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Journal of Chinese Integrative Medicine ›› 2008, Vol. 6 ›› Issue (7): 682-689.doi: 10.3736/jcim20080705

Special Issue: Traditional Chinese Medicine

• Original Clinical Research • Previous Articles     Next Articles

Reliability and validity of Health Scale of Traditional Chinese Medicine

Da-rong Wu1, Shi-long Lai1,2(), Xin-feng Guo2, Ze-huai Wen2, Wei-xiong Liang2   

  1. 1. Applied Clinical Epidemiology Research Unit, the Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province 510120, China
    2. DME Center, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province 510405, China
  • Received:2007-12-03 Online:2008-07-20 Published:2008-07-15
  • Contact: LAI Shi-long E-mail:gzxuntcm@pub.guangzhou.gd.cn

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Objective: To test the reliability and validity of Health Scale of Traditional Chinese Medicine (HSTCM) by means of questionnaires.
Methods: A cross-sectional survey was conducted at Liwan Community of Guangzhou, Old People's Home in Guangzhou and Outpatient Department of the Second Affiliated Hospital of Guangzhou University of Chinese Medicine. A total of 652 Chinese individuals (over 18 years old) were assessed with the 88-item version of HSTCM and World Health Organization Quality of Life Measure-Abbreviated Version (WHOQOL-BREF), which were randomly delivered to them. Some socioeconomic characteristics were registered.
Results: A test-retest reliability (15-day interval) was found among the 76 persons who completed the questionnaires by themselves. Intra-class correlation coefficient (ICC) was 0.93. Associated 95% confidence interval (CI) was 0.89-0.96. Split-half reliability was 0.79. Inter-investigator reliability (0.93) was also good, and the ICC of HSTCM was 0.90 (95%CI 0.67-0.97). The correlation between HSTCM and WHOQOL-BREF was –0.66. The correlations of HSTCM and questionnaire deliver order, investigator, interview date and interview time were 0.06, –0.12, –0.17 and 0.20 respectively. The correlation between HSTCM and self-rated health (0.46) was greater than that between HSTCM and chronic illness (0.28). Divided by individuals with or without chronic illness, area under the ROC (receiver operator characteristic) curve for HSTCM was 0.67 (95%CI 0.63-0.71).
Conclusion: It indicates that the HSTCM is conceptually valid with satisfactory psychometric properties and forms a basis for further applications in clinical research of traditional or integrative medicine.

Key words: traditional Chinese medicine, health surveys, scale, reliability, validity

CLC Number: 

  • R-31

Table 1

Internal consistency of Health Scale of Traditional Chinese Medicine"

Domain and facet scale Cronbach's coefficient α Number of items
Health Scale of Traditional Chinese Medicine 0.93 45
T_Physical Functioning under Natural Environment (tPFNE) 0.89 18
T_Physical Functioning (tPF) 0.89 9
T_Voice (tVOC) 0.68 2
T_Stool and Urine (tSU) 0.67 2
T_Adaptability of Natural Environment (tANE) 0.71 5
T_Spirit (tSP) 0.84 14
T_Confidence and Content (tCC) 0.83 6
T_Self-confidence (tSC) 0.87 2
T_Energy (tEG) 0.71 4
T_Basic Ability of Thinking (tBAT) 0.49 2
T_Adaptability of Social Environment (tASE) 0.89 13
T_Ability of Contacting with People (tACP) 0.79 2
T_Adaptability of Noisy Condition (tANC) 0.57 2
T_Ability of Dealing with Bad Stimulations (tADBS) 0.89 9

Table 2

Divergent construct validity of Health Scale of Traditional Chinese Medicine"

tPFNE tSP tASE HSTCM
Scale delivering order 0.07** 0.02** 0.06** 0.06**
Interviewer –0.14* –0.07** –0.08** –0.12*
Date –0.15* –0.18* –0.08* –0.17*
Time 0.11* 0.30* 0.13* 0.20*

Table 3

Discriminant validity of Health Scale of Traditional Chinese Medicine"

tPFNE tSP tASE HSTCM
Chronic disease 0.32 0.27 0.11 0.28
Self-reported health status 0.39 0.54 0.25 0.46

Table 4

The areas under ROC curves"

Variable Area Standard error Significant level 95% CI
Lower bound Upper bound
tPFNE 0.69 0.02 0.00 0.65 0.74
tSP 0.67 0.02 0.00 0.62 0.71
tASE 0.57 0.02 0.00 0.53 0.62
T_45 0.67 0.02 0.00 0.63 0.71

Figure 1

ROC curves of Health Scale of Traditional Chinese Medicine in comparing different samples of whether having chronic disease or not"

Figure 2

Structure model of Health Scale of Traditional Chinese Medicine"

Table 5

Demographic characteristics of overall scores of Health Scale of Traditional Chinese Medicine"

Characteristics n x±s 95% CI
Age
18-34 years old 153 90.0±18.63 87.0-93.0
35-44 years old 138 96.9±22.32 93.1-100.6
45-54 years old 139 100.2±25.34 96.0-104.5
≥55 years old 190 93.9±21.34 90.9-97.0
Number of missing value 3 - -
Chronic disease
No 362 89.0±19.36 87.1-91.2
Yes 252 102.9±23.38 100.2-106.1
Number of missing value 9 - -
Self-reported health status
Poor 100 110.0±24.71 105.2-115.2
Neither poor nor good 240 100.7±20.19 98.1-103.4
Good 283 84.7±17.60 82.5-86.6
Number of missing value 0 - -
Self-reported health status change
Worse 236 106.4±22.59 103.5-109.4
No change 270 87.1±18.31 84.6-89.1
Better 115 89.9±19.74 86.1-93.5
Number of missing value 2 - -
Medical care need
A good many 106 110.0±26.21 105.0-115.2
A moderate amount 135 100.0±19.90 96.4-103.3
Few 375 88.9±19.17 86.8-90.8
Number of missing value 7 - -

Table 6

Demographic characteristics of domain scores of Health Scale of Traditional Chinese Medicine"

Chracteristics n tPFNE tSP tASE
$\bar{x}$±s 95% CI $\bar{x}$±s 95% CI $\bar{x}$±s 95% CI
Age
18-34 years old 153 32.7±8.57 31.3-34.1 29.0±6.35 27.9-30.0 28.4±7.87 27.1-29.6
35-44 years old 138 34.8±10.34 33.1-36.6 31.5±7.69 30.2-32.8 30.6±8.82 29.1-32.0
45-54 years old 139 36.0±11.55 34.1-37.9 32.4±8.27 31.0-33.8 31.8±9.43 30.2-33.4
≥55 years old 190 33.2±10.14 31.8-34.7 33.3±7.23 32.3-34.4 27.4±8.60 26.2-28.6
Number of missing value 3 - - - - - -
Chronic disease
No 362 31.1±8.50 30.2-32.0 29.7±6.93 29.0-30.5 28.2±8.39 27.3-29.0
Yes 252 38.1±11.07 36.7-39.5 34.1±7.67 33.2-35.1 30.7±9.30 29.5-31.8
Number of missing value 9 - - - - - -
Self-reported health status
Poor 100 40.1±11.91 37.8-42.5 37.4±8.46 35.7-39.1 32.5±9.52 30.6-34.4
Neither poor nor good 240 36.0±9.79 34.7-37.2 34.2±6.02 33.4-35.0 30.5±8.78 29.4-31.6
Good 283 30.3±8.26 29.3-31.3 27.4±5.83 26.7-28.1 27.1±8.09 26.1-28.0
Number of missing value 0 - - - - - -
Self-reported health status change
Worse 236 38.3±11.04 36.9-39.7 35.9±7.06 35.0-36.8 32.3±9.09 31.1-33.5
No change 270 30.5±8.29 29.6-31.5 29.6±6.40 28.8-30.3 27.0±8.15 26.0-28.0
Better 115 33.6±9.30 31.9-35.3 27.8±6.95 26.5-29.1 28.5±8.19 27.0-30.0
Number of missing value 2 - - - - - -
Medical care need
A good many 106 40.2±12.59 37.8-42.7 36.1±9.06 34.3-37.8 33.6±10.38 31.6-35.6
A moderate amount 135 37.0±9.38 35.4-38.6 33.1±7.19 31.9-34.3 29.9±8.06 28.5-31.3
Few 375 31.3±8.60 30.4-32.2 29.8±6.48 29.1-30.4 27.8±8.23 27.0-28.6
Number of missing value 7 - - - - - -
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