Social determinants of health questionnaire development for patients with Alzheimer’s disease and frontotemporal dementia

Abstract

Background There is a lack of instruments designed to capture exposures across various social and determinants of health throughout the lifespan in persons with late‐life neurodegenerative disorders. Responding to this need, we created and piloted the administration of the MAC‐RedLat Social Determinants of Health Questionnaire. Method The questionnaire was administered to 137 dyads of participants‐caregivers. An exploratory factor analysis was conducted using the software R. Results Participants had a mean age of 67 years (SD = 11.0). 47.7% had Alzheimer´s disease dementia and 12.4% had frontotemporal dementia, the rest were controls. Data were screened for multivariate assumptions (normality, linearity, homogeneity, and homoscedasticity). All assumptions were met with slight problems of heteroscedasticity. Bartlet’s test indicated correlation adequacy x2 = 2191.611, p<0.001, and the KMO test indicated borderline sampling adequacy, MSA = 0.75. A parallel analysis and Scree plot examination suggested 4 overall factors. Additionally, a 3‐factor model was run based on theory. Maximum likelihood examination was used with Oblimin rotation. After testing all the 37 questions, 19 items split among several factors using the criterion that loadings must be greater than .300. These items were eliminated from further analysis. The final 3‐factor model is presented in Table 1. This model achieved simple structure with each item loading on only one factor. This model had moderate fit: Tucker Lewis Index = 0.764, RMSEA = 0.062, 90%CI (0.054,0.071) and SRMR = 0.06. The CFI = 0.884 indicated room for improvement. Factor 1 included 9 items related to socioeconomic status, factor 2 included 5 items related to challenging life experiences, and factor 3 included 4 items related educational environment. The reliability of the 3 factors was 0.074, 0.071, and 0.069, for factors 1, 2, and 3 respectively. The mean scores for each factor were factor 1 M = 5.322(SD = 1.283), factor 2 M = 3.19(SD = 1.108), and factor 3 M = 1.809(SD = 0.444). Conclusion Our instrument is adequate to measure social determinants of health in persons with neurodegenerative dementia with the input of caregivers.