E-ISSN:2456-3110

Research Article

QOL

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 1 Jan-Feb
Publisherwww.maharshicharaka.in

A cross sectional study to develop a scale on health related QOL for assessing the effect of Unhealthy Food Habits in apparently Healthy Subjects

Bhatt R.1*, Rajeshwari N M R.2, Powar V.3, P M.4
DOI: http://dx.doi.org/10.21760/jaims.7.1.6

1* Rashmi Bhatt, Assistant Professor, , Shivalik Institute of Ayurveda and Research, Dehradun, Uttrakahand, India.

2 Raja Rajeshwari N M, Professor, Dept. of Samhita and Siddhanta, Sri Dharmasthala Manjunatheswara College of Ayurveda and Hospital, Hassan, Karnataka, India.

3 Vibhu Powar, Consultant, , Atharva Ayurveda Clinic, Navi Mumbai, Maharashtra, India.

4 Madhuvratha P, Consultant Physician, , Kottakkal Arya Vaidyasala, Adyar, Chennai, Tamil Nadu, India.

Background: Non communicable diseases continue to be important public health problem and are responsible for major proportion of mortality and morbidity in India and about 60% of deaths in India are due to these diseases. Early identification of these indicators can result in early remedy to preventforthcoming diseases. Objectives of the Study: To develop validated scale to assess HRQOL in healthy individuals who have unhealthy food habits. Methods: All data regarding components which are taken as indicator of HRQOL were compiled and critically analyzed for construction of domains and item generation. Content validity was carried out by giving to 5 experts as process of pretesting of questionnaire and for checking face value. Questionnaire administration was done on 77 healthy subjects as first set of analysis and later on 111 healthy subjects’ development and validation. For internal consistency Cronbach’s alpha was run, & for item reduction Principal component analysis (PCA) was done and components were extracted and accordingly domains were reframed. Reframed questionnaire was administered to 270 healthy subjects and to check reliability Cronbach’s alpha was done. Scoring was done based on mean of all domains to create scale. Results: Initially 104 items were framed based onintense literature search, after content validity no items were deleted. So, 104 questions were administered for 1st assessment after checking internal consistency 28 items were deleted and 76 items remained. After 2nd set of assessment with deletion of 7 items 69 items remained. After data extraction 43 items remained which were used for generation of scale scoring. Scoring was done based on mean of all domains. Conclusion: This developed self-assessment scale will help in assessment of effect of unhealthy food habits over HRQOL in apparently healthy subjects.

Keywords: Ayurveda, QOL, HRQOL, Health, Scale, Scale Development, Unhealthy food habits

Corresponding Author How to Cite this Article To Browse
Rashmi Bhatt, Assistant Professor, , Shivalik Institute of Ayurveda and Research, Dehradun, Uttrakahand, India.
Email: 		Rashmi Bhatt, Raja Rajeshwari N M, Vibhu Powar, Madhuvratha P, A cross sectional study to develop a scale on health related QOL for assessing the effect of Unhealthy Food Habits in apparently Healthy Subjects. J Ayu Int Med Sci. 2022;7(1):37-45.
Available:https://jaims.in/jaims/article/view/1711

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-01-29 2022-01-31 2022-02-07 2022-02-14 2022-02-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 2022by Rashmi Bhatt, Raja Rajeshwari N M, Vibhu Powar, Madhuvratha Pand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Bhatt R. et al: A cross sectional study to develop a scale on health related QOL

Introduction

This era of Globalization has led to the advancement in the health care sector resulting in better management of communicable diseases, but the non-communicable diseases continue to be an important public health problem leading for the major proportion of mortality and morbidity, in India about 60% of deaths are due to these diseases.[1] The major regions for these diseases are change in lifestyle and food habits. Ayurveda considered the food as the prime factor for the maintenance of the body. It is also considered one among the three pillars (Traya - Upasthambhas) for the sustenance of the life. As food plays important role in the manifestation of any disease which eventually affects the quality of life of the person. Gramyahara is a concept which explains how unhealthy food and lifestyle which leads to deterioration in HRQOL and eventually to various ailments. Along with this there is a mention of the indicators which can be used for early detection of HRQOL which can help in early detection of the forthcoming diseases and hence can be taken as key markers of health which are as follows - Glani (tiredness), Sada (weakness), Nidra (sleepiness), Tandra (drowsiness), Manah Sarira chestha Asamarthaya (unfit to work physically and mentally), Nastha Smruti (reduced memory), Alasya (lack of enthusiasm).[2] So, a scale needs to be developed so that a check can be put over these diseases at an exceedingly early stage. Scale development is a process of developing a reliable and valid measure of a construct in order to assess an attribute of interest.[3]

Materials and Methods

Scale development mainly comprises of these steps.

Step 1: Identification of Domain and Item Generation

Identification of Domain

Each of the indicator mentioned above were taken as individual domain.

Defining the domain

Defining the domain was done by an exclusive search of the literature for references which defined these domains in various contexts.

These definitions were later analyzed for the

relevance to the present study and the relevant references were accepted and translated into English. Questions were framed in such a manner to elicit the right response.

The grading of the questions was done using Likert scale of five (strongly agree, agree, uncertain/unsure, disagree, strongly disagree).

Step 2: Content Validity

This includes cross checking that whether the data pooled is related or well matched with each other or not. For this quality check of the questionnaire, it was given to the experts to asses -

  1. Whether the understanding of each term is appropriate or not
  2. Whether the grading given are appropriate or not
  3. Whether the question framed is reflecting the concept properly or not.

Step 3: Pre-testing Questions

Pilot study was done to check whether the items generated are meaningful to the target population or not, check the face value of the questionnaire and also to minimize misunderstanding and subsequent measurement error.

It will also help to examine to what extent the questions framed in the questionnaire are reflecting the domains properly. The data obtained was analyzed for internal consistency.

Step 4: Survey Administration and Sample Size

After testing the internal consistency of the questionnaire, the finalized questionnaire was administered to sample population and checked for internal consistency.

Step 5: Item Reduction

It was conducted to check only internally consistent items are included.

Step 6: Extraction of Factors

It was done to understand the latent structure of set of items and also the extent to which the relationship between the items is internally consistent.

Step 7: Tests of Reliability

It is the degree of consistency exhibited when a measurement is repeated under identical conditions.


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Step 8: Tests of Validity

To ensure that the scores are predicting the desired outcome.

Result and Discussion

Item generation

A detail literature search was done regarding the unhealthy food habits (Ahara Vidhi Vidhana) and risk indicators of health related QOL (Tandra, Nidra, Glani, Sada, Manah Sarira Chestha Asamarthaya, Nastha Smruti, Alasya) from Ayurveda texts and were critically analyzed. Nine domains i.e., Tandra, Nidra, Glani, Sada, Manah Sarira Chestha Asamarthaya, Nastha Smruti, Alasya, and questionnaire was prepared based on these. As the study design was self-administered questionnaire so the questions were framed in such a way that they can be understood easily by the sample population. Framed items were allotted in five optional Likert scaling for both positive and negative question.

SN Options Score for PQ Score for NQ
1. Strongly Disagree 1 5
2. Disagree 2 4
3. Uncertain or unsure 3 3
4. Agree 4 2
5. Strongly agree 5 1

Expert opinion\Validation

Prepared questionnaire was given to the experts for opinion or validation regarding the approach of the questions, positive and negative aspects of the prepared questionnaire.

The questionnaire with 142 items with options “Better, Good, Poor, Very Poor” prepared one was given to the experts with appropriate information regarding the study and space was provided for their suggestions. Based on the suggestions of the expert questionnaires were grammatically corrected and two questions from domain (with Q6 and Q10) were added to Manah Sarira Chestha Asamarthaya.

Pilot study

The 142 itemed self-administered questionnaires were administered to 77 healthy subjects (based on the assessment done by WHO HRQOL, who scored better to good in the scale).

Participants were given one hour time to fill the questionnaire.

The data analysis was done using the software “Statistical Package for Social Sciences”, Version 20 (SPSS IBM).

Cronbach’s alpha

To analyze the data for internal consistency Cronbach’s alpha was run. The alpha value greater 0.7 is acceptable. If Alpha value will be greater than Cronbach’s coefficient alpha, the corresponding item will be deleted and the whole process will be repeated.

The test was run for all the domains combined and for each domain as a separate one. The Cronbach’s alpha value obtained for pilot study was 0.930 after deletions of 28 questions which were considered as excellent score.

Administration of questionnaire to samples

The questionnaire after the 1st step of assessment of reliability and consistency was administered with 114 items to the 111 apparently healthy subjects.

The obtained data was checked for internal consistency and principal component analysis.

Principle Component Analysis (PCA) and Factor Extraction

Principle component analysis is a technique used to emphasize variation and bring out the strong patterns in a dataset. It is often used to make data easy to explore and visualize. CA was done for each domain. Kaiser-Meyer-Olkin measure of sampling adequacy” was 0.860 which is considered as significant. Bartlett’s test of sphericity was 0.000 which is considered as significant.

Factor extraction was done based on the table showing total variance, in which the components with Eigen values more than one were extracted. Total 18 components were extracted. Based on the maximum loading of the questions in the components, only 5 components were retained.

Redefining the questionnaire

Based on the component extracted and maximum loading of the questions domains were redefined. After extraction 5 components were framed which were as follows;


  1. Component 1 had strong loading of Domain Manah Sarira Chestha Asamarthaya and Nasta Smruti items

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  1. Component 2 had strong loading of Domain Tandra and Nidra items
  2. Component 3 had strong loading of Domain Glani.
  3. Component 4 had strong loading of Domain Sada.
  4. Component 5 had strong loading of Domain Alasya.

Therefore, a questionnaire developed has 5 components and 43 items.

Test for Reliability

Reliability is the degree of consistency exhibited when a measurement is repeated under identical conditions.

Cronbach’s alpha was done to check the reliability of the scale. Cronbach’s alpha assesses the internal consistency of scale items i.e., degree to which the set of items in scale co-vary or relative to their sum score. The alpha value obtained was 0.910 that means the reliability is excellent.

Scoring the scale

Finalized items from the test of Reliability were used to create scale. Scale scores were calculated based on the mean obtained after adding all observation of the particular domains.

jaims_1711_01.JPG

The grade given are “Good, Betterand Poor” based on the obtained mean.

Scores Between 70 - 100 are considered as “Good”, 35 - 70 are considered as “Better”, and score below 35 are considered as “Poor”.

Test of validity

Scale validity is the extent to which “an instrument indeed measures the latent dimension or construct it was developed to evaluate”.

Validation is an ongoing process that starts with the Identification and defining of the domain of study and continues to its generalizability with other constructs.

The Finalized Scale on Health Related QOL for Assessing the Effect of Unhealthy Food Habits in Apparently Healthy Subjects is presented in table 1.

Table 1: Final Validated Questionnaire - 43 Items

AYU-HRQOL Equations for Computing Domain Scores Score
Domain 1 Q40+17+20+23+2+39+34+9+14+1+36+32+41+19+10+15
Domain 2 Q6+35+18+21+37+27+4+28+33+3
Domain 3 Q5+22+16+31+12
Domain 4 Q8+38+29+13+25
Domain 5 Q30+43+24+7+26

jaims_1711_02.JPG

Grade Score
Good 70 - 100
Moderate 35 - 70
Poor Below 35

SN Question Scale
Strongly disagree disagree Unsure/uncertain Agree Strongly agree
1. I want to convey something to someone but I fail to recollect what I was supposed to say. 1 2 3 4 5
2. Even smaller issues make me angry easily 1 2 3 4 5
3. I often prefer to take naps 1 2 3 4 5
4. I often feel rested after getting out of bed 5 4 3 2 1
5. I feel nervous 1 2 3 4 5
6. Most of the days in a week I feel tried throughout the day 1 2 3 4 5
7. I initiate work late 1 2 3 4 5
8. I feel tiredness even in the morning 1 2 3 4 5
9. I struggle to concentrate in studies 1 2 3 4 5
10. I fail to do something I was supposed to do a few minutes later even though it's there in front of me. like take pill or turn off the stove 1 2 3 4 5
11. I don't feel fresh after waking up in the morning 1 2 3 4 5
12. I find problem in initiating things 1 2 3 4 5
13. I feel no desire to do any work 1 2 3 4 5
14. I find it difficult to think clearly when I have to decide something in hurry 1 2 3 4 5
15. I forget to contact the friend or the relative to whom I was supposed to contact 1 2 3 4 5

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16. I feel no interest in doing work which, earlier, I used to feel happy doing 1 2 3 4 5
17. I have so many plans that it's hard for me to focus on any one of them 1 2 3 4 5
18. Most of the days in a week I yawn in most part of the day 1 2 3 4 5
19. I fail to recognize a character in a radio or television show from scene to scene 1 2 3 4 5
20. I usually over react to the situation even for the minor problem 1 2 3 4 5
21. I feel lazy throughout the day 1 2 3 4 5
22. I have lost interest in my hobbies 1 2 3 4 5
23. I feel difficulty in understanding complex questions 1 2 3 4 5
24. If any stuff I have to buy from the nearby place I usually prefer vehicles than walking 1 2 3 4 5
25. Without any strenuous work/physical work I feel body ache 1 2 3 4 5
26. I have the tendency to postpone my work 1 2 3 4 5
27. I feel sleepy after waking up in the morning 1 2 3 4 5
28. Do you consider your excess sleep problem interferes with your daily functioning 1 2 3 4 5
29. I feel dull in my behavior/activities 1 2 3 4 5
30. I always put things which are to be in their place 5 4 3 2 1
31. I feel no interest in doing any work or daily regimen 1 2 3 4 5
32. I usually forget what I watched on television the previous day 1 2 3 4 5
33. I feel sleepy throughout the day 1 2 3 4 5
34. I can come up with lot of ways to change but it’s hard for me to decide which one to choose 1 2 3 4 5
35. Most of the days in a week I feel lack of energy in doing work 1 2 3 4 5
36. I forget something that was told a few minutes before 1 2 3 4 5
37. Because I feel tired I am unable to concentrate on my routine work 1 2 3 4 5
38. I feel lack of energy even for doing the small work 1 2 3 4 5
39. I have ambiguity in thinking 1 2 3 4 5
40. I feel that I am unable to concentrate in the work I am doing 1 2 3 4 5
41. I usually decide to do something in a few minutes time and then forget to do it 1 2 3 4 5
42. I am unable to concentrate on my work due to laziness 1 2 3 4 5
43. I always fall asleep because of boredom 1 2 3 4 5

Questionnaire for Assessing the Unhealthy Food Habits

SN Questions Scale
Strongly Disagree Disagree Unsure/Uncertain Agree Strongly Agree
1. I have the habit of consuming mixed fruit juice 1 2 3 4 5
2. While taking my meal with my friends, among all I will be the first to finish my meal 5 4 3 2 1
3. while consuming my meal I tend to see mobile phone or TV 1 2 3 4 5
4. While taking my meal with my friends ,among all I finish very late 1 2 3 4 5
5. How often do you eat fried food away from home Once in a month Twice in a month 3-4 times a month 4-5 times a month More than 6 times
6. even at home, I tend to have more packed, instant food etc 1 2 3 4 5
7. I like to have more traditional homemade food items 5 4 3 2 1
8. I always prefer to have hot meal 5 4 3 2 1
9. I consume homemade food More often 5 4 3 2 1
10. I consume fast food 1 2 3 4 5
11. It will be ok for me to not having hot meal 1 2 3 4 5
12. I feel lightness in my body after taking the food 5 4 3 2 1
13. I have the habit of consuming banana with milk 1 2 3 4 5
14. After having my meal, I feel discomfort while doing any activities like laughing, breathing, talking, walking etc. 1 2 3 4 5
15. For preparing my meal I prefer the oil /ghee 5 4 3 2 1
16. I feel heaviness in stomach after my meal 1 2 3 4 5
17. I have the habit of taking cold drink after my meal 1 2 3 4 5

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18. I have my food only when I feel hunger 5 4 3 2 1
19. I usually take my meal at a particular time even though I didn’t feel hungry 1 2 3 4 5
20. I have the habit of consuming curd with milk 1 2 3 4 5
21. I am very much fond of consuming milk shakes from fruits 1 2 3 4 5
22. More often I consume outside food 1 2 3 4 5
23. I feel heaviness of my body immediately after food 1 2 3 4 5
24. I have the habit of eating in between meals 1 2 3 4 5
25. I have the habit of consuming less quantity of food multiple times in a day 1 2 3 4 5
26. How often do you eat food that is fried at home Once in a month Twice in a month 3-4 times a month 4-5 times a month More than 6 times a month
27. I often consume instantly made foods (noodles, canned food, frozen food, food that is easily made in microwave) 1 2 3 4 5
28. while consuming my meal I always focus on meal 5 4 3 2 1
29. I feel heaviness in the chest region after my meal 1 2 3 4 5
30. Do your food timing varies 1 2 3 4 5
31. From how many years do you have these type of food habits Few months 6 months to 1 year 1-5 years 5- 10 years More than 10 years
32. The quantity of food I take varies 1 2 3 4 5
33. Which type of outside food you prefer more (Gobhi Manchurian, Vada pav, Samosa, Dahi puri, Masala puri, Pani puri, Kachori, Puffs, Burger, Pizza, Sevapuri, Pav bhaji, Nippattu, Dosa, Paratha, Other, please mention)
34. The food usually I consume always have some amount of ghee/oil 5 4 3 2 1
35. I have the habit of skipping my meals frequently 1 2 3 4 5
36. I always check whether my previous meal is properly digested before taking the next meal 5 4 3 2 1
37. Before consuming my meal I always assess whether it is good for me or not 1 2 3 4 5

Conclusion

Due to this fast-moving world and change in the lifestyle and food habits there are drastic increase in the non-communicable diseases these non-communicable diseases largely affect the quality of life of the person. Ayurveda has described such diseases which are occurring due to faulty lifestyle and food habits under the heading of “Gramyahara” along with the description of early indicators of deterioration of health. Scale developed based on these indicators helps in assessing the Health Related QOL and can be used to prevent forth coming diseases.

Reference

  1. Suzanne Nethan, Dhirendra Sinha, Ravi Mehrotra. Non Communicable Disease Risk Factors and their Trends in India. 18.7.2005; (DOI:10.22034/APJCP.2017):
  2. Rasayana Adhyaya, Pranakamiya Rasayanapada (chapter No-1), verse-3. In: Acharya Y T (editor). Charaka Samhita Chikitsasthana. Reprint ed. Varanasi: Chaukhamba Prakashan. 2013; p.381.
  3. https://www.researchgate.net/publication/305462834_scale_development.

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