Development And Evaluation Of Chinese Rural Health Literacy Scale

ObjectivesTo develop a Chinese rural health literacy scale,as an evaluation tool for rural public health,health education and health promotion in China.,Methods1 The evaluation index system and item pooling of Chinese rural health literacy Literature review and in-depth interviews were used to define the Chinese rural health literacy and build an evaluation index system.Questionnaire items were written based on the evaluation system.2 Expert consultation10 experts were invited to participated in a nominal group to discuss the evaluation index system and item pooling.Indicators are retained when more than 8 out of 10 experts agree.30 experts were invited to conduct 2 rounds Delphi consultation,they need to scores the weights of each indicator and assigns 1-10 points to each item based on their importance,sensitivity,and specificity.3Pre-trialFifty rural residents aged above 15 yrs were randomly selected to conduct pre-trial in Yongsheng County,Yunnan Province.The item with a high answer rate was deleted.4Field verificationUsing stratified random sampling methods,Shandong Province,Shanxi Province and Gansu Province were sampled in the eastern,central and western regions of china respectively.One county was selected from each province,and two townships were selected from each county.Rural residents aged above 15 yrs were randomly selected from each township.The inclusion criteria are:local rural residents;aged above 15 yrs;volunteered to be surveyed.Exclusion criteria are:mental illness;disturbance of consciousness;reluctant to participate in the survey.A total of 750 rural residents were selected for investigation.5Item reductionCoefficient of variation,Cronbach's alpha coefficient,CITC,correlation coefficient,discrimination,cluster analysis and exploratory factor analysis were used to select items.Coefficient of variation and discrimination were used to determine whether the items can be distinguished from each other by different levels of research objects.Cronbach's ?-coefficient and CITC both consider the internal consistency of the scale.Correlation coefficient was to examine the correlation between each item and the total score.Exploratory factor analysis can condensed information.6 Determine the passing scoreThe ROC is a curve with sensitivity as the ordinate and 1-specificity as the abscissa.The point closest to the upper left corner has the highest sum of sensitivity and specificity.It can be used as a passing score of the sacle.7 Scale evaluationThe scale was evaluated by validity,reliability,and acceptability.The content validity index,the confirmatory factor analysis,the combination reliability,half-reliability and the Cronbach's coefficient were used to evaluate validity and reliability.The acceptability,pass rate,and response time were used to evaluate acceptability.Results1 The evaluation index system and item pooling of Chinese rural health literacy Rural health literacy means the rural residents must acquire,understand and handle basic health information or services in agricultural labor,rural life and rural environment,and use these information and services to make correct decisions to maintain and promote their own health.Rural residents refer to residents living and working in rural areas for more than half a year.Rural health literacy includes four dimensions:health awareness and concept,health knowledge,health skills,andknowledge and application of health information.After Literature review and in-depth interviews,the item pooling contains 107 items.2 Expert consultationNominal group retained 98 items.The first round of Delphi recovery was 93.3%,and the second round was 100%.The average age of experts was 50.96±8.46 years old,and the average length of professional is 25.57±8.81 years.Most of them have above-the-post titles(96.4%).The first round of expert coordination coefficient was 0.159,and the second round rose to 0.332.The coordination of the expert assessment was good.Finally,we retained 52 items.3 Pre-trialAccording to the results of the pre-test,6 items with a irrational high rate of correct answer was deleted.Finaly,a 46 items initial questionnaire were formed.4 Field verification750 rural residents over the age of 15 were randomly selected from 3 provinces.667 valid questionnaires were recovered,and the effective recovery rate was 88.93%.5 Item reductionCombined statistical results and professional knowledge,24 items were deleted.finally,a rural health literacy scale with five dimensions and 22 items was formed.6 Determine the passing score The area under the ROC was 65.6%,P<0.001.The scale's passing score was 25.01.The health literacy rate of rural residents in three provinces in China was 11.09%.7 Scale evaluationThe content validity was higher than 0.8,CMIN/DF,GFI,AGFI,PRATIO,RMSEA,and CN values were 2.29,0.942,0.926,0.857,0.044 and 341.The half reliability is 0.754 and the Cronbach's coefficient is 0.726.The Cronbach's coefficients of five dimensions were 0.608,0.642,0.609,0.774,and 0.540;the combinations coefficients were 0.68,0.65,0.63,0.79,and 0.54.The recovery rate of the questionnaire was 94.9%,and the effective recovery rate was 88.9%.All of the questionnaires could be completed within 30 minutes.ConclusionThe study defines the rural health literacy and develops an evaluation index system.The scale has a good reliability,validity and acceptability.