Health Constructs and Measurement

Walker, S.N., Sechrist, K.R., & Pender, N.J. (1987). The Health Promoting Lifestyle Profile: Development and Psychometric Characteristics. Nursing Research, 36 (2), 76-81.

Note: Available in Spanish. There is now a 52-item revised version (HPLP-II).

48 items measuring health-promoting lifestyle.

Self-initiated health behaviors that serve to maintain or enhance level of wellness, self-actualization, or wellness, based upon the Health Promoting Model (Pender, 1982). Includes both health-protecting (preventive) behaviors that decrease risk for illness, & health-promoting behaviors that sustain or increase well-being, self-actualization, and personal fulfillment.

Subscales include:

§ Self-Actualization (SA), (13 items)

§ Health Responsibility (HR), (10 items)

§ Exercise (E), (5 items)

§ Nutrition (N), (6 items)

§ Interpersonal Support (IS), (7 items)

§ Stress Management (SM), (7 items)

Note: some subscale items overlap with other subscales

Self-administered questionnaire with 4-point response format; Present (current) activity

48 items, Ordinal scale; summated scores of the six subscales; Range of scores: 1-4

(1= never,

2= sometimes, 3= often,

4=routinely); all positive items (no negative or undesirable items)

N = 952; Convenience sample of literate volunteers recruited from general adult population (corporate and industry worksites, colleges, etc. ) in two Midwestern states, with wide range in frequency of participation in health behaviors. Majority was middle-class, median education was some college.

Total instrument has high internal consistency with alpha coefficient of .922.

Subscale reliability:

SA: alpha (α) = .904

HR: α = .814

E: α = .809

N: α = .757

IS: α = .800

SM: α = .702

Content validity was assessed using factor analysis & PAF extraction; the 6 factors explained 47.1% of the variance.

Variance (σ²) explained by each factor:

SA: σ² = 23.4

HR: σ² = 31.3

E: σ² = 35.9

N: σ² = 40.1

IS: σ² = 43.8

SM: σ² = 47.1

Item analysis used to measure criterion validity of each individual question; an inter-item correlation matrix was created. Inter-item correlation ranged from -0.098 to .651, with the exception of 2 exercise items (.703) and 2 nutrition items (.745). Evaluated using item analysis, factor analysis, and reliability measures. Items pertaining to illness prevention rather than health promotion were not retained.

Disability populations used:

Researchers at the Center for Research on Women with Disabilities (CROWD) used the HPLP with women with physical disabilities over 45 in the Healthy Aging Study, and Becker, Stuifbergen, Ingalsbe, and Sands used this instrument in a study of health promoting attitudes and behaviors among people with disabilities. Stuifbergen and Becker (1994) report Cronbach’s alpha as .92 for the total scale and between .75 and .90 for the subscales in this sample. Tate and colleagues (2002) used the HPLP in a study evaluating a health promotion program in persons with spinal cord injury.

Becker, H.A., Stuifbergen, A.K., Ingalsbe, K., and Sands, D., (1989). International Journal of Rehabilitation Research, 12 (3), 235-250.

Stuifbergen, A.K., and Becker, H.A., (1994). Predictors of health promoting lifestyles in persons with disabilities. Research in Nursing and Health, 17, 3-13.

Tate, D.G., Chiodo, A., Nelson, V., et al., (2002). The effect of a holistic health promotion program on individuals with spinal cord injury. Final Report of Study Findings. University of Michigan Health System: Department of Physical Medicine and Rehabilitation.

Health Promoting Lifestyle Profile-II (HPLP-II)

Walker, S.N., Hill-Polrecky, D., (1996). Psychometric evaluation of the Health-Promoting Lifestyle Profile-II. In: Proceedings of the 1996 Scientific Session of the American Nurse Association’s Council of Nurse Researchers. 1996 June 13-14, Washington (DC). p.110.

52 items measuring the frequency of self-reported healthy behaviors. The HPLP-II revises the HPLP to reflect more current health information (e.g. food pyramid) and to achieve a more even distribution across subscales.

6 subscales:

§ Physical activity

§ Spiritual Growth

§ Health Responsibility

§ Interpersonal Relations

§ Nutrition

§ Stress Management

Self-administered questionnaire with 4-point response format; Present (current) activity

52 items, Ordinal scale; summated scores of the six subscales; Range of scores: 1-4

(1= never,

2= sometimes, 3= often,

4=routinely); all positive items (no negative or undesirable items). Scores range from 52 to 208.

712 community-residing adults.

3-week test-retest reliability was .89 in a sample of undergraduate students.

Validity of this instrument has been supported in the sample of community-residing adults.

Disability populations used:

Stuifbergen, Seraphine, and Roberts (2000) also have used the HPLP-II in a sample of persons with multiple sclerosis in a study titled Health Promotion and Quality of Life in Chronic Illness. Stuifbergen and colleagues also used the HPLP-II in a study evaluating a wellness intervention for women with multiple sclerosis. They report the internal consistency reliability of the HPLP-II subscales ranged from .71 to .90, and the alpha for the total score ranged from .93 to .95 for this sample. Stuifbergen and Roberts (1997) further explored the HPLP-II in a sample of women with multiple sclerosis, using multivariate analysis of variance (MANCOVA) to test differences in frequency of health promoting behaviors between women experiencing different clinical courses of MS.

Stuifbergen, A.K., Becker, H.A., Blozis, S., Timmerman, G., & Kullberg, V., (2000). A randomized clinical trial of a wellness intervention for women with multiple sclerosis. Archives of Physical Medicine and Rehabilitation, 84, (April), 467-476.

Stuifbergen, A.K., & Roberts, G.J., (1997). Health promotion practices of women with multiple sclerosis. Archives of Physical Medicine and Rehabilitation, 78, S3-S9.

Stuifbergen, A., Seraphine, A., & Roberts, G., (2000). An explanatory model of health promotion and quality of life in chronic illness. Nursing Research, 49 (3), 122-129.

Barriers to Health Promoting Activities for Disabled Persons Scale

(BHADP)

Becker, H., Stuifbergen, A., Sands, D., (1991). Development of a scale to measure barriers to health promotion activities among persons with disabilities. American Journal of Health Promotion, 5 (6), 449-454.

Measures perceptions of how frequently various problems interfere with the ability to take care of one’s health. Measures both internal and external barriers that are perceived as obstacles to health promoting behaviors in general. Examples of barriers are fatigue, impairment, inaccessibility, lack of safety, lack of interest, lack of information, lack of time, in climate weather, lack of transportation, and lack of social support.

2 subscales:

Motivation subscale (7 items)

External Barriers subscale (9 items)

Self-report.

16 item scale measuring how often the specified barriers keep a person from taking care of his or her health. Likert scale (1=never, 4=routinely). Scores can range from 16 to 64, higher scores indicate greater perceived barriers.

Sample consisted of a group of disabled persons (135 adults living in the community with a variety of conditions), and a comparison group of 144 nondisabled persons participating in health screenings.

Internal consistency for the total instrument (Cronbach’s alpha = .82), and 2-week test-retest reliability was .75. Item-total correlations ranged from .25 to .59. Cronbach’s alpha for the Motivation subscale was .80, and Cronbach’s alpha for the External Barriers subscale was .69. The correlation between the two subscales was. 57.

Discriminant validity was supported by analyses that demonstrated significant differences in scores between a sample of persons with disabilities and a comparison group of nondisabled persons. The BHADP correlated as expected with several measures of health, attitudes, and behavior. The BHADP negatively correlated with Sherer’s General Self-Efficacy measure (r=-.48), and with two scales of the Multidimensional Health Locus of Control Scale, and Perceived Health Status scale. Analyses indicated this instrument was one of the best predictors of scores on the HPLP. Most correlations were higher between the health measures and the Motivation subscale than the External Barriers subscale, perhaps reflecting the higher reliability of the Motivation subscale. The BHADP was not significantly correlated with demographic variables.

Disability populations used:

Developed by Becker, Stuifbergen, Ingalsbe, and Sands for use in a study of health promoting attitudes and behaviors among people with disabilities. Stuifbergen, Seraphine, and Roberts (2000) have used this scale in a sample of persons with multiple sclerosis in a study titled Health Promotion and Quality of Life in Chronic Illness. Harrison and Stuifbergen (2001) used this scale in a descriptive study of persons with post-polio. Internal consistency (Cronbach’s alpha) was reported as .79. Becker, Stuifbergen, and Sands (1991) report that this scale can discriminate between disabled and nondisabled persons’ perceptions of barriers to health promotion. Stuifbergen and Becker (1994) used this scale in a study of 117 persons with disabilities, and reported an alpha coefficient of .75. Tate and colleagues (2002) also used this scale in a health promotion study of individuals with spinal cord injury.

Becker, H.A., Stuifbergen, A.K., Ingalsbe, K., and Sands, D., (1989). Health promoting attitudes and behaviors among persons with disabilities. International Journal of Rehabilitation Research, 12 (3), 235-250.

Harrison, T., and Stuifbergen, A., (2001). Barriers that further disablement: A study of survivors of polio. Journal of Neuroscience Nursing, 33 (3), 160-166.

Stuifbergen, A.K., and Becker, H.A., (1994). Predictors of health promoting lifestyles in persons with disabilities. Research in Nursing and Health, 17, 3-13.

Stuifbergen, A., Seraphine, A., & Roberts, G., (2000). An explanatory model of health promotion and quality of life in chronic illness. Nursing Research, 49 (3), 122-129.

Self-Rated Abilities for Health Practices Scale

(SRAHP)

Becker, H., Stuifbergen, A., Oh, H.S., & Hall, A., (1993). The self-rated abilities for health practices scale: A health-efficacy measure. Health Values, 17, 42-50.

Measures beliefs (self-efficacy) about one’s abilities to perform specific health promoting behaviors.

Domains: nutrition, physical activity/ exercise, psychological well-being, and responsible health practices.

Self-rated, current or present timing. Stem, “I am able to”.

28 items, 5-point Likert scale (0=not at all, 4=completely). Summated scores, range 0-112 (higher scores indicated greater self-efficacy).

Pilot tested with 15 persons with disabilities, and samples of 188 health fair participants and 111 undergraduate nursing students.

Cronbach’s alpha for the total scale was .94 in both the health fair and nursing student samples. Two-week test-retest reliability in the nursing student sample was .70, two-week test retest reliability in undergraduate samples was .73.

Principal components factor analysis from the health fair sample supported that the four-factor solution accounted for 61% of the total variance. The Self-Rated Abilities for Health Practices Scale was correlated with other health attitude and behavior measures, supporting concurrent validity of the scale. Scores were negatively correlated with the Barriers to Health Promotion Scale and positively correlated with the Health Promoting Lifestyle Profile.

Disability populations used:

Stuifbergen and Becker (1994) used this scale in a study of 117 persons with disabilities. Stuifbergen, Becker, Blozis, Timmerman, and Kullberg, (2000) used this instrument in a sample of 142 women with multiple sclerosis. Stuifbergen, Seraphine, and Roberts (2000) have used this scale in a sample of persons with multiple sclerosis in a study titled Health Promotion and Quality of Life in Chronic Illness.

Stuifbergen, A.K., and Becker, H.A., (1994). Predictors of health promoting lifestyles in persons with disabilities. Research in Nursing and Health, 17, 3-13.

Stuifbergen, A.K., Becker, H.A., Blozis, S., Timmerman, G., and Kullberg, V., (2000). A randomized clinical trial of a wellness intervention for women with multiple sclerosis. Archives of Physical Medicine and Rehabilitation, 84, (April), 467-476.

Stuifbergen, A., Seraphine, A., & Roberts, G., (2000). An explanatory model of health promotion and quality of life in chronic illness. Nursing Research, 49 (3), 122-129.

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Participating Patient

Instrument Name and Original Reference	Instrument Description & Construct Measured	Dimensions/ subscales	Indicator (Timing + Source of Data)	Variables (Number of Items, Scale, & Range)	Test Population	Instrument Reliability	Psychometric Review of Instrument Validity
Autonomy Preference Index (API) Ende, J., Kazis, L., Ash, A., & Moskowitz, M.A. (1989). Measuring patients’ desire for autonomy: Decision-making and information-seeking preferences among medical patients. Journal of General Internal Medicine, 4, 23-30.	Measures construct of autonomy as a patient, as defined by medical decision-making and information-seeking.	Assesses two dimensions of autonomy: preferences for medical decision-making (6-item scale) and information-seeking (8-item scale).		14 total items, 5-point Likert scale (1=strongly agree, 5=strongly disagree). Total scores are calculated by summing responses to each item. Low scores indicate a low preference for decision-making or a disagreement with statements favoring patients being informed.		Both scales have yielded evidence of adequate test-retest reliability (0.84 for decision-making and 0.83 for information seeking). Each scale had a Cronbach’s alpha coefficient of 0.82.	Concurrent and criterion validity have been established for the decision-making scale.
Disability populations used:

See also: II. Psychosocial: Self-Efficacy for Active Participation In Health Care.

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Physical Activity

Instrument Name and Original Reference	Instrument Description & Construct Measured	Dimensions/ subscales	Indicator (Timing + Source of Data)	Variables (Number of Items, Scale, & Range)	Test Population	Instrument Reliability	Psychometric Review of Instrument Validity
Physical Activity and Disability (PADS) Rimmer, J. H., Riley, B. B., & Rubin, S. S. (2001). A new measure for assessing the physical activity behaviors of persons with disabilities: The Physical Activity and Disability Survey. American Journal of Health Promotion, 16, 34-45.	Measures levels of physical activity among persons with physical disabilities. Questions relate to types and frequency of physical activity, activity, interest in exercise, and disability.	Three subscales: Exercise (8 items), Leisure Time Physical Activity (6 items), and Household Activity (10 items)	Semi-structured, self-report.	If participants engage in exercise, they are asked to list the types of exercise and number of minutes per day. The three types of exercise (cardiovascular, strength, and flexibility), can be separated for analysis.
Disability populations used:	Rimmer and colleagues have used the PADS in numerous studies of physical activity behaviors in people with a variety of disabilities. Tate and colleagues (2002) also used this scale in a health promotion study of people with spinal cord injury. Tate, D.G., Chiodo, A., Nelson, V., et al., (2002). The effect of a holistic health promotion program on individuals with spinal cord injury. Final Report of Study Findings. University of Michigan Health System: Department of Physical Medicine and Rehabilitation.

Barriers to Physical Activity and Disability (B-PADS)
Disability populations used:	Rimmer and colleagues have used this scale in several studies of physical activity behaviors in people with a variety of disabilities.

Kaiser Physical Activity Survey (KPAS) Sternfeld, B. (1999). Physical activity patterns in a diverse population of women. Prev Med, 28(3), 313-323.	Includes constructs of self-efficacy, social support, and perceived barriers to exercise. Adapted version adds 11 items about household and child or elder care activities in an attempt to be more sensitive to activity patterns in women (Sternfeld, 1999).
Disability populations used:	Santiago and colleagues (1998) used an early version of the KPAS with 126 women with physical disabilities.

Physical Activity Scale for the Elderly (PASE) Washburn, R.A., McAuley, E., Katula, J., Mihalko, S.L., & Boileau, R.A. (1999). The physical activity scale for the elderly (PASE): Evidence for validity. Journal of Clinical Epidemiology, 52, 643-651. Washburn, R. A., Smith, K. W., Jette, A. M., & Janney, C. A. (1993). The physical activity scale for the elderly (PASE): development and evaluation. Journal of Clinical Epidemiology, 46, 153-162.
Activity Scale for Individuals with Physical Disabilities (PASIPD) Washburn, R. A., Zhu, W., McAuley, E., Frogley, M., & Figoni, S. F. (2002). The Physical Activity Scale for Individuals with Physical Disabilities: development and evaluation. Archives of Physical Medicine and Rehabilitation, 83, 193-200.	Adaptation of the Physical Activity Scale for the Elderly (PASE), also developed by Washburn and colleagues. Covers broad range of activities.	leisure time activity (6 items) household activity (6 items) occupational activity (1 item).		13 items.
Disability populations used:

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Diet

Instrument Name and Original Reference	Instrument Description & Construct Measured	Dimensions/ subscales	Indicator (Timing + Source of Data)	Variables (Number of Items, Scale, & Range)	Test Population	Instrument Reliability	Psychometric Review of Instrument Validity
Berkeley Nutrition Screens
Disability populations used:	The Center for Research on Women with Disabilities has submitted a grant proposing to use these measures in a weight management study of women with physical disabilities.

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Alcohol Abuse

Instrument Name and Original Reference	Instrument Description & Construct Measured	Dimensions/ subscales	Indicator (Timing + Source of Data)	Variables (Number of Items, Scale, & Range)	Test Population	Instrument Reliability	Psychometric Review of Instrument Validity
CAGE Mayfield, D., McLeon, G., and Hall, P., (1974). The CAGE questionnaire: validation of a new alcoholism screening instrument. American Journal of Psychiatry, 131, 1121-1123.	Brief alcohol screening questionnaire designed to determine whether an individual has ever abused alcohol. The CAGE is often used in clinical settings due to its short length.	1) Have you ever felt you should cut down on your drinking 2) Have people ever annoyed you by criticizing your drinking 3) have you ever felt bad or guilty about drinking? 4) have you ever taken a drink first thing in the morning?	Interviewer or clinician-administered. No time frame- asks about lifetime experiences (ever).	4-items. An endorsement of two or more items is indicative alcohol abuse, warrants additional follow-up questioning and/or intervention.
Other populations used:	Clark, Stump, and Wollnsky (1998) used the CAGE in a study to identify predictors of onset and recovery from mobility difficulty in older adults. Clark, D.O., Stump, T.E., Wollnsky, F.D., (1998). Predictors of Onset of and Recovery from Mobility Difficulty among Adults Aged 51-61 Years. American Journal of Epidemiology, 148 (1), 63-71.

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Goal-Setting/ Goal Attainment

Instrument Name and Original Reference	Instrument Description & Construct Measured	Dimensions/ subscales	Indicator (Timing + Source of Data)	Variables (Number of Items, Scale, & Range)	Test Population	Instrument Reliability	Psychometric Review of Instrument Validity
Goal Attainment Scale (GAS) Kiresuk, T., Smith, A., & Cardillo, J. (1994). Goal Attainment Scaling. Hillsdale, NJ: Erlbaum Associates.	Measures treatment-induced behavior change and allows comparisons between different individuals in their success of goal-attainment. Intended to be sensitive to small changes.		Intraindividual measure, self-report	5-point scale, from -2 to +2. A score of 0 represents the goal; a negative point represents a less than expected outcome, and a positive point being a better than expected outcome. Multiple goals are measured (authors suggest minimum of three).
Disability populations used:	The GAS has been used in health promotion studies of women with multiple sclerosis, as described in Becker, Stuifbergen, Rogers, and Timmerman, (2000). This scale has also been used in studies of chronic disease management, and with neurologically-disabled children. Becker, H., Stuifbergen, A., Rogers, S., and Timmerman, G., (2000). Goal attainment scaling to measure individual change in intervention studies. Nurs Res, 49 (3): 176-180.

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