Psychometric Properties of Dysphagia Handicap Index Scale for Older Adults with Oropharyngeal Dysphagia in China.

Abstract

The impact of oropharyngeal dysphagia (OD) on older adults is recognized in Western countries but has not received sufficient attention in China. The dysphagia handicap index (DHI) scale is an OD quality-of-life evaluation instrument. This study evaluated the psychometric properties of the Chinese version of DHI scale in older Chinese adults. A total of 600 older adults were recruited from five nursing homes in one city to complete the 25-item scale. The reliability and validity of the scale were evaluated: internal consistency was investigated using Cronbach's alpha; test-retest reliability was evaluated using the intraclass correlation coefficient; the content validity of the scale was evaluated using content validity ratio; and the factor structure was examined using an exploratory factor analysis, principal component analysis, and confirmatory factor analysis. The scale was divided into three subscales: physical, functional, and emotional. Cronbach's alpha was 0.97 for the entire scale and between 0.89 and 0.94 for the three subscales. The item-to-total correlation coefficients for the three subscales were between 0.63 and 0.92, and the test-retest correlation coefficient was 0.87. The content validity was 0.93. In the factor analysis, these three factors accounted for 75.3% variance of 25 items. The confirmatory factor analysis was significant (p < 0.0001). The Chinese version of dysphagia index scale had good reliability and validity. Thus, it can provide a subjective evaluation of older adults with OD and can be used by clinicians to improve the outcomes of older adults with OD.