Method
This study was a cross-sectional descriptive and correlational study to explore health-promoting
lifestyles, depression and their relationship among the urban, community-dwelling elderly
in China.
1. Location
Xi’an is one of the oldest historical cities in China and has a vivid history and rich culture. It
was called Chang’an in ancient times and is now the capital of Shaanxi province and the political,
economic and cultural center of northwest China. There are six districts in the city of
Xi’an, including: Xincheng district, Beilin district, Lianhu district, Yanta district, Baqiao districts
and Weiyang district. Xi’an has a geographic area of 9983km2 and a population of 8.37
million in 2009. Out of this total population, the percentage of elderly people (aged 60) is
14.83% (1.24/8.37).
2. Samples
The sample size was estimated according to the following formula N = t2
×P×Q/d2 (P: Prevalence,
Q = 1-P), which is commonly used in cross-sectional studies in epidemiology. Previous
studies estimated that the average prevalence of depressive disorders was 17.3% in China
[11–15]. If d = 0.15P and α = 0.05, the estimated sample would be 850 participants. An additional
15% was added to this sample estimate in anticipation that the final sample would include
elderly adults who would not consent to participate in the survey. Thus the final sample
size was estimated to be 979.
Multi-stage stratified random cluster sampling was used. First, four districts were randomly
selected from the six districts of Xi'an. Second, two or three street areas were randomly selected
in every selected district. Third, one community was randomly selected in every selected street
area. In all, nine communities were randomly selected from July to December in 2010. All the
elderly adults aged 60 years and older in the nine selected communities were invited to a faceto-face
interview to answer a standardized questionnaire. Exclusion criteria included: people in
long-term care, with terminal diseases, or with moderate/severe cognitive impairment and currently
suffering from deafness, aphasia or other communication disorders.
3. Ethical issues
The study was approved by the Institutional Review Board of the Fourth Military Medical University.
Each participant was informed verbally about the aims and methods of the survey before
the interview. They were assured that the data would be treated confidentially.
Participation was voluntary, and written consent was obtained from each participant.
4. Measures
The questionnaire used during the face-to-face interviews included individual demographics,
the Simplified Chinese Version of the 40-item Health-Promoting Lifestyles Profile and the 30-
item Geriatric Depression Scale and Personal Data Form.
The Simplified Chinese Version of the 40-item Health-Promoting Lifestyles Profile
(HPLP-C). The HPLP-C is used to identify patterns of health-promoting lifestyles and
health-promoting behaviors which are conceptualized as a multidimensional pattern of selfinitiated
actions and perceptions that serve to maintain or enhance the level of wellness[20].
The HPLP-C consists of 40 items which encompass 6 subscales: nutrition, physical activity,
health responsibility, interpersonal relations, self-actualization and stress management.