| Objective:Since the release of the Health Article 66, many investigations on residents' health literacy have been carried out throughout the nation. But the indicators of the investigation questionnaire and the definition of dimensions still need to be further improved. Based on the data from residents' health literacy survey of Jiangsu province in 2013, this study explores the questionnaire structure and the connotation of health literacy by employing the method of structural equation model, and even obtains the information on the status of residents' health literacy in Jiangsu province and its influencing factors. Therefore, this thesis provides references for government departments in order to improve residents' health literacy status and to take relevant measures.Method:With the multistage, stratified and cluster random sampling method, residents aged 15?69 in 13 cities of Jiangsu province in 2013 were selected to participate in the survey of Questionnaire on National Residents' Health Literacy. The questionnaire includes 3 first-level indicators,6 second-level indicators and 20 third-level indicators.3 first-level indicators correspond to 3 dimensions of heath literacy:basic knowledge and concepts, healthy lifestyles and behavior and basic skills,20 tertiary indicators were analyzed in this study. The database was established by Epidata3.1 and the health literacy scores were expressed as mean±standard devation. Residents who answered correctly above the 80% of the total can be recognized as having health literacy. Descriptive analysis and multiple linear regression analysis of influencing factors are made by SAS9.1. Confirmatory factor analysis and model construction between latent variables are made by AMOS 17.0, and the latent variable score calculation based on structural equation model is made by LISREL 8.80.Result:Eventually,14622 were returned with a recovery rate of 99.52%, in which the valid questionnaires were 14560 with an effective rate of 99.58%.1. Residents' health literacy status in Jiangsu provinceThe rate of residents' health literacy in Jiangsu province in 2013 was 14.13%. Among the three dimensions, the rate of Basic knowledge and concepts was 21.92%; the rate of healthy lifestyles and behavior was 11.12% and the rate of basic skills was 17.68%. The study shows that the rate of basic knowledge and concepts of health was higher than the other two dimensions among various groups of subjects.2. Reliability and validity analysis of the questionnaires(1) Reliability analysis:Reliability is reflected by the factor loading and reliability coefficients, combinations reliability of dimensions and Cronbach a coefficient. The result was that the factor loading rose from 0.39 to 0.78; the reliability coefficient was from 0.15 to 0.61; the combination reliability values of three dimensions were 0.84,0.70,0.73 respectively and Cronbach a coefficients were 0.80,0.69,0.73, respectively. It is considered that the questionnaire meets the basic standards of reliability.(2) Validity analysis:The average variance extracted (AVE) is used to test the convergent validity of each dimension. The AVE values of the three dimensions were 0.38,0.26,0.40, lower than the boundary value 0.5. Also, the correlation coefficients between the three dimensions appeared greater than or equal to 1 and the error variance is less than 0, which proved that the data and model could not fit well and the discriminant validity of health literacy three dimensions was poor.3. Redefinition of the questionnaire diminsionsSince the unreasonable estimate appeared in the model parameter estimation, we decided to further redefine the questionnaire variables structure. The overall samples were randomly divided into two half, one half of which were used for exploratory factor analysis, and the other half were used to verify the result of analysis. The result of redefining was that indicator 1,2,3,8,9,12,15,19 were included in dimension of basic knowledge and concepts; indicator 4,5,6,10,11 were included in dimension of healthy lifestyles and behavior; indicator 7,13,14,16,17,18,20 were included in dimension of basic skills. The factor loading of each indicator was from 0.42 to 0.83. The reliability coefficient was from 0.18 to 0.69. The combination reliability values of three dimensions were 0.80,0.76,0.84, respectively. Cronbach a values were 0.79,0.78,0.81. The AVE values of the three dimensions were 0.34,0.40,0.44, and the correlation coefficients between the three dimensions were 0.84,0.85,0.83,and error variance values were all above 0. Competitive model comparison method was used to test the discriminant validity of three dimension and the discriminant validity of three paired measurement model was statistically significant (p<0.01).4. Theoretical Model of three dimensionsThere is an internal relation among the three dimensions of health literacy content:basic knowledge and concepts, healthy lifestyles and behavior and basic skills. Basic knowledge and concepts had a direct effect on basic skills, and indirectly affect basic skills through healthy lifestyles and behavior. Three paths of Structural model were statistically significant (P<0.05):basic knowledge and concepts?healthy lifestyles and behavior, basic knowledge and concepts?basic skills, healthy lifestyles and behavior?basic skills. The main effect (indirect effects) values of three paths were 0.87 (0),0.46 (0.47),0.54 (0).5. Influencing factors of residents' health literacy Multivariate stepwise regression analysis was used to analyze the influencing factors, with the latent variable score of three dimensions obtained from structural equation model acting as a dependent variable, and the social demographic characteristics were used as an independent variable. The results show that regions, age, educational levels, medical workers or not and suffering from chronic diseases or not were the mainly influencing factors. In rural areas, older, less educated, not suffering from chronic diseases and non-medical workers were the negative factors of health literacy.Conclusion:1. The discriminant validity of Questionnaire on National Residents'Health Literacy is poor, and the redefined questionnaire has good reliability and validity.2. Basic knowledge and concepts has a direct effect on the basic skills, and an indirect influence on basic skills through healthy lifestyles and behavior.3. Influencing factors of health literacy include:regions, age, education levels, whether engaging in medical work and whether suffering from chronic diseases. Living in cities, high degree of education, medical workers and suffering from chronic diseases are protective factors of health literacy, and age is a risk factor. |
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