To develop and validate a quality of life (QOL) questionnaire for nursing home (NH) residents in mainland China.
A cross-sectional study including a development sample (n = 176) and validation sample (n = 371) of NH residents aged 60 and older was conducted between 2015 and 2016 in Jinan, Shandong Province, China. Resident interviews, literature reviews, expert panels, and pilot studies were used to identify QOL domains and items pertinent to NH life. Exploratory and confirmatory factor analysis were used to develop and validate a QOL questionnaire. Reliability (internal consistency, spilt-half reliability, and test–retest reliability) and validity (construct and criterion validity) were evaluated for the questionnaire.
The self-report Chinese NH QOL questionnaire had 9 domains and 38 items including physical health (4 items), food enjoyment (6 items), security (3 items), environmental comfort (5 items), autonomy (2 items), meaningful activity (3 items), interrelationship (6 items), family relationships (3 items), and mood (6 items). The nine-factor model was confirmed with the following fit indices: χ2/df = 1.872, root mean square error of approximation = 0.049, comparative fit index = 0.913, and Tucker-Lewis index = 0.903. The 38-item NH QOL questionnaire showed satisfactory construct validity, criterion validity, internal consistency (Cronbach’s alpha = 0.89, spilt-half reliability = 0.73, test–retest reliability = 0.76).
The NH QOL questionnaire appears to be a reliable and valid instrument and should be incorporated into a set of quality measures for use with NH residents in mainland China
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Kane, R. A., Kling, K. C., Bershadsky, B., Kane, R. L., Giles, K., Degenholtz, H. B., et al. (2003). Quality of life measures for nursing home residents. Journals of Gerontology Series A, Biological Sciences and Medical Sciences,58, 240–248.
Kane, R. L., & Kane, R. A. (2001). What older people want from long-term care, and how they can get it. Health Aff (Millwood),20, 114–127.
Kane, R. L., Rockwood, T., Hyer, K., Desjardins, K., Brassard, A., Gessert, C., et al. (2005). Rating the importance of nursing home residents’ quality of life. Journal of the American Geriatrics Society,53, 2076–2082.
Kelley-Gillespie, N. (2012). A secondary analysis of perceptions of quality of life of older adults residing in a nursing home and assisted living setting using an integrated conceptual model of measurement. Applied Research Quality Life.,7(2), 137–154.
Lai, F. C., Chen, I. H., Chen, P. J., Chen, I. J., Chien, H. W., & Yuan, C. F. (2017). Acupressure, sleep, and quality of life in institutionalized older adults: A randomized controlled trial. Journal of the American Geriatrics Society,65, e103–e108.
Xiao, H., Yoon, J. Y., & Bowers, B. (2017). Quality of life of nursing home residents in China: A mediation analysis. Nurs Health Sci,19, 149–156.
Scocco, P., & Nassuato, M. (2017). The role of social relationships among elderly community-dwelling and nursing-home residents: Findings from a quality of life study. Psychogeriatrics,17, 231–237.
Lung, T., Howard, K., Etherton-Beer, C., Sim, M., Lewin, G., & Arendts, G. (2017). Comparison of the HUI3 and the EQ-5D-3L in a nursing home setting. PLoS ONE,12, e0172796.
Huang, H. L., Weng, L. C., Tsai, Y. H., Chiu, Y. C., Chen, K. H., Huang, C. C., et al. (2015). Predictors of self- and caregiver-rated quality of life for people with dementia living in the community and in nursing homes in northern Taiwan. International Psychogeriatrics,27, 825–836.
Harrison, S. L., O’Donnell, L. K., Bradley, C. E., Milte, R., Dyer, S. M., Gnanamanickam, E. S., et al. (2018). Associations between the drug burden index, potentially inappropriate medications and quality of life in residential aged care. Drugs and Aging,35, 83–91.
Grske, J., Meyer, S., & Wolf-Ostermann, K. (2014). Quality of life ratings in dementia care? a cross-sectional study to identify factors associated with proxy-ratings. Health and Quality of Life Outcomes,12, 177.
Tiit, E. M., & Saks, K. (2008). Subjective quality of life of care-dependent older people in five european union countries. In N. Y. New York (Ed.), Care-related quality of life in old age: Concepts, models and empirical findings (pp. 153–167). York: Springer, New.
Meyer, R., Drewniak, D., Hovorka, T., & Schenk, L. (2018). Questioning the questionnaire: Methodological challenges in measuring subjective quality of life in nursing homes using cognitive interviewing techniques. Qualitative Health Research. https://doi.org/10.1177/1049732318812042.
Schenk, L., Meyer, R., Behr, A., Kuhlmey, A., & Holzhausen, M. (2013). Quality of life in nursing homes: Results of a qualitative resident survey. Quality of Life Research,22(10), 2929–2938.
Makai, P., Brouwer, W. B., Koopmanschap, M. A., Stolk, E. A., & Nieboer, A. P. (2014). Quality of life instruments for economic evaluations in health and social care for older people: A systematic review. Social Science and Medicine,102, 83–93.
Estermann, J., & Kneubuhler, H. (2006). How to measure quality of life in nursing homes. European Journal of Public Health, Supplement 1,16, 39–40.
Kane, R. A. (2001). Long-term care and a good quality of life: Bringing them closer together. Gerontologist,41, 293–304.
Kane, R. L., Bershadsky, B., Kane, R. A., Degenholtz, H. H., Liu, J. J., Giles, K., et al. (2004). Using resident reports of quality of life to distinguish among nursing homes. The Gerontologist,44, 624–632.
Liu, C., Feng, Z., & Mor, V. (2014). Case-mix and quality indicators in Chinese elder care homes: Are there differences between government-owned and private-sector facilities? Journal of the American Geriatrics Society,62, 371–377.
Zhang, H. H., Liu, P. C., Ying, J., Shi, Y., Wang, S. Q., Zhang, M. L., et al. (2018). Evaluation of MESSAGE communication strategy combined with group reminiscence therapy on elders with mild cognitive impairment in long-term care facilities. International Journal of Geriatric Psychiatry,33, 613–622.
Wu, M., Yang, Y., Zhang, D., Zhao, X., Sun, Y., Xie, H., et al. (2018). Association between social support and health-related quality of life among Chinese rural elders in nursing homes: The mediating role of resilience. Quality of Life Research,27, 783–792.
Wang, J., Wang, J., Cao, Y., Jia, S., & Wu, B. (2016). Older residents’ perspectives of long-term care facilities in China. J Gerontol Nurs,42, 34–43.
Ai, Y., Wang, L., Gao, X., Ren, H., Wang, Z., & Hu, H. (2017). Quality of life of the aged stroke survivors in an advanced nursing home in China: A qualitative research. Journal of the American Geriatrics Society,65, S338.
The WHOQOL Group. (1993). Study protocol for the World Health Organization project to develop a Quality of Life assessment instrument (WHOQOL). Quality of Life Research,2(2), 153–159.
Leung, B. W., Moneta, G. B., & McBride-Chang, C. (2005). Think positively and feel positively: Optimism and life satisfaction in late life. International Journal of Aging and Human Development,61, 335–365.
Diener, E. (2000). Subjective well-being. The science of happiness and a proposal for a national index. American Psychologist,55, 34–43.
Gu, D., Dupre, M. E., & Liu, G. (2007). Characteristics of the institutionalized and community-residing oldest-old in China. Social Science & Medicine,64(4), 871–883.
Shi, Z. (2016). Does the number of children matter to the happiness of their parents? Journal of Chinese Sociology,3, 16.
Liu, G., Dupre, M. E., Gu, D., Mair, C. A., & Chen, F. (2012). Psychological well-being of the institutionalized and community-residing oldest old in China: The role of children. Social Science & Medicine,75(10), 1874–1882.
Li, T., Wang, S. W., Zhou, J. J., Ren, Q. Z., & Gao, Y. L. (2018). Assessment and predictors of grief reactions among bereaved Chinese adults. Journal of Palliative Medicine,21(9), 1265–1271. https://doi.org/10.1089/jpm.2018.0001.
Mou, H., Chen, L., Zhu, S., Xu, D., Ling, J., & Wang, K. (2018). Qualitative research on the quality of life of the elderly in the old-age care institution. Journal of Qilu Nursing,24(4), 5–7.
An, R., & Liu, G. G. (2016). Cognitive impairment and mortality among the oldest-old Chinese. International Journal of Geriatric Psychiatry,31, 1345–1353.
Rabin, R., & de Charro, F. (2001). EQ-5D: A measure of health status from the EuroQol Group. Annals of Medicine,33, 337–343.
Brooks, R. (1996). EuroQol: The current state of play. Health Policy,37, 53–72.
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research,12, 189–198.
Honig, L. S., Vellas, B., Woodward, M., Boada, M., Bullock, R., Borrie, M., et al. (2018). Trial of solanezumab for mild dementia due to alzheimer’s disease. The New England Journal of Medicine,378(4), 321–330.
Mahoney, F. I., & Barthel, D. W. (1965). Functional evaluation: The barthel index. Maryland State Medical Journal,14, 61–65.
Groll, D. L., To, T., Bombardier, C., & Wright, J. G. (2005). The development of a comorbidity index with physical function as the outcome. Journal of Clinical Epidemiology,58, 595–602.
Doustmohammadian, A., Omidvar, N., Keshavarz-Mohammadi, N., Abdollahi, M., Amini, M., & Eini-Zinab, H. (2017). Developing and validating a scale to measure food and nutrition literacy (FNLIT) in elementary school children in Iran. PLoS ONE,12(6), e0179196.
Reigada, L. C., Moore, M. T., Martin, C. F., & Kappelman, M. D. (2018). Psychometric evaluation of the IBD-specific anxiety scale: A novel measure of disease-related anxiety for adolescents with IBD. Journal of Pediatric Psychology,43(4), 413–422.
Givens, J. L., Jones, R. N., Mazor, K. M., Prigerson, H. G., & Mitchell, S. L. (2015). Development and psychometric properties of the family distress in advanced dementia scale. Journal of the American Medical Directors Association,16(9), 775–780.
Bentler, P. M. (1990). Comparative fit indexes in structural models. Psychological Bulletin,107, 238–246.
Muthén, B. O. (1989). Latent variable modeling in heterogeneous populations. Psychometrika,54, 557–585.
Han, J., Meng, Y., Xu, C., & Qin, S. (2017). Urban residents’ religious beliefs and influencing factors on christianity in Wuhan. China. Religions,8, 244.
Low, L. P., Lee, D. T., & Chan, A. W. (2007). An exploratory study of Chinese older people’s perceptions of privacy in residential care homes. Journal of Advanced Nursing,57(6), 605–613.
Wu, B., Mao, Z. F., & Zhong, R. (2009). Long-term care arrangements in rural China: Review of recent developments. Journal of the American Medical Directors Association,10(7), 472–477.
The authors would like to thank all the participants in this study.
This study was funded by the National Social Sciences Fund of China (14CSH063).
Conflicts of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Institutional Review Board of Shandong University.
Informed consent was obtained from all individual participants included in the study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
About this article
Cite this article
Xu, D., Gao, J., Chen, L. et al. Development of a quality of life questionnaire for nursing home residents in mainland China. Qual Life Res 28, 2289–2297 (2019). https://doi.org/10.1007/s11136-019-02180-2
- Quality of life
- Nursing home
- Instrument development