Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
This study examined the psychometrics of the Elderly Lifestyle Profile (ELP) that measures individuals' lifestyle. The unidimensionality and data–model fit of the ELP were supported by the Rasch model. OTs working with community-dwelling elderly people can apply ELP to their clients, and the results can be incorporated into the evaluation and intervention planning process for improving health of clients.
Primary Author and Speaker: Kanghyun Park
Contributing Authors: Ji-Hyuk Park, Ickpyo Hong
PURPOSE: Lifestyle affects individual’s health and quality of life. Lifestyle also plays an important role in determining health and vitality among older adults. However, there is limited evidence about the lifestyle assessment. The Elderly Lifestyle Profile (ELP) is a newly developed questionnaire designed for screening and classifying individual’s lifestyle behavior. The ELP can provide guidance for individual’s lifestyle modification for enhancing their health and well-being. This study aims to examine the construct validity of the ELP using the Rasch measurement model.
DESIGN: A retrospective study design. The ELP consists of 16 items designed to represent the level of individual's satisfaction for their lifestyle, such as meaningful activity participation (n = 10) and diet (n = 6). People were asked to respond to each questions according to their typical routine during the last week. The two subscales consist of a 3-point rating scale, including (1) Always less/more than I want, (2) Sometimes less/more than I want, and (3) About right for me. The item-level psychometrics of the test items were analyzed with the rating scale model (Andrich, 1978).
METHODS: The study participants were community-dwelling older adults in South Korea who had intact cognitive function and communication skills. Convenience and snowball sampling methods were used to recruit participants from various community sites. Psychometric characteristics were examined for the ELP, including unidimensionality, fit statistics, item difficulty hierarchy, and person separation index. A confirmatory factor analysis (CFA) with one-factor solution was used to test the unidimensionality assumption of the ELP. The CFA model fit criteria include Root Mean Square Error of Approximation (RMSEA < 0.08), comparative fit index (CFI > 0.95), and Tucker Lewis index (TLI > 0.95). Item fit was examined using infit (information weighted) mean-square and standardized fit statistics. Rasch anlaysis was conducted using the WINSTEPS Version 4.4.5. program.
RESULTS: A total of 144 older adults were recruited for this study. Four were excluded form data analysis because these participants did not complete the full sets of the test items. The remaining 140 participants consisted of 87 females (60.4%). Participants' mean age was 74.0 years old (SD = 11.0) with a range of 55 to 96 years. The CFA demonstrated the meaningful activity participation and nutrition subscales met the unidimensionality assumption (RMSEA = 0.066, 0.00; CFI = 0.972, 1.00; TLI = 0.964, 1.00, respectively). None of the test items in both subscales misfit the Rasch model. There was a conceptual item difficulty hierarchy among the test items. The item difficulty hierarchy formed through logits provided an expected pattern of lifestyle behaviors for improving health and quality of life of old adults. The person strata value of the meaningful activity participation and nutrition was 5.37 and 1.33 which are equivalent to a conventional reliability index value of .94 and .50, respectively.
CONCLUSION: The Rasch analysis demonstrated that the two subscales of the ELP represented a unidimensional construct and conceptually logical item difficulty hierarchy. The item-level Rasch analysis supports the preliminary psychometric properties of the ELP. The 16 items of the ELP provide a holistic viewpoint of a wide range of the satisfaction of elderly's daily lifestyle.
IMPACT STATEMENT: The good psychometrics of the ELP will support its utilization in community health-care settings. Occupational therapists working with community-dwelling elderly can apply the ELP to their clients and the results can be incorporate into the evaluation and intervention planning process for improving their daily lifestyle.
References
Andrich, D. A. (1978). A rating formulation for ordered response categories. Psychometrika, 43, 561–73
Kurth, T., Moore, S., Gaziano, M., & Kase, C. (2006). Healthy lifestyle and the risk of stroke in women. Archives of Internal Medicine, 166 (13), 1403-1409. https://doi.org/10.1001/archinte.166. 13.1403
