with special conditions. Therefore, it has the necessary comprehensiveness to assess all elderly’s lifestyle. Moreover, the researchers benefited from the elderly’s ideas while interviewing them in designing the EHLSQ. Furthermore, the EHLSQ provided a desirable validity and reliability due to benefiting from more experts’ opinions (20 individuals); diversity in the specialty (8 specialties); CVR and CVI assessment; using the target group opinions (the elderly), and obtaining a high Cronbach’s alpha coefficient (0.974). The researchers attempted to act scientifically and standardly in the field of scale production during the operation procedure; thus, that the method used in designing the EHLSQ could have the adequate assurance to design scales. Besides, the researchers tried to eliminate the previous scales’ faults in assessing lifestyle while designing the EHLSQ.
Ethical Considerations
Compliance with ethical guidelines
All ethical principles were considered in this article. The participants were informed about the purpose of the research and its implementation stages; they were also assured about the confidentiality of their information; Moreover, They were allowed to leave the study whenever they wish, and if desired, the results of the research would be available to them.
Funding
The present paper was extracted from the PhD. thesis the first author, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences.
Authors' contributions
Design and conceptualization: Fereshteh Farzianpour, Morad Esmaeil Zali; Methodology and data analysis: Morad Esmaeil Zali, Abbas Rahimi Foroushani; Supervision and final writing: Morad Esmaeil Zali, Mohammad Arab, Fereshteh Farzianpour.
Conflicts of interest
The authors declared no conflict of interest.
References
Mohammadi M, Mohammadi Shahboulaghi F, Shati M, Khanke HR. [The validity and reliability of the Persian version of the device to identify older people at risk for re-admission in emergency centers (Persian)]. Nursing Journal of Vulnerable. 2016; 3(8):48-58. http://njv.bpums.ac.ir/article-1-740-en.html
Park SH, Han KS, Kang CB. Effects of exercise programs on depressive symptoms, quality of life and self-esteem in older people: A systematic review of randomized controlled trials. Applied Nursing Research. 2014; 27(4):219-26. [DOI:10.1016/j.apnr.2014.01.004] [PMID]
Mohammadzadeh A, Dolatshahy B, Mohammadkhani P. [The effects of integrative reminiscence therapy on signs and symptoms of depression in the elderly (Persian)]. Iranian Journal of Ageing. 2011; 6(1):23-8. http://salmandj.uswr.ac.ir/article-1-373-en.html
Imani ADS, Azizi Zeinalhajlou A. [Population aging and burden of diseases (Persian)]. Depiction of Health. 2015; 6(2):54-61. https://doh.tbzmed.ac.ir/Article/doh-125
Statistical Center of Iran. Selected findings of the 2016 national population and housing census. Tehran: Statistical Center of Iran; 2018. https://www.amar.org.ir/Portals/1/census/2016/Census_2016_Selected_Findings.pdf
Hekmatpou D, Shamsi M, Zamani M. [The effect of healthy lifestyle educational programs on the quality of life of the elderly in Arak (Persian)]. Journal of Arak University of Medical Sciences. 2013; 16(72):1-11. http://jams.arakmu.ac.ir/article-1-2024-en.html
Ghasemi V, Rabani R, Rabbani A, Alizadeh MB. [Structural and capital determinants of health-oriented lifestyle (Persian)]. Journal of Faculty of Literature and Humanities Kharazmi. 2009; 1387(63):181-213. https://jspi.khu.ac.ir/article-1-229-fa.html
Son KY, Park SM, Lee J, Kim CY. Difference in adherence to and influencing factors of a healthy lifestyle between middle-aged and elderly people in Korea: A multilevel analysis. Geriatrics & Gerontology International. 2015; 15(6):778-88. [DOI:10.1111/ggi.12335] [PMID]
Kendig H, Browning CJ, Thomas SA, Wells Y. Health, lifestyle, and gender influences on aging well: An Australian longitudinal analysis to guide health promotion. Frontiers in Public Health. 2014; 2(2):70. [DOI:10.3389/fpubh.2014.00070] [PMID] [PMCID]
Taheri M. The study of life style and demographic characteristics of iranian elderly. Journal of Sports Research. 2014; 1(3):45-8. https://ideas.repec.org/a/pkp/josres/2014p45-48.html
Movahedi M, Khamseh F, Ebadi A, Haji Amin Z, Navidian A. [Assessment of the lifestyle of the elderly in Tehran (Persian)]. Journal of Health Promotion Management. 2016; 5(3):51-9. http://jhpm.ir/article-1-630-en.html
Abbasi M, Daniali SSM, Hazrati M. Lifestyle of fallen elderly patients referred to Isfahan Hospitals. Iran Journal of Nursing. 2017; 30(107):20-31. [DOI:10.29252/ijn.30.107.20]
Anahita Babak SD, Davari S, Aghdak P, Pirhaji O. Assessment of healthy lifestyle among elderly in Isfahan, Iran. Journal of Isfahan Medical School. 2011; 29(149):64-74. https://b2n.ir/578878
Fallah Mehrabadi E PM, Asadi S, Haghani H. [Lifestyle of elderly people with osteoporosis and its related factors (Persian)]. Iranian Journal of Ageing. 2017; 12( 2):132-45. [DOI:10.21859/sija-1202132]
Eshaghi SR, Farajzadegan Z, Babak A. [Healty lifestyle assessment questionnaire in elderly: Translation, reliability and validity (Persian)]. Payesh. 2010; 9(1):91-9. http://payeshjournal.ir/article-1-593-en.html
Shamsadini Lori A, PourMohammadi K, Vida K, Ahmadi Kashkol S, PourAhmad MR. [A survey on the level of the elderly lifestyle in Shiraz (Persian)]. Journal of Health-Based Research. 2015; 1(1):75-84. http://hbrj.kmu.ac.ir/article-1-35-en.html
Mahmudi Gh, Niazazari K, Sanati T. [Evaluation of life style in the elderly (Persian)]. Journal of Health Breeze. 2013; 1(3):45-50. http://jfh.iausari.ac.ir/article_633408.html
Darviri C, Alexopoulos EC, Artemiadis AK, Tigani X, Kraniotou C, Darvyri P, et al. The Healthy Lifestyle and Personal Control Questionnaire (HLPCQ): A novel tool for assessing self-empowerment through a constellation of daily activities. BMC Public Health. 2014; 14(1):995. [DOI:10.1186/1471-2458-14-995] [PMID] [PMCID]
Hwang JE. Promoting healthy lifestyles with aging: Development and validation of the Health Enhancement Lifestyle Profile (HELP) using the Rasch measurement model. American Journal of Occupational Therapy. 2010; 64(5):786-95. [DOI:10.5014/ajot.2010.09088] [PMID]
Aubi E, Shadnoush M, Nazarzadeh M, Bidel Z, Ranaei A, Delpisheh A. [Translation and assessment of validity andreliability of the health-promoting lifestyle questionnaire, using factor analysis (Persian)]. Pejouhandeh. 2012; 17(3):114-20. https://www.academia.edu/21511928/
Hajizadeh E, Asghari M. [Methods and statistical analyzes by looking at the research method in the biological sciences and health sciences (Persian)]. Tehran: University Jihad Publishing Organization; 2011. https://b2n.ir/425749
Mohd Tajudin N, Puteh M, Mazlini A. Guiding principles to foster higher order thinking skills in teaching and learning of mathematics. International Journal of Engineering & Technology. 2018; 7(4.15):195-9. [DOI:10.14419/ijet.v7i4.15.21445]
Rodriguez Añez CR, Reis RS, Petroski EL. Brazilian version of a lifestyle questionnaire: Translation and validation for young adults. Arquivos Brasileiros de Cardiologia. 2008; 91(2):102-9. [DOI:10.1590/S0066-782X2008001400006] [PMID]
Chen MY, Wang EK, Yang RJ, Liou YM. Adolescent health promotion scale: Development and psychometric testing. Public Health Nursing. 2005; 22(2):209-20. [DOI:10.1046/j.1525-1446.2003.20204.x]
Sotos-Prieto M SBG, Bodega P, Pocock S, Mattei J, Peñalvo JL. Validation of a questionnaire to measure overall Mediterranean lifestyle habits for research application: The MEDiterranean LIFEstyle Index (MEDLIFE). Nutricion Hospitalaria. 2015; 32(3):1153-63. http://scielo.isciii.es/scielo.php?pid=S0212-16112015000900026&script=sci_abstract&tlng=en
Walker SN, Sechrist KR, Pender NJ. The health-promoting lifestyle profile: Development and psychometric characteristics. Nursing Research. 1987; 36(2):76-81. [DOI:10.1097/00006199-198703000-00002] [PMID]
Tanjani PT, Azadbakht M, Garmaroudi G, Sahaf R, Fekrizadeh Z. Validity and reliability of health promoting lifestyle profile II in the Iranian elderly. International Journal of Preventive Medicine. 2016; 7:74. [DOI:10.4103/2008-7802.182731] [PMID] [PMCID]
Type of Study: Research |
Subject:
Geriatric
Received: 2019/01/21 | Accepted: 2019/06/26 | Published: 2020/07/01
Received: 2019/01/21 | Accepted: 2019/06/26 | Published: 2020/07/01
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