老年人简短健康素养评估量表的修订及信效度检验

Revision of brief health literacy assessment scale among the older adults and its reliability and validity test

目的:开发验证老年人特异性健康素养评估工具是开展老年人健康素养研究的基础。我国大陆地区现有的老年人健康素养评估量表存在条目数过多,调查时依从性较差等局限,有必要开发或引进简版评估工具为今后开展大规模调查提供支持。本研究旨在修订台湾学者编制的简短健康素养评估量表,并在大陆老年人群体中进行信效度和跨性别测量等值性检验。方法:采用整群抽样法,于2021年3月至4月从济南市选取508名老年人采用简短健康素养评估量表和健康促进生活方式量表进行问卷调查。4周后,选取其中的83名老年人进行重测。采用SPSS 25.0统计学软件进行描述性分析、项目分析、探索性因子分析、相关分析及信度检验,采用Mplus 8.0进行验证性因子分析和性别测量等值性检验。结果:量表的各条目具有良好的区分度,高低分组的各条目得分差异均具有统计学意义(均P<0.05),各条目得分与总分相关(r为0.721~0.891,均P<0.001)。探索性因子分析提取1个特征根大于1的因子,累积方差解释量为67.94%。验证性因子分析表明单因子结构拟合良好[χ^(2)/df为2.260,Tucker-Lewis指数(Tucker-Lewis index,TLI)为0.973,比较拟合指数(comparison fit index,CFI)为0.982,近似均方根误差(root mean square error of approximation,RMSEA)为0.071]。多组验证性因子分析结果显示简短健康素养评估量表的跨性别形态等值、弱等值、强等值性模型均被接受。测量等值性模型比较结果显示RMSEA变化量均<0.015,且CFI变化量均<0.01,表明简短健康素养评估量表在不同性别的群体之间具有测量等值性。Cronbach’sα系数为0.945,重测信度为0.946。健康素养与健康促进生活方式的相关系数为0.557(P<0.05)。结论:简短健康素养评估量表具有良好的信效度及跨性别的测量等值性,可以作为我国老年人群体健康素养的有效测量工具。

Objective:The development and validation of the specific health literacy assessment tool for older adults is the basis for conducting the research on health literacy among older adults.The existing health literacy assessment scale for older adults in Chinese mainland has some limitations,such as too many items and poor compliance during the survey.It is necessary to develop or introduce simplified assessment tools to support large-scale surveys in the future.This study aims to modify the brief health literacy assessment scale compiled by Taiwan scholars,and to conduct the test for the reliability,validity and the measurement equivalence across gender in the older population in China's Mainland.Methods:From March to April 2021,508 older adults from Jinan,Shandong Province,China were selected by cluster sampling method to conduct a questionnaire survey using the brief health literacy assessment scale and health-promoting lifestyle profile.After 4 weeks,83 of them were selected for retesting.SPSS 25.0 statistical software was used for descriptive analysis,item analysis,exploratory factor analysis,correlation analysis,and reliability test,and Mplus 8.0 was used for confirmatory factor analysis and gender measurement equivalence test.Results:Each item of the scale had good discrimination,and there were significant differences in the scores of each item between high score and low score groups(P<0.05),and the coefficient of correlation between the scores of each item and the total score was between 0.721 and 0.891.Exploratory factor analysis extracted a factor with a characteristic root greater than 1,and the cumulative variance interpretation amount was 67.94%.The confirmatory factor analysis showed that the single factor structure fit was good[χ^(2)/df was 2.260,the Tucker-Lewis index was 0.973,the comparison fit index(CFI)was 0.982,and the root mean square error of approximation(RMSEA)was 0.071].The multi-group confirmatory factor analysis results showed that the brief health literacy assessment scale’s configural equivalence,weak equivalence,and strong equivalence models were all accepted.The comparison results of measurement equivalence models showed that the changes of RMSEA were less than 0.015,and the changes of CFI were less than 0.01,indicating that the brief health literacy assessment scale had measurement equivalence between different gender groups.Cronbach’sαcoefficient was 0.945,and the test-retest reliability was 0.946.The correlation coefficient between health literacy and health-promotion lifestyles was 0.557(P<0.05).Conclusion:The brief health literacy assessment scale has good reliability,validity,and measurement equivalence across gender,and can be used as an effective measurement tool for the health literacy of the older people in Chinese mainland.