Development Of Health Literacy Assessment Questionnaire Among Adults In Chongqing

Objective: This study aimed to develop a health literacy assessment questionnaire among adults in Chongqing,which is an effective evaluation tool for related works on health education and promotion in Chongqing.Methods: Systematic review:Pub Med,Embase,and Web of Science were used to search articles regarding tools for assessing health literacy among the general population published up to 10 January 2018.Two researchers independently conducted literature screening,quality assessment of methodology,and data extraction according to preset inclusion and exclusion criteria.The quality assessment of the research was examined with the use of the specifications of the reporting guidelines for survey research(SURGE).The following categories usually need to be considered in a review: health literacy measurement approaches and modes;theoretical basis;specific dimensions or items;analysis of the feasibility,reliability,and validity of the scale;and the findings of the identified tools.Development and evaluation of questionnaire: In accordance with the final results of literature search and data collection,the definition,framework and items of the questionnaire were preliminarily compiled in this study.The experts of the research group revised and improved the definition,framework and items of this questionnaire.(1)Item development: Health-related policies and official data were collected,consulted and analyzed by means of classified data collection.Based on the results of systematic evaluation and data access,the topic group proposed the definition,theoretical framework and specific item pool of the questionnaire.A core working group composed of experts in the field of health used focus group discussion to discuss the questionnaire.Subject group members revised the items according to consensus discussions of the core working group.(2)Expert Consultation.Experts in health-related fields were invited to conduct two rounds of Delphi expert consultation.Experts scored depending on the importance,judgment basis and familiarity of the questionnaire.The degree of authority and coordination of experts were analyzed.Items of less than 7 of coefficient of variation or greater than 0.2 of importance would be modified.(3)Trial investigation.Ten adults in Chongqing were surveyed to test the completion time,readability and practicability of the questionnaire.(4)Field verification.Using the stratified multistage random sampling method,one district and one county in Chongqing were selected randomly;one neighbourhood committee and one village were selected from each district and county,respectively;and approximately 50 adults aged >18 were selected from each neighbourhood committee and village as subjects.A total of 201 respondents were selected.T-test,Spearman correlation coefficient method and internal consistency test were used to input data utilizing Epi Data 3.1software and analyse data with IBM SPSS 23.0 software.P<0.05 was considered to have statistical significance.(5)Evaluation of questionnaire.The reliability of the questionnaire was evaluated by Cronbach’s alpha coefficient and split-half reliability.Completion rate and time were used to evaluate the feasibility of the questionnaire.Factor analysis and preliminary exploration of the questionnaire: The items were screened by seven methods: discrimination analysis,Cronbach’s alpha coefficient,corrected item–total correlation,correlation coefficient 1,correlation coefficient 2 and exploratory factor analysis.Confirmative factor analysis was used to evaluate the structural validity of the questionnaire.The reliability of the questionnaire was evaluated by Cronbach’s alpha coefficient.Results: Systematic review:Eleven articles met the inclusion criteria.The multistage process of making all the scales generally involved the following steps: item development,pre-testing,and evaluation of readability.However,the specific methods were different.Most of the identified instruments derived from the definition of health literacy or were based on existing health literacy theory.Approximately 30% of theperformed studies provided no description of the important features specified in the SURGE.Development and evaluation of questionnaire:(1)On the basis of the results of literature search and expert opinions of the research group,the definition of adult health literacy in Chongqing was determined referring to the KAP theoretical model.The questionnaire included 3dimensions and 80 item pools.After discussion by 15 experts,41 items were revised and deleted,and 39 items were retained.(2)The first recovery rate was 95%(20 experts),and the second recovery rate was 83%(18experts).Experts mainly worked for 6 to 10 years or more.Most experts were undergraduate or above.The two rounds of experts’ authoritativeness coefficients were all above 1.6,which showed that these experts have high authoritativeness.The coordination coefficients of the two rounds had statistical significance(P < 0.05),which indicated that the experts’ opinions were consistent.After the principle of less than 7 of coefficient of variation or greater than 0.2 of importance was used,41 items were retained.(3)Ten adults in Chongqing were randomly surveyed to test the completion time,readability and practicability of the questionnaire.(4)A total of 201 adults over 18 years old in Chongqing were investigated in this study.The effective recovery rate was 100%.The total Cronbach’s alpha coefficient and split-half reliability was 0.791 and 0.771,respectively,which indicated that the questionnaire had acceptable reliability.Factor analysis and preliminary exploration of the questionnaire: In accordance with the results of six-item screening combined with professional knowledge,17 items and 4 dimensions(i.e.health knowledge,concept,lifestyle and skills)were retained.Confirmatory factor analysis showed that CFI,IFI,GFI,PRATIO,RMR,PNFI and PFFI were 0.916,0.919,0.920,0.831,0.025,0.628 and 0.761,respectively,which indicated that the model fitted well and the questionnaire had high structural validity.The total Cronbach’s alpha coefficient was 0.735,and the Cronbach coefficients of health knowledge,concept,lifestyle and skills were 0.633,0.636,0.645 and 0.544,respectively,which indicated that the questionnaire had acceptable reliability.The recovery rate of the questionnaire was 100%,which could be completed in approximately 30 min,which showed that the questionnaire was feasible.Conclusion: This study developed a questionnaire for assessing health literacy among adult in Chongqing.The questionnaire has acceptable reliability and validity and is easy to use.