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Development and validation of a short-form suboptimal health status questionnaire

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Abstract

Background

Suboptimal health status (SHS) is a reversible, borderline state between optimal health and disease. Although this condition’s definition is widely understood, related questionnaires must be developed to identify individuals with SHS in various populations relative to predictive, preventive, and personalized medicine (PPPM/3PM). This study presents a short-form suboptimal health status questionnaire (SHSQ-SF) that appears to possess sufficient reliability and validity to assess SHS in large-scale populations.

Methods

A total of 6183 participants enrolled from Southern China constituted a training set, while 4113 participants from Northern China constituted an external validation set. The SHSQ-SF includes nine key items from the Suboptimal Health Status Questionnaire-25 (SHSQ-25), an instrument that has been applied to Africans, Asians, and Caucasians. Item analysis and reliability and validity tests were carried out to validate the SHSQ-SF. The receiver operating characteristic (ROC) curve was used to identify an optimal cutoff value for SHS diagnosis, by which the area under the curve (AUC) and 95% confidence interval (CI) were determined.

Results

Cronbach’s α coefficient for the training dataset was 0.902; the split-half reliability was 0.863. The Kaiser–Meyer–Olkin (KMO) value was 0.880, and Bartlett’s test of sphericity was significant (χ2 = 32,929.680, p < 0.05). Both Kaiser’s criteria (eigenvalues > 1) and the scree plot revealed one factor explaining 57.008% of the total variance. Standardized factor loadings for the confirmatory factor analysis (CFA) indices ranged between 0.58 and 0.74, with χ2/dƒ = 4.972, GFI = 0.996, CFI = 0.996, RFI = 0.989, and RMSEA = 0.031. The AUC was equal to 0.985 (95% CI: 0.983–0.988) for the training dataset. A cutoff value (≥ 11) was then identified for SHS diagnosis. The SHSQ-SF showed good discriminatory power for the external validation dataset (AUC = 0.975, 95% CI: 0.971–0.979) with a sensitivity of 96.2% and a specificity of 87.4%.

Conclusions

We developed a short form of the SHS questionnaire that demonstrated sound reliability and validity when assessing SHS in Chinese residents. From a PPPM/3PM perspective, the SHSQ-SF is recommended for the rapid screening of individuals with SHS in large-scale populations.

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Data availability

The data are available from the corresponding authors on a reasonable request.

Code availability

Not applicable.

Abbreviations

AUC :

Area under the curve

AVE :

Average variance extracted

CFA :

Confirmatory factor analysis

CFI :

Comparative fit index

CI :

Confidence interval

CITC :

Corrected item-total correlation

C.R. :

Critical ratio

CR :

Composite reliability

CSHES :

Chinese Sub-health State Evaluation Scale

CVD :

Cardiovascular disease

df :

Degree of freedom

EFA :

Exploratory factor analysis

GFI :

Goodness-of-fit index

KMO :

Kaiser–Meyer–Olkin

MI :

Modified index

MSQA :

Multidimensional sub-health questionnaire of adolescents

NCDs :

Non-communicable diseases

NFI :

Normed fit index

PPPM/3PM :

Predictive, preventive, and personalized medicine

RFI :

Relative fit index

RMSEA :

Root-mean-square error of approximation

ROC :

Receiver operating characteristic

SD :

Standard deviation

S.E. :

Standard error

Se :

Sensitivity

SHMS V1.0 :

Sub-health Measurement Scale Version1.0

SHS :

Suboptimal health status

SHSQ-25 :

Suboptimal health status questionnaire-25

SHSQ-SF :

Short-form suboptimal health status questionnaire

SMC :

Squared multiple correlation

Sp :

Specificity

SSS :

Sub-Health Self-Rating Scale

t :

t-statistic

T2DM :

Diabetes mellitus type 2

WHO :

World Health Organization

YI :

Youden’s index

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Acknowledgements

We would like to thank the participants who participated in the study for their consent and involvement in this investigation.

Funding

This work was supported by the Natural Science Foundation of Shandong Province (ZR2022MH082) and the Scientific Research Foundation of Education Department of Yunnan Province (2021J1359).

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Author notes

  1. Shuyu Sun, Hongzhi Liu, and Zheng Guo contributed equally.

Authors and Affiliations

  1. School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, **an, China

    Shuyu Sun, Hongzhi Liu, Qihua Guan, Yinghao Wang, Jie Wang & Haifeng Hou

  2. Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA

    Zheng Guo

  3. School of Rehabilitation and Nursing, Yunnan Medical Health College, Kunming, China

    Yan Qi

  4. Bei**g Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Bei**g, China

    Yuxiang Yan & Youxin Wang

  5. Centre for Precision Health, Edith Cowan University, Perth, Australia

    Jun Wen

  6. The Second Affiliated Hospital of Shandong First Medical University, Taian, China

    Haifeng Hou

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  1. Shuyu Sun
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Contributions

Haifeng Hou conceived the study and guided the development of research and the preparation of manuscripts. Shuyu Sun, Hongzhi Liu, Zheng Guo, Qihua Guan, Yinghao Wang, Jie Wang, and Yan Qi performed the material preparation and data collection. Shuyu Sun, Hongzhi Liu, and Zheng Guo researched data, performed statistical analyses, and wrote the manuscript. Yuxiang Yan, Youxin Wang, and Jun Wen provided critical expert advice or critical review of the current manuscript. All authors read and approved the final manuscript.

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Correspondence to Haifeng Hou.

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The Ethics Committee of Shandong First Medical University (SDFMU) approved this study.

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All procedures performed in the study involving human participants were in accordance with the principles outlined in the Helsinki Declaration. All participants were required to sign an informed consent form before being enrolled in this study.

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Sun, S., Liu, H., Guo, Z. et al. Development and validation of a short-form suboptimal health status questionnaire. EPMA Journal 14, 601–612 (2023). https://doi.org/10.1007/s13167-023-00339-z

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