Construct Validity of a New Health Assessment Questionnaire for the National Screening Program of Older Adults in Japan: The SONIC Study

Abstract

The Japanese government has implemented a new screening program to promote measures to avoid worsening lifestyle-related diseases and frailty among the older population. In this effort, the government formulated a new health assessment questionnaire for the screening program of old-old adults aged ≥75 years. The questionnaire comprises 15 items, of which 12 address frailty, two address general health status, and one addresses smoking habits. This study examined the construct validity of this questionnaire, using the explanatory factor analysis (EFA) and confirmatory factor analysis (CFA). The data used in this study were drawn from a mail-in survey conducted in 2020 as part of the Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians study. A total of 1576 respondents (range, 78–99 years of age) were included in the study. Although the EFA did not show an interpretable factor structure of the questionnaire with 15 items, the CFA using only 12 frailty-related items showed the goodness of fit for a higher-order factor “frailty”, and the five frailty-related sub-factors model was acceptable. These results suggest that the total score of the 12 frailty-related items in the questionnaire can be used as an indicator of the degree of “frailty”.

Criterion validity of the health assessment questionnaire for the national screening program for older adults in Japan: The SONIC study

“…there were five sub-factors (e.g., physical function, nutritional status, oral function, cognitive function, and social aspects), with the higher-order factor of frailty on top of these five sub-factors. 10 In contrast, the explanatory factor analysis did not reveal an interpretable factor structure of the 15 items that would justify the use of a total score of 15 items. Second, the 12-item questionnaire, which is consistent with the conceptual model of frailty, may be expected to have a better predictive validity of future health status (e.g., the incidence of disability) than the 15-item questionnaire.…”

“…The items used in this study constituted a comprehensive assessment of frailty across physical, psychological, and social dimensions. 10 We believe that the lower sensitivity (56%) of the 12 items may be because the J-CHS criteria assess mainly the physical aspect of frailty. We conducted another ROC analysis using the eight items (Q3-Q9 and Q13) to assess the physical aspect of the 12 items, 10 using the J-CHS criteria as a gold standard (sub-analysis I).…”

“…9 We previously reported that the 12 frailty-related items of the questionnaire (Table 1) met the construct validity for comprehensively assessing frailty from physical, psychological, and social perspectives. 10 However, the criterion validity of the 12 items has not yet been examined in terms of the extent to which these items can discriminate frailty. Two recent studies 11,12 have examined the validity of the 15 items of the health assessment questionnaire for old-old adults in determining frailty using the Kihon Checklist (KCL) 13,14 or the 5-item Japanese version of the Cardiovascular Health Study (J-CHS) criteria 15 as the gold standard for assessing frailty.…”

“…We previously reported that the 12 frailty‐related items of the questionnaire (Table 1) met the construct validity for comprehensively assessing frailty from physical, psychological, and social perspectives 10 . However, the criterion validity of the 12 items has not yet been examined in terms of the extent to which these items can discriminate frailty.…”

“…† The number of each item is the original item number of the health assessment questionnaire for old-old adults 10. N Hori et al…”