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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 2  |  Issue : 1  |  Page : 8-12

Development and validation of self-recorded swasthya assessment scale


1 AMO, Govt. Ayurvedic Dispensary, Andola, Jajpur, Odisha, India
2 Department of Swasthavritta, All India Institute of Ayurveda, New Delhi, India
3 Department of Swasthavritta and Yoga, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Date of Submission18-Feb-2021
Date of Decision26-Feb-2021
Date of Acceptance05-Mar-2021
Date of Web Publication17-Apr-2021

Correspondence Address:
Prajna Paramita Panda
AMO, GAD Andola, Jajpur, Odisha - 755 007
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijaim.ijaim_3_21

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  Abstract 


Background: The Self-Recorded Swasthya Assessment Scale (SRSAS) is intended to develop a comprehensive questionnaire to assess the health status of an individual. SRSAS has three sections, namely physical, mental, and social health.
Materials and Methods: The questionnaire has been prepared based on physical, mental, and social health parameters. In section 1, the questions of the physical fitness component are derived from International Fitness Scale and the questions of physical ill-health component are prepared on the basis of Swastha criteria described in literature from Charaka Samhita, Sushruta Samhita, and Kashyapa Samhita. In section 2, the mental toughness questions are prepared based on Ayurveda parameters and MTQ-48 and mental ill-health questions are prepared from Ayurveda parameters and guidelines of the American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders 5th Edition. The health status will be assessed based on the self-recorded response of the subjects. The time frame for the questions is the PAST WEEK. The questionnaire is designed to assess subject's USUAL abilities in their routine environment.
Results: The questionnaire was administrated on 117 individuals. The data collected were statistically analyzed for internal consistency by Cronbach's alpha and for sampling adequacy by Kaiser–Meyer–Olkin (KMO) test. The Cronbach's alpha for the fitness group of questions and ill-health group of questions were 0.832 and 0.799, respectively. The KMO value for the fitness group of questions and ill-health group of questions were 0.791 and 0.588, respectively.
Conclusion: The Cronbach's alpha and KMO value showing the internal consistency and sampling adequacy are acceptable. It is concluded that the questionnaire is reliable and valid to use to assess the health status of an individual according to Ayurveda.

Keywords: Ayurveda, mental health, physical health, social health


How to cite this article:
Panda PP, Harti SS, Rao MV. Development and validation of self-recorded swasthya assessment scale. Indian J Ayurveda lntegr Med 2021;2:8-12

How to cite this URL:
Panda PP, Harti SS, Rao MV. Development and validation of self-recorded swasthya assessment scale. Indian J Ayurveda lntegr Med [serial online] 2021 [cited 2021 Oct 25];2:8-12. Available from: http://www.ijaim.com/text.asp?2021/2/1/8/313995




  Introduction Top


Health is a state of complete physical, mental, and social well-being and not merely an absence of disease or infirmity.[1] Although perfect health is one of the cherished wish of all individuals, still misery is an in evitable part of life. Health is a state of balance between Dosha (vata, pitta, and kapha), Dhatu (body humors), Agni (factor responsible for digestion, assimilation, and metabolism), proper Malakriya (excretory functions) along with the peaceful mind.[2] In some other literature, the detailed description of health is available as good appetite, digestion, excretion, lightness of body, joyful mind, good sleep, possessing good body strength, luster, and longevity of life.[3] According to Acharya Charaka along with these factors, the tolerating capacity to hunger, thirst, sunray, cold environment, and exertion are also the parameters to determine health.[4] The recent definition of health also describes the above in various domains.

Many research works such as Health Assessment Questionnaire (HAQ),[5] HAQ-Disability Index,[6] Multi-Dimensional Health Assessment Questionnaire,[7] Short Form Health Survey-36,[8] EuroQol-5D-5L,[9] etc., are available as a partial health assessment Performa. These questionnaires are disease specific, age specific, for a diseased person or to measure one dimension of health like psychological state assessment performa, etc. However, there is no such tool till now which can assess the health status as a holistic manner considering all dimensions of health in Ayurveda.

Hence, we have tried to develop the Self-Recorded Swasthya Assessment Scale (SRSAS) in the form of a comprehensive questionnaire to assess the health status of an individual. The questionnaire does not apply for the patients who are under medication. The SRSAS will help the researchers and clinicians to quantify the health status of an individual.

Aims and objectives

The aim of this study was to frame and validate the Self-Recorded Swasthya Assessment Scale (SRSAS) to assess the health status of individuals.


  Materials and Methods Top


Framing the Self-Recorded Swasthya Assessment Scale

SRSAS has three main sections, namely physical, mental, and social health; physical health and mental health again containing subsections as fitness scale and ill-health scale. In section 1, the questions of the physical fitness component are taken from International Fitness Scale and the questions of physical ill-health component are prepared on the basis of Swastha criteria described in Charaka Samhita,[10] Sushruta Samhita,[2] and Kashyapa Samhita.[3] Acharya Charaka's version of health status mainly is inclined toward physical health which were considered while framing the questions. Acharya Sushruta's health assessment is based on the balance of Dosha, Agni, Dhatu, and Mala along with the balanced state of mind.[2] The state of Samadoshata implies the normal function of Dosha (Prakrit Karma)[11] limited to normal variation based on Prakriti, Kala, Desha, etc., and devoid of Dosha Vriddhi[12] and Kshaya Lakshanas.[13] The questionnaire was built taking into consideration of the above factors. Acharya Kashyapa's version of health assessment factors such as good appetite, digestion, excretion, lightness of body, joyful mind, good sleep, possessing good body strength, luster, and longevity of life[3] were also taken into consideration while framing.

In section 2, the mental toughness questions are prepared based on Ayurveda parameters and MTQ-48,[14] and mental ill-health questions are prepared from Ayurveda parameters[15] and guidelines of the American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders 5th Edition.[16] The health status will be assessed based on the self-recorded response of the subjects.

The questionnaire was prepared and sent for experts' review. The suggestions were taken and questionnaire was reframed.

Generation of items and scoring convention

The questionnaire consists of statements on the good health signs along with the health assessment parameters described in Ayurveda. There are three sections and five subsections in this questionnaire. There are 47 questionnaires in total: physical domain – 31, mental domain – 11, and social domain – 5 [Table 1].
Table 1: Question distribution pattern

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The scoring of fitness subsections of physical health and mental health is based on Likert's scale ranging from 1 to 5; 1 being “very poor” to 5 being “very good” in physical component, and 1 being “almost never” to 5 being “always” in mental component.

The scoring of ill-health subsection of physical and mental health has initially a dichotomous response in the format – “yes or no.” If the response is “no,” it is the optimum health. But if the response is “yes,” then the score of the ill-health status is taken on the basis of Likert's scale, ranging from 1 being mild to 5 being very severe/poorest level of the condition.

The scoring of social health is also based on the Likert's scale ranging from 1 to 5; 1 being “not good” to 5 being “excellent.”

The final score of the questionnaire was calculated as (1) fitness score and (2) ill-health score. In fitness component, the maximum score is 80 and minimum score is 16. In ill-health component, maximum score is 155 and the minimum score is 0. In case of fitness, higher the score the better the health status, and in case of ill health, the lower the score the better is the health status.

Outcomes

Test of items

The SRSAS is usually self-administered, but can also be given face-to-face in a clinical setting or in a telephone interview format by trained outcome assessors. The time frame for the questions is the past week. The questionnaire is designed to assess subject's usual abilities in their routine environment. The questionnaire was administered on 117 individuals.

Methodology

Content validation of a questionnaire helps one determine as to how well the individual items in the questionnaire correspond to the concept being examined. It is usually tested using qualitative techniques. Content validation of the questionnaire assessing the state of health was done using references available in the classics of Ayurveda. The feasibility of measurement of the selected variable was crossvalidated by Ayurveda experts for its suitability as a dependable parameter to identify the dominance of the particular state of health.

The questionnaire framed was administered to four different groups, namely Ayurveda academicians, Ayurveda practitioners, Ayurveda postgraduates, and also the general public those who had not come across Ayurveda. Based on their suggestions, the questionnaire was refined at different levels.

Internal consistency

Internal consistency is typically a measure based on the correlations between different items in the same test (or the same subscale for a larger test). It measures whether several items that are proposed to measure the same general construct produce similar scores. Internal consistency was measured with Cronbach's alpha. Split-half reliability was also applied to test the internal consistency of the questionnaire. Split-half reliability is used to measure the equivalence of two halves of the questionnaire.

Factor analysis

Factor analysis is used to identify underlying dimensions, or factors, those explain the correlations among a set of variables.[17]

The Kaiser–Meyer–Olkin (KMO) measure of sampling adequacy is applied to examine the appropriateness of factor analysis separately on fitness and ill-health group of questions. After getting an acceptable KMO value, principal component analysis (PCA) was done for factor analysis.

Study and administration of the questionnaire

The study consisted of 117 volunteers of both the gender living in and around Delhi NCR. The individuals who were under medication or unwilling to be a part of this study were excluded from the study. The participant characteristic is given in [Table 2].
Table 2: Participant characteristic in exploratory factor analysis

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Execution of test

Consent was taken from the subjects included in the study and they were informed about the importance and subject of study in brief along with their role. The questionnaire also collects the demographic data of the individual.


  Results Top


Design

The questionnaire was designed from various sources keeping the Ayurveda classical statements on good health in mind. The questionnaire was available in both the languages, i.e., Hindi and English. For a better Cronbach's alpha value, the statements were managed.

Construct validity

Exploratory factor analysis

The tool crafted then was administered to randomly chosen individuals for exploratory factor analysis (EFA) and further after deletion and reframing of the items which either had low correlations (<0.3) or factor loading (<0.3); the tool was reconstructed.

Sample size

The sample size was calculated keeping in mind two rules, the minimum sample size rule and the sample to variable ratio.

The most commonly used methods were minimum sample size should be 100 (Gorsuch, 1983 and Kline, 1979) and the ratio of variable to sample should be 5:1 (Bryant and Yarnold, 1995, David Garson, 2008).

The sample size calculated for EFA was based on the rule of the minimum sample; the sample size for EFA was 117.

Participant characteristics

A total of 117 participants were taken for construct validity with a response rate of 100%.

The KMO and Bartlett's test has the following results. The KMO value for ill health group of questions is 0.588 [Table 3] and fitness group of questions is 0.791 [Table 4].
Table 3: Results of initial Kaiser-Meyer-Olkin and Bartlett's test for ill health

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Table 4: Results for initial Kaiser-Meyer-Olkin Bartlett's test for fitness

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The KMO value of measuring sampling adequacy between 0.8 and 0.5 is acceptable. However, the approximate Chi-square and the significance are adequate; we proceed further for principal component analysis.

When PCA was done, all the items showed correlations above 0.3 in all the components; the total variance was 66% in ill-health data and 60% in fitness data (above 60%–70% is acceptable).

Conclusion of principal component analysis

According to PCA, none of the items in both domains of the questionnaires were found to be drifting away from the basic construct and hence, no items were removed.

Reliability

The Cronbach's alpha for reliability was conducted in two phases. In the first phase, the test was conducted for all the fitness questions, and in the second phase for ill-health questions. This was done as the scoring pattern in fitness questions is in reverse order as in ill-health questions. The Cronbach's alpha for the fitness group of questions was 0.832 and Cronbach's alpha for ill-health group of questions was 0.799 [Table 5].
Table 5: Cronbach's alpha for fitness and ill-health group of questions

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After getting a satisfactory level of Cronbach's alpha coefficient split-half reliability test was performed.

In the fitness group of questions, the Cronbach's alpha was 0.735 and 0.807 for part 1 and part 2, respectively [Table 6]. It shows both the parts contribute equally to measure the fitness of an individual.
Table 6: Split-half for fitness group of questions

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In the ill-health group of questions, the Cronbach's alpha was 0.748 and 0.705 for part 1 and part 2, respectively [Table 7]. It shows both the parts contribute equally to measure the ill health of an individual.
Table 7: Split-half test for ill-health group of questions

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Implication of results

This questionnaire can be utilized for assessment of health in clinical setup and for research purpose.


  Discussion Top


The rule of thumb in the interpretation of Cronbach's alpha is > 0.9: excellent, >0.8: good, 0.7: acceptable, >0.6: questionable, >0.5: poor, and <0.5: unacceptable.[18] The value obtained for Cronbach's alpha internal consistency of the fitness group of questions and ill-health assessment group of questions were 0.832 and 0.799, respectively [Table 5]. These values show that the internal consistency of the questionnaire is good.

Split-half reliability is a measure of equivalence and each half should give value of alpha more than 0.7; the value of alpha for both ill health and fitness has values more than 0.7 for both the halves, thus making the scale reliable.

The KMO measures the sampling adequacy. It should be >0.5 for a satisfactory factor analysis. The KMO value obtained for the fitness group of questions and ill-health assessment group of questions were 0.787 and 0.588, respectively. Hence, the sample was adequate to conduct the factor analysis.

The factor analysis is done in the two phases – EFA and the confirmatory factor analysis. EFA gives the relation between the variables and those having less correlation is deemed less valid. This helps in simplifying the data. For item reduction, PCA was done and those items having correlation <0.3 are considered insignificant;[19] none of the items were found to have correlations <0.3 hence none were removed.

The strength of the relationship among variables is tested by Bartlett's test. The Bartlett's test of the questionnaire is 0.000 and hence is significant.


  Conclusion Top


The developed scale consists of 3 domains and 47 items. The scale was tested for face validity, content validity, and construct validity and reliability with Cronbach's alpha and split-half value above 0.7. The developed questionnaire appears to be acceptable tool for assessing the health status of healthy individuals. This questionnaire will state the health status of the individual in the health spectrum.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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