Development And Preliminary Application Of Scale On Health Literacy For Patients With Chronic Disease

Objectives (1) To explore the connotation of health literacy by reviewing the international and domestic literatures on health literacy.(2) To develop scale of health literacy for patients with chronic disease by using foreign experience for reference;(3) To study the status of chronic patients’ health literacy in order to provide evidences for health education and health promotion in Shanghai.Methods Based on studies home and abroad, the health literacy connotation was investigated from the public health perspective. Health Literacy Management Scale(HeLMS)which was developed by Jordan was translated into Chinese.1529patients from5districts in Shanghai were selected by multistage stratified random sample method. Firstly, the first stage investigation was conducted in one district and totally439chronic patients were investigated. Factor analysis was used to analysis the structure of health literacy scale for chronic patients and some of the items were deleted according to the results. The test-retest reliability, construct validity, Cronbach’s a coefficient, criterion validity was tested. The final scale was used to investigate in the other4districts. The exploratory factor analysis and confirmatory factor analysis were used to confirm the structure. Epidata3.1software was used to construct database, SPSS18.0and LISREL8.7were used for exploratory factor analysis and confirmatory factor analysis. The SPSS18.0was used to conduct test-retest reliability, construct validity, Cronbach’s a coefficient, criterion validity and the stata10.0was used for univariate analysis and multivariate analysis.Results(1) The Scale on health literacy for patients with chronic disease was composed of24items, which was separated into4dimensions:information acquisition ability, communicative interaction ability, health improvement willingness, economic support willingness.(2) The Cronbach’s α coefficient of the4dimensions was between0.885-0.925; The test-retest Pearson coefficient was0.683; The result of confirmatory factor analysis showed:RMSEA was0.079; χ2/df was4.12; NFI, IFI and CFI were more than0.9. The correlation coefficient was respectively0.226,0.241,0.159, and0.172for information acquisition ability, communicative interaction ability, health improvement willingness, economic support willingness.(3) After adjusted by gender, age group, marital status, occupations, the information acquisition ability score(β=0.357, P<0.001), the communicative interaction ability score(P=0.095, P=0.003), the health improvement willingness score(P=0.175, P<0.001) and the economic support willingness score(β=0.119, P<0.001)were increased with the increase of education level. After adjusted by age group, marital status, occupation and level of education, information acquisition ability(β=0.074, P=0.013) and economic support willingness score(β=0.070, P=0.028) of married individuals were significantly higher than the divorced and the bereft. After adjusted by age group, marital status, occupation and education, health information assistant ability(P=0.126, P<0.001)and health improvement willingness of the females (β=0.071, P<0.003)were significantly higher than that of the males. With the number of diseases increase, patients’ information acquisition ability and economic support willingness was decreased but the communicative interaction ability and the health improvement willingness were increased, the difference was not statically significant.(4) Proportion analysis for patients’ health literacy of5chronic diseases indicated that patients’ information acquisition ability proportion was relatively lower than the other dimensions. The proportion of the information acquisition ability for hypertension, diabetes mellitus, coronary heart disease or the heart failure, chronic bronchitis or bronchial asthma and arthritis were69.0%,66.7%,76.2%,51.9%,58.4%respectively. The proportion of the hypertension who possessed the health literacy was higher than the other patients. As for information acquisition ability, the difference was statistically significant(P<0.001). The proportion of the diabetes mellitus who possessed the health literacy was lower than the other patients. As for the information acquisition ability, the difference was statistically significant(P=0.015).The proportion of the coronary heart disease or the heart failure who possessed the health information assistant ability was higher than the other patients, the difference was statistically significant(P=0.001), and lower in other dimensions. The proportion of the chronic bronchitis or bronchial asthma and arthritis who possessed the health information assistant ability were lower than that of the other patients, the difference were not statistically significant.Conclusion (1)4dimensions of scale on health literacy for patients with chronic disease, which was correspond to the definition and connotation, could reflect the abilities that was needed for patients to obtain, understand and use health information and health services.(2) Patients’ health literacy scale of chronic diseases was of high reliability and consistency, which could be used to evaluate the patients’ health literacy of chronic diseases.(3) The patients’ communicative interaction ability of chronic diseases was relatively lower, which needed further improvement.(4) The patients’ health literacy of diabetes mellitus needs further improvement. The health improvement willingness for heart failure, chronic bronchitis or bronchial asthma and arthritis needed further improvement.