# Development and psychometric evaluation of a lifestyle adherence assessment scale for patients with dry eye syndrome

## TL;DR

This paper introduces a new scale to assess lifestyle adherence in dry eye patients, validated for reliability and accuracy.

## Contribution

A novel lifestyle adherence assessment scale for dry eye syndrome with strong psychometric properties is developed and validated.

## Key findings

- The final scale has 18 items across five dimensions with high content validity and reliability.
- Confirmatory factor analysis showed good model fit with indices like CFI = 0.958 and RMSEA = 0.038.
- Test-retest reliability was 0.931, and Cronbach’s α was 0.894, indicating strong internal consistency.

## Abstract

To develop the lifestyle adherence assessment scale for patients with dry eye syndrome and conduct validity and reliability analyses.

A cross-sectional and methodological scale validation design, following classical test theory.

The study was conducted in three stages. The initial stage focused on item generation and revision, which involved a comprehensive literature analysis and expert inquiries. Phase two involved the assessment and exploration of items. The third phase involved a cross-sectional survey to establish construct validity, content validity, internal consistency reliability, and exploratory factor analysis. A total of 422 samples that met the study criteria were included during the second and third stages (June 2024 to March 2025).

The final scale contains 18 items across five dimensions: ophthalmic care standards, ocular strain regulation standards, seeking supports, tobacco and alcohol consumption regulations, and daily conduct guidelines. Twenty-three experts with professional experience participated in two rounds of expert consultations. Expert authority coefficients were 0.854 and 0.894 in two Delphi rounds, with 100% response and validity rates. Exploratory factor analysis extracted five factors accounting for 54.65% of the variance. Confirmatory factor analysis indicated good model fit (χ²/df = 3.580, CFI = 0.958, TLI = 0.947, SRMR = 0.072, RMSEA = 0.038). The scale-level and item-level content validity indices were both 1.000. Cronbach’s α was 0.894, and test-retest reliability was 0.931.

The Lifestyle Adherence Assessment Scale for Dry Eye Patients has excellent reliability and validity, making it a suitable instrument for evaluating patients’ adherence to lifestyle modifications.