Development And Application Of Health Literacy Scale For Patients With Acute Pancreatitis

ObjectiveThe purpose of this study was to develop a health literacy scale for patients with acute pancreatitis（AP）,and explore the level and influencing factors of health literacy through a cross-sectional survey.In addition,analyzing the change trajectory of health literacy at different phase through longitudinal study,which provides a basis for the clinical intervention.Methods1.Part Ⅰ:Establishment of health literacy scale for patients with AP.Two rounds of Delphi experts correspondence were performed to evaluate and screen the items,and then completed the first draft of Acute Pancreatitis Health Literacy Scale（APHLS）.Four commonly used item screening methods were used for item screening,including critical ratio,correlation coefficient,Cronbach coefficient and factor analysis,to form a predictive scale.Then,the final draft of APHLS was established through reliability and validity test.2.Part Ⅱ:Investigation on the current situation and influencing factors of health literacy.A cross-sectional study design was adapted to facilitate the extraction of AP patients hospitalized in three tertiary hospitals.General information questionnaire,APHLS,social support scale,medical coping style scale and general self-efficacy scale were used to investigate the level and influencing factors of health literacy for patients with AP.3.Part III:The change trajectory of health literacy of AP patients.A prospective longitudinal study design was adopted in this part.A convenience sampling approach was used to recruit AP patients hospitalized in the three tertiary hospitals.The general information questionnaire,APHLS,self-rated abilities for health practices scale and medical outcomes study 12-item short-form health survey were used.In addition,the trend of health literacy,health behavior ability and quality of life in patients was analysed by curve and line graph.Results1.Part I:The health literacy scale for AP patients contained 20 items,including disease cognition,health behavior and health awareness.The results of reliability test showed that the Cronbach’s α coefficient of the scale was 0.915,and the Cronbach α coefficient of each dimension was 0.710-0.892.Validity test results indicated that Kendall’s W value of two rounds of Delphi expert letter consultation were 0.383 and 0.530 respectively（P<0.01）,and expert authority coefficient was 0.89 and 0.93,respectively.Meanwhile,exploratory factor analysis extracted three common factors,which could explain 65.080%of the total variation.Furthermore,the discriminant validity results showed that 27%of patients in the high group and 27%of patients in the low group had statistical difference in scores（P<0.05）.The health literacy of the patients was divided into three grades according to their degree of education:low health literacy（≤57 scores）,medium health literacy（57-62 scores）and good health literacy（≥62 scores）.2.Prat II:The results of the cross-sectional study showed that the average score of health literacy in AP patients was 52.09±9.91,which was at a low level overall.The results of independent sample T test and one-way ANOVA showed that gender,age,marital status,degree of education,occupation,annual total income of family members,economic burden,place of residence,type of medical insurance,access to medical information,attention to AP,comorbidities,number of underlying diseases,AP recurrence and recurrence times had significant effects on health literacy score（P<0.05）.Health literacy score of patients with AP was positively correlated with social support（r=0.213,P<0.001）,medical coping style（r=0.474,P<0.001）and self-efficacy（r=0.736,P<0.001）.Multiple linear regression showed that age,education,occupation,attention to disease,social support,medical coping style and self-efficacy were the influencing factors of health literacy in patients with AP.3.Part III:Longitudinal study results indicated that the health literacy trajectory presented an overall inverted "∪" shaped trend within 6 months of discharge.At the time point of 1 month after discharge,health literacy showed an increasing trend,while it decreased to a certain extent in the 3rd month,and reached saturation or a slight downward trend in the 6th month,suggesting that the medical staff intervened 1 month after discharge.In the aspect of health behavior ability,the overall level showed a trend of increase firstly and then descend,with a downward inflection point in the third month.In terms of quality of life,the overall trend was rising slowly.Conclusions1.APHLS has good reliability and validity,and all statistical indicators are in line with psychometric standards,which has certain practical application significance.The reliability and validity of APHLS can be further verified by large sample and multi-center.2.The health literacy level of patients with AP is not optimistic,and the overall level is low.The health literacy of AP patients is influenced by individuals and society.In addition to taking personalized guidance according to patients’ own factors,the utilization of social support,choice of medical coping styles,self-efficacy evaluation or intervention should also be strengthened to improve their health.3.Within 6 months after discharge,the overall trajectory of health literacy of AP patients increased firstly,then decreased,and gently finally.The "∪"-shaped change trend of health literacy in patients with AP pointed out that health literacy showed a downward trend 1 month after discharge,suggesting that this stage is the best time for clinical intervention.