{"paper_id":"2ca34d83-bca3-43f7-99a2-cced503c3fbe","body_text":"Psychological evaluation of the Chinese Version of the chronic disease adaptation scale for community elderly : a translation and validation Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Psychological evaluation of the Chinese Version of the chronic disease adaptation scale for community elderly : a translation and validation Study Yuting Zeng, Lingling Gao, Ting Huang, Ling Zhu, Dian Xu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8874701/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract OBJECTIVE : This study aims to translate the \"Chronic Disease Adaptation Scale\" into Chinese and test its psychometric properties in the elderly patients with chronic diseases in China. METHODS : Following Brislin's translation and cross-cultural adaptation model, the Chronic Disease Adaptation Scale was localized through the method of forward and backward translation. 435 elderly individuals were conveniently selected in Shenzhen, Guangdong Province as the research subjects. Item analysis was used for discriminant validity analysis, and internal reliability, external reliability, content validity, exploratory factor, confirmatory factor, and multi-group tests were used for reliability and validity analysis. RESULTS : Through exploratory factor analysis, 5 factor eigenvalues were greater than 1, and they were named as denial behavior of the disease, compliance behavior of the disease, active participation, emotional support for the disease, and emotional support. The cumulative variance contribution rate was 72.853%. Using confirmatory factor analysis, the results showed that the chi-square degree of freedom ratio (c2 / df) was 2224.030, the approximate root mean square error (RMSEA) was 0.027, both within the standard range. The multi-group analysis showed that the model fitting effect of the Chronic Disease Adaptation Scale was similar in different genders. The critical ratio (CR) of each item was -16.156 to -31.05, and the correlation coefficient (r) between the item and the total score was 0.532 to 0.679 (P < 0.001). The Cronbach α coefficient of the total scale was 0.913, and the Cronbach α coefficients of the five factors were 0.850, 0.862, 0.884, 0.827, and 0.870, respectively. The test-retest reliability of the total scale was 0.945. Conclusion : The Chinese version of the Chronic Disease Adaptation Scale has good reliability and validity and is suitable for measuring the adaptation ability of chronic diseases in the Chinese elderly population. old people chronic disease illness adjustment validation study Figures Figure 1 Figure 2 Background As the aging process of the population advances, as well as changing the circle of diseases, over recent years, the number of chronic diseases among the aged population in our country has been growing each year. The data given by the World Health Organization (WHO) postulates that about 41 million deaths per year occur globally due to chronic diseases, which is 71.3 percent of the total death [1] . According to the statistics presented by the seventh national population census, more than 264 million individuals are aged 60 and over in China that constitute 18.70 percent of the country population. Approximately 180 million individuals in this group are afflicted with one chronic condition out of which approximately 75 per cent of the group fall in this category [2] . This is because factors like physiological age aging, aging of tissues and organs, and deterioration of physical functions predispose the elderly population to the prevalence of chronic diseases. This affects considerably the quality of life and health of the inhabitants [3] . Chronic illnesses are also difficult to treat and therefore create a significant burden to both family and society, which can cause the patients to become fearful, anxious, depressed and other unpleasant feelings and diminish his adaptability to the disease [4, 5] . The proportion of those that die as a result of chronic diseases in China constitutes 88 percent of the overall number of people who die and the burden of chronic diseases constitutes over 70 percent of the overall disease burden [6, 7] .Therefore, how to conduct early prevention and enhance the adaptability of the elderly after they fall ill has become an urgent issue that needs to be addressed. Chronic diseases refer to a category of diseases including hypertension, diabetes, chronic respiratory diseases, etc, characterized by complex causes, wide prevalence, high disability and mortality rates, etc [8] . Firstly, chronic diseases not only cause damage to patients' physical health and functions, but also affect their autonomy, freedom and personal identity [9] . Secondly, chronic diseases require long-term treatment, increasing the demand for medical care services and changing their nature. This demand for long-term care leads to a decline in the quality of life of the elderly [10] . Finally, with the changes in social dietary structure, living habits and disease patterns, the incidence of chronic diseases in the elderly is constantly rising, imposing a heavy disease burden and a high mortality risk on patients. To avoid this situation, elderly patients must actively control their conditions and change their lifestyles to adapt to the disease state, so as to effectively deal with the disease without aggravating the symptoms. Some researchers believe that disease adaptation refers to the individual's self-awareness of physical, psychological, and interpersonal discomfort caused by the disease. With external assistance and self-adjustment, they make positive changes to adapt to the disease and accept the changes in the condition [11] . Good adaptability is helpful in coping with the challenges brought about by the changes in the disease [12] . The research conducted by Wang Xiyi and others [13] shows that good physiological adaptation can enable individuals to maintain energy, thereby slowing down the progression of the disease and promoting its recovery. In the long-term management and treatment of chronic diseases, due to their long course and recurring nature of the condition, it will cause significant psychological and economic pressure on family members, leading to negative emotions such as \"dragging down the family\" and \"being unable to cope\" among elderly patients with chronic diseases. This is not conducive to the physiological, psychological and disease recovery of elderly patients with chronic diseases [14] , while a good level of adaptation will reduce negative emotions and can encourage elderly patients with chronic diseases to take more self-care behaviors [15] . Therefore, the degree of adaptation of elderly patients to the disease is particularly important. If patients have good adaptability in terms of physiology, psychology and society, it is beneficial for them to return to family and society [16] . In China, although there are numerous studies on the assessment of chronic disease adaptation, there is a lack of appropriate measurement tools. Regarding chronic disease adaptation in our country, some scholars have used the Chinese version of the Psychosocial Adaptation Index for Illness Scale (PAIS-SR) developed by Derogatis et al [17] and translated by Yao Jingjing [18] to investigate the disease adaptation levels of cancer patients or other patients with chronic diseases. However, the PAIS-SR scale has numerous items, and its reliability still needs to be verified in other chronic diseases except for cancer. Indian scholar Meera Padha [19] developed the Chronic Disease Adaptation Scale in March 2024 to meet the needs of different types of chronic disease patients for an effective measurement of disease adaptability. This scale is designed to create an acceptable alternative to replace longer assessment tools that are specific to certain diseases and have specific contexts. Moreover, this scale is simple to understand, easy to complete, and has good reliability and validity in the Indian population. It can be used to measure the ability of elderly patients with chronic diseases in other Asian countries to adapt to their diseases. The purpose of this study is to translate the chronic disease adaptation scale into Chinese and verify its reliability and validity in community elderly people with a high risk of chronic disease occurrence. Methods Study Design and Subjects This study translated the Chronic Disease Adaptation Scale and evaluated its psychometric properties through a status survey conducted from October 2022 to February 2023. The survey was conducted among community elderly patients with chronic diseases using a convenience sampling method. According to the rough estimation method of the reference sample size, the sample size required for the reliability and validity tests of this scale should be 5 to 10 times the number of scale items [20] . To ensure the stability of the factor structure, the structural equation model (confirmatory factor analysis) should include at least 200 cases [21] , and a larger sample size should be considered. In this study, the Chinese version of the Chronic Disease Adaptation Scale contains 19 items. The reference sample size should be 10 times the number of scale items, but considering a possible 20% sample loss rate, it is estimated that this study should include 140 elderly patients with chronic diseases. Inclusion criteria: (1) Age 60 years or older; (2) Have at least 1 chronic disease; (3) Have been diagnosed with a chronic disease in a secondary or higher-level hospital and have a disease course of ≥ 1 year; (4) Have given informed consent and voluntarily participated in this study. Exclusion criteria: (1) Cognitive impairment, severe mental disorders; (2) Those with communication disorders and unclear expression due to various reasons. A total of 435 community elderly patients with chronic diseases were recruited in this study. Instruments General information questionnaire After a thorough review of the literature, we designed a general information questionnaire, which included questions about age, gender, educational level, marital status, monthly income and the duration of chronic diseases. Chronic illness adjustment scale (CIAS) Padhy M et al. [19] developed the Chronic Disease Adaptation Scale, which consists of 19 items across 5 dimensions: denial of the disease (4 items), compliance with the disease (4 items), active participation (4 items), emotional support for the disease (3 items), and emotional involvement (4 items). Respondents were required to rate each item on a Likert 4-point scale, with 1 representing \"never\" and 4 representing \"always\". The score range of the Chronic Disease Adaptation Scale is from 19 to 76 points, with the items of the denial of the disease dimension being reverse-scored. The higher the score, the higher the disease adaptation ability. The Cronbach's α coefficients of each dimension of the scale range from 0.850 to 0.884. Procedure Scale translation and cross‑cultural adaptation procedure After obtaining the email authorization from the original author Padhy M [19] , the translators strictly followed Brislin [22] 's reverse translation scale and made cross-cultural adjustments. The specific steps are as follows: (1) Initial translation: Nursing researchers and doctoral students translated the original scale into Chinese. (2) Correction: Another researcher translated the Chinese version back into English. A nursing expert and a clinical medicine doctor compared the translation versions, discussed and evaluated the translation quality, and then revised the professional terms to form the first draft. (3) Back translation: To ensure semantic equivalence, a researcher without a medical background was specially invited to retranslate the first draft into English, and finally the Chinese version of the chronic disease adaptation scale was formed. Subsequently, 30 elderly patients with chronic diseases were randomly selected from the local community to evaluate the performance of the translation scale items in terms of clarity and comprehensibility. Data collection procedure The questionnaire includes standard explanations, which clarify its purpose, importance, personal data protection measures, and filling methods. After receiving appropriate training, the researchers, with the assistance of local community managers, visited four communities in Shenzhen to recruit participants. During the research period, the researchers distributed questionnaires to the participants, explained the filling methods to them, and asked them to answer anonymously. After the questionnaires were completed, the researchers collected them on the spot. Participation was voluntary and anonymous. After understanding the research purpose and background, 441 elderly patients with chronic diseases participated in the questionnaire survey. During the data analysis process, questionnaires with obvious patterns or logical contradictions were excluded. Finally, 435 valid questionnaires were collected, with a response rate of 98.63%. Two weeks later, 60 elderly patients with chronic diseases were randomly selected to participate in the second survey to evaluate the reliability of the scale re-assessment. Data analysis procedure Two persons took the input data in the Excel software, and after checking, they were transferred to SPSS 26.0 software and AMOS 22.0 software to analyze the statistical data. Frequency, percentage and mean ± standard deviation were used in the statistical description of count data and measurement data. Skewness and kurtosis of every item were obtained. In case the skewness and kurtosis value fell in the range of -2 to +2 [23] , it was assumed that the data was normally distributed. This paper presented to the Chinese version of the Chronic Disease Adaptation Scale, an item analysis, a validity analysis, as well as reliability analysis. Items analysis The total scores of the Chinese version of the Chronic Disease Adaptation Scale for 435 community-dwelling elderly individuals were ranked using the Critical Ratio (CR) method. Based on the total scores, the sample was divided into high-score group and low-score group using the 27th percentile method, and the differences in item scores between the two groups were compared [24] . The 27th percentile was chosen as the dividing line because it is commonly used in psychometrics to maximize discrimination while ensuring adequate sample size [25] . An independent sample T-test was conducted, and no items with statistical significance were deleted. A critical ratio > 3.000 [26] indicates that these items have good discrimination. The correlation between the items and the translated scale, as well as the Cronbach's alpha coefficient after deleting items, were analyzed to evaluate whether each item in the translated scale can be retained. The correlation between the items and the total score was set as 0.4 as the inclusion criterion [27] . Validity analysis The validity of this scale refers to the extent to which the research tool accurately reflects the measured variable [28] . Content validity refers to the degree to which the concept that the researcher intends to measure is reflected in the questionnaire items [29] . Seven experts were invited to evaluate each item of the translated scale from the perspective of content importance. The content validity index (I-CVI) and scale content validity index (S-CVI) were calculated using the Delphi method. The 4-point Likert scale was used to assess the content relevance of each item in the Chinese version of the Chronic Disease Adaptation Scale, ranging from 1 = not relevant to 4 = very relevant. I-CVI > 0.780 and S-CVI > 0.900 indicate good content validity [30]. The name structural validity is a subdivision of validity, which is defined by the level of congruence between a measurement scale and its theoretical or conceptual framework. It is employed in assessing the ideal professional structure of a particular objective thing in the form of multi-indicator measurement [28] . This study involved EFA and CFA to investigate and confirm the fundamental structure of factor of the translated scale, whereby 435 samples were randomly divided to form two groups; one group (n = 217) was used in EFA, and the other one (n = 218) was used in CFA. The rationality of the use of the principal component analysis (PCA) and maximum rotation in EFA was determined by using the Kaiser-Meyer-Olkin (KMO) measurement and the test of sphericity. The most widely used orthogonal technique is the maximum rotation which reduces as much as possible the complexity of the factors by maximizing the variance of the factor loadings. The data set is only deemed to be appropriate to undergo factor analysis when the test of sphericity of the Bartlett (P < 0.05) is significant and KMO is greater than 0.60 [31] . Principal component analysis was applied because it was needed to obtain the factor with the highest eigenvalue of more than 1 to apply the variance maximizing rotation technique, and the items whose factor loading is below 0.500 were removed [32] . Structural equation model measurement method portrays the compliance of the relationship between the factor and indicators of the factor adhering to the theoretical relationship established by the researchers. The hypothesis of factor model was tested through the application of structural equation model (CFA) and maximum likelihood method was applied to get the estimation. At the point which every fit was greater than 0.090 with RMSEA smaller than 0.080, the model structure was taken to be good. A convergence or aggregation validity is the similarity of various measurement indicators who measure the same concept; discriminant validity is the capacity to be able to distinguish between various latent major variables [33] . The extracted average variance (AVE 0.50 and above) and composite reliability (CR 0.70 and above) were considered as measures of convergence validity. In each dimension, when the square root of AVE was greater than the inter-factor correlation, it was shown that discriminant validity was supported which implied that the scale was viewed to have good convergence and discriminant validity [34, 35] . Reliability analysis Reliability Analysis: Reliability of this scale is used in terms of consistency and stability of the measurement results get using the research tool [28] . The tested scale was estimated to be reliable by determining the Cronbachs alpha coefficient, split half reliability and the test-retest reliability. Standard Cronbach alpha value of the scale and dimension of the scale were computed and a minimum that should be received by the coefficient of reliability was 0.6 [28] . The scale items were put in odd even sequence and the correlation of the score of the two parts determined to assess the split half reliability. The same translated scale was retested again after two weeks on a group of community elderly patients with chronic illnesses in order to determine the retest correlation and to confirm their stability and consistency over the data collection time. As Pearson correlation coefficients are typically computed by using higher indicators of true reliability as well as intraclass correlation coefficients (ICC) as an indication of the consistency of the two measurement results. Results Descriptive statistics In this study, a total of 441 questionnaires were distributed, and 435 valid questionnaires were retrieved, with an effective rate of 98.63%. Respondents aged between 65 and 69 accounted for 67.1%. 68% of the respondents had an education level of primary school or below. The majority (86.9%) of the respondents were married; 77% of the respondents had a monthly income of less than 2000 yuan. Before retirement, the occupations of the respondents were mainly farmers (22.5%) and workers (21.1%), and 59.5% of the respondents used rural medical insurance. More respondents (38.9%) had a disease duration of 1 to 5 years, and the severity of the diseases of the respondents was mostly mild to moderate. Table 1 lists the characteristics of all the respondents. Table 1 Frequency distribution of general information (n=435) Factors Group N % Age (years) 65 - 69 years old 292 67.1 70 - 74 years old 93 21.4 75 - 79 years old 31 7.1 80 years old and above 19 4.4 Gender Man 201 46.2 Woman 234 53.8 Educational level Primary school and below 292 67.1 Junior high school and technical secondary school 84 19.3 senior high school 44 10.1 College degree or above 15 3.4 Marital status Unmarried 7 1.6 Married 378 86.9 Divorce 19 4.4 Bereft of one's spouse 31 7.1 Monthly income (yuan) <2000 335 77.0 2000~4000 63 14.5 >4000 37 8.5 Previous career before retirement Farmer 98 22.5 Worker 92 21.1 Teacher 24 5.5 Medical staff 40 9.2 other 181 41.6 Type of medical insurance Urban medical insurance 158 36.3 Rural medical insurance 259 59.5 Self-payment 18 4.1 Duration of illness ＜1 year 138 31.7 1 - 5 years 169 38.9 6 - 10 years 106 24.4 10 years and above 22 5.1 severity of illness Mild (stable condition with no obvious symptoms / mild symptoms) 174 40.0 Moderate (present with typical symptoms, mild restriction in daily activities) 148 34.0 Severe (severe symptoms that persist, significant restriction in daily activities) 78 17.9 Extremely severe (critical condition, severely affecting quality of life) 35 8.0 Scale translation and cross cultural adaptation procedure The research team revised the scale content based on expert feedback. For example, item 9 was changed from \"I cancelled the doctor's appointment\" to \"I made an appointment with the doctor for a visit, but ultimately did not go for the consultation.\" making the item's meaning clearer to respondents. In the preliminary study, 30 participants completed the scale in approximately 6 to 7 minutes. Participants found the wording of each item concise and clear, and believed that older adults with chronic conditions in the community could use the scale to accurately assess their ability to manage chronic diseases. Item Analysis Cronbach of all the items of translation scale was found to be between -16.156 and -31.05 and the findings between the high scores group and the low score group of each item were statistically significant (P<0.05). Correlations coefficient presented between the scores of each item and total score amounted to 0.532 to 0.679 (P <0.05) that satisfied inclusion criteria of the correlation coefficient procedure.. The translation scale had a Cronbach alpha value of 0.913 which represents good internal consistency. Table 2 presents the values of the average (standard deviation), skewness, and kurtosis of each item. The deviation and kurtosis of the items were also within a reasonable range, -2 to +2 and this showed close to normality. Table 2 Mean (SD) scores with skewness and kurtosis, item analysis for Chinese version of the chronic disease adaptation scale Item Item score (SD) Critical ratio Item-total correlation Cronbach’s alpha if item deleted Skewness Kurtosis a1 2.17（0.052） -21.817 0.651 0.908 0.515 -1.02 a2 2.15（0.052） -23.477 0.671 0.907 0.537 -1.019 a3 2.14（0.05） -16.659 0.624 0.908 0.569 -0.862 a4 2.19（0.048） -19.603 0.628 0.908 0.493 -0.774 b1 2.13（0.053） -21.929 0.667 0.907 0.554 -1.027 b2 2.16（0.051） -21.05 0.639 0.908 0.486 -1.014 b3 2.13（0.05） -18.741 0.679 0.907 0.516 -0.924 b4 2.15（0.05） -18.355 0.657 0.907 0.492 -0.96 c1 2.17（0.05） -17.665 0.623 0.908 0.453 -1.008 c2 2.09（0.051） -17.183 0.656 0.907 0.562 -0.94 c3 2.18（0.047） -17.355 0.595 0.909 0.505 -0.744 c4 2.17（0.051） -16.666 0.592 0.909 0.488 -1.001 d1 2.17（0.05） -21.419 0.620 0.908 0.43 -0.99 d2 2.15（0.051） -19.455 0.582 0.91 0.484 -0.995 d3 2.11（0.048） -17.514 0.587 0.909 0.481 -0.857 f1 2.96（0.051） -18.394 0.589 0.909 -0.627 -0.91 f2 2.8（0.049） -20.627 0.595 0.909 -0.515 -0.836 f3 2.85（0.055） -31.05 0.658 0.907 -0.48 -1.21 f4 2.77（0.049） -16.156 0.532 0.911 -0.478 -0.867 Validity analysis Content validity analysis Seven experts evaluated the correlation between each item in the translated scale and the actual measured content. The I-CVI and S-CVI of 19 items at the level of the scale were calculated, where the I-CVI value ranged from 0.846 to 1.000, and the S-CVI was 0.934. Exploratory factor analysis To start with, KMO test and sphericity test by Bartlett were performed. KMO was 0.901 (>0.600) and in Bartletts test of sphericity, x2 = 2224.030, P = 0.001, which meant that factor analysis could be done. Out of these 5 general factors were obtained which explained 72.853% of the total variance. All the factor loadings of the items were above 0.500 and nothing was dropped out. Table 3 presents the loading of each item. The structure of the slope graph showed further the five factors aspect as the slope became downwards after the 5th point. (Figure 1). Table3 Factor loadings of exploratory factor analysis for the Chinese version of the chronic disease adaptation scale Item Factor 1 Factor 2 Factor 3 Factor 4 Factor 5 Strategic positive interaction 1.I divert my thoughts from health issues by reading books. 0.852 0.116 0.120 0.115 0.082 2.I treat others well to temporarily relieve myself from the pain. 0.837 0.045 0.169 0.187 0.112 3.I prefer to interact with others so as to avoid thinking about my poor health condition. 0.823 0.173 0.038 0.157 0.181 4.I engage in religious activities to divert my worries about my health situation. 0.795 0.141 0.151 0.220 0.118 Emotional engagement 5.Whenever I think about my illness, I feel depressed. 0.067 0.830 0.112 0.140 0.113 6.If someone discusses my illness, I feel uneasy. 0.101 0.829 0.051 0.111 0.122 7.I always think about my illness. 0.121 0.808 0.247 0.089 0.064 8.When others don't notice the symptoms of my illness, I feel very depressed. 0.194 0.755 0.165 0.253 0.137 Disease-related behaviors 9.I do everything possible to handle my health issues. 0.152 0.155 0.802 0.172 0.034 10.我I follow the doctor's advice to do physical exercises. 0.175 0.210 0.802 0.055 0.243 11. I strictly adhere to the prescribed diet plan without any resistance. 0.200 0.098 0.793 0.252 0.176 12.I strictly follow the doctor's suggestions. -0.032 0.153 0.697 0.325 0.296 Denial of illness behavior 13. I always find some excuses to avoid following the doctor's advice. 0.141 0.208 0.217 0.773 0.032 14.I avoid taking any new measures to improve my health. 0.130 0.039 0.192 0.757 0.184 15.I registered for the doctor's appointment but didn't go for the visit. 0.199 0.169 0.172 0.739 0.190 16.I have entrusted my illness to fate. 0.253 0.197 0.101 0.731 0.129 Psychological support for diseases 17.I discussed issues related to illness with my family. 0.108 0.035 0.136 0.196 0.830 18.When I felt depressed about my illness, I sought support from others. 0.184 0.148 0.188 0.138 0.777 19.I shared my worries about health with my friends. 0.158 0.236 0.228 0.118 0.741 Confirmatory Factor Analysis To determine whether the structure of this scale was agreeable with the original scale, a CFA analysis was done on 218 randomly selected samples (Figure 2). Table 4 indicates the appropriate indices of the model. Table 5 has shown the CR and AVE results of each of the dimensions, with the range of the CR values between 0.847 and 0.875 (more than 0.700) and the range of the AVE values between 0.604 and 0.648 (more than 0.500). ABE values of each factor are also negative and the strength of the association between that factor with others is also maximum. ( Table 6). Table 4 Fit indices of the Chinese version of the chronic disease adaptation scale model Fit indices χ 2 /df RMSEA GFI NFI TLI CFI IFI Model modification 1.163 0.027 0.929 0.930 0.987 0.989 0.990 Range <3.000 <0.080 >0.900 >0.900 >0.900 >0.900 >0.900 RMSEA,the root mean square error of approximation; GFI,the goodness-of-fit index; NFI,the normed fit index; TLI,the Tucker Lewis index; CFI,the comparative fit index; IFI,the incremental fit index Table 5 Results of confirmatory factor analysis Factor Item Parameter significance estimation Construct reliability Con- vergent validity Unstd. estimate SE P Std. estimate CR AVE A a1 1 0.795 0.865 0.617 a2 0.985 0.077 *** 0.829 a3 0.925 0.077 *** 0.786 a4 0.768 0.07 *** 0.728 B b1 1 0.735 0.859 0.604 b2 1.004 0.096 *** 0.746 b3 1.036 0.092 *** 0.802 b4 1.085 0.095 *** 0.822 C c1 1 0.815 0.875 0.636 c2 1.081 0.082 *** 0.826 c3 0.956 0.079 *** 0.768 c4 1.027 0.083 *** 0.779 D d1 1 0.807 0.847 0.648 d2 1.016 0.083 *** 0.836 d3 0.878 0.076 *** 0.771 F f1 1 0.801 0.869 0.624 f2 0.892 0.075 *** 0.776 f3 1.153 0.09 *** 0.832 f4 0.882 0.077 *** 0.749 Table 6 AVE square root value of each latent variable and variable correlation coefficient Variable AVE F D C B A F 0.624 0.691 D 0.648 0.405 0.805 C 0.636 0.388 0.47 0.797 B 0.604 0.503 0.561 0.565 0.777 A 0.617 0.477 0.52 0.502 0.643 0.785 The numbers in bold represent AVE square root value Reliability analysis The Cronbach's alpha coefficient of this translation scale is 0.913. The split-half reliability is 0.691. Within the following two weeks, 60 community elderly patients with chronic diseases were randomly selected for a retest. The reliability of the retest was 0.945 (Table 7), and the reliability coefficient was 0.945. Table 7 Reliability analysis for Chinese version of the chronic disease adaptation scale The scale and its dimension Cronbach’s alpha Split-half reliability Test–retest reliability The chronic illness adjustment scale 0.913 0.691 0.945 Illness denial behaviour 0.850 Illness-compliant behaviour 0.862 Strategic positive engagement 0.884 Emotional support for illness 0.827 Emotional engagement 0.870 Discussion Compared with Western countries, the early screening for chronic diseases in China started relatively late. The awareness of early prevention and treatment of chronic diseases among the elderly in China is weak. Moreover, the economic pressure and family conflicts that arise after getting sick further reduce their adaptability to chronic diseases, resulting in poor clinical prognosis. The measurement tools widely used in China were developed by Western countries, with many items but limited measurement contents. The existing evaluation devices are less than suitable to evaluate the disease adaptation ability level of the elderly patients with chronic diseases in China. Scholar Padhy M[19] invented Chronic Disease Adaptation Scale in 2024 that comprehensively addresses the topic of disease adaptation and behavior status and can have a better measurement of the level of the ability to adapt the disease ability of the elderly with chronic diseases. No translation version of this scale exists nowadays, and the studies of reliability and validity have not been described so far. The present research is the first to make the Chronic Disease Adaptation Scale into Chinese and confirm its psychometric properties based on the reliability and validity tests on the elderly population in the community. The findings indicate that the Chinese form of Chronic Disease Adaptation Scale in the research has relevant reliability and validity, is capable of measuring the behavioural factors of the overall adaptation of elderly people to chronic disease diagnosis, and assists to enhance the adaptability to chronic diseases. It may assist the staff in medical practice to better monitor and rectify the diagnosis of chronic diseases in the elderly, enhancing their disease adaptation capacity. The CR values of the translation scale are in the normal range, which implies that every item of the scale serves the purpose of determining the degree of adaptation ability of the ability to deal with chronic disease of the various survey subjects. The findings of the correlation coefficient method indicate that the results of each item and the dimensions exhibit high correlation. Moreover, the Cronbach 0 coefficient of the translated scale never increased after the deletions of the items, which means that the relationship between the items is high, the ratio between them is high. This demonstrates that all the 19 items in the Chinese version of Chronic Disease Adaptation Scale are well-discriminating and capable of maintaining the information. The values of I-CVI and S-CVI in this study are in the right scale giving the idea that the scale in use has proper content validity and the scale items are able to capture the content under measurement [30] . Factor analysis was the method of evaluation of construct validity that was employed in this study. With no exclusion of items EFA produced 5 common factors and the items in each dimension were similar to the original scale [19] . The contribution rate of cumulative variance was found to be 72.853 which is more than the original scale score (51.89%), and this proves that the extracted common factors were very useful in explaining each dimension. Hence, the research feels that the validity of structure of the translated scale is good. In this research, CFA techniques were applied to confirm the structure of the translated scale even further and the value of the fit met the optimum level of fitting. CR and AVE scale values are in the normal range of reference and this has revealed that the five factors of the scale are consistent [34,35] . The Pearson correlation coefficients between any two particular factors in the scale are smaller than the square root of its average variance extraction value which shows that these five dimensions can easily be separated and their discriminating validity is good. The findings of the additional confirmatory factor analysis indicate that the scale which is translated has a scientific stabilized and good structure validity. The Cronbach's α coefficients of the translated scale and all sub-scales in this study all fall within the reference standards, and this shows that the scale has a high internal consistency reliability[28]. The dimensions are higher than the original scale[19] which can be associated with the low adaptability of the elderly people in China to the levels of chronic diseases. Simultaneously, the test-retest reliability of the Chinese version scale is also quite good [36] and it demonstrates the stability of the translated scale over time. As such, Chinese adaptation of Chronic Disease Adaptation Scale is appropriately reliable. Limitations There are certain weaknesses in this research that should be taken into account and overcome. First, the sample size of this study is small because it was conducted only in Shenzhen. The sample size must also be increased in future to revise the scale further to increase the represent ativeness of the achieved results. Secondly, this study conducted a cross-sectional survey and was unable to verify the stability of the scale in different periods; therefore, future longitudinal studies should be carried out to verify it. Finally, this study did not conduct a calibration test for the validity of the correlation. In subsequent research, this aspect should be supplemented. Conclusion Overall, Chinese version of the Chronic Disease Adaptation Scale that was created during this work has understandable items descriptions, minimal time to complete, and suitable reliability and validity within the community. It is highly operational and very appropriate to clinical research, it can efficiently evaluate the degree of adaptation of the older patients with chronic illnesses in the community to chronic illnesses. The results of the measurement using this scale can be used by the medical staff to interpret how elderly patients with chronic diseases adapt to the diseases, and to formulate relevant measures to increase disease prevention and health care awareness in elderly patients in the community, thereby reducing the incidence of chronic diseases and the harm caused by potential complications. Declarations Acknowledgements The authors are grateful to community elderly who participated in this study, and also to the community manager for their strong support in collecting samples. Furthermore, we thank the reviewers from the bottom of our hearts for their useful feedback and valuable editorial suggestions on our manuscript. Authors’ contributions YZ did the data collection and analysis and drafted the manuscript, TH and DX made significant contributions to the collection of data, LG and LZ made key modifications to the manuscript in order to obtain important academic content. Funding The authors received no external funding for this study. Availability of data and materials The data garnered during the current study and the final dataset used for statistical analysis are available from the corresponding author on reasonable request. The Chinese version of the Chronic Disease Adaptation Scale are available from the corresponding author on reasonable request. Ethics approval and consent to participate Prior to the investigation, participants were informed of the purpose and significance of this study and signed informed consent. All data were protected throughout the study. All procedures were performed with the 1964 Helsinki declaration, and the study protocol was approved by the Ethics Committee of Guangzhou University of Chinese Medicine Shenzhen Hospital (Futian). Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. 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BMJ.1997;314(7080):572.https://doi.org/10.1136/bmj.314.7080.572. Vederhus JK, Timko C, Haugland SH. Adverse childhood experiences and impact on quality of life in adulthood: development and validation of a short difficult childhood questionnaire in a large population-based health survey. Qual Life Res. 2021;30(6):1769–78. https://doi.org/10.1007/s11136-021-02761-0. Fuhua H, Lili L, Wenzhuan C. A study on the status quo of psychological pain in low-income type 2 diabetic patients based on confirmatory factor analysis. Gen Nurs.2021;19:2449–54. https://doi.org/10.12104/j.issn.1674-4748.2021.18.001. Lingling Z, Kunjuan J, Xinran G. Questionnaire validation factor analysis of factors influencing long-term care needs of disabled elderly people. Med Res Educ. 2021;38:59–68. https://doi.org/10.3969/j.issn.1674-490X.2021.05.009. Wu Y, Jin S, Guo J, Zhu Y, Chen L, Huang Y. The Economic Burden Associated with Depressive Symptoms among Middle-Aged and Elderly People with Chronic Diseases in China. Int J Environ Res Public Health. 2022;19(19):12958. Published 2022 Oct 10. doi:10.3390/ijerph191912958. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 27 Mar, 2026 Reviewers agreed at journal 20 Mar, 2026 Reviewers invited by journal 17 Mar, 2026 Editor assigned by journal 16 Mar, 2026 Editor invited by journal 20 Feb, 2026 Submission checks completed at journal 20 Feb, 2026 First submitted to journal 20 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-8874701\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":608973958,\"identity\":\"7a2572ad-af83-4bfc-afa9-675c32cc5537\",\"order_by\":0,\"name\":\"Yuting Zeng\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Guangzhou University of Chinese Medicine Shenzhen Hospital 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scale\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8874701/v1/bbed73c9cdd7855765b1d0e9.png\"},{\"id\":105057136,\"identity\":\"60378f40-aad7-4622-b7bc-71537c58bf4a\",\"added_by\":\"auto\",\"created_at\":\"2026-03-20 11:58:03\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":279634,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eStandardized six-factor structural model of the Chinese version of the chronic disease adaptation scale (\\u003cem\\u003en\\u003c/em\\u003e=218)\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8874701/v1/4c9c04bbb3f1af7178dc6b0e.png\"},{\"id\":105903854,\"identity\":\"3dcdc496-c38c-4ec3-80c3-383f86d75edb\",\"added_by\":\"auto\",\"created_at\":\"2026-04-01 09:55:28\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1336091,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8874701/v1/018099c2-fb4c-426a-b72a-ae9db3322fed.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Psychological evaluation of the Chinese Version of the chronic disease adaptation scale for community elderly : a translation and validation Study\",\"fulltext\":[{\"header\":\"Background\",\"content\":\"\\u003cp\\u003eAs the aging process of the population advances, as well as changing the circle of diseases, over recent years, the number of chronic diseases among the aged population in our country has been growing each year. The data given by the World Health Organization (WHO) postulates that about 41 million deaths per year occur globally due to chronic diseases, which is 71.3 percent of the total death \\u003csup\\u003e[1]\\u003c/sup\\u003e. According to the statistics presented by the seventh national population census, more than 264 million individuals are aged 60 and over in China that constitute 18.70 percent of the country population. Approximately 180 million individuals in this group are afflicted with one chronic condition out of which approximately 75 per cent of the group fall in this category \\u003csup\\u003e[2]\\u003c/sup\\u003e. This is because factors like physiological age aging, aging of tissues and organs, and deterioration of physical functions predispose the elderly population to the prevalence of chronic diseases. This affects considerably the quality of life and health of the inhabitants \\u003csup\\u003e[3]\\u003c/sup\\u003e. Chronic illnesses are also difficult to treat and therefore create a significant burden to both family and society, which can cause the patients to become fearful, anxious, depressed and other unpleasant feelings and diminish his adaptability to the disease \\u003csup\\u003e[4, 5]\\u003c/sup\\u003e. The proportion of those that die as a result of chronic diseases in China constitutes 88 percent of the overall number of people who die and the burden of chronic diseases constitutes over 70 percent of the overall disease burden \\u003csup\\u003e[6, 7]\\u003c/sup\\u003e.Therefore, how to conduct early prevention and enhance the adaptability of the elderly after they fall ill has become an urgent issue that needs to be addressed.\\u003c/p\\u003e\\n\\u003cp\\u003eChronic diseases refer to a category of diseases including hypertension, diabetes, chronic respiratory diseases, etc, characterized by complex causes, wide prevalence, high disability and mortality rates, etc\\u003csup\\u003e\\u0026nbsp;[8]\\u003c/sup\\u003e. Firstly, chronic diseases not only cause damage to patients\\u0026apos; physical health and functions, but also affect their autonomy, freedom and personal identity\\u003csup\\u003e[9]\\u003c/sup\\u003e. Secondly, chronic diseases require long-term treatment, increasing the demand for medical care services and changing their nature. This demand for long-term care leads to a decline in the quality of life of the elderly \\u003csup\\u003e[10]\\u003c/sup\\u003e. Finally, with the changes in social dietary structure, living habits and disease patterns, the incidence of chronic diseases in the elderly is constantly rising, imposing a heavy disease burden and a high mortality risk on patients. To avoid this situation, elderly patients must actively control their conditions and change their lifestyles to adapt to the disease state, so as to effectively deal with the disease without aggravating the symptoms.\\u003c/p\\u003e\\n\\u003cp\\u003eSome researchers believe that disease adaptation refers to the individual\\u0026apos;s self-awareness of physical, psychological, and interpersonal discomfort caused by the disease. With external assistance and self-adjustment, they make positive changes to adapt to the disease and accept the changes in the condition\\u003csup\\u003e\\u0026nbsp;[11]\\u003c/sup\\u003e. Good adaptability is helpful in coping with the challenges brought about by the changes in the disease\\u0026nbsp;\\u003csup\\u003e[12]\\u003c/sup\\u003e. The research conducted by Wang Xiyi and others\\u0026nbsp;\\u003csup\\u003e[13]\\u003c/sup\\u003e shows that good physiological adaptation can enable individuals to maintain energy, thereby slowing down the progression of the disease and promoting its recovery. In the long-term management and treatment of chronic diseases, due to their long course and recurring nature of the condition, it will cause significant psychological and economic pressure on family members, leading to negative emotions such as \\u0026quot;dragging down the family\\u0026quot; and \\u0026quot;being unable to cope\\u0026quot; among elderly patients with chronic diseases. This is not conducive to the physiological, psychological and disease recovery of elderly patients with chronic diseases\\u0026nbsp;\\u003csup\\u003e[14]\\u003c/sup\\u003e, while a good level of adaptation will reduce negative emotions and can encourage elderly patients with chronic diseases to take more self-care behaviors\\u0026nbsp;\\u003csup\\u003e[15]\\u003c/sup\\u003e. Therefore, the degree of adaptation of elderly patients to the disease is particularly important. If patients have good adaptability in terms of physiology, psychology and society, it is beneficial for them to return to family and society\\u003csup\\u003e\\u0026nbsp;[16]\\u003c/sup\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003eIn China, although there are numerous studies on the assessment of chronic disease adaptation, there is a lack of appropriate measurement tools. Regarding chronic disease adaptation in our country, some scholars have used the Chinese version of the Psychosocial Adaptation Index for Illness Scale (PAIS-SR) developed by Derogatis et al\\u0026nbsp;\\u003csup\\u003e[17]\\u003c/sup\\u003e and translated by Yao Jingjing\\u0026nbsp;\\u003csup\\u003e[18]\\u003c/sup\\u003e to investigate the disease adaptation levels of cancer patients or other patients with chronic diseases. However, the PAIS-SR scale has numerous items, and its reliability still needs to be verified in other chronic diseases except for cancer. Indian scholar Meera Padha\\u0026nbsp;\\u003csup\\u003e[19]\\u003c/sup\\u003e developed the Chronic Disease Adaptation Scale in March 2024 to meet the needs of different types of chronic disease patients for an effective measurement of disease adaptability. This scale is designed to create an acceptable alternative to replace longer assessment tools that are specific to certain diseases and have specific contexts. Moreover, this scale is simple to understand, easy to complete, and has good reliability and validity in the Indian population. It can be used to measure the ability of elderly patients with chronic diseases in other Asian countries to adapt to their diseases.\\u003c/p\\u003e\\n\\u003cp\\u003eThe purpose of this study is to translate the chronic disease adaptation scale into Chinese and verify its reliability and validity in community elderly people with a high risk of chronic disease occurrence.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cp\\u003eStudy Design and Subjects\\u003c/p\\u003e\\n\\u003cp\\u003eThis study translated the Chronic Disease Adaptation Scale and evaluated its psychometric properties through a status survey conducted from October 2022 to February 2023. The survey was conducted among community elderly patients with chronic diseases using a convenience sampling method. According to the rough estimation method of the reference sample size, the sample size required for the reliability and validity tests of this scale should be 5 to 10 times the number of scale items \\u003csup\\u003e[20]\\u003c/sup\\u003e. To ensure the stability of the factor structure, the structural equation model (confirmatory factor analysis) should include at least 200 cases \\u003csup\\u003e[21]\\u003c/sup\\u003e, and a larger sample size should be considered. In this study, the Chinese version of the Chronic Disease Adaptation Scale contains 19 items. The reference sample size should be 10 times the number of scale items, but considering a possible 20% sample loss rate, it is estimated that this study should include 140 elderly patients with chronic diseases. Inclusion criteria: (1) Age 60 years or older; (2) Have at least 1 chronic disease; (3) Have been diagnosed with a chronic disease in a secondary or higher-level hospital and have a disease course of \\u0026ge; 1 year; (4) Have given informed consent and voluntarily participated in this study. Exclusion criteria: (1) Cognitive impairment, severe mental disorders; (2) Those with communication disorders and unclear expression due to various reasons. A total of 435 community elderly patients with chronic diseases were recruited in this study.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eInstruments\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eGeneral information questionnaire\\u003c/p\\u003e\\n\\u003cp\\u003eAfter a thorough review of the literature, we designed a general information questionnaire, which included questions about age, gender, educational level, marital status, monthly income and the duration of chronic diseases.\\u003c/p\\u003e\\n\\u003cp\\u003eChronic illness adjustment scale (CIAS)\\u003c/p\\u003e\\n\\u003cp\\u003ePadhy M et al. \\u003csup\\u003e[19]\\u003c/sup\\u003e developed the Chronic Disease Adaptation Scale, which consists of 19 items across 5 dimensions: denial of the disease (4 items), compliance with the disease (4 items), active participation (4 items), emotional support for the disease (3 items), and emotional involvement (4 items). Respondents were required to rate each item on a Likert 4-point scale, with 1 representing \\u0026quot;never\\u0026quot; and 4 representing \\u0026quot;always\\u0026quot;. The score range of the Chronic Disease Adaptation Scale is from 19 to 76 points, with the items of the denial of the disease dimension being reverse-scored. The higher the score, the higher the disease adaptation ability. The Cronbach\\u0026apos;s \\u0026alpha; coefficients of each dimension of the scale range from 0.850 to 0.884.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eProcedure\\u003c/strong\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eScale translation and cross‑cultural adaptation procedure\\u003c/p\\u003e\\n\\u003cp\\u003eAfter obtaining the email authorization from the original author Padhy M\\u003csup\\u003e[19]\\u003c/sup\\u003e, the translators strictly followed Brislin \\u003csup\\u003e[22]\\u003c/sup\\u003e\\u0026apos;s reverse translation scale and made cross-cultural adjustments. The specific steps are as follows: (1) Initial translation: Nursing researchers and doctoral students translated the original scale into Chinese. (2) Correction: Another researcher translated the Chinese version back into English. A nursing expert and a clinical medicine doctor compared the translation versions, discussed and evaluated the translation quality, and then revised the professional terms to form the first draft. (3) Back translation: To ensure semantic equivalence, a researcher without a medical background was specially invited to retranslate the first draft into English, and finally the Chinese version of the chronic disease adaptation scale was formed. Subsequently, 30 elderly patients with chronic diseases were randomly selected from the local community to evaluate the performance of the translation scale items in terms of clarity and comprehensibility.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData collection procedure\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe questionnaire includes standard explanations, which clarify its purpose, importance, personal data protection measures, and filling methods. After receiving appropriate training, the researchers, with the assistance of local community managers, visited four communities in Shenzhen to recruit participants. During the research period, the researchers distributed questionnaires to the participants, explained the filling methods to them, and asked them to answer anonymously. After the questionnaires were completed, the researchers collected them on the spot. Participation was voluntary and anonymous. After understanding the research purpose and background, 441 elderly patients with chronic diseases participated in the questionnaire survey. During the data analysis process, questionnaires with obvious patterns or logical contradictions were excluded. Finally, 435 valid questionnaires were collected, with a response rate of 98.63%. Two weeks later, 60 elderly patients with chronic diseases were randomly selected to participate in the second survey to evaluate the reliability of the scale re-assessment.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData analysis procedure\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eTwo persons took the input data in the Excel software, and after checking, they were transferred to SPSS 26.0 software and AMOS 22.0 software to analyze the statistical data. Frequency, percentage and mean \\u0026plusmn; standard deviation were used in the statistical description of count data and measurement data. Skewness and kurtosis of every item were obtained. In case the skewness and kurtosis value fell in the range of -2 to +2 \\u003csup\\u003e[23]\\u003c/sup\\u003e, it was assumed that the data was normally distributed. This paper presented to the Chinese version of the Chronic Disease Adaptation Scale, an item analysis, a validity analysis, as well as reliability analysis.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eItems analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe total scores of the Chinese version of the Chronic Disease Adaptation Scale for 435 community-dwelling elderly individuals were ranked using the Critical Ratio (CR) method. Based on the total scores, the sample was divided into high-score group and low-score group using the 27th percentile method, and the differences in item scores between the two groups were compared\\u003csup\\u003e[24]\\u003c/sup\\u003e. The 27th percentile was chosen as the dividing line because it is commonly used in psychometrics to maximize discrimination while ensuring adequate sample size\\u003csup\\u003e[25]\\u003c/sup\\u003e. An independent sample T-test was conducted, and no items with statistical significance were deleted. A critical ratio \\u0026gt; 3.000 \\u003csup\\u003e[26]\\u003c/sup\\u003e indicates that these items have good discrimination. The correlation between the items and the translated scale, as well as the Cronbach\\u0026apos;s alpha coefficient after deleting items, were analyzed to evaluate whether each item in the translated scale can be retained. The correlation between the items and the total score was set as 0.4 as the inclusion criterion \\u003csup\\u003e[27]\\u003c/sup\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eValidity analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe validity of this scale refers to the extent to which the research tool accurately reflects the measured variable \\u003csup\\u003e[28]\\u003c/sup\\u003e. Content validity refers to the degree to which the concept that the researcher intends to measure is reflected in the questionnaire items \\u003csup\\u003e[29]\\u003c/sup\\u003e. Seven experts were invited to evaluate each item of the translated scale from the perspective of content importance. The content validity index (I-CVI) and scale content validity index (S-CVI) were calculated using the Delphi method. The 4-point Likert scale was used to assess the content relevance of each item in the Chinese version of the Chronic Disease Adaptation Scale, ranging from 1 = not relevant to 4 = very relevant. I-CVI \\u0026gt; 0.780 and S-CVI \\u0026gt; 0.900 indicate good content validity [30].\\u003c/p\\u003e\\n\\u003cp\\u003eThe name structural validity is a subdivision of validity, which is defined by the level of congruence between a measurement scale and its theoretical or conceptual framework. It is employed in assessing the ideal professional structure of a particular objective thing in the form of multi-indicator measurement \\u003csup\\u003e[28]\\u003c/sup\\u003e. This study involved EFA and CFA to investigate and confirm the fundamental structure of factor of the translated scale, whereby 435 samples were randomly divided to form two groups; one group (n = 217) was used in EFA, and the other one (n = 218) was used in CFA. The rationality of the use of the principal component analysis (PCA) and maximum rotation in EFA was determined by using the Kaiser-Meyer-Olkin (KMO) measurement and the test of sphericity. The most widely used orthogonal technique is the maximum rotation which reduces as much as possible the complexity of the factors by maximizing the variance of the factor loadings. The data set is only deemed to be appropriate to undergo factor analysis when the test of sphericity of the Bartlett (P \\u0026lt; 0.05) is significant and KMO is greater than 0.60 \\u003csup\\u003e[31]\\u003c/sup\\u003e. Principal component analysis was applied because it was needed to obtain the factor with the highest eigenvalue of more than 1 to apply the variance maximizing rotation technique, and the items whose factor loading is below 0.500 were removed \\u003csup\\u003e[32]\\u003c/sup\\u003e. Structural equation model measurement method portrays the compliance of the relationship between the factor and indicators of the factor adhering to the theoretical relationship established by the researchers. The hypothesis of factor model was tested through the application of structural equation model (CFA) and maximum likelihood method was applied to get the estimation. At the point which every fit was greater than 0.090 with RMSEA smaller than 0.080, the model structure was taken to be good. A convergence or aggregation validity is the similarity of various measurement indicators who measure the same concept; discriminant validity is the capacity to be able to distinguish between various latent major variables \\u003csup\\u003e[33]\\u003c/sup\\u003e. The extracted average variance (AVE 0.50 and above) and composite reliability (CR 0.70 and above) were considered as measures of convergence validity. In each dimension, when the square root of AVE was greater than the inter-factor correlation, it was shown that discriminant validity was supported which implied that the scale was viewed to have good convergence and discriminant validity\\u003csup\\u003e[34, 35]\\u003c/sup\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eReliability analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eReliability Analysis: Reliability of this scale is used in terms of consistency and stability of the measurement results get using the research tool\\u003csup\\u003e\\u0026nbsp;[28]\\u003c/sup\\u003e. The tested scale was estimated to be reliable by determining the Cronbachs alpha coefficient, split half reliability and the test-retest reliability. Standard Cronbach alpha value of the scale and dimension of the scale were computed and a minimum that should be received by the coefficient of reliability was 0.6\\u003csup\\u003e\\u0026nbsp;[28]\\u003c/sup\\u003e. The scale items were put in odd even sequence and the correlation of the score of the two parts determined to assess the split half reliability. The same translated scale was retested again after two weeks on a group of community elderly patients with chronic illnesses in order to determine the retest correlation and to confirm their stability and consistency over the data collection time. As Pearson correlation coefficients are typically computed by using higher indicators of true reliability as well as intraclass correlation coefficients (ICC) as an indication of the consistency of the two measurement results.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eDescriptive statistics\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eIn this study, a total of 441 questionnaires were distributed, and 435 valid questionnaires were retrieved, with an effective rate of 98.63%. Respondents aged between 65 and 69 accounted for 67.1%. 68% of the respondents had an education level of primary school or below. The majority (86.9%) of the respondents were married; 77% of the respondents had a monthly income of less than 2000 yuan. Before retirement, the occupations of the respondents were mainly farmers (22.5%) and workers (21.1%), and 59.5% of the respondents used rural medical insurance. More respondents (38.9%) had a disease duration of 1 to 5 years, and the severity of the diseases of the respondents was mostly mild to moderate. Table 1 lists the characteristics of all the respondents.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 1\\u003c/strong\\u003e Frequency distribution of general information (n=435)\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003eFactors\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003eGroup\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003eN\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003eAge (years)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003e65 - 69 years old\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e292\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e67.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003e70 - 74 years old\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e93\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e21.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003e75 - 79 years old\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e31\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e7.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003e80 years old and above\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e19\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e4.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003eGender\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003eMan\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e201\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e46.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003eWoman\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e234\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e53.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003eEducational level\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003ePrimary school and below\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e292\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e67.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003eJunior high school and technical secondary school\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e84\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e19.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003esenior high school\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e44\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e10.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003eCollege degree or above\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e15\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e3.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003eMarital status\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003eUnmarried\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e1.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003eMarried\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e378\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e86.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003eDivorce\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e19\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e4.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003eBereft of one\\u0026apos;s spouse\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e31\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e7.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003eMonthly income (yuan)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;2000\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e335\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e77.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003e2000~4000\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e63\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e14.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026gt;4000\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e37\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e8.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003ePrevious career before retirement\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003eFarmer\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e98\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e22.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003eWorker\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e92\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e21.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003eTeacher\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e24\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e5.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003eMedical staff\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e40\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e9.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003eother\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e181\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e41.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003eType of medical insurance\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003eUrban medical insurance\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e158\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e36.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003eRural medical insurance\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e259\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e59.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003eSelf-payment\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e18\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e4.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003eDuration of illness\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003e＜1 year\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e138\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e31.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003e1 - 5 years\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e169\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e38.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003e6 - 10 years\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e106\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e24.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003e10 years and above\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e22\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e5.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003eseverity of illness\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003eMild (stable condition with no obvious symptoms / mild symptoms)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e174\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e40.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003eModerate (present with typical symptoms, mild restriction in daily activities)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e148\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e34.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003eSevere (severe symptoms that persist, significant restriction in daily activities)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e78\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e17.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 230px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 232px;\\\"\\u003e\\n \\u003cp\\u003eExtremely severe (critical condition, severely affecting quality of life)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e35\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e8.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eScale translation and cross cultural adaptation procedure\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe research team revised the scale content based on expert feedback. For example, item 9 was changed from \\u0026quot;I cancelled the doctor\\u0026apos;s appointment\\u0026quot; to \\u0026quot;I made an appointment with the doctor for a visit, but ultimately did not go for the consultation.\\u0026quot; \\u0026nbsp;making the item\\u0026apos;s meaning clearer to respondents. In the preliminary study, 30 participants completed the scale in approximately 6 to 7 minutes. Participants found the wording of each item concise and clear, and believed that older adults with chronic conditions in the community could use the scale to accurately assess their ability to manage chronic diseases.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eItem Analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eCronbach of all the items of translation scale was found to be between -16.156 and -31.05 and the findings between the high scores group and the low score group of each item were statistically significant (P\\u0026lt;0.05). Correlations coefficient presented between the scores of each item and total score amounted to 0.532 to 0.679 (P \\u0026lt;0.05) that satisfied inclusion criteria of the correlation coefficient procedure.. The translation scale had a Cronbach alpha value of 0.913 which represents good internal consistency. Table 2 presents the values of the average (standard deviation), skewness, and kurtosis of each item. The deviation and kurtosis of the items were also within a reasonable range, -2 to +2 and this showed close to normality.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 2\\u003c/strong\\u003e Mean (SD) scores with skewness and kurtosis, item analysis for Chinese version of the chronic disease adaptation scale\\u003c/p\\u003e\\n\\u003cdiv align=\\\"\\\"\\u003e\\n \\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"564\\\"\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 49px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eItem\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 88px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eItem score\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e(SD)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCritical ratio\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 105px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eItem-total correlation\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCronbach\\u0026rsquo;s alpha if item deleted\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSkewness\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eKurtosis\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 49px;\\\"\\u003e\\n \\u003cp\\u003ea1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 88px;\\\"\\u003e\\n \\u003cp\\u003e2.17（0.052）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e-21.817\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 105px;\\\"\\u003e\\n \\u003cp\\u003e0.651\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e0.908\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e0.515\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e-1.02\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 49px;\\\"\\u003e\\n \\u003cp\\u003ea2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 88px;\\\"\\u003e\\n \\u003cp\\u003e2.15（0.052）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e-23.477\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 105px;\\\"\\u003e\\n \\u003cp\\u003e0.671\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e0.907\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e0.537\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e-1.019\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 49px;\\\"\\u003e\\n \\u003cp\\u003ea3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 88px;\\\"\\u003e\\n \\u003cp\\u003e2.14（0.05）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e-16.659\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 105px;\\\"\\u003e\\n \\u003cp\\u003e0.624\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e0.908\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e0.569\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e-0.862\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 49px;\\\"\\u003e\\n \\u003cp\\u003ea4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 88px;\\\"\\u003e\\n \\u003cp\\u003e2.19（0.048）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e-19.603\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 105px;\\\"\\u003e\\n \\u003cp\\u003e0.628\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e0.908\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e0.493\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e-0.774\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 49px;\\\"\\u003e\\n \\u003cp\\u003eb1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 88px;\\\"\\u003e\\n \\u003cp\\u003e2.13（0.053）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e-21.929\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 105px;\\\"\\u003e\\n \\u003cp\\u003e0.667\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e0.907\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e0.554\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e-1.027\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 49px;\\\"\\u003e\\n \\u003cp\\u003eb2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 88px;\\\"\\u003e\\n \\u003cp\\u003e2.16（0.051）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e-21.05\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 105px;\\\"\\u003e\\n \\u003cp\\u003e0.639\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e0.908\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e0.486\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e-1.014\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 49px;\\\"\\u003e\\n \\u003cp\\u003eb3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 88px;\\\"\\u003e\\n \\u003cp\\u003e2.13（0.05）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e-18.741\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 105px;\\\"\\u003e\\n \\u003cp\\u003e0.679\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e0.907\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e0.516\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e-0.924\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 49px;\\\"\\u003e\\n \\u003cp\\u003eb4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 88px;\\\"\\u003e\\n \\u003cp\\u003e2.15（0.05）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e-18.355\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 105px;\\\"\\u003e\\n \\u003cp\\u003e0.657\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e0.907\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e0.492\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e-0.96\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 49px;\\\"\\u003e\\n \\u003cp\\u003ec1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 88px;\\\"\\u003e\\n \\u003cp\\u003e2.17（0.05）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e-17.665\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 105px;\\\"\\u003e\\n \\u003cp\\u003e0.623\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e0.908\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e0.453\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e-1.008\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 49px;\\\"\\u003e\\n \\u003cp\\u003ec2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 88px;\\\"\\u003e\\n \\u003cp\\u003e2.09（0.051）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e-17.183\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 105px;\\\"\\u003e\\n \\u003cp\\u003e0.656\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e0.907\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e0.562\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e-0.94\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 49px;\\\"\\u003e\\n \\u003cp\\u003ec3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 88px;\\\"\\u003e\\n \\u003cp\\u003e2.18（0.047）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e-17.355\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 105px;\\\"\\u003e\\n \\u003cp\\u003e0.595\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e0.909\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e0.505\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e-0.744\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 49px;\\\"\\u003e\\n \\u003cp\\u003ec4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 88px;\\\"\\u003e\\n \\u003cp\\u003e2.17（0.051）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e-16.666\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 105px;\\\"\\u003e\\n \\u003cp\\u003e0.592\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e0.909\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e0.488\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e-1.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 49px;\\\"\\u003e\\n \\u003cp\\u003ed1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 88px;\\\"\\u003e\\n \\u003cp\\u003e2.17（0.05）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e-21.419\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 105px;\\\"\\u003e\\n \\u003cp\\u003e0.620\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e0.908\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e0.43\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e-0.99\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 49px;\\\"\\u003e\\n \\u003cp\\u003ed2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 88px;\\\"\\u003e\\n \\u003cp\\u003e2.15（0.051）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e-19.455\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 105px;\\\"\\u003e\\n \\u003cp\\u003e0.582\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e0.91\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e0.484\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e-0.995\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 49px;\\\"\\u003e\\n \\u003cp\\u003ed3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 88px;\\\"\\u003e\\n \\u003cp\\u003e2.11（0.048）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e-17.514\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 105px;\\\"\\u003e\\n \\u003cp\\u003e0.587\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e0.909\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e0.481\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e-0.857\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 49px;\\\"\\u003e\\n \\u003cp\\u003ef1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 88px;\\\"\\u003e\\n \\u003cp\\u003e2.96（0.051）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e-18.394\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 105px;\\\"\\u003e\\n \\u003cp\\u003e0.589\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e0.909\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e-0.627\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e-0.91\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 49px;\\\"\\u003e\\n \\u003cp\\u003ef2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 88px;\\\"\\u003e\\n \\u003cp\\u003e2.8（0.049）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e-20.627\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 105px;\\\"\\u003e\\n \\u003cp\\u003e0.595\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e0.909\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e-0.515\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e-0.836\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 49px;\\\"\\u003e\\n \\u003cp\\u003ef3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 88px;\\\"\\u003e\\n \\u003cp\\u003e2.85（0.055）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e-31.05\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 105px;\\\"\\u003e\\n \\u003cp\\u003e0.658\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e0.907\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e-0.48\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e-1.21\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 49px;\\\"\\u003e\\n \\u003cp\\u003ef4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 88px;\\\"\\u003e\\n \\u003cp\\u003e2.77（0.049）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e-16.156\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 105px;\\\"\\u003e\\n \\u003cp\\u003e0.532\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e0.911\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e-0.478\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e-0.867\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eValidity analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eContent validity analysis\\u003c/p\\u003e\\n\\u003cp\\u003eSeven experts evaluated the correlation between each item in the translated scale and the actual measured content. The I-CVI and S-CVI of 19 items at the level of the scale were calculated, where the I-CVI value ranged from 0.846 to 1.000, and the S-CVI was 0.934.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eExploratory factor analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eTo start with, KMO test and sphericity test by Bartlett were performed. KMO was 0.901 (\\u0026gt;0.600) and in Bartletts test of sphericity, x2 = 2224.030, P = 0.001, which meant that factor analysis could be done. Out of these 5 general factors were obtained which explained 72.853% of the total variance. All the factor loadings of the items were above 0.500 and nothing was dropped out. Table 3 presents the loading of each item. The structure of the slope graph showed further the five factors aspect as the slope became downwards after the 5th point. (Figure 1).\\u003c/p\\u003e\\n\\u003cdiv align=\\\"\\\"\\u003e\\n \\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"554\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"6\\\" valign=\\\"bottom\\\" style=\\\"width: 554px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTable3\\u0026nbsp;\\u003c/strong\\u003eFactor loadings of exploratory factor analysis for the Chinese version of the chronic disease adaptation scale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 297px;\\\"\\u003e\\n \\u003cp\\u003eItem\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003eFactor 1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003eFactor 2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003eFactor 3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003eFactor 4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003eFactor 5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 297px;\\\"\\u003e\\n \\u003cp\\u003eStrategic positive interaction\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 297px;\\\"\\u003e\\n \\u003cp\\u003e1.I divert my thoughts from health issues by reading books.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.852\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.116\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.120\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.115\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.082\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 297px;\\\"\\u003e\\n \\u003cp\\u003e2.I treat others well to temporarily relieve myself from the pain.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.837\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.045\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.169\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.187\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.112\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 297px;\\\"\\u003e\\n \\u003cp\\u003e3.I prefer to interact with others so as to avoid thinking about my poor health condition.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.823\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.173\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.038\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.157\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.181\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 297px;\\\"\\u003e\\n \\u003cp\\u003e4.I engage in religious activities to divert my worries about my health situation.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.795\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.141\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.151\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.220\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.118\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 297px;\\\"\\u003e\\n \\u003cp\\u003eEmotional engagement\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 297px;\\\"\\u003e\\n \\u003cp\\u003e5.Whenever I think about my illness, I feel depressed.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.067\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.830\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.112\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.140\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.113\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 297px;\\\"\\u003e\\n \\u003cp\\u003e6.If someone discusses my illness, I feel uneasy.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.101\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.829\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.051\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.111\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.122\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 297px;\\\"\\u003e\\n \\u003cp\\u003e7.I always think about my illness.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.121\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.808\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.247\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.089\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.064\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 297px;\\\"\\u003e\\n \\u003cp\\u003e8.When others don\\u0026apos;t notice the symptoms of my illness, I feel very depressed.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.194\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.755\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.165\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.253\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.137\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 297px;\\\"\\u003e\\n \\u003cp\\u003eDisease-related behaviors\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 297px;\\\"\\u003e\\n \\u003cp\\u003e9.I do everything possible to handle my health issues.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.152\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.155\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.802\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.172\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.034\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 297px;\\\"\\u003e\\n \\u003cp\\u003e10.我I follow the doctor\\u0026apos;s advice to do physical exercises.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.175\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.210\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.802\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.055\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.243\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 297px;\\\"\\u003e\\n \\u003cp\\u003e11. I strictly adhere to the prescribed diet plan without any resistance.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.200\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.098\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.793\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.252\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.176\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 297px;\\\"\\u003e\\n \\u003cp\\u003e12.I strictly follow the doctor\\u0026apos;s suggestions.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e-0.032\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.153\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.697\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.325\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.296\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 297px;\\\"\\u003e\\n \\u003cp\\u003eDenial of illness behavior\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 297px;\\\"\\u003e\\n \\u003cp\\u003e13. I always find some excuses to avoid following the doctor\\u0026apos;s advice.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.141\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.208\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.217\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.773\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.032\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 297px;\\\"\\u003e\\n \\u003cp\\u003e14.I avoid taking any new measures to improve my health.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.130\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.039\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.192\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.757\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.184\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 297px;\\\"\\u003e\\n \\u003cp\\u003e15.I registered for the doctor\\u0026apos;s appointment but didn\\u0026apos;t go for the visit.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.199\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.169\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.172\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.739\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.190\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 297px;\\\"\\u003e\\n \\u003cp\\u003e16.I have entrusted my illness to fate.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.253\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.197\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.101\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.731\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.129\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 297px;\\\"\\u003e\\n \\u003cp\\u003ePsychological support for diseases\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 297px;\\\"\\u003e\\n \\u003cp\\u003e17.I discussed issues related to illness with my family.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.108\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.035\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.136\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.196\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.830\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 297px;\\\"\\u003e\\n \\u003cp\\u003e18.When I felt depressed about my illness, I sought support from others.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.184\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.148\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.188\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.138\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.777\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 297px;\\\"\\u003e\\n \\u003cp\\u003e19.I shared my worries about health with my friends.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.158\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.236\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e0.228\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50px;\\\"\\u003e\\n \\u003cp\\u003e0.118\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.741\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConfirmatory Factor Analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eTo determine whether the structure of this scale was agreeable with the original scale, a CFA analysis was done on 218 randomly selected samples (Figure 2). Table 4 indicates the appropriate indices of the model. Table 5 has shown the CR and AVE results of each of the dimensions, with the range of the CR values between 0.847 and 0.875 (more than 0.700) and the range of the AVE values between 0.604 and 0.648 (more than 0.500). ABE values of each factor are also negative and the strength of the association between that factor with others is also maximum. ( Table 6).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 4\\u003c/strong\\u003e Fit indices of the Chinese version of the chronic disease adaptation scale model\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 170px;\\\"\\u003e\\n \\u003cp\\u003eFit indices\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 59px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003e\\u0026chi;\\u003c/em\\u003e2 /df\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003eRMSEA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003eGFI\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003eNFI\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003eTLI\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 56px;\\\"\\u003e\\n \\u003cp\\u003eCFI\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 55px;\\\"\\u003e\\n \\u003cp\\u003eIFI\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 170px;\\\"\\u003e\\n \\u003cp\\u003eModel modification\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 59px;\\\"\\u003e\\n \\u003cp\\u003e1.163\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e0.027\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.929\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e0.930\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e0.987\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 56px;\\\"\\u003e\\n \\u003cp\\u003e0.989\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 55px;\\\"\\u003e\\n \\u003cp\\u003e0.990\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 170px;\\\"\\u003e\\n \\u003cp\\u003eRange\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 59px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;3.000\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 63px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.080\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026gt;0.900\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026gt;0.900\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 54px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026gt;0.900\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 56px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026gt;0.900\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 55px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026gt;0.900\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eRMSEA,the root mean square error of approximation; GFI,the goodness-of-fit index; NFI,the normed fit index; TLI,the Tucker Lewis index; CFI,the comparative fit index; IFI,the incremental fit index\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 5\\u003c/strong\\u003e Results of confirmatory factor analysis\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"100%\\\" class=\\\"fr-table-selection-hover\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 10px;\\\"\\u003e\\n \\u003cp\\u003eFactor\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003eItem\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" colspan=\\\"4\\\" style=\\\"width: 49px;\\\"\\u003e\\n \\u003cp\\u003eParameter significance estimation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003eConstruct reliability\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 17px;\\\"\\u003e\\n \\u003cp\\u003eCon-\\u003c/p\\u003e\\n \\u003cp\\u003evergent\\u003c/p\\u003e\\n \\u003cp\\u003evalidity\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 10px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003eUnstd. estimate\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003eSE\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 8px;\\\"\\u003e\\n \\u003cp\\u003eP\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003eStd. estimate\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003eCR\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 17px;\\\"\\u003e\\n \\u003cp\\u003eAVE\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"4\\\" style=\\\"width: 10px;\\\"\\u003e\\n \\u003cp\\u003eA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003ea1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 8px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.795\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" rowspan=\\\"4\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.865\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" rowspan=\\\"4\\\" style=\\\"width: 17px;\\\"\\u003e\\n \\u003cp\\u003e0.617\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003ea2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.985\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e0.077\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 8px;\\\"\\u003e\\n \\u003cp\\u003e***\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.829\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003ea3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.925\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e0.077\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 8px;\\\"\\u003e\\n \\u003cp\\u003e***\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.786\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003ea4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.768\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e0.07\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 8px;\\\"\\u003e\\n \\u003cp\\u003e***\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.728\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"4\\\" style=\\\"width: 10px;\\\"\\u003e\\n \\u003cp\\u003eB\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003eb1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 8px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.735\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" rowspan=\\\"4\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.859\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" rowspan=\\\"4\\\" style=\\\"width: 17px;\\\"\\u003e\\n \\u003cp\\u003e0.604\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003eb2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e1.004\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e0.096\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 8px;\\\"\\u003e\\n \\u003cp\\u003e***\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.746\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003eb3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e1.036\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e0.092\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 8px;\\\"\\u003e\\n \\u003cp\\u003e***\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.802\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003eb4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e1.085\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e0.095\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 8px;\\\"\\u003e\\n \\u003cp\\u003e***\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.822\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"4\\\" style=\\\"width: 10px;\\\"\\u003e\\n \\u003cp\\u003eC\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003ec1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 8px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.815\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" rowspan=\\\"4\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.875\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" rowspan=\\\"4\\\" style=\\\"width: 17px;\\\"\\u003e\\n \\u003cp\\u003e0.636\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003ec2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e1.081\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e0.082\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 8px;\\\"\\u003e\\n \\u003cp\\u003e***\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.826\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003ec3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.956\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e0.079\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 8px;\\\"\\u003e\\n \\u003cp\\u003e***\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.768\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003ec4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e1.027\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e0.083\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 8px;\\\"\\u003e\\n \\u003cp\\u003e***\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.779\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"3\\\" style=\\\"width: 10px;\\\"\\u003e\\n \\u003cp\\u003eD\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003ed1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 8px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.807\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" rowspan=\\\"3\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.847\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" rowspan=\\\"3\\\" style=\\\"width: 17px;\\\"\\u003e\\n \\u003cp\\u003e0.648\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003ed2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e1.016\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e0.083\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 8px;\\\"\\u003e\\n \\u003cp\\u003e***\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.836\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003ed3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.878\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e0.076\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 8px;\\\"\\u003e\\n \\u003cp\\u003e***\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.771\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"4\\\" style=\\\"width: 10px;\\\"\\u003e\\n \\u003cp\\u003eF\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003ef1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 8px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.801\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" rowspan=\\\"4\\\" style=\\\"width: 16px;\\\"\\u003e\\n \\u003cp\\u003e0.869\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" rowspan=\\\"4\\\" style=\\\"width: 17px;\\\"\\u003e\\n \\u003cp\\u003e0.624\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003ef2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.892\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e0.075\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 8px;\\\"\\u003e\\n \\u003cp\\u003e***\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.776\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003ef3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e1.153\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e0.09\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 8px;\\\"\\u003e\\n \\u003cp\\u003e***\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.832\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 7px;\\\"\\u003e\\n \\u003cp\\u003ef4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.882\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e0.077\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 8px;\\\"\\u003e\\n \\u003cp\\u003e***\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15px;\\\"\\u003e\\n \\u003cp\\u003e0.749\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 6\\u003c/strong\\u003e AVE square root value of each latent variable and variable correlation coefficient\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"562\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003eVariable\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003eAVE\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003eF\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003eD\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003eC\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003eB\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003eA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003eF\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e0.624\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e0.691\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003eD\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e0.648\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e0.405\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e0.805\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003eC\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e0.636\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e0.388\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e0.47\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e0.797\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003eB\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e0.604\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e0.503\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e0.561\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e0.565\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e0.777\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd nowrap=\\\"\\\" style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003eA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e0.617\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e0.477\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e0.52\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 153px;\\\"\\u003e\\n \\u003cp\\u003e0.502\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e0.643\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e0.785\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eThe numbers in bold represent AVE square root value\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eReliability analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe Cronbach\\u0026apos;s alpha coefficient of this translation scale is 0.913. The split-half reliability is 0.691. Within the following two weeks, 60 community elderly patients with chronic diseases were randomly selected for a retest. The reliability of the retest was 0.945 (Table 7), and the reliability coefficient was 0.945.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 7\\u003c/strong\\u003e Reliability analysis for Chinese version of the chronic disease adaptation scale\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eThe scale and its dimension\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003eCronbach\\u0026rsquo;s alpha\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 129px;\\\"\\u003e\\n \\u003cp\\u003eSplit-half reliability\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 135px;\\\"\\u003e\\n \\u003cp\\u003eTest\\u0026ndash;retest reliability\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eThe chronic illness adjustment scale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e0.913\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 129px;\\\"\\u003e\\n \\u003cp\\u003e0.691\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 135px;\\\"\\u003e\\n \\u003cp\\u003e0.945\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eIllness denial behaviour\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e0.850\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 129px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 135px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eIllness-compliant behaviour\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e0.862\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 129px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 135px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eStrategic positive engagement\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e0.884\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 129px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 135px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eEmotional support for illness\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e0.827\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 129px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 135px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eEmotional engagement\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 124px;\\\"\\u003e\\n \\u003cp\\u003e0.870\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 129px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 135px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eCompared with Western countries, the early screening for chronic diseases in China started relatively late. The awareness of early prevention and treatment of chronic diseases among the elderly in China is weak. Moreover, the economic pressure and family conflicts that arise after getting sick further reduce their adaptability to chronic diseases, resulting in poor clinical prognosis. The measurement tools widely used in China were developed by Western countries, with many items but limited measurement contents. The existing evaluation devices are less than suitable to evaluate the disease adaptation ability level of the elderly patients with chronic diseases in China. Scholar Padhy M[19] invented Chronic Disease Adaptation Scale in 2024 that comprehensively addresses the topic of disease adaptation and behavior status and can have a better measurement of the level of the ability to adapt the disease ability of the elderly with chronic diseases. No translation version of this scale exists nowadays, and the studies of reliability and validity have not been described so far. The present research is the first to make the Chronic Disease Adaptation Scale into Chinese and confirm its psychometric properties based on the reliability and validity tests on the elderly population in the community. The findings indicate that the Chinese form of Chronic Disease Adaptation Scale in the research has relevant reliability and validity, is capable of measuring the behavioural factors of the overall adaptation of elderly people to chronic disease diagnosis, and assists to enhance the adaptability to chronic diseases. It may assist the staff in medical practice to better monitor and rectify the diagnosis of chronic diseases in the elderly, enhancing their disease adaptation capacity.\\u003c/p\\u003e\\n\\u003cp\\u003eThe CR values of the translation scale are in the normal range, which implies that every item of the scale serves the purpose of determining the degree of adaptation ability of the ability to deal with chronic disease of the various survey subjects. The findings of the correlation coefficient method indicate that the results of each item and the dimensions exhibit high correlation. Moreover, the Cronbach 0 coefficient of the translated scale never increased after the deletions of the items, which means that the relationship between the items is high, the ratio between them is high. This demonstrates that all the 19 items in the Chinese version of Chronic Disease Adaptation Scale are well-discriminating and capable of maintaining the information.\\u003c/p\\u003e\\n\\u003cp\\u003eThe values of I-CVI and S-CVI in this study are in the right scale giving the idea that the scale in use has proper content validity and the scale items are able to capture the content under measurement\\u003csup\\u003e[30]\\u003c/sup\\u003e. Factor analysis was the method of evaluation of construct validity that was employed in this study. With no exclusion of items EFA produced 5 common factors and the items in each dimension were similar to the original scale\\u003csup\\u003e[19]\\u003c/sup\\u003e. The contribution rate of cumulative variance was found to be 72.853 which is more than the original scale score (51.89%), and this proves that the extracted common factors were very useful in explaining each dimension. Hence, the research feels that the validity of structure of the translated scale is good. In this research, CFA techniques were applied to confirm the structure of the translated scale even further and the value of the fit met the optimum level of fitting. CR and AVE scale values are in the normal range of reference and this has revealed that the five factors of the scale are consistent\\u003csup\\u003e[34,35]\\u003c/sup\\u003e. The Pearson correlation coefficients between any two particular factors in the scale are smaller than the square root of its average variance extraction value which shows that these five dimensions can easily be separated and their discriminating validity is good. The findings of the additional confirmatory factor analysis indicate that the scale which is translated has a scientific stabilized and good structure validity.\\u003c/p\\u003e\\n\\u003cp\\u003eThe Cronbach\\u0026apos;s \\u0026alpha; coefficients of the translated scale and all sub-scales in this study all fall within the reference standards, and this shows that the scale has a high internal consistency reliability[28]. The dimensions are higher than the original scale[19] which can be associated with the low adaptability of the elderly people in China to the levels of chronic diseases. Simultaneously, the test-retest reliability of the Chinese version scale is also quite good\\u003csup\\u003e[36]\\u003c/sup\\u003e and it demonstrates the stability of the translated scale over time. As such, Chinese adaptation of Chronic Disease Adaptation Scale is appropriately reliable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eLimitations\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThere are certain weaknesses in this research that should be taken into account and overcome. First, the sample size of this study is small because it was conducted only in Shenzhen. The sample size must also be increased in future to revise the scale further to increase the represent ativeness of the achieved results. Secondly, this study conducted a cross-sectional survey and was unable to verify the stability of the scale in different periods; therefore, future longitudinal studies should be carried out to verify it. Finally, this study did not conduct a calibration test for the validity of the correlation. In subsequent research, this aspect should be supplemented.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eOverall, Chinese version of the Chronic Disease Adaptation Scale that was created during this work has understandable items descriptions, minimal time to complete, and suitable reliability and validity within the community. It is highly operational and very appropriate to clinical research, it can efficiently evaluate the degree of adaptation of the older patients with chronic illnesses in the community to chronic illnesses. The results of the measurement using this scale can be used by the medical staff to interpret how elderly patients with chronic diseases adapt to the diseases, and to formulate relevant measures to increase disease prevention and health care awareness in elderly patients in the community, thereby reducing the incidence of chronic diseases and the harm caused by potential complications.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors are grateful to community elderly who participated in this study, and also to the community manager for their strong support in collecting samples. Furthermore, we thank the reviewers from the bottom of our hearts for their useful feedback and valuable editorial suggestions on our manuscript.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026rsquo; contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eYZ did the data collection and analysis and drafted the manuscript, TH and DX made significant contributions to the collection of data, LG and LZ made key modifications to the manuscript in order to obtain important academic content.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors received no external funding for this study.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe data garnered during the current study and the final dataset used for statistical analysis are available from the corresponding author on reasonable request. The Chinese version of the Chronic Disease Adaptation Scale are available from the corresponding author on reasonable request.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003ePrior to the investigation, participants were informed of the purpose and significance of this study and signed informed consent. All data were protected throughout the study. All procedures were performed with the 1964 Helsinki declaration, and the study protocol was approved by the Ethics Committee of Guangzhou University of Chinese Medicine Shenzhen Hospital (Futian).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare that they have no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003eAll methods were carried out in accordance with relevant guidelines and regulations.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eWorld Health Organization.Non communicable diseases[EB/OL].（2022-09-16）[2025-05-31].https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases.\\u003c/li\\u003e\\n\\u003cli\\u003eNational Bureau of Statistics, Office of the Seventh National Population Census Leading Group of the State Council. 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Nursing and Rehabilitation, 2021, 20(04): 37-40.\\u003c/li\\u003e\\n\\u003cli\\u003eDEROGATIS L R.The psychosocial adjustment to illness scale (PAIS)[J].Journal of Psychosomatic Research,1986,30(1):77-91.\\u003c/li\\u003e\\n\\u003cli\\u003eYao Jingjing. Cross-sectional Investigation on Adaptation Level of Cancer Patients and Analysis of Its Predictive Factors [D]. Shanghai: Second Military Medical University, 2013.\\u003c/li\\u003e\\n\\u003cli\\u003ePadhy, M., Hariharan, M., Pandey, P., Maryam, R., \\u0026amp; Anand, V. (2025). Chronic illness adjustment scale (CIAS): Development and validation. Chronic illness, 21(1), 130\\u0026ndash;144. https://doi.org/10.1177/17423953231205911.\\u003c/li\\u003e\\n\\u003cli\\u003eNi P, Chen JL, Liu N. The sample size estimation in quantitative nursing research. Chin J Nurs. 2010;45(04):378\\u0026ndash;80. \\u003c/li\\u003e\\n\\u003cli\\u003eHinkin TR. A brief tutorial on the development of measures for use in Survey Questionnaires. Organ Res Methods. 1998;1(1):104\\u0026ndash;21. \\u003c/li\\u003e\\n\\u003cli\\u003eKlotz AC, Swider BW, Kwon SH. Back-translation practices in organizational research: avoiding loss in translation. J Appl Psychol. 2022. https://doi.org/10.1037/apl0001050.\\u003c/li\\u003e\\n\\u003cli\\u003eAdawi M, Bragazzi NL, Argumosa-Villar L, Boada-Grau J, VigilColet A, Yildirim C, Del Puente G, Watad A. Translation and validation of the Nomophobia Questionnaire in the Italian language: exploratory factor analysis. JMIR Mhealth Uhealth. 2018;6(1): e24. https://doi.org/10.2196/mhealth.9186.\\u003c/li\\u003e\\n\\u003cli\\u003eCappelleri J. C., Jason Lundy J., Hays R. D. (2014). Overview of classical test theory and item response theory for the quantitative assessment of items in developing patient-reported outcomes measures. Clin. Ther. 36, 648\\u0026ndash;662. doi: 10.1016/j.clinthera.2014.04.006\\u003c/li\\u003e\\n\\u003cli\\u003eKelley T. L. (1939). The selection of upper and lower groups for the validation of test items. J. Educ. Psychol. 30, 17\\u0026ndash;24. doi: 10.1037/h0057123;Rush B. R., Rankin D. C., White B. J. (2016). The impact of item-writing flaws and item complexity on examination item difficulty and discrimination value. BMC Med. Educ. 16:250. doi: 10.1186/s12909-016-0773-3\\u003c/li\\u003e\\n\\u003cli\\u003eHuang F, Wang H, Wang Z, Zhang J, Du W, Su C, Jia X, Ouyang Y, Wang Y, Li L, Jiang H, Zhang B. Psychometric properties of the perceived stress scale in a community sample of Chinese. BMC Psychiatry.2020;20(1):130.https://doi.org/10.1186/s12888-020-02520-4.Erratum.In:BMCPsychiatry.2020;20(1):260.\\u003c/li\\u003e\\n\\u003cli\\u003eFerketich S. Focus on psychometrics. Aspects of item analysis. Res Nurs Health. 1991;14(2).\\u003c/li\\u003e\\n\\u003cli\\u003eZhou CL, Wang SQ, Wang YF, Ou JX, Wu YN. A Chinese version of the Patient perceptions of patient-empowering nurse behaviours scale: reliability and validity assessment in chronically ill patients. J Clin Nurs. 2019;28(3\\u0026ndash;4):444\\u0026ndash;57. https://doi.org/10.1111/jocn. 14613. \\u003c/li\\u003e\\n\\u003cli\\u003eHaynes SN, Richard D, Kubany ES. Content validity in psychological assessment: a functional approach to concepts and methods. Psychol Assess. 1995;7(3):238\\u0026ndash;47. \\u003c/li\\u003e\\n\\u003cli\\u003ePolit DF, Beck CT. The content validity index: are you sure you know what\\u0026rsquo;s being reported? Critique and recommendations. Res Nurs Health. 2006;29(5):489\\u0026ndash;97.\\u003c/li\\u003e\\n\\u003cli\\u003eWu M. Questionnaire statistical analysis practice: SPSS operation and application. Chongqing: Chongqing University Press; 2010.\\u003c/li\\u003e\\n\\u003cli\\u003eBland JM, Altman DG. Cronbach\\u0026rsquo;s alpha. BMJ.1997;314(7080):572.https://doi.org/10.1136/bmj.314.7080.572.\\u003c/li\\u003e\\n\\u003cli\\u003eVederhus JK, Timko C, Haugland SH. Adverse childhood experiences and impact on quality of life in adulthood: development and validation of a short difficult childhood questionnaire in a large population-based health survey. Qual Life Res. 2021;30(6):1769\\u0026ndash;78. https://doi.org/10.1007/s11136-021-02761-0.\\u003c/li\\u003e\\n\\u003cli\\u003eFuhua H, Lili L, Wenzhuan C. A study on the status quo of psychological pain in low-income type 2 diabetic patients based on confirmatory factor analysis. Gen Nurs.2021;19:2449\\u0026ndash;54. https://doi.org/10.12104/j.issn.1674-4748.2021.18.001.\\u003c/li\\u003e\\n\\u003cli\\u003eLingling Z, Kunjuan J, Xinran G. Questionnaire validation factor analysis of factors influencing long-term care needs of disabled elderly people. Med Res Educ. 2021;38:59\\u0026ndash;68. https://doi.org/10.3969/j.issn.1674-490X.2021.05.009.\\u003c/li\\u003e\\n\\u003cli\\u003eWu Y, Jin S, Guo J, Zhu Y, Chen L, Huang Y. The Economic Burden Associated with Depressive Symptoms among Middle-Aged and Elderly People with Chronic Diseases in China. Int J Environ Res Public Health. 2022;19(19):12958. Published 2022 Oct 10. doi:10.3390/ijerph191912958.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-geriatrics\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bgtc\",\"sideBox\":\"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bgtc/default.aspx\",\"title\":\"BMC Geriatrics\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"old people, chronic disease, illness adjustment, validation study\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-8874701/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-8874701/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eOBJECTIVE\\u003c/strong\\u003e: This study aims to translate the \\\"Chronic Disease Adaptation Scale\\\" into Chinese and test its psychometric properties in the elderly patients with chronic diseases in China.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMETHODS\\u003c/strong\\u003e: Following Brislin's translation and cross-cultural adaptation model, the Chronic Disease Adaptation Scale was localized through the method of forward and backward translation. 435 elderly individuals were conveniently selected in Shenzhen, Guangdong Province as the research subjects. Item analysis was used for discriminant validity analysis, and internal reliability, external reliability, content validity, exploratory factor, confirmatory factor, and multi-group tests were used for reliability and validity analysis.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eRESULTS\\u003c/strong\\u003e: Through exploratory factor analysis, 5 factor eigenvalues were greater than 1, and they were named as denial behavior of the disease, compliance behavior of the disease, active participation, emotional support for the disease, and emotional support. The cumulative variance contribution rate was 72.853%. Using confirmatory factor analysis, the results showed that the chi-square degree of freedom ratio (c2 / df) was 2224.030, the approximate root mean square error (RMSEA) was 0.027, both within the standard range. The multi-group analysis showed that the model fitting effect of the Chronic Disease Adaptation Scale was similar in different genders. The critical ratio (CR) of each item was -16.156 to -31.05, and the correlation coefficient (r) between the item and the total score was 0.532 to 0.679 (P \\u0026lt; 0.001). The Cronbach α coefficient of the total scale was 0.913, and the Cronbach α coefficients of the five factors were 0.850, 0.862, 0.884, 0.827, and 0.870, respectively. The test-retest reliability of the total scale was 0.945.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusion\\u003c/strong\\u003e: The Chinese version of the Chronic Disease Adaptation Scale has good reliability and validity and is suitable for measuring the adaptation ability of chronic diseases in the Chinese elderly population.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Psychological evaluation of the Chinese Version of the chronic disease adaptation scale for community elderly : a translation and validation Study\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-03-20 11:57:58\",\"doi\":\"10.21203/rs.3.rs-8874701/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-03-28T02:41:00+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"109607190031306030412536754333546263401\",\"date\":\"2026-03-20T15:02:44+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2026-03-17T14:26:19+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2026-03-16T08:40:13+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2026-02-20T17:56:43+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2026-02-20T17:02:10+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Geriatrics\",\"date\":\"2026-02-20T16:56:42+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-geriatrics\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bgtc\",\"sideBox\":\"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bgtc/default.aspx\",\"title\":\"BMC Geriatrics\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"42e071e7-0ec2-487a-845c-a3808d66801b\",\"owner\":[],\"postedDate\":\"March 20th, 2026\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"under-review\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-03-20T11:57:58+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-03-20 11:57:58\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-8874701\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-8874701\",\"identity\":\"rs-8874701\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}