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      Development and psychometric evaluation of a Positive Health measurement scale: a factor analysis study based on a Dutch population

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          Abstract

          Objectives

          The My Positive Health (MPH) dialogue tool is increasingly adopted by healthcare professionals in the Netherlands as well as abroad to support people in their health. Given this trend, the need arises to measure effects of interventions on the Positive Health dimensions. However, the dialogue tool was not developed for this purpose. Therefore, this study aims to work towards a suitable measurement scale using the MPH dialogue tool as starting point.

          Design

          A cross-sectional study design.

          Participants and settings

          A total of 708 respondents, who were all members of the municipal health service panel in the eastern part of the Netherlands, completed the MPH dialogue tool.

          Methods

          The factor structure of the MPH dialogue tool was explored through exploratory factor analysis using maximum likelihood extraction. Next, the fit of the extracted factor structure was tested through confirmatory factor analysis. Reliability and discriminant validity of both a new model and the MPH scales were assessed through Cronbach’s alpha tests.

          Results

          Similar to the MPH dialogue tool, the extracted 17-item model has a six-factor structure but named differently, comprising the factors physical fitness, mental functions, future perspectives, contentment, social relations and health management. The reliability tests suggest good to very good reliability of the aimed measurement tool and MPH model (Cronbach’s alpha values ranging from, respectively, 0.820 to 0.920 and 0.882 to 0.933). The measurement model shows acceptable discriminant validity, whereas the MPH model suggests overlap between domains.

          Conclusion

          The results suggest that the current MPH dialogue tool seems reliable as a dialogue, but it is not suitable as a measurement scale. We therefore propose a 17-item model with improved, acceptable psychometric properties which can serve as a basis for further development of a measurement scale.

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          Most cited references41

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          Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives

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            lavaan: AnRPackage for Structural Equation Modeling

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              Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study.

              Long-term disorders are the main challenge facing health-care systems worldwide, but health systems are largely configured for individual diseases rather than multimorbidity. We examined the distribution of multimorbidity, and of comorbidity of physical and mental health disorders, in relation to age and socioeconomic deprivation. In a cross-sectional study we extracted data on 40 morbidities from a database of 1,751,841 people registered with 314 medical practices in Scotland as of March, 2007. We analysed the data according to the number of morbidities, disorder type (physical or mental), sex, age, and socioeconomic status. We defined multimorbidity as the presence of two or more disorders. 42·2% (95% CI 42·1-42·3) of all patients had one or more morbidities, and 23·2% (23·08-23·21) were multimorbid. Although the prevalence of multimorbidity increased substantially with age and was present in most people aged 65 years and older, the absolute number of people with multimorbidity was higher in those younger than 65 years (210,500 vs 194,996). Onset of multimorbidity occurred 10-15 years earlier in people living in the most deprived areas compared with the most affluent, with socioeconomic deprivation particularly associated with multimorbidity that included mental health disorders (prevalence of both physical and mental health disorder 11·0%, 95% CI 10·9-11·2% in most deprived area vs 5·9%, 5·8%-6·0% in least deprived). The presence of a mental health disorder increased as the number of physical morbidities increased (adjusted odds ratio 6·74, 95% CI 6·59-6·90 for five or more disorders vs 1·95, 1·93-1·98 for one disorder), and was much greater in more deprived than in less deprived people (2·28, 2·21-2·32 vs 1·08, 1·05-1·11). Our findings challenge the single-disease framework by which most health care, medical research, and medical education is configured. A complementary strategy is needed, supporting generalist clinicians to provide personalised, comprehensive continuity of care, especially in socioeconomically deprived areas. Scottish Government Chief Scientist Office. Copyright © 2012 Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2021
                5 February 2021
                : 11
                : 2
                : e040816
                Affiliations
                [1 ] Institute for Positive Health , Utrecht, The Netherlands
                [2 ] Salut , Arnhem, The Netherlands
                [3 ] departmentSchool of Business and Economics , Vrije Universiteit Amsterdam , Amsterdam, Noord-Holland, The Netherlands
                [4 ] GGD Twente , Enschede, Overijssel, The Netherlands
                [5 ] departmentBiomedical Data Sciences , Leiden University Medical Center , Leiden, The Netherlands
                Author notes
                [Correspondence to ] Dr Marja Van Vliet; m.vanvliet@ 123456iph.nl
                Author information
                http://orcid.org/0000-0002-0178-2046
                http://orcid.org/0000-0001-9711-4167
                Article
                bmjopen-2020-040816
                10.1136/bmjopen-2020-040816
                7925905
                33550237
                3e4a319c-ecee-48ba-a370-ca64b6e2c9ab
                © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 22 May 2020
                : 14 December 2020
                : 27 December 2020
                Categories
                Public Health
                1506
                1724
                Original research
                Custom metadata
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                Medicine
                quality in healthcare,health economics,preventive medicine,primary care,public health,statistics & research methods

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