| Objectives To develop the Chinese version of health literacy scale for occupational population and apply the scale to the health literacy survey among working people in one district of Shanghai. To explore the association between health literacy and health related behaviors, and provide the basis for implementing the occupational people’s health literacy promotion.Methods The occupational people were selected from the urban and rural residents in one district of Shanghai as the participants. Both quantitative and qualitative studies were conducted. For the qualitative study, initial items were generated on the basis of references reading and discussions among group members, and the cognitive interviews were conducted in employees with different job categories to revise the items and develop the scale draft. For the quantitative study, sample size was calculated through the software. Neighborhoods, buildings and families were selected step by step through multistage cluster random sampling method. All the members in the selected families would be investigated on the basis of informed consent. Demographics, health literacy, behavior characteristics and other information were collected through the survey. Epidata3.1 software was used to establish the database, the reliability and validity of the scale were evaluated through SPSS18.0 software, and LISREL 8.7 software was used to do the confirmatory factor analysis and model fitting. Besides the scale evaluation, SPSS18.0 was also applied to do descriptive statistics, correlation and multi-factor analysis of the participants’ health literacy and health related behavior.Results 38 workers from different job fields were interviewed, most of the respondents (31/38) approved the validity, intelligibility, logicality of item setting of the scale. Through the cognitive interviews, the scale draft containing 42 items was produced with the concluded cognitive process of the respondents and items revision.2330 valid questionnaires were returned, and the valid response rate was 99.57%. All the participants were randomly allocated into two groups, one group (1162 people) was used to do the exploratory factor analysis and explore the scale structure, the other group (1168 people) was applied to do the confirmatory factor analysis and model fitting. The analysis results were showed as following:(1) health literacy scale for occupational people consisted of 26 items which were divided into 7 dimensions (information evaluation and utilization, workfare utilization, health care information accessibility, job hazard identification ability, job hazard protection capability,right-protectionawareness of occupational health and health awareness). (2) The seven common factors explained 55.762% variance variation and KMO value was 0.873. For the 7 common factors model, the χ2 value was the minimum, RMSEA and RMR value was respectively 0.058 (<0.08) and 0.024 (<0.05), other fitting indexes including AGFI, NNFI, IFI and CFI were all above 0.9, indicating the 7-factor-model fitted well. (3) The Cronbach’s a value of the scale was 0.887, and theCronbach’s a values of each dimension of the scale ranged from 0.654 to 0.900, which indicating higher level of internal consistency. The ICC value of the health literacy level measured in the two surveys was 0.938, and the ICC values of every item ranged from 0.779 to 0.956, which were all above 0.75 and indicated the good test-retest reliability of the scale.2315 participants who completely responded to the health literacy related items were selected to do the association between health literacy and health related behavior. And the results showed, the health literacy was associated with smoking, physical activity, BMI and dietary habits, the r5values were respectively-0.118,0.110,-0.099 and 0.097(P<0.001), indicating that the participants with higher score of health literacy would be further away from the tobacco damage, more physically active, have a more normal BMI, more balanced diet, and that the participants with lower score of health literacy would be more inclined to foster a negative lifestyle. Conducting health literacy level as the independent variables, the binary Logistic regression analysisused individual characteristics and behavioral features as the dependent variables. The results showed health literacy was associated with education background, work property classification, physical activity, dietary habit, smoking behaviors and cognition of health condition. Participants with higher level of education background tended to have lower level of health literacy, and people with lower health literacy level were more inclined to be smokers, physically inactive and have an imbalanced diet.Conclusion On the basis of the scale development and association explore, the conclusions can be drawn as following:(1) The developed health literacy scale for occupational people had good reliability and validity. (2) The division of health literacy test threshold and the standard of health literacy level should be modified in the future with large sample test. (3) With the public health perspective, the associations between health literacy and health outcomes, health literacy and health related behaviors need to be further confirmed. (4) The aged, people with low education background, manufacturing workers and service personnel should be the key intervention population in the health literacy promotion. (5) Improving the feasibility, accuracy and practicability of the information, resources and services provided by various domains of the society should be the key work of future health education and health promotion. |
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