The Concept of Health Scale: Development and Psychometric Testing

The purpose of this study was to develop an instrument to measure the concept of health for people with chronic illness, investigate its contributing factors and the relative contribution of these factors, and analyze its reliability and validity. The concept of health was initially conceptualized as a measurable state through an exhaustive literature review and drawing from previous clinical nursing experience of the researcher with chronically ill people. The originally developed Concept of Health Scale (CHS) consisted of 48 items representing three dimensions of the concept of health with each dimension a manifestation of the concept of health. It was revised following scrutiny by a panel of experts. Then the data gathered from 80 Taiwanese people with chronic illness were subjected to item analysis and exploratory factor analysis. Dimension-to-total correlation was computed to determine the relationship of each dimension to the total index score. It was found that there was high correlation and statistical significance in the CHS. Hence, the dimensions presented in the CHS are appropriate. A series of exploratory factor analyses using maximum likelihood with a promax rotation was performed to investigate the item factor structure of each dimension of the CHS. In the physical dimension, two factors, physical functioning and independence, were required to describe the data. A scree plot indicated that two factors in the psychosocial dimension (zest for life and contentment in social interaction) would best fit the data. In the spiritual dimension two factors, meaning and serenity, explained the data. Test-retest reliability after six weeks with 32 people with chronic illness showed a Pearson correlation coefficient of 0.81 for the CHS; the three dimensions were 0.83 (physical dimension), 0.81 (psychosocial dimension) and 0.79 (spiritual dimensioan) respectively. Cronbach's alpha for the subscales was physical 0.94, psychosocial 0.93, and spiritual 0.85. This study shows that the Chinese version of the CHS has been employed with Taiwanese people with chronic illness with remarkable reliability and validity.