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      The development and evaluation of a sub-health self-rating scale for university students in China

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          Abstract

          Background

          Sub-health status is defined as declines in vitality, physiological function and capacity for adaptation, but without the presence of clinical or sub-clinical disease. We have developed and evaluated a comprehensive questionnaire, the Sub-Health Self-Rating Scale (SSS), to assess sub-health status in university students.

          Method

          The items for the draft questionnaire were discussed in focus groups. The WHOQOL-BREF was selected as the validity reference. From a professional perspective and large sample evaluation, the scale ultimately consisted of 58 items. The reliability and validity of the SSS was examined in undergraduate students and 1000 questionnaires were randomly selected from the samples for expert evaluation.

          Results

          Cronbach’s α of the total scale was 0.942. The dimensions of physiological, psychological and social had high reliability: 0.915, 0.856 and 0.850, respectively. Based on scree plot and related theories, there were 10 factors to be extracted. The correlation coefficient between the total scale and sub-scale was high. The dimensions of physiological, psychological and social had high correlations with the total scale: 0.929, 0.803 and 0.774, respectively. The sub-health cut-off point of the total scale was 72; for the physiological field, it was 72; for the psychological field, it was 60; and the social field, it was 56. The fit between the expert evaluation method and the scale method was 0.758. The lower the score, the worse the health condition.

          Conclusion

          We established and evaluated a valid instrument (SSS) that encompasses physiological, psychological and social factors to investigate sub-health status. It is short and easy to complete, and therefore suitable for use with undergraduate students.

          Electronic supplementary material

          The online version of this article (10.1186/s12889-019-6650-3) contains supplementary material, which is available to authorized users.

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          Most cited references20

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          Optimal cut-point and its corresponding Youden Index to discriminate individuals using pooled blood samples.

          Stephen J. Perkins, Aiyi Liu, Howard Bondell … (2004)
          Costs can hamper the evaluation of the effectiveness of new biomarkers. Analysis of smaller numbers of pooled specimens has been shown to be a useful cost-cutting technique. The Youden index (J), a function of sensitivity (q) and specificity (p), is a commonly used measure of overall diagnostic effectiveness. More importantly, J is the maximum vertical distance or difference between the ROC curve and the diagonal or chance line; it occurs at the cut-point that optimizes the biomarker's differentiating ability when equal weight is given to sensitivity and specificity. Using the additive property of the gamma and normal distributions, we present a method to estimate the Youden index and the optimal cut-point, and extend its applications to pooled samples. We study the effect of pooling when only a fixed number of individuals are available for testing, and pooling is carried out to save on the number of assays. We measure loss of information by the change in root mean squared error of the estimates of the optimal cut-point and the Youden index, and we study the extent of this loss via a simulation study. In conclusion, pooling can result in a substantial cost reduction while preserving the effectiveness of estimators, especially when the pool size is not very large.
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            The Preamble of the Constitution of the World Health Organization.

            Frank Grad (2002)
            Article 0 comments Cited 70 times – based on 0 reviews     Review now
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              Association of lifestyle factors and suboptimal health status: a cross-sectional study of Chinese students

              Jianlu Bi, Ying Huang, Ya Xiao … (2014)
              Objectives Suboptimal health status (SHS) is considered to be an intermediate status between disease and health, and is characterised by a decline in vitality, in physiological function and in the capacity for adaptation. Although the incidence of SHS is high, the underlying causes remain unclear. Lifestyle is one of the most important factors affecting health status; however, the relationship between SHS and lifestyle has not been elucidated. Design Cross-sectional survey. Setting A questionnaire, based on ‘Health Promoting Lifestyle Profile-II (HPLP-II)’ and ‘Sub-Health Measurement Scale V1.0 (SHMS V1.0)’, was sent to four colleges in four districts (Guangzhou, Foshan, Zhanjiang and Shaoguan) of China between May and July 2013. Participants A total of 12 429 questionnaires were distributed during the study period, and 11 144 completed responses were received. Results The prevalence rates for the ‘healthy’, ‘SHS’ and ‘disease’ groups of respondents (students) were 22.81% (2542), 55.9% (6234) and 21.25% (2368), respectively. Most of the students reported a ‘moderate’ or ‘good’ lifestyle. There were significant differences in lifestyle and health status between the two genders. It was notable that health status was significantly positively correlated with lifestyle (r=0.563). For every dimension of the HPLP-II model, the mean values were lower for those participants who reported as ‘SHS’ or ‘disease’ than for those who reported that they were ‘healthy’. The individual dimensions of the HPLP-II model, including ‘spiritual growth’, ‘health responsibility’, ‘physical activity’, ‘interpersonal relations’ and ‘stress management’ were all related to SHS. Conclusions Health status is significantly positively correlated with lifestyle. Poor lifestyle is a risk factor for SHS. Conversely, adopting a healthier lifestyle can improve SHS. Trial registration number ChiCTR-OCH-12002317.
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                Author and article information

                Contributors
                Jian-lu Bi: 116706379@qq.com
                Jing Chen: 739825878@qq.com
                Xiao-min Sun: 332673508@qq.com
                Xiao-li Nie: 316581736@qq.com
                Yan-yan Liu: 799042406@qq.com
                Ren Luo: luoren@wo.com.cn
                Xiao-shan Zhao: zhaoxs0609@163.com
                Journal
                Journal ID (nlm-ta): BMC Public Health
                Journal ID (iso-abbrev): BMC Public Health
                Title: BMC Public Health
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2458
                Publication date (Electronic): 21 March 2019
                Publication date PMC-release: 21 March 2019
                Publication date Collection: 2019
                Volume: 19
                Electronic Location Identifier: 330
                Affiliations
                [1 ]Endocrinology Department, Guangdong Second Traditional Chinese medicine Hospital, Guangzhou, 510095 Guangdong China
                [2 ]ISNI 0000 0000 8877 7471, GRID grid.284723.8, School of Traditional Chinese Medicine, , Southern Medical University, ; Guangzhou, 510515 Guangdong China
                [3 ]ISNI 0000 0001 0040 0205, GRID grid.411851.8, Hospital of Guangdong University of Technology, , Guangdong University of Technology, ; Guangzhou, 510006 Guangdong China
                Article
                Publisher ID: 6650
                DOI: 10.1186/s12889-019-6650-3
                PMC ID: 6429791
                PubMed ID: 30898160
                SO-VID: 216d9786-b38e-4b67-a247-8aff17517001
                Copyright © © The Author(s). 2019
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 7 August 2018
                Date accepted : 12 March 2019
                Funding
                Funded by: NSFC-Guangdong joint fund
                Award ID: U1132001
                Award Recipient :
                Funded by: the National Science Foundation of China
                Award ID: 81703891
                Funded by: TCM State Administration Foundation of Guangdong Province, China
                Award ID: 20161014
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2019

                ScienceOpen disciplines: Public health
                Keywords: sub-health,questionnaire,reliability,validity,university students
                Data availability:
                ScienceOpen disciplines: Public health
                Keywords: sub-health, questionnaire, reliability, validity, university students

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