The questionnaireIn the self-reported questionnaire, the following variables were included: age, sex, marital status, profession, type of dwelling and size of living-municipality, 11 health-related questions (that could be answered by yes or no), three questions on ordinal level about frequency of contact with family, neighbours and friends, and five instruments. These instruments were the Norwegian versions of the SASE (20), the Appraisal of Self-care Agency scale (ASA) (29, 30), the Sense of Coherence scale (SOC) (13, 14), the Nutritional Form For the Elderly (NUFFE) (31–33) and the Goldberg’s General Health Questionnaire (GHQ) (34).Self-care Ability Scale for the Elderly is an instrument at ordinal level, developed in Sweden, for assessing older peoples’ self-care ability. The items are reflecting areas of concern for older people such as activities of daily living, mastery, well-being, volition, determination, loneliness and dressing. Each item score ranges from 1 to 5 scores on a Likert scale, i.e. totally disagree to totally agree. A score of 3 was considered to be a neutral score. Four items are negatively stated and must be reversed in the summation of the scores. The total score can range between 17 and 85. A higher score indicates higher perceived self-care ability (20). SASE is shown to be a reliable and valid instrument (20, 35), and the cut-off score of £69 was indicating lower self-care ability and >69 indicating higher self-care ability (35).The ASA scale is an ordinal Likert-type scale that mea- sures engagement and activation of power in self-care actions. It includes 24 items, and each item has five response categories that ranges from one ‘totally disagree’, to five ‘totally agree’. Maximum score is 120. A higher score indicates higher self-care agency. Nine items are negatively stated and have to be reversed in the summa- tion (29, 36). The scale has been translated from Dutch to Norwegian, and this version has been tested by Van Ach- terberg et al. (37) and Lorensen et al. (30).Sense of coherence is the central concept in Antonov- sky’s salutogenic theory that is designed to advance the understanding of stressors, coping and health. The SOC scale is a semantic differential scale on the ordinal level with two anchoring phrases and with each item ranging from 1 to 7 scores. The scale consists of 29 items. These are distributed in the following way: eleven items address the comprehensibility, ten items the manageability and eight items the meaningfulness. Thirteen of the items are for- mulated negatively and have to be reversed before sum- mation. Total score ranges from 29 to 203, with a higher score expressing a stronger SOC. The SOC scale was ini- tially developed and tested in Israel, but it has beentranslated into many languages and has been used in several studies in various countries. It has been shown to be a reliable and valid scale (13, 14).Nutritional Form For the Elderly is a nutritional screening instrument, at ordinal level, developed in Swe- den, for screening older people. It contains 15 three-point items that involve dietary history, dietary assessment and general assessment. The most favourable option produces a score of 0 and the most unfavourable option a score of 2. Maximum score is 30. Higher screening scores indicate higher risk for undernutrition (31, 32). In Swedish (31, 32) and Norwegian testing studies (33), regarding reliability and validity, sufficient psychometric properties have been found.Goldberg’s General Health Questionnaire is an instru- ment with a four-point Likert-type scoring system for screening mental problems. It contains 30 items or state- ments with responses from strong ‘symptom absence’ to strong ‘symptom presence’. Fifteen items are positively worded and 15 are negatively worded. The wording of the items means that they all can be scored in the same direction. Total scores ranges between 0 and 90. Higher scores indicate that conditions are more severe (34, 38). GHQ is developed in USA and has been translated into many languages. The Norwegian version of GHQ is tested by Dale et al. (39) with support for reliability and validity.Statistical analysesDescriptive statistics were used for describing the study sample, as numbers (n) and percentages (%) for nominal data. Ordinal data, regarding the instruments, were described with mean values and standard deviations (SD). Missing data up to five items, regarding the instruments SASE, ASA and SOC, were replaced with the neutral scores.The assumption of normal distribution of the sample was not met, and nonparametric statistics were used in most of the analyses. Chi-square test, Mann–Whitney U-test for independent samples (two-tailed significance) and t-test for independent samples (two-tailed significance) were used for testing differences between groups regarding nominal, ordinal and interval data, respectively. When multiple comparisons were performed for testing differ- ences between two groups, Bonferroni’s correction was used to adjust p-values to control the Type 1 error rate at no more than 5% (40). When testing differences between three age groups, regarding SASE and ASA scores, one- way ANOVA with Bonferroni post hoc test was used.To find the predictors for self-care ability, a multiple forward stepwise conditional logistic regression analysis was performed. Dependent variable was SASE scores dichotomized and labelled as 1 = higher SASE scores (>69) and as 0 = lower SASE scores (£69). The choice of inde- pendent variables was based on variables that in univariate analyses reached a p-value of <0.2 (40), when compared to higher or lower SASE scores. The following variables were included: age, marital status (married/cohabitant or not), type of dwelling (own home or sheltered residence), pro- fession (professional/white collar or blue collar/home wife), perceived health, perceived helplessness, feeling satisfied with life, having chronic disease/handicap, being active, preparing food, having food distribution, having home nursing, having home help, having family help, telephone contact as a social contact, frequency of contact with family, frequency of contact with neighbours, fre- quency of contact with friends, ASA scores, NUFFE scores, GHQ scores and SOC scores. For statistical analyses, the computer program PASW Statistics 18 (SPSS Inc., Chicago, IL, USA) was used. A p-value of <0.05 was considered statistically significant.
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