Development and validation of the social frailty scale for the elderly in China

Chaoming Hou Xiaoyan Gong Dingxi Bai Wenting Ji Huan Chen Xianying Lu Xinyu Chen Xiaohui Dong ^* Jing Gao ^*

• Chengdu University of Traditional Chinese Medicine, Chengdu, China

Objectives: Existing social frailty instruments are not tailored to the linguistic and cultural characteristics of Chinese-speaking patients; a version addressing this gap will increase clinical understanding of their healthcare experience and may help guide social frailty. To develop a Chinese version of a Social Frailty Scale (CVSFS) for the elderly and to examine the psychometric properties of this instrument. Method: Based on the recommendations of the COSMIN guidelines, the scale development inclued three phases: development of the initial scale, optimisation of scale items, and validation test for scale. The initial CVSFS 1.0 version was developed through literature review, semi-structured interviews, research team discussion, and Delphi method. Then, cross-sectional survey was conducted (n=265) and scale items were optimised based on the survey results using item analysis and exploratory factor analysis (EFA) to form CVSFS 2.0 version. Lastly, the cross-sectional survey (n=287) was repeated using CVSFS 2.0 version, and the reliability and validity of the scale's measurement properties were tested.Results: The initial scale stage of development formed a 42-item CVSFS 1.0 version. After item analysis and EFA, 6 items were excluded to form a four-dimension with 36-item CVSFS 2.0 version including individual level, family level, interpersonal level, community and social level. The CVSFS 2.0 version demonstrated good reliability and validity, with a Cronbach’s α coefficient of 0.926 and a McDonald's ω estimate of 0.931, split-half reliability of 0.928, and test–retest reliability of 0.978. The I-CVI of the scale was calculated to be 0.889~1.000, and the S-CVI/Ave was 0.930. Confirmatory factor analysis results indicated satisfactory fit indices: χ2/df =2.17, GFI = 0.813, TLI = 0.932, CFI = 0.937, RMSEA=0.064. Conclusions: The CVSFS 2.0 version developed in this study based on a social-ecological framework has high reliability and validity, making it a suitable instrument for evaluating social frailty among the elderly in China.