Parkerson George R, Eisenson Howard J, Campbell Colin
Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC, United States.
Lincoln Community Health Center, Durham, NC, United States.
Front Public Health. 2019 Sep 4;7:248. doi: 10.3389/fpubh.2019.00248. eCollection 2019.
Our purpose was to develop and test a brief, self-report, and scorable survey instrument for measuring population health profiles from the individual respondent's perspective. We defined population health as the state of physical, mental, and social well-being of a group of individuals, including determinants of their well-being. Respondents were adult patients in a community health center. Instrument items, an overall scale, and two subscales were developed and evaluated. Reliability was tested by Cronbach's alphas and test-retest correlations; construct validity was tested by correlations between scores and economic and clinical factors; criterion validity was tested by regression analyses for prediction of morbidity and health care utilization by baseline scores; and feasibility was tested by length of administration time. This was a 2-years prospective study of 450 patients, mostly black non-Hispanics (54%) and Hispanics (29%), many with no health insurance (45%), and poor enough to meet the federal poverty level (73%). The Duke Population Health Profile (Duke-PH) was developed with a 14-item PH scale for overall population health profile and two 7-item subscales, one for social determinants and the other for health determinants. Validity of item selection was indicated by item convergent and item discriminant correlations. Scale and subscale reliability were supported for internal consistency by Cronbach's alphas of 0.63-0.73, and for temporal stability by test-retest correlations of 0.65-0.78. Support for construct validity was shown by the more favorable baseline subscale and scale mean scores for patients able to buy private insurance than for patients unable to afford it. Criterion validity was supported by regression analyses showing that baseline scale and subscale scores predicted both baseline morbidity and 6-months utilization. Feasibility was shown by the mean self-administration time of 3.9 min and mean interviewer-administration time of 5.8 min. The strength of this study is support for Duke-PH reliability, validity, and feasibility in a community health center patient population. The new instrument is unique because it measures both social and health determinants of population health from the perspective of individuals in the population.
我们的目的是开发并测试一种简短、可自我报告且可评分的调查工具，用于从个体受访者的角度衡量人群健康状况。我们将人群健康定义为一组个体的身体、心理和社会福祉状态，包括其福祉的决定因素。受访者为社区健康中心的成年患者。我们开发并评估了工具项目、一个总体量表和两个子量表。通过克朗巴哈系数和重测相关性来测试信度；通过分数与经济及临床因素之间的相关性来测试结构效度；通过回归分析以基线分数预测发病率和医疗保健利用率来测试标准效度；通过施测时间长度来测试可行性。这是一项对450名患者进行的为期两年的前瞻性研究，这些患者大多是非西班牙裔黑人（54%）和西班牙裔（29%），许多人没有医疗保险（45%），且贫困程度足以达到联邦贫困线（73%）。杜克人群健康状况量表（Duke-PH）是用一个包含14个项目的PH量表来衡量总体人群健康状况，以及两个包含7个项目的子量表，一个用于社会决定因素，另一个用于健康决定因素。项目选择的效度通过项目收敛和项目区分相关性来表明。量表和子量表的信度在内部一致性方面得到了克朗巴哈系数0.63 - 0.73的支持，在时间稳定性方面得到了重测相关性0.65 - 0.78的支持。能够购买私人保险的患者在基线子量表和量表平均得分方面比无力购买的患者更有利，这表明了对结构效度的支持。回归分析表明基线量表和子量表分数能够预测基线发病率和6个月的医疗保健利用率，这支持了标准效度。自我施测平均时间为3.9分钟，访谈者施测平均时间为5.8分钟，这表明了可行性。本研究的优势在于支持了杜克-PH在社区健康中心患者群体中的信度、效度和可行性。这种新工具很独特，因为它从人群中个体的角度衡量了人群健康的社会和健康决定因素。
