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dentro de la responsabilidad individual en el cuidado de la salud&#44; los h&#225;bitos de vida van a constituirse en uno de los principales elementos predictores para que la salud adquiera un car&#225;cter o tendencia positiva<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">15&#8211;18</span></a>&#46; En este sentido&#44; los h&#225;bitos de vida son comportamientos que el sujeto desarrolla de manera regular y sistem&#225;tica&#44; susceptibles de generar cambios sensibles en el &#225;mbito fisiol&#243;gico&#44; psicol&#243;gico y afectivo-social&#46; La literatura internacional es muy prolija en el estudio de todos los h&#225;bitos de vida que constituyen los denominados &#171;<span class="elsevierStyleItalic">estilos de vida</span>&#187;&#46; De este modo&#44; al igual que sucede con los h&#225;bitos&#44; diversos trabajos de investigaci&#243;n detallan que los estilos de vida pueden caracterizarse y definirse seg&#250;n su tendencia hacia la salud&#44; 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que pueden tener grandes beneficios para la salud o&#44; por el contrario&#44; amenazas para su vida posterior<a class="elsevierStyleCrossRefs" href="#bib0450"><span class="elsevierStyleSup">27&#8211;31</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Es muy interesante poder plantear m&#233;todos de an&#225;lisis de los diversos h&#225;bitos de vida que permitan evaluar y medir el &#171;<span class="elsevierStyleItalic">estilo de vida adquirido</span>&#187; por cada persona&#46; Siguiendo la referencia de diversas investigaciones nacionales e internacionales<a class="elsevierStyleCrossRefs" href="#bib0430"><span class="elsevierStyleSup">23&#44;26&#44;32&#8211;47</span></a>&#44; el objetivo de la presente investigaci&#243;n se centr&#243; en la construcci&#243;n y validaci&#243;n de la Escala de evaluaci&#243;n del estilo de vida saludable adquirido &#40;E-VEVSA&#41;&#44; conformada por 52 &#237;tems y estructurada en siete dimensiones que incluyen las dos tendencias de predictores de los estilos de vida revisados en la literatura internacional&#44; y que hemos denominado&#58; 1&#41; Responsabilidad individual en el cuidado de la salud&#46; 2&#41; H&#225;bitos de pr&#225;ctica f&#237;sico-deportiva&#46; 3&#41; H&#225;bitos de salud en las relaciones sociales&#46; 4&#41; H&#225;bito de consumo de tabaco y alcohol&#46; 5&#41; H&#225;bito de alimentaci&#243;n saludable&#46; 6&#41; H&#225;bito de salud psicol&#243;gica y &#40;7&#41; h&#225;bito de descanso y sue&#241;o diario&#46; La escala E-VEVSA podr&#225; medir el nivel de estilo de vida saludable adquirido por adultos espa&#241;oles entre 22 y 72 a&#241;os de edad&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Sujetos y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dise&#241;o de la escala inicial E-VEVSA &#40;1&#41;</span><p id="par0025" class="elsevierStylePara elsevierViewall">El objeto de nuestra investigaci&#243;n se centr&#243; en construir una escala para evaluar y medir el constructo te&#243;rico que hemos denominado &#171;<span class="elsevierStyleItalic">estilo de vida saludable adquirido</span>&#187;&#44; que viene determinado por el an&#225;lisis del conjunto de h&#225;bitos que constituyen nuestro estilo de vida en una situaci&#243;n transitoria y estable en la etapa adulta y en el contexto del sureste espa&#241;ol&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Una revisi&#243;n exhaustiva de la literatura internacional y la contribuci&#243;n de diversos investigadores especializados en l&#237;neas de investigaci&#243;n relacionadas con la promoci&#243;n de la salud y los estilos de vida saludables&#44; nos llev&#243; a elaborar un cuestionario de 70 &#237;tems estructurado en siete dimensiones &#40;<a class="elsevierStyleCrossRef" href="#sec0095">ANEXO 1</a>&#41;&#46; Dicho cuestionario se denomin&#243; &#171;<span class="elsevierStyleItalic">Escala de evaluaci&#243;n del estilo de vida saludable adquirido</span>&#187; &#40;E-VEVSA&#41; &#40;1&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">La puntuaci&#243;n m&#225;xima de la escala se obtendr&#237;a mediante la suma de las puntuaciones de los 70 &#237;tems iniciales&#46; Dichos &#237;tems se construyeron de forma jerarquizada con cinco modalidades de respuesta &#40;nunca&#44; casi nunca&#44; con poca frecuencia&#44; con bastante frecuencia&#44; con mucha frecuencia&#41;&#46; Estas modalidades se codificaron asign&#225;ndoles una puntuaci&#243;n de 1 a 5&#44; de modo que la puntuaci&#243;n m&#225;s alta indicaba siempre la conducta m&#225;s saludable y la menor&#44; la menos saludable&#46; La puntuaci&#243;n m&#225;xima posible en la escala era de 350 y la m&#237;nima de 70&#46; Dichas dimensiones fueron &#40;<a class="elsevierStyleCrossRef" href="#sec0095">ANEXO 1</a>&#41;&#58; &#171;descanso y sue&#241;o diario&#187; &#40;&#237;tems&#58; 1&#44; 6&#44; 9&#44; 15&#44; 23&#44; 34&#44; 43&#44; 49&#44; 53 y 64&#41;&#59; &#171;h&#225;bitos de pr&#225;ctica de actividad f&#237;sica y deportiva&#187; &#40;&#237;tems&#58; 10&#44;16&#44; 18&#44; 25&#44; 27&#44; 39&#44; 40&#44; 47&#44; 50 y 66&#41;&#59; &#171;h&#225;bitos de alimentaci&#243;n saludable&#187; &#40;&#237;tems&#58; 2&#44; 7&#44; 13&#44; 17&#44; 20&#44; 26&#44; 30&#44; 32&#44; 53 y 56&#41;&#59; &#171;responsabilidad individual en el cuidado de la salud&#187; &#40;&#237;tems&#58; 5&#44; 14&#44; 22&#44; 28&#44; 35&#44; 38&#44; 43&#44; 45&#44; 51 y 60&#41;&#59; &#171;h&#225;bitos de salud psicol&#243;gica&#187; &#40;&#237;tems&#58; 12&#44; 19&#44; 21&#44; 24&#44; 29&#44; 36&#44; 59&#44; 63&#44; 67 y 68&#41;&#59; &#171;h&#225;bitos de salud social&#187; &#40;&#237;tems&#58; 4&#44; 8&#44; 31&#44; 33&#44; 41&#44; 44&#44; 54&#44; 58&#44; 61 y 64&#41; y &#171;consumo de tabaco y alcohol&#187; &#40;&#237;tems&#58; 3&#44; 11&#44; 37&#44; 46&#44; 49&#44; 55&#44; 57&#44; 62&#44; 69 y 70&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Los &#237;tems se redactaron variando las codificaciones positivas y negativas en relaci&#243;n con el estilo de vida y&#44; aunque la forma de respuesta siempre se ordenaba desde la modalidad &#171;nunca&#187; a &#171;con mucha frecuencia&#187;&#44; unos &#237;tems puntuaban de 1 a 5 y otros de 5 a 1&#46; Dichas puntuaciones ser&#237;an recodificadas tras introducir los datos para su an&#225;lisis mediante el programa inform&#225;tico SPSS versi&#243;n 28 &#40;IBM Corp&#46;&#44; Armonk&#44; NY&#44; EE&#46; UU&#46;&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Es preciso tener en cuenta la interpretaci&#243;n de los &#237;tems 69 y 70 a la hora de asignar las modalidades de respuesta teniendo en cuenta la cantidad de cigarrillos consumida y el nivel de alcohol ingerido al d&#237;a&#46; La codificaci&#243;n de las respuestas se realiz&#243; <span class="elsevierStyleItalic">a posteriori</span>&#44; una vez que se hab&#237;an recogido los cuestionarios cumplimentados&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">H&#225;bito de consumo de tabaco</span>&#46; Se categoriz&#243; a los participantes en los siguientes grupos siguiendo las orientaciones de Londo&#241;o-P&#233;rez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0555"><span class="elsevierStyleSup">48</span></a>&#44; quedando las puntuaciones&#58; 5&#44; no fumador&#59; 4&#44; leve riesgo &#40;entre 1-5 cigarrillos diarios&#41;&#59; 3&#44; moderado riesgo &#40;entre 6-5 cigarrillos diarios&#41;&#59; 2&#44; alto riesgo &#40;entre 16-30 cigarrillos diarios&#41; y 1&#44; muy alto riesgo &#40;m&#225;s de 30 cigarrillos diarios&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">H&#225;bito de consumo de alcohol</span>&#46; Se categoriz&#243; a los participantes siguiendo las orientaciones de Rodr&#237;guez-Martos<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">49</span></a>&#44; que emplea las llamadas unidades de bebida est&#225;ndar &#40;UBE&#41; para estimar la cantidad diaria de alcohol ingerido&#46; Para los varones se establecieron los siguientes grupos&#58; a&#41; <span class="elsevierStyleItalic">ning&#250;n riesgo</span> &#40;&#60; 2 UBE d&#237;a&#47;&#60; 14 UBE a la semana&#41;&#59; <span class="elsevierStyleItalic">consumo prudente</span> &#40;2-3 UBE d&#237;a&#47;14-21 a la semana&#41;&#59; <span class="elsevierStyleItalic">bajo riesgo</span> &#40;3 &#60; UBE &#60; 4 d&#237;a&#47;21 &#60; UBE &#60; 28 a la semana&#41;&#59; <span class="elsevierStyleItalic">moderado riesgo</span> &#40;4 &#60; UBE &#60; 6 d&#237;as&#47;28 &#60; UBE &#60; 42 a la semana&#41;&#59; <span class="elsevierStyleItalic">alto riesgo</span> &#40;&#62; 6 UBE d&#237;a&#47;&#62; 42 UBE a la semana&#41;&#46; Para las mujeres la clasificaci&#243;n fue la siguiente&#58; a&#41; <span class="elsevierStyleItalic">ning&#250;n riesgo</span> &#40;&#60; 1 UBE d&#237;a&#47;&#60;7 UBE a la semana&#41;&#59; <span class="elsevierStyleItalic">consumo prudente</span> &#40;1-2 UBE d&#237;a&#47;7-14 a la semana&#41;&#59; <span class="elsevierStyleItalic">bajo riesgo</span> &#40;2 &#60; UBE &#60; 2&#44;5 d&#237;a&#47;14 &#60; UBE &#60; 17 a la semana&#41;&#59; <span class="elsevierStyleItalic">moderado riesgo</span> &#40;2&#44;5 &#60; UBE &#60; 4 d&#237;a&#47;17 &#60; UBE &#60; 28 a la semana&#41;&#59; <span class="elsevierStyleItalic">alto riesgo</span> &#40;&#62; 4 UBE d&#237;a&#47;&#62; 28 UBE a la semana&#41;&#46;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Estudio preliminar&#46; Pilotaje cognitivo de la escala</span><p id="par0060" class="elsevierStylePara elsevierViewall">Con el objeto de analizar el grado de comprensi&#243;n de los 70 &#237;tems que conformaron el cuestionario E-VEVSA &#40;1&#41;&#44; se seleccion&#243; una muestra intencional de 50 sujetos &#40;25 varones y 25 mujeres&#41; distribuida equitativamente teniendo en cuenta el rango de edad &#40;sujetos entre 22 y 72 a&#241;os&#41; que formar&#237;a la muestra inicial para realizar las pruebas psicom&#233;tricas exploratorias&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">El pilotaje cognitivo no nos indic&#243; la necesidad de eliminar ninguno de los &#237;tems&#44; tan solo realizamos algunas modificaciones en la redacci&#243;n de alguno de ellos para simplificar su lectura y economizar el tiempo de cumplimentaci&#243;n total del cuestionario&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Tras elaborar el dossier de &#237;tems del primer cuestionario E-VEVSA &#40;1&#41; procedimos a realizar las pruebas psicom&#233;tricas exploratorias&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Pruebas psicom&#233;tricas exploratorias de la escala E-VEVSA &#40;1&#41;</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Muestra inicial &#40;fase exploratoria&#41;</span><p id="par0075" class="elsevierStylePara elsevierViewall">El cuestionario inicial E-VEVSA &#40;1&#41; fue administrado por m&#233;dicos de familia en centros de atenci&#243;n primaria de la Comunidad de Castilla-La Mancha y Comunidad de Murcia a una muestra aleatoria&#44; intencional o de conveniencia de 248 sujetos &#40;51&#44;6&#37; hombres y 48&#44;4&#37; mujeres&#41; distribuidos en tres franjas de edad &#40;22-42 a&#241;os&#58; 86 sujetos&#59; 43-51 a&#241;os&#58; 81 sujetos&#59; 52-72 a&#241;os&#58; 81 sujetos&#41;&#46; La selecci&#243;n de los participantes se realiz&#243; mediante muestreo no probabil&#237;stico&#44; aleatorio e intencional<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">50</span></a>&#46; Los criterios de aleatorizaci&#243;n se basaron en el orden extricto de llegada de los pocientes a las consultas externas&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Se imparti&#243; un seminario de formaci&#243;n para instruir a los m&#233;dicos participantes &#40;investigadores colaboradores&#41; con las directrices que deb&#237;an dar a los sujetos para que cumplimentasen los &#237;tems del cuestionario&#46; Se determin&#243; que este cuestionario fuese autoadministrado por parte de los propios sujetos diana&#44; bajo estrecha supervisi&#243;n de los investigadores colaboradores&#46; Toda la investigaci&#243;n se realiz&#243; siguiendo las normas deontol&#243;gicas reconocidas por la Declaraci&#243;n de Helsinki &#40;revisi&#243;n de 2008&#41; y siguiendo las recomendaciones de Buena Pr&#225;ctica Cl&#237;nica de la CEE &#40;documento &#40;111&#47;3976&#47;88 de julio de 1990&#41; y la normativa legal vigente espa&#241;ola que regula la investigaci&#243;n cl&#237;nica en humanos &#40;Real decreto 561&#47;1993 sobre ensayos cl&#237;nicos&#41;&#46; As&#237; mismo&#44; para la selecci&#243;n de los participantes fueron determinados como criterios de exclusi&#243;n&#58; no tener una edad inferior a 20 a&#241;os&#44; ya que por encima de este l&#237;mite&#44; nos aseguramos una mayor estabilidad de los h&#225;bitos adquiridos por los sujetos&#44; no sufrir graves patolog&#237;as diagnosticadas&#44; por lo que no se incluyeron sujetos con patolog&#237;as org&#225;nicas de media o severa gravedad&#44; tanto f&#237;sicas como mentales&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Una vez que realizamos las pruebas psicom&#233;tricas de fiabilidad &#40;alfa de Cronbach&#41; validez &#40;an&#225;lisis factorial&#41; exploratorias y analizamos la consistencia interna de las siete dimensiones de la escala renovada que llamamos E-VEVSA &#40;2&#41;&#44; se eliminaron aquellos &#237;tems que no cumpl&#237;an las siguientes condiciones&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">a&#41;</span><p id="par0090" class="elsevierStylePara elsevierViewall">&#205;tems que arrojaban un alfa de Cronbach superior al obtenido en el alfa de la prueba global de consistencia interna si eran eliminados&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">b&#41;</span><p id="par0095" class="elsevierStylePara elsevierViewall">&#205;tems que arrojaban un alfa de Cronbach superior al obtenido si eran eliminados en las pruebas parciales de consistencia interna de las siete dimensiones en que se agruparon los &#237;tems de la escala E-VEVSA &#40;2&#41; en el an&#225;lisis factorial exploratorio&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">c&#41;</span><p id="par0100" class="elsevierStylePara elsevierViewall">&#205;tems que no obten&#237;an correlaciones interelementos situadas entre valores de 0&#44;3 y 0&#44;7 en el estad&#237;stico <span class="elsevierStyleItalic">r</span> de Pearson &#40;se corresponde con &#237;tems que ya fueron eliminados en las fases de depuraci&#243;n anteriores&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">d&#41;</span><p id="par0105" class="elsevierStylePara elsevierViewall">&#205;tems que no presentaban las cargas factoriales en la dimensi&#243;n para la cual fueron incluidos inicialmente &#40;se corresponde con &#237;tems que ya fueron eliminados en las fases de depuraci&#243;n anteriores&#41;&#46;</p></li></ul></p></span></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">An&#225;lisis de fiabilidad de la escala inicial &#40;E-VEVSA 1&#41;</span><p id="par0110" class="elsevierStylePara elsevierViewall">Para el c&#225;lculo de la fiabilidad total de la escala se utiliz&#243; el coeficiente alfa de Cronbach&#44; que debe interpretarse como un indicador de la consistencia interna de los &#237;tems&#44; puesto que se calcula a partir de la covarianza entre ellos&#46; Para otorgar validez a los &#237;tems&#44; deb&#237;an discriminar satisfactoriamente cada constructo definido y su valor deb&#237;a estar por encima de 0&#44;2&#46; Del mismo modo&#44; tan solo ser&#237;an incluidos en la escala aquellos &#237;tems que alcanzaran&#44; al menos&#44; una correlaci&#243;n <span class="elsevierStyleItalic">r</span> de Pearson con la escala global de 0&#44;50&#46; El valor alfa determinado como v&#225;lido deb&#237;a superar el 0&#44;70<a class="elsevierStyleCrossRefs" href="#bib0570"><span class="elsevierStyleSup">51&#44;52</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Ning&#250;n &#237;tem de la escala quedar&#237;a incluido si&#44; en los resultados previstos con su eliminaci&#243;n&#44; el valor alfa global fuese superior al obtenido con el &#237;tem incluido&#46; De esta forma&#44; tras analizar los 70 &#237;tems para el estudio de su consistencia interna&#44; decidimos eliminar siete de ellos por no cumplir los criterios estad&#237;sticos establecidos&#46; Dichos &#237;tems fueron el 25&#44; 29&#44; 18&#44; 39&#44; 43&#44; 48 y 59&#46; La escala resultante reducida se denomin&#243; E-VEVSA &#40;2&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">An&#225;lisis factorial exploratorio</span><p id="par0120" class="elsevierStylePara elsevierViewall">Una vez aplicado el primer filtro de selecci&#243;n&#44; realizamos un primer an&#225;lisis factorial exploratorio con los 63 &#237;tems resultantes para comprobar que se agrupaban en las siete dimensiones propuestas &#40;E-VEVSA 2&#41;&#46; Para verificar la estructura factorial y las dimensiones de la escala reducida se aplic&#243; una rotaci&#243;n de factores mediante un m&#233;todo oblicuo &#40;oblimin&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">La estructura propuesta en la escala E-VEVSA &#40;2&#41;&#44; una vez que fueron excluidos los &#237;tems anteriormente se&#241;alados&#44; nos confirm&#243; la distribuci&#243;n de las siete dimensiones propuestas inicialmente de manera te&#243;rica&#46; Tras ello&#44; realizamos un estudio de la consistencia interna de cada uno de los factores resultantes&#44; tal y como reflejamos en el siguiente apartado&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">An&#225;lisis de fiabilidad de los diferentes factores de la escala E-VEVSA &#40;2&#41;</span><p id="par0130" class="elsevierStylePara elsevierViewall">Mediante este an&#225;lisis y&#44; una vez establecida una primera distribuci&#243;n exploratoria de la escala en siete dimensiones principales&#44; procedimos a verificar el &#237;ndice alfa de Cronbach parcial de cada uno de los factores de la escala y considerar de manera m&#225;s pormenorizada la inclusi&#243;n en cada factor de los diferentes &#237;tems que superaban el primer filtro de consistencia interna aplicado para los 63 &#237;tems resultantes del primer an&#225;lisis exploratorio&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Para determinar los &#237;tems v&#225;lidos en la escala&#44; tuvimos en consideraci&#243;n la matriz de correlaciones entre los &#237;tems&#44; ya que nos indica el grado de fuerza relacional que estos tienen a la hora de explicar cada uno de los factores o dimensiones&#46; Es un dato estad&#237;stico que suele desenmascarar las debilidades de consistencia de cada dimensi&#243;n&#44; ya que debe mantenerse en valores intermedios o &#171;<span class="elsevierStyleItalic">c&#225;lidos&#187;</span>&#46; No deben acercarse a la unidad&#44; ya que&#44; cuando supera el valor de 0&#44;7 en la <span class="elsevierStyleItalic">r</span> de Pearson&#44; significar&#237;a que esos dos &#237;tems son casi id&#233;nticos&#44; por lo que la escala est&#225; perdiendo econom&#237;a y eficacia&#46; Pero si el &#237;ndice llega a situarse por debajo de 0&#44;3 tambi&#233;n presentar&#237;a problemas&#44; ya que nos indicar&#237;a que ambos &#237;tems no se centran en el mismo subconstructo conceptual&#46; Por tanto&#44; incluimos en cada dimensi&#243;n solamente aquellos &#237;tems cuyas correlaciones se encontraban en un rango de valor entre 0&#44;3 y 0&#44;7<a class="elsevierStyleCrossRefs" href="#bib0570"><span class="elsevierStyleSup">51&#44;52</span></a>&#46; Como ejemplo&#44; se&#241;alamos la tabla de an&#225;lisis de consistencia interna &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41; y la matriz de correlaciones &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41; establecida entre los &#237;tems del primer factor&#58; responsabilidad individual en el cuidado de la salud&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Pruebas psicom&#233;tricas confirmatorias de la escala E-VEVSA</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Muestra final &#40;fase confirmatoria&#41;</span><p id="par0140" class="elsevierStylePara elsevierViewall">Para realizar las pruebas confirmatorias&#44; seleccionamos una muestra incidental y aleatoria de 788 sujetos &#40;49&#44;5&#37; hombres y 50&#44;5&#37; mujeres&#41;&#44; distribuidos en tres franjas de edad &#40;133 varones y 148 mujeres en la franja de 22 a 42 a&#241;os&#59; 126 varones y 137 mujeres en la franja de 43 a 51 a&#241;os y 131 varones y 113 mujeres en la franja de 52 a 72 a&#241;os&#41;&#46; Al igual que en la fase exploratoria&#44; la selecci&#243;n de los participantes se realiz&#243; mediante muestreo no probabil&#237;stico&#44; aleatorio e intencional &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">An&#225;lisis de fiabilidad de la escala definitiva E-VEVSA</span><p id="par0145" class="elsevierStylePara elsevierViewall">Una vez eliminados los siete &#237;tems del cuestionario E-VEVSA &#40;1&#41; y los 11 &#237;tems de E-VEVSA &#40;2&#41;&#44; obtuvimos un alfa de Cronbach confirmatorio total de la escala definitiva E-VEVSA de 0&#44;894&#44; resultando finalmente una versi&#243;n nueva y reducida de la escala con un total de 52 &#237;tems distribuidos en siete dimensiones&#44; a la cual llamamos E-VEVSA &#40;<a class="elsevierStyleCrossRef" href="#sec0095">Anexo</a>&#41;&#46; La distribuci&#243;n definitiva de los &#237;tems y el alfa de Cronbach parcial de cada una de las dimensiones se presenta en la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">An&#225;lisis factorial confirmatorio de la escala E-VEVSA</span><p id="par0150" class="elsevierStylePara elsevierViewall">Una vez verificada la consistencia interna global de la escala E-VEVSA &#40;2&#41; y el an&#225;lisis de consistencia pormenorizado por cada una de las siete dimensiones exploratorias en que quedaron inicialmente distribuidos los 63 &#237;tems del cuestionario E-VEVSA &#40;2&#41;&#44; procedimos a realizar un segundo an&#225;lisis factorial confirmatorio de la estructura de la escala reducida a 52 &#237;tems E-VEVSA &#40;2&#41;&#46; En esta ocasi&#243;n utilizamos una rotaci&#243;n de factores mediante el m&#233;todo varimax con extracci&#243;n de factores ajustada a siete dimensiones&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">La fiabilidad global de la escala E-VEVSA y la fiabilidad de cada dimensi&#243;n espec&#237;fica&#44; as&#237; como la varianza total explicada y la varianza explicada por cada una de las dimensiones se presenta en la <a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#46; La distribuci&#243;n definitiva de los 52 &#237;tems y sus cargas factoriales correspondientes al an&#225;lisis confirmatorio se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0030">tabla 6</a>&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></span></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Discusi&#243;n</span><p id="par0160" class="elsevierStylePara elsevierViewall">La revisi&#243;n de la literatura internacional sobre la validaci&#243;n de instrumentos y escalas de medida del estilo de vida nos hizo tener en consideraci&#243;n para la construcci&#243;n de la escala E-VEVSA los principales factores que conforman los h&#225;bitos de vida incorporados en los principales cuestionarios elaborados con la aplicaci&#243;n de las pruebas psicom&#233;tricas m&#225;s exhaustivas&#46; El resultado final de nuestra escala fue un instrumento constituido por 52 &#237;tems estructurados en siete dimensiones con propiedades psicom&#233;tricas que&#44; en la mayor&#237;a de los casos&#44; son similares o superiores a las encontradas en las publicaciones estudiadas&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">En la mayor&#237;a de los trabajos&#44; el an&#225;lisis de h&#225;bitos de vida que definen las dimensiones del estilo de vida se corresponde con los tres elementos o perfiles fundamentales del concepto global de salud&#58; salud f&#237;sica &#40;donde encontramos h&#225;bitos de descanso y sue&#241;o&#44; h&#225;bitos de alimentaci&#243;n&#44; h&#225;bitos de actividad f&#237;sica o ejercicio&#44; el cuidado sobre el estado o situaci&#243;n de variables cl&#237;nicas fisiol&#243;gicas&#41;&#44; &#225;mbito psicol&#243;gico y &#225;mbito social y&#47;o espiritual&#46; Uno de los instrumentos que responde a este perfil conceptual es el desarrollado por Walker et al&#46;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">32</span></a>&#44; llamado <span class="elsevierStyleItalic">Health-Promoting Lifestyle Profile &#40;</span>HPLP&#41;&#46; Es una escala de medida del estilo de vida constituida por 48 &#237;tems distribuidos en seis dimensiones&#58; autoactualizaci&#243;n&#44; responsabilidad en salud&#44; ejercicio f&#237;sico&#44; nutrici&#243;n&#44; soporte interpersonal y manejo del estr&#233;s&#46; Dichos factores explican 47&#44;1&#37; de la varianza total y un alfa de Cronbach global de 0&#44;922&#44; variando en las diferentes subescalas o dimensiones entre 0&#44;702 y 0&#44;904&#46; Al igual que en la escala E-VEVSA&#44; la responsabilidad individual en el cuidado de la salud y los h&#225;bitos de pr&#225;ctica regular de ejercicio f&#237;sico son factores que explican la mayor varianza total y poseen unos valores de fiabilidad m&#225;s altos&#46; Llama la atenci&#243;n&#44; en contraste con nuestra escala&#44; la no presencia de &#237;tems que hagan referencia al consumo de tabaco&#44; alcohol u otras drogas como variable determinante de los h&#225;bitos de salud&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">El HPLP fue adaptado a poblaci&#243;n hispana adulta por Walker et al&#46;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">33</span></a> Se aplic&#243; el cuestionario a una muestra de 485 hispanos mexicano-estadounidenses y se confirm&#243; la estructura factorial de la versi&#243;n inglesa de la escala&#46; Sigue explicando una varianza total menor &#40;45&#44;9&#37;&#41; que nuestra escala E-VEVSA &#40;66&#44;87&#37;&#41; y que la versi&#243;n original del HPLP &#40;47&#44;1&#37;&#41;&#46; El coeficiente de fiabilidad &#945; para la escala total fue de 0&#44;93 y la confiabilidad test-retest realizada tras dos semanas fue de 0&#44;86&#59; los coeficientes alfa para las subescalas oscilaron entre 0&#44;70 y 0&#44;87&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Posteriormente&#44; Walker y Hill-Polerecky<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">34</span></a> realizaron una revisi&#243;n de las dimensiones del instrumento HPLP y&#44; bas&#225;ndose en la congruencia de las investigaciones sobre el constructo te&#243;rico del estilo de vida&#44; modificaron tres de los factores iniciales&#46; De este modo&#44; la subescala de autorrealizaci&#243;n fue renombrada como crecimiento espiritual&#44; la subescala de apoyo interpersonal pas&#243; a llamarse relaciones interpersonales&#44; para distinguirlo de la construcci&#243;n m&#225;s amplia de apoyo social&#46; La subescala de ejercicio pas&#243; a denominarse actividad f&#237;sica&#46; Este nuevo instrumento fue denominado bajo el nombre de HPLP-II<span class="elsevierStyleItalic">&#44;</span> que qued&#243; conformado por un total de 52 &#237;tems y seis dimensiones o factores&#46; Esta nueva escala se valid&#243; aplic&#225;ndose a una muestra de 712 adultos de 18 a 92 a&#241;os de edad&#44; que es muy similar a la utilizada en nuestra escala E-VEVSA&#46; El coeficiente alfa de consistencia interna para la escala total fue de 0&#44;943 y los coeficientes alfa para las subescalas oscilaron entre 0&#44;793 y 0&#44;872&#44; que son tambi&#233;n muy parecidos a los obtenidos en E-VEVSA&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">La escala HPLP-II ha sido traducida y validada a varios idiomas en diferentes pa&#237;ses&#46; Pinar et al&#46;<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">53</span></a> validaron en Turqu&#237;a el instrumento HPLP-II en una muestra de 972 adultos&#46; Empleando un dise&#241;o similar al que hemos realizado en la escala E-VEVSA&#44; los an&#225;lisis exploratorios y confirmatorios llevaron a reducir los 52 &#237;tems a 48 y a cinco dimensiones de la escala original que explicaron 41&#37; de la varianza total&#46; Teng et al&#46;<a class="elsevierStyleCrossRef" href="#bib0585"><span class="elsevierStyleSup">54</span></a> en China reducen la escala a 30 &#237;tems&#44; Lo y Wong<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">22</span></a> en Taiw&#225;n&#44; Mohamadian et al&#46;<a class="elsevierStyleCrossRef" href="#bib0590"><span class="elsevierStyleSup">55</span></a> en Ir&#225;n&#44; P&#233;rez-Fortis et al&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">24</span></a> en Espa&#241;a&#44; Sousa et al&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">25</span></a> en Portugal&#46; No obstante&#44; los resultados de las pruebas psicom&#233;tricas realizadas arrojan valores inferiores a los encontrados en la escala E-VEVSA&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Coincidimos con Walker y Hill-Polerecky<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">34</span></a> acerca de que los factores que definen el estilo de vida pueden ser divididos en dos dimensiones conceptuales&#46; Por un lado&#44; los factores referidos a comportamientos promotores de salud f&#237;sica&#44; en el caso de E-VEVSA&#58; responsabilidad en el cuidado de la salud&#44; h&#225;bitos de alimentaci&#243;n&#44; h&#225;bitos de pr&#225;ctica de ejercicio f&#237;sico&#44; h&#225;bitos de sue&#241;o y descanso y h&#225;bitos de consumo de tabaco y alcohol y&#44; por otro lado&#44; factores referidos al bienestar cognitivo y emocional&#44; como son los h&#225;bitos de salud psicol&#243;gica y h&#225;bitos de salud social&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">La construcci&#243;n de nuestra escala E-VEVSA encuentra un paralelismo en el contexto espa&#241;ol con el cuestionario de estilo de vida saludable &#40;CEVS&#41; para poblaci&#243;n adulta validado por Leyton et al&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">35</span></a>&#46; En una muestra de 812 sujetos entre 14 y 88 a&#241;os eval&#250;an cuatro dimensiones del estilo de vida que coinciden con tres de los subconstructos desarrollados en la escala E-VEVSA&#46; En dichos factores encuentran una buena consistencia interna&#58; consumo de tabaco &#40;0&#44;85&#41;&#44; h&#225;bitos de descanso &#40;0&#44;71&#41;&#44; respeto al horario de comidas &#40;0&#44;71&#41; y mantener una alimentaci&#243;n equilibrada &#40;0&#44;75&#41;&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Con posterioridad&#44; Leyton et al&#46;<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">40</span></a> validar&#237;an una nueva versi&#243;n del cuestionario anterior&#44; al que llamaron CEVS-II y sobre una muestra de 1&#46;132 sujetos con edades comprendidas entre los 18 y 89 a&#241;os aplicaron un cuestionario constituido por 27 &#237;tems divididos en siete dimensiones&#44; que guarda un gran paralelismo con nuestra escala E-VEVSA&#46; En el caso del CEVS-II<span class="elsevierStyleSmallCaps">&#44;</span> los siete factores son&#58; dieta equilibrada &#40;tres &#237;tems&#41;&#59; respeto a los horarios de comidas &#40;tres &#237;tems&#41;&#59; h&#225;bitos de descanso &#40;tres &#237;tems&#41;&#59; consumo de tabaco &#40;tres &#237;tems&#41;&#59; consumo de alcohol &#40;cinco &#237;tems&#41;&#59; consumo de otras drogas &#40;cinco &#237;tems&#41; y qctividad f&#237;sica &#40;cinco &#237;tems&#41;&#46; Las pruebas psicom&#233;tricas obtenidas arrojan adecuados &#237;ndices de fiabilidad y validez para este instrumento&#46; Podemos ver que en el cuestionario CEVS-II se incluyen dimensiones relacionadas con los h&#225;bitos de vida que afectan a la vertiente fisiol&#243;gica de la salud&#44; sin embargo&#44; en el E-VEVSA se incorporan dos dimensiones relacionadas con los h&#225;bitos de salud psicol&#243;gica y social&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Mayor similitud con E-VEVSA encontramos en la validaci&#243;n de una escala sobre el estilo de vida de adolescentes mexicanos de Baz&#225;n-River&#243;n et al&#46;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">36</span></a>&#44; donde 523 adolescentes son evaluados con un instrumento que consta de seis dimensiones que presentan un alfa de Cronbach global de 0&#44;75&#46; Las dimensiones de la escala fueron&#58; alimentaci&#243;n&#44; actividad f&#237;sica&#44; estado emocional&#44; relaciones sociales&#44; toxicoman&#237;as y salud &#40;prevenci&#243;n de enfermedades y sexualidad&#41;&#46; Los dos &#250;ltimos factores arrojan valores de fiabilidad m&#225;s bajos &#40;0&#44;68 y 0&#44;69&#44; respectivamente&#41; que los autores atribuyen a la polarizaci&#243;n de los resultados&#46; Es necesario destacar que es una de las pocas escalas que incluye la prevenci&#243;n de enfermedades y aspectos relacionados con la sexualidad&#44; que tampoco ha sido considerada en nuestra escala E-VEVSA&#46; Por su parte&#44; Santiago-Baz&#225;n y Carcausto<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">37</span></a> dise&#241;aron el Cuestionario de estilo de vida saludable &#40;CEVS&#41;&#44; que fue conformado por cuatro factores con valores aceptables de fiabilidad que coinciden con cuatro de los subconstructos que conforman nuestra escala E-VEVSA&#58; f&#237;sico&#47;mental &#40;0&#44;70&#41; que incluye &#237;tems sobre alimentaci&#243;n saludable&#44; actividad f&#237;sica y salud mental&#59; relaciones sociales &#40;0&#44;60&#41;&#44; &#233;tico&#47;moral &#40;0&#44;60&#41; y acad&#233;mico&#47;familiar &#40;0&#44;70&#41;&#46; Para la validez utilizaron el criterio de concordancia entre expertos mediante la <span class="elsevierStyleItalic">W</span> de Kendall&#44; obteniendo los siguientes resultados&#58; claridad &#40;0&#44;78&#41;&#44; coherencia &#40;0&#44;70&#41;&#44; relevancia &#40;0&#44;76&#41; y suficiencia &#40;0&#44;71&#41;&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Con 550 adultos colombianos mayores de 18 a&#241;os&#44; Ram&#237;rez-V&#233;lez y Agredo<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">23</span></a> utilizaron el instrumento llamado &#171;FANT&#193;STICO&#187; para medir el estilo de vida en adultos colombianos&#46; Para evaluar las propiedades psicom&#233;tricas de este instrumento se sigui&#243; el protocolo de adaptaci&#243;n y validez del cuestionario original<a class="elsevierStyleCrossRef" href="#bib0595"><span class="elsevierStyleSup">56</span></a> y la validaci&#243;n en poblaci&#243;n mexicana y brasilera<a class="elsevierStyleCrossRefs" href="#bib0600"><span class="elsevierStyleSup">57&#8211;59</span></a>&#44; quienes encontraron que las escalas superaron el est&#225;ndar propuesto de fiabilidad &#40;alfa de Cronbach &#62; 0&#44;6&#41;&#46; El instrumento consta de 25 &#237;tems agrupados en 10 dominios que tienen una gran similitud con la estructura factorial de la escala E-VEVSA&#58; familia y amigos&#44; actividad f&#237;sica&#44; nutrici&#243;n&#44; consumo de tabaco&#44; consumo de alcohol&#44; sue&#241;o y estr&#233;s&#44; tipo de personalidad&#44; introspecci&#243;n&#44; conducci&#243;n al trabajo y otras drogas&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Andr&#233;s-Garc&#237;a et al&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">26</span></a> construyeron una escala de 93 &#237;tems distribuidos en 11 dimensiones para analizar la pr&#225;ctica de la actividad f&#237;sica&#44; las actitudes ante la actividad f&#237;sica y otros aspectos sobre el estilo de vida de los adolescentes escolares de la provincia de Valladolid&#46; Se utiliz&#243; el m&#233;todo Delphi modificado para la elaboraci&#243;n del cuestionario y la validaci&#243;n de contenido del mismo&#46; El criterio utilizado para la elecci&#243;n de los &#237;tems fue que el promedio obtenido fuese superior a 3&#44;5 puntos y el resultado de la prueba <span class="elsevierStyleItalic">V</span> de Aiken mayor o igual a 0&#44;70&#46; Para la fiabilidad aplicaron la prueba alfa de Cronbach&#46; Observamos claras coincidencias entre las dimensiones incluidas en este cuestionario para la evaluaci&#243;n del estilo de vida y las que estructuran nuestra escala E-VEVSA&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Daniel Orej&#243;n<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">38</span></a> valid&#243; un instrumento llamado &#171;Estilo de vida en estudiantes de medicina &#40;EVEM&#41;&#187; para medir el estilo de vida en una muestra de 332 estudiantes universitarios peruanos&#46; El instrumento cuenta con 49 &#237;tems agrupados en 11 factores que explican una varianza total de 56&#44;7&#37;&#46; Adem&#225;s&#44; el instrumento presenta una fiabilidad global por alfa de Cronbach de 0&#44;79&#46; Los factores agrupados presentan valores m&#225;s bajos de varianza explicada y de fiabilidad que los arrojados por la escala E-VEVSA&#46; Dichos factores fueron&#58; actividad f&#237;sica &#40;formado por siete &#237;tems que explicaban 11&#44;9&#37; de la varianza total acumulada y un alfa de 0&#44;854&#41;&#59; nutrici&#243;n y dieta &#40;contaba con 16 &#237;tems que explicaban 9&#44;45&#37; y un alfa de 0&#44;734&#41;&#59; h&#225;bitos nocivos &#40;cuatro &#237;tems explicaban 5&#44;4&#37; y un alfa de 0&#44;712&#41;&#59; salud mental &#40;10 &#237;tems que explicaban 7&#44;8&#37; y un alfa de 0&#44;801&#41;&#59; introspecci&#243;n &#40;formado por dos &#237;tems&#44; un alfa de 0&#44;579 y explicaba 3&#44;9&#37;&#41;&#59; otras conductas alimentarias &#40;con ocho &#237;tems&#44; un alfa de 0&#44;562 y explicaba 3&#44;6&#37;&#41;&#59; autocuidado &#40;tres &#237;tems&#44; un alfa de 0&#44;540 y explicaba 3&#44;2&#37;&#41;&#59; sue&#241;o &#40;dos &#237;tems&#44; un alfa de 0&#44;374 y explicaba 3&#37;&#41;&#59; conductas de riesgo &#40;cuatro &#237;tems&#44; un alfa de 0&#44;283 y explicaba 2&#44;8&#37;&#41;&#59; motivaci&#243;n &#40;contaba con tres &#237;tems&#44; un alfa de 0&#44;250 y explicaba 2&#44;7&#37;&#41;&#59; prevenci&#243;n &#40;cuatro &#237;tems&#44; un alfa de 0&#44;243 y explicaba 2&#44;4&#37;&#41;&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">M&#225;s recientemente&#44; De la Cruz Vargas et al&#46;<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">41</span></a> han validado un instrumento que consta de 47 &#237;tems distribuidos en 13 componentes principales que explicaban un 56&#44;7&#37; de la varianza total&#46; Los factores se agruparon en&#58; actividad f&#237;sica &#40;9&#44;22&#37; de la varianza explicada y un valor &#945; de 0&#44;84&#41;&#44; salud mental &#40;11&#44;7&#37; y 0&#44;83&#41;&#44; consumo de alimentos procesados y uso poco saludable de internet &#40;7&#44;89&#37; y 0&#44;79&#41;&#44; h&#225;bitos nocivos de salud &#40;85&#44;44&#37; y 0&#44;75&#41;&#44; consumo de l&#225;cteos y probi&#243;ticos naturales &#40;4&#37; y 0&#44;72&#41;&#44; patrones de alimentaci&#243;n &#40;3&#44;48&#37; y 0&#44;57&#41;&#44; s&#237;ntomas depresivos &#40;3&#44;30&#37; y 0&#44;82&#41;&#44; actividades de autocuidado &#40;2&#44;97&#37; y 0&#44;62&#41;&#44; consumo de frutas y ser vegetariano &#40;2&#44;77&#37; y 0&#44;54&#41;&#44; higiene del sue&#241;o &#40;2&#44;69&#37; y 0&#44;40&#41;&#44; conductas seguras &#40;2&#44;48&#37; y 0&#44;20&#41; y cuidado dental y otros h&#225;bitos alimentarios que presentaron coeficientes de fiabilidad muy comprometidos o no v&#225;lidos desde el punto de vista estad&#237;stico&#46; Todos los factores coincidentes de este instrumento presentan valores de varianza explicada y coeficientes de fiabilidad m&#225;s bajos que los observados en la escala E-VEVSA&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Los h&#225;bitos de vida adquiridos van a tener una gran relevancia en las condiciones de salud establecidas en la vida adulta<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">16&#44;17&#44;28&#44;60</span></a>&#59; en este sentido&#44; algunos autores han desarrollado instrumentos para medir el grado de motivaci&#243;n que los sujetos poseen para mantener un adecuado estilo de vida&#46; Entre los principales instrumentos desarrollados podemos citar el &#205;ndice de autodeterminaci&#243;n de salud<a class="elsevierStyleCrossRef" href="#bib0620"><span class="elsevierStyleSup">61</span></a>&#44; la Escala de motivaci&#243;n de salud general<a class="elsevierStyleCrossRef" href="#bib0625"><span class="elsevierStyleSup">62</span></a>&#44; la Escala de conducta de motivadores y barreras de estilo de vida saludable<a class="elsevierStyleCrossRef" href="#bib0630"><span class="elsevierStyleSup">63</span></a>&#44; el Inventario de motivaciones y barreras para el comportamiento saludable<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">47</span></a>&#44; la Escala de incentivo y promoci&#243;n de la salud<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">43</span></a> y la Escala de motivaci&#243;n para la salud<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">45</span></a>&#46; Sin embargo&#44; desde el punto de vista de la validez de contenido&#44; los objetivos y las dimensiones establecidas en estos instrumentos de medida del estilo de vida son distintos a los planteados en nuestro estudio dentro de la escala E-VEVSA&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Como limitaciones m&#225;s importantes de nuestra investigaci&#243;n podemos se&#241;alar que debido a que la selecci&#243;n de la muestra ha sido realizada por criterios de conveniencia en centros de salud de las ciudades de Albacete y Murcia&#44; aunque esta circunstancia ha facilitado el control y la calidad a la hora de cumplimentar los cuestionarios&#44; ha supuesto un sesgo en el car&#225;cter aleatorio de la misma y ha limitado que la franja de edad pueda ser superior a los 72 a&#241;os&#46; Por otro lado&#44; el hecho de que la muestra haya sido seleccionada entre pacientes que acud&#237;an a centros de salud&#44; ha podido generar un sesgo en relaci&#243;n con el nivel de estilo de vida de los sujetos&#44; ya que podr&#237;an tener afectadas de alg&#250;n modo sus condiciones de salud&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conclusi&#243;n</span><p id="par0235" class="elsevierStylePara elsevierViewall">Como conclusi&#243;n a nuestra investigaci&#243;n&#44; podemos decir que la escala E-VEVSA ha quedado conformada por siete factores que se reproducen en la mayor&#237;a de los instrumentos validados en el &#225;mbito internacional y que explican las tres &#225;reas principales con incidencia en la salud&#44; como son las variables o h&#225;bitos que tienen una relaci&#243;n directa con los cambios en el plano f&#237;sico o fisiol&#243;gico&#44; los h&#225;bitos con incidencia en el estado psicol&#243;gico personal y los h&#225;bitos que definen la estabilidad de nuestras relaciones interpersonales&#46; Esta identidad conceptual con la mayor&#237;a de las escalas analizadas y los registros arrojados en las pruebas psicom&#233;tricas exploratorias y confirmatorias realizadas&#44; convierten a la escala E-VEVSA en un instrumento v&#225;lido y &#250;til para mediar el nivel del estilo de vida adquirido por adultos espa&#241;oles&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Financiaci&#243;n</span><p id="par0240" class="elsevierStylePara elsevierViewall">La financiaci&#243;n del presente trabajo se ha establecido mediante los fondos del Grupo de Investigaci&#243;n AFYDOS &#40;Actividad F&#237;sica Deportes Orientados hacia la Salud&#41; de la Universidad de Murcia &#40;Espa&#241;a&#41;&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conflicto de intereses</span><p id="par0245" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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              "titulo" => "Pruebas psicom&#233;tricas confirmatorias de la escala E-VEVSA"
              "secciones" => array:3 [
                0 => array:2 [
                  "identificador" => "sec0060"
                  "titulo" => "Muestra final &#40;fase confirmatoria&#41;"
                ]
                1 => array:2 [
                  "identificador" => "sec0065"
                  "titulo" => "An&#225;lisis de fiabilidad de la escala definitiva E-VEVSA"
                ]
                2 => array:2 [
                  "identificador" => "sec0070"
                  "titulo" => "An&#225;lisis factorial confirmatorio de la escala E-VEVSA"
                ]
              ]
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0075"
          "titulo" => "Discusi&#243;n"
        ]
        8 => array:2 [
          "identificador" => "sec0080"
          "titulo" => "Conclusi&#243;n"
        ]
        9 => array:2 [
          "identificador" => "sec0100"
          "titulo" => "Financiaci&#243;n"
        ]
        10 => array:2 [
          "identificador" => "sec0085"
          "titulo" => "Conflicto de intereses"
        ]
        11 => array:1 [
          "titulo" => "Bibliograf&#237;a"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2022-09-06"
    "fechaAceptado" => "2022-11-29"
    "PalabrasClave" => array:2 [
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1616273"
          "palabras" => array:9 [
            0 => "Estilo de vida"
            1 => "Salud"
            2 => "Calidad de vida"
            3 => "Adultos"
            4 => "Pruebas psicom&#233;tricas"
            5 => "Escala"
            6 => "Cuestionario"
            7 => "Fiabilidad"
            8 => "Validez"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1616272"
          "palabras" => array:9 [
            0 => "Lifestyle"
            1 => "Health"
            2 => "Quality of life"
            3 => "Adults"
            4 => "Psychometric tests"
            5 => "Scale"
            6 => "Questionnaire"
            7 => "Reliability"
            8 => "Validity"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El estilo de vida es un constructo te&#243;rico que est&#225; formado por los h&#225;bitos de vida de un sujeto&#46; El an&#225;lisis y la cuantificaci&#243;n objetivable del estilo de vida&#44; puede tener un gran impacto sobre la salud de las personas&#44; as&#237; como en la evoluci&#243;n del estado de la misma con el transcurso de los a&#241;os&#46; El objetivo de la presente investigaci&#243;n ha sido la validaci&#243;n de la Escala de valoraci&#243;n del estilo de vida saludable adquirido &#40;E-VEVSA&#41; en adultos espa&#241;oles&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Sobre una muestra inicial para las pruebas exploratorias de 248 sujetos y final para las pruebas confirmatorias de 780 sujetos&#44; de edades comprendidas entre los 22 y 72 a&#241;os de edad&#44; se realizaron pruebas psicom&#233;tricas exploratorias y confirmatorias basadas en el estad&#237;stico alfa de Cronbach &#40;fiabilidad&#41; y an&#225;lisis factorial exploratorio con rotaci&#243;n oblicua &#40;oblimin&#41; y confirmatorio con rotaci&#243;n varimax &#40;validez de constructo&#41;&#44; que dieron lugar a un instrumento definitivo formado por 52 &#237;tems y estructurado en siete dimensiones&#58; Responsabilidad individual en el cuidado de la salud &#40;nueve &#237;tems&#41;&#44; h&#225;bitos de pr&#225;ctica f&#237;sico-deportiva &#40;seis &#237;tems&#41;&#44; h&#225;bitos de salud en las relaciones sociales &#40;10 &#237;tems&#41;&#44; h&#225;bito de consumo de tabaco y alcohol &#40;nueve &#237;tems&#41;&#44; h&#225;bito de alimentaci&#243;n saludable &#40;siete &#237;tems&#41;&#44; h&#225;bito de salud psicol&#243;gica &#40;seis &#237;tems&#41; y h&#225;bito de descanso y sue&#241;o diario &#40;cinco &#237;tems&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Todos los &#237;tems explicaron una varianza total de 66&#44;87&#37; y un alfa de Cronbach de 0&#44;894&#44; estando por encima de 0&#44;700 el alfa parcial de cada dimensi&#243;n o factor&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Los resultados arrojan pruebas psicom&#233;tricas que confirman la validez de la escala E-VEVSA como un instrumento &#250;til para medir el estilo de vida saludable adquirido en personas adultas&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Fundamentos"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Lifestyle is a theoretical construct that is formed by the life habits of a subject&#46; The analysis and objective quantification of lifestyle can have a great impact on people&#39;s health&#44; as well as on the evolution of its status over the years&#46; The objective of this research has been the validation of the Acquired Healthy Lifestyle Assessment Scale &#40;E-VEVSA&#41; in Spanish adults&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">On an initial sample for the exploratory tests of 248 subjects and a final sample for the confirmatory tests of 780 subjects&#44; aged between 22 and 72 years of age&#46; Exploratory and confirmatory psychometric tests were carried out based on the Cronbach&#39;s alpha statistic &#40;reliability&#41; and exploratory factorial analysis with oblique rotation &#40;oblimin&#41; and confirmatory with varimax rotation &#40;construct validity&#41;&#44; which resulted in an instrument made up of 52 items and structured in 7 dimensions&#58; individual responsibility in health care &#40;9 items&#41;&#44; habits of physical-sports practice &#40;6 items&#41;&#44; health habits in social relationships &#40;10 items&#41;&#44; habit of tobacco and alcohol consumption &#40;9 items&#41;&#44; habit of healthy eating &#40;7 items&#41;&#44; psychological health habits &#40;6 items&#41; and daily rest and sleep habits &#40;5 items&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">All the items explained a total variance of 66&#46;87&#37; and a Cronbach&#39;s alpha of &#46;894&#44; with the partial alpha of each dimension or factor being above &#46;700&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The results show psychometric tests that confirm the validity of the E-VEVSA scale as a useful instrument to measure the healthy lifestyle acquired among adults&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Background"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Method"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusions"
          ]
        ]
      ]
    ]
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        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0255" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Anexo A"
            "titulo" => "Material suplementario"
            "identificador" => "sec0095"
          ]
        ]
      ]
    ]
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            "identificador" => "at1"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Alfa de Cronbach &#61; 0&#44;876&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Alfa de Cronbach &#40;eliminado el &#237;tem 18&#41; &#61; 0&#44;896&#46;</p>"
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                  """
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        "descripcion" => array:1 [
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      1 => array:8 [
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        "mostrarFloat" => true
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            "detalle" => "Tabla "
            "rol" => "short"
          ]
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                  \t\t\t\t">0&#44;367<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;338<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Valor p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;000&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;000&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;000&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">r</span> de Pearson&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;357<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;326<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;322<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;382<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;314<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;313<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;326<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;338<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Valor p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Matriz de correlaciones establecida entre los nueve &#237;tems correspondientes a la dimensi&#243;n &#171;responsabilidad individual en el cuidado de la salud&#187;</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">133&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">126&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">131&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">390&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mujer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">148&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">137&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">113&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">398&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">281&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">263&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">244&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">788&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Muestra final de sujetos distribuidos en funci&#243;n del sexo y la edad en la fase confirmatoria</p>"
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        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">&#205;tems 18&#44; 25&#44; 29&#44; 39&#44; 43&#44; 48 y 59&#46; Eliminados al registrar un valor alfa de Cronbach superior al obtenido en el alfa de la prueba global de consistencia interna si eran eliminados&#46; Dichos &#237;tems fueron los siguientes&#58;</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">&#205;tems 2&#44; 6&#44; 27&#44; 30&#44; 34&#44; 38&#44; 41&#44; 52&#44; 62&#44; 63 y 67&#46; Eliminados por no registrar carga factorial dentro de la dimensi&#243;n en la cual fueron incluidos inicialmente o por tener un valor alfa de Cronbach superior al obtenido si eran eliminados en las pruebas parciales de consistencia interna de las siete dimensiones en que se agruparon los &#237;tems de la escala inicial E-VEVSA &#40;2&#41; en el an&#225;lisis factorial exploratorio&#46;</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">&#205;tems 9&#44; 17 y 68&#46; Presentan cargas factoriales en otro factor diferentes al que inicialmente fueron situados&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Factor o dimensi&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&#46;&#176; de &#237;tems&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Alfa de Cronbach&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;1&#41; Responsabilidad individual en el cuidado de la salud&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44; 14&#44; 17&#44; 22&#44; 28&#44; 35&#44; 45&#44; 51 y 60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;896&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;2&#41; H&#225;bitos de pr&#225;ctica f&#237;sico-deportiva&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;16&#44; 40&#44; 47&#44; 50 y 66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;848&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;3&#41; H&#225;bitos de salud en las relaciones sociales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44; 8&#44; 31&#44; 33&#44; 44&#44; 54&#44; 58&#44; 61&#44; 64 y 68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;776&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;4&#41; H&#225;bito de consumo de tabaco y alcohol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44; 11&#44; 37&#44; 46&#44; 49&#44; 55&#44; 57&#44; 69 y 70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;758&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;5&#41; H&#225;bito de alimentaci&#243;n saludable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44; 13&#44; 20&#44; 26&#44; 32&#44; 53 y 56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;744&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;6&#41; H&#225;bito de salud psicol&#243;gica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;12&#44; 19&#44; 21&#44; 24 y 36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;742&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;7&#41; H&#225;bito de descanso y sue&#241;o diario&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44; 15&#44; 23&#44; 42&#44; y 65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;732&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Distribuci&#243;n de &#237;tems definitivos y valor alfa de Cronbach parcial para cada factor o dimensi&#243;n de la escala E-VEVSA</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0025"
        "etiqueta" => "Tabla 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at5"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Alfa global y parcial de la escala&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="7" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#945; de Cronbach de E-VEVSA&#58; 0&#44;894</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">1 &#40;9 &#237;tems&#41;0&#44;896&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2 &#40;6 &#237;tems&#41;0&#44;848&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">3 &#40;10 &#237;tems&#41;0&#44;776&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">4 &#40;9 &#237;tems&#41;0&#44;758&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">5 &#40;7 &#237;tems&#41;0&#44;744&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">6 &#40;6 &#237;tems&#41;0&#44;742&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">7 &#40;5 &#237;tems&#41;0&#44;732&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Varianza total explicada por E-VEVSA&#58; 66&#44;87&#37;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Varianza explicada global y parcial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Factor 112&#44;83&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Factor 210&#44;53&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Factor 39&#44;86&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Factor 48&#44;87&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Factor 58&#44;70&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Factor 68&#44;19&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Factor 78&#44;04&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Escala E-VEVSA&#46; Valores de fiabilidad global y parcial de cada dimesi&#243;n y varianza total y parcial explicada</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0030"
        "etiqueta" => "Tabla 6"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at6"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">M&#233;todo de extracci&#243;n&#58; an&#225;lisis de componentes principales&#46;</p><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">M&#233;todo de rotaci&#243;n&#58; normalizaci&#243;n varimax con Kaiser&#46;</p><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">a&#46; La rotaci&#243;n ha convergido en nueve iteraciones&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dimensiones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Responsabilidad individual en el cuidado de la salud&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">H&#225;bitos de pr&#225;ctica de actividad f&#237;sico-deportiva&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">H&#225;bitos de salud en las relaciones sociales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">H&#225;bitos de consumo de tabaco y alcohol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">H&#225;bitos de alimentaci&#243;n saludable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">H&#225;bitos de salud psicol&#243;gica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">H&#225;bitos de sue&#241;o y descanso diario&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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