台灣版健康生活型態剖析量表之發展

Abstract

背景：健康的生活型態可預防慢性疾病與失能或延緩惡化，是健康促進方案的重點，良好的健康生活型態評量與篩檢工具，可利於檢視生活型態風險以及精確評量方案效益，是推動老人健康促進方案之重要前提。近年，美國有發展健康生活型態剖析量表(the Health Enhancement Lifestyle Profile, HELP)，其具有良好的信效度，但生活型態應與在地文化與情境有極大相關，欲應用於台灣需經過本土化之修正。 目的：本研究主要目的為發展中文版HELP，以剖析當代老人的健康相關生活型態現況，驗證其信效度。另希冀因藉由本評估工具的發展，探討台灣老人之生活型態之概念架構、範疇與內涵，作為未來老人健康促進介入之參考依據。 方法：原始版HELP問卷先進行翻譯並作文化上之調整，經三場焦點團體後，整理台灣老人健康相關生活型態的概念架構、並提出8題台灣本土文化題，形成預試版「台灣版健康生活型態剖析量表」問卷。經269位社區老人測試之結果，以羅序法分析及篩選。形成最終試題版本，且同時分析其心理計量特質。 結果：本問卷之原版56題預定全數保留，經羅序測驗之檢視後加入3題台灣文化題，正式版「台灣版健康生活型態剖析量表」問卷共59題，並建議將評分量尺由6點量尺調整為3點量尺。整體問卷再次經由羅序測驗分析模式之試題合適度、試題階層性，大致符合單一向度。其中飲食、日常生活動與其他健康行為次量表較不符合羅序之指標，需進一步探討；8題在可接受差異試題功能，與原版不符合，此顯示出東西之文化差異。 結論：生活型態受到環境與文化之情境影響甚深，「台灣版健康生活型態剖析量表」進行羅序心理計量驗證，可協助檢測台灣老人之生活型態因子，並作為健康促進之評估工具，但未來仍須更進一步修改及驗證 。

Background: Healthy lifestyle is a modifiable factor for preventing or delaying the deteriorating effects of chronic illness, and is a key component of health promotion program. A sound health-related lifestyle measurement can assist in detecting older adults at risk of unhealthy lifestyles. It can also serve as an outcome measure of health promotion programs. The Health Enhancement Lifestyle Profile (HELP) is a measure that monitors one’s health-related lifestyle. It has been validated within the American population. Given that lifestyle is embedded within environmental and cultural contexts, the applicability of HELP for the Taiwanese elderly needs to be examined. Objectives: The purpose of the current study is to develop and validate the Chinese Version of Health Enhancement Lifestyle Profile (HELP-C) by translating the original one into Chinese version modifying the descriptions, adding the cultural specific items, and to examine the psychometric characteristics through the Rasch analysis. Methods: The original HELP was translated and cultural-adapted first, and cultural-specific items were added through 3 focus groups, forming a preliminary version of the HELP-C. The preliminary HELP-C was field-tested in a sample of 269 community-dwelling older adults. Items of the cultural specific items were selected based on the results of Rasch analysis. HELP-C formed up by adding the selected ones in to the original HELP. Psychometric properties such as uni-dimensionality, model-of fit, DIF, and rating scale validity of the HELP-C were investigated. Results: Considering cultural difference, 56 items were modified in examples and wording. In addition, 3 cultural-specific items were selected (total were 59 items) into the final HELP-C. Uni-dimensionality and data-model fit of HELP were generally supported through the analyses of Principal Components of Analysis (PCA) and fit statistics. Participants were not able to differentiate reliability between the 6-point rating scale, so category collapsing were made (3-point). The item hierarchy formed through logits provided an expected pattern of healthy lifestyle behaviors. Acceptable person separation and reliability statistics supported the clinical applicability and consistency of the HELP scores. “Diet”, “activities of daily living” and “other health promotion and risks behaviors” subscales were less consistency with the Rasch model characteristics, so that further investigation is needed. DIF items were allowed due to cultural differences. Finally, although 6 items were not fit the 3-point scale, analysis of the rating scale structure confirmed the functioning of the 0- to 2-point rating scale used. Conclusions: Lifestyle is embedded within environmental and cultural contexts. HELP-C was developed for Taiwanese elderly generation. It can assist in monitoring lifestyle risk factors and measuring the outcome of services aimed at promoting healthy lifestyles among older adults. However, future validation and modification of the HELP-C was needed.