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BMC Public Health
Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Research article

Assessment of the Chinese Resident Health Literacy Scale in a population-based sample in South China

Authors: Minxue Shen, Ming Hu, Siyun Liu, Yan Chang, Zhenqiu Sun

Published in: BMC Public Health | Issue 1/2015

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Abstract

Background

A national health literacy scale was developed in China in 2012, though no studies have validated it. In this investigation, we assessed the reliability, construct validity, and measurement invariance of that scale.

Methods

A population-based sample of 3731 participants in Hunan Province was used to validate the Chinese Resident Health Literacy Scale based on item response theory and classical test theory (including split-half coefficient, Cronbach’s alpha, and confirmatory factor analysis). Measurement invariance was examined by differential item functioning.

Results

The overall Cronbach’s alpha of the scale was 0.95 and Spearman-Brown coefficient 0.94. Confirmatory factor analysis showed that the test measured a unidimensional construct with three highly correlated factors. Highest discrimination was found among participants with limited to moderate health literacy. In all, 64 items were selected from the original scale based on factor loading, Pearson’s correlation coefficient, and discrimination and difficulty parameters in item response theory. Measurement invariance was significant but slight. According to the two-level linear model, health literacy was associated with education level, occupation, and income.

Conclusions

The 2012 national health literacy scale was validated, and 64 items were selected based on classical test theory and item response theory. The revised version of the scale has strong psychometric properties with minor measurement invariance.
Literature
1.
Chinese Ministry of Health. 66 tips of health: Chinese resident health literacy manual. Beijing: People’s Medical Publishing House; 2008.
2.
Li XH. Brief introduction on identification and dissemination of the Basic Knowledge and Skill of People’s Health Literacy by Chinese government. Chinese J Health Educ. 2008;24(5):385–8.
3.
World Health Organization. Health promotion glossary. Geneva: World Health Organization; 1998.
4.
Institute of Medicine. Health literacy: a prescription to end confusion. Washington DC: National Academies Press; 2004.
5.
6.
Wang P, Mao Q, Tao M, Tian X, Li Y, Qian L, et al. Survey on the status of health literacy of Chinese residents in 2008. Chin J Health Educ. 2010;26(4):243–6.
7.
Li Y. Introduction of 2012 Chinese residents health literacy monitoring program. Chin J Health Educ. 2014;30(6):563–5.
8.
Davis TC, Crouch MA, Long SW, Jackson RH, Bates P, George RB, et al. Rapid assessment of literacy levels of adult primary care patients. Fam Med. 1991;23(6):433–5.PubMed
9.
10.
Arozullah AM, Yarnold PR, Bennett CL, Soltysik RC, Wolf MS, Ferreira RM, et al. Development and validation of a short-form, rapid estimate of adult literacy in medicine. Med Care. 2007;45(11):1026–33.CrossRefPubMed
11.
Parker RM, Baker DW, Williams MV, Nurss JR. The test of functional health literacy in adults: a new instrument for measuring patients’ literacy skills. J Gen Intern Med. 1995;10(10):537–41.CrossRefPubMed
12.
Baker DW, Williams MV, Parker RM, Gazmararian JA, Nurss J. Development of a brief test to measure functional health literacy. Patient Educ Couns. 1999;38(1):33–42.CrossRefPubMed
13.
Weiss BD, Mays MZ, Martz W, Castro KM, DeWalt DA, Pignone MP, et al. Quick assessment of literacy in primary care: the newest vital sign. Ann Fam Med. 2005;3(6):514–22.CrossRefPubMedPubMedCentral
14.
Chew LD, Bradley KA, Boyko EJ. Brief questions to identify patients with inadequate health literacy. Fam Med. 2004;36(8):588–94.PubMed
15.
Ishikawa H, Takeuchi T, Yano E. Measuring functional, communicative, and critical health literacy among diabetic patients. Diabetes Care. 2008;31(5):874–9.CrossRefPubMed
16.
17.
Dumenci L, Matsuyama R, Riddle DL, Cartwright LA, Perera RA, Chung H, et al. Measurement of cancer health literacy and identification of patients with limited cancer health literacy. J Health Commun. 2014;19 Suppl 2:205–24.CrossRefPubMedPubMedCentral
18.
Ishikawa H, Nomura K, Sato M, Yano E. Developing a measure of communicative and critical health literacy: a pilot study of Japanese office workers. Health Promot Int. 2008;23(3):269–74.CrossRefPubMed
19.
Huizinga MM, Elasy TA, Wallston KA, Cavanaugh K, Davis D, Gregory RP, et al. Development and validation of the Diabetes Numeracy Test (DNT). BMC Health Serv Res. 2008;8:96.CrossRefPubMedPubMedCentral
20.
Hanson-Divers EC. Developing a medical achievement reading test to evaluate patient literacy skills: a preliminary study. J Health Care Poor Underserved. 1997;8(1):56–69.CrossRefPubMed
21.
Malloy-Weir LJ, Charles C, Gafni A, Entwistle VA. Empirical relationships between health literacy and treatment decision making: a scoping review of the literature. Patient Educ Couns. 2015;98(3):296–309.CrossRefPubMed
22.
Hanchate AD, Ash AS, Gazmararian JA, Wolf MS, Paasche-Orlow MK. The Demographic Assessment for Health Literacy (DAHL): a new tool for estimating associations between health literacy and outcomes in national surveys. J Gen Intern Med. 2008;23(10):1561–6.CrossRefPubMedPubMedCentral
23.
Kutner M, Greenberg E, Jin Y, Paulsen C. The health literacy of America’s adults: results from the 2003 National Assessment of Adult Literacy. Washington, DC: National Center for Education Statistics; 2006.
24.
25.
Canadian Council on Learning. Health literacy in Canada: initial results from the International Adult Literacy and Skills Survey 2007. Ottawa: Canadian Council on Learning; 2007.
26.
Australian Bureau of Statistics. Health literacy, Australia 2006. Canberra: Australian Bureau of Statistics; 2008.
27.
Hahn EA, Choi SW, Griffith JW, Yost KJ, Baker DW. Health literacy assessment using talking touchscreen technology (Health LiTT): a new item response theory-based measure of health literacy. J Health Commun. 2011;16 Suppl 3:150–62.CrossRefPubMedPubMedCentral
28.
Jordan JE, Osborne RH, Buchbinder R. Critical appraisal of health literacy indices revealed variable underlying constructs, narrow content and psychometric weaknesses. J Clin Epidemiol. 2011;64(4):366–79.CrossRefPubMed
29.
Leung AY, Cheung MK, Chi I. Supplementing vitamin D through sunlight: associating health literacy with sunlight exposure behavior. Arch Gerontol Geriatr. 2015;60(1):134–41.CrossRefPubMed
30.
Leung AY, Lou VW, Cheung MK, Chan SS, Chi I. Development and validation of Chinese Health Literacy Scale for Diabetes. J Clin Nurs. 2013;22(15–16):2090–9.CrossRefPubMed
31.
Wang J, He Y, Jiang Q, Cai J, Wang W, Zeng Q, et al. Mental health literacy among residents in Shanghai. Shanghai Arch Psychiatry. 2013;25(4):224–35.PubMedPubMedCentral
32.
Lam LT, Yang L. Is low health literacy associated with overweight and obesity in adolescents: an epidemiology study in a 12-16 years old population, Nanning, China, 2012. Arch Public Health. 2014;72(1):11.CrossRefPubMedPubMedCentral
33.
Simon MA, Li Y, Dong X. Levels of health literacy in a community-dwelling population of Chinese older adults. J Gerontol A Biol Sci Med Sci. 2014;69 Suppl 2:S54–60.CrossRefPubMedPubMedCentral
34.
Guo SJ, Yu XM, Sun YY, Nie D, Li XM, Wang L. Adaptation and evaluation of Chinese version of eHEALS and its usage among senior high school students. Chin J Health Educ. 2013;29(2):106–8.
35.
Xu WH, Rothman RL, Li R, Chen Y, Xia Q, Fang H, et al. Improved self-management skills in Chinese diabetes patients through a comprehensive health literacy strategy: study protocol of a cluster randomized controlled trial. Trials. 2014;15:498.CrossRefPubMedPubMedCentral
36.
Lin X, Wang M, Zuo Y, Li M, Lin X, Zhu S, et al. Health literacy, computer skills and quality of patient-physician communication in Chinese patients with cataract. PLoS One. 2014;9(9), e107615.CrossRefPubMedPubMedCentral
37.
Sun X, Yang S, Fisher EB, Shi Y, Wang Y, Zeng Q, et al. Relationships of health literacy, health behavior, and health status regarding infectious respiratory diseases: application of a skill-based measure. J Health Commun. 2014;19 Suppl 2:173–89.CrossRefPubMed
38.
Sun X, Shi Y, Zeng Q, Wang Y, Du W, Wei N, et al. Determinants of health literacy and health behavior regarding infectious respiratory diseases: a pathway model. BMC Public Health. 2013;13:261.CrossRefPubMedPubMedCentral
39.
Powers BJ, Trinh JV, Bosworth HB. Can this patient read and understand written health information. JAMA. 2010;304(1):76–84.CrossRefPubMed
40.
Ye XH, Yang Y, Gao YH, Chen SD, Xu Y. Status and determinants of health literacy among adolescents in Guangdong, China. Asian Pac J Cancer Prev. 2014;15(20):8735–40.CrossRefPubMed
41.
Wang C, Li H, Li L, Xu D, Kane RL, Meng Q. Health literacy and ethnic disparities in health-related quality of life among rural women: results from a Chinese poor minority area. Health Qual Life Outcomes. 2013;11:153.CrossRefPubMedPubMedCentral
42.
Wang X, Guo H, Wang L, Li X, Huang M, Liu Z, et al. Investigation of Residents’ Health Literacy Status and Its Risk Factors in Jiangsu Province of China. Asia Pac J Public Health. 2015;27(2):NP2764–2772.CrossRefPubMed
43.
Kish L. A procedure for objective respondent selection within the household. J Am Statist Assoc. 1949;44(247):380–7.CrossRef
44.
Xiao L, Cheng YL, Ma Y, Chen GY, Hu JF, Li YH, et al. A study on applying Delphi method for screening evaluation indexes of health literacy of China adults. Chin J Health Educ. 2008;24(2):81–4.
45.
Reise SP, Waller NG. Item response theory and clinical measurement. Annu Rev Clin Psychol. 2009;5:27–48.CrossRefPubMed
46.
Hambleton RK, Swaminathan H. Item response theory: principles and applications. Boston, Massachusetts: Kluwer-Nijhoff; 1985.CrossRef
47.
Baker FB. The basics of item response theory. 2nd ed. The United States of America: ERIC Clearinghosue on Assessment and Evaluation; 2001.
48.
Richard T. Interpretation of the correlation coefficient: a basic review. J Diagn Med Sonog. 1990;6(1):35–9.CrossRef
49.
Gerbing DW, Anderson JC. An updated paradigm for scale development incorporating unidemensionality and its assessment. J Marketing Res. 1988;25(2):186–92.CrossRef
50.
Gorsuch RL. Exploratory factor analysis: its role in item analysis. J Pers Assess. 1997;68(3):532–60.CrossRefPubMed
51.
Velicer WF, Fava JL. Effects of variable and subject sampling on factor pattern recovery. Psychol Methods. 1998;3(2):231–51.CrossRef
52.
Nunnally JC, Bernstein IH. Psychometric Theory. New York: McGraw-Hill, Inc; 1994.
53.
Thomas ML. The value of item response theory in clinical assessment: a review. Assessment. 2011;18(3):291–307.CrossRefPubMed
54.
Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int. 2000;15(3):259–67.CrossRef
Metadata
Title
Assessment of the Chinese Resident Health Literacy Scale in a population-based sample in South China
Authors
Minxue Shen
Ming Hu
Siyun Liu
Yan Chang
Zhenqiu Sun
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-1958-0

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