4～6岁儿童家长健康素养量表编制及信效度评价

Development and validation of a health literacy scale for parents of 4–6 years old children

目的编制适用于4~6岁儿童家长的健康素养量表,并评价该量表的信度、效度。方法研究对象为上海市4~6岁儿童家长。以2013年世界卫生组织欧洲区办事处(EU WHO)提出的健康素养整合模型为理论框架,通过文献评阅、专家组讨论和Delphi专家咨询法,初步拟定量表条目,通过预调查修改完善量表。使用修订后的量表进一步评价信度和效度。结果本次研究通过临界比值、条目–量表总分的相关系数、Cronbach'sα系数进行条目筛选,最终形成35个条目的 4~6岁儿童家长健康素养量表。根据理论框架,分为医疗服务、疾病预防、健康促进3个分量表,每个分量表包含获取、理解、评价、应用4个维度结构。通过验证性因子分析显示,模型拟合良好(医疗服务:χ~2/df=1.138,RMSEA=0.036,GFI=0.919,AGFI=0.870;疾病预防:χ~2/df=1.136,RMSEA=0.036,GFI=0.892,AGFI=0.845;健康促进:χ~2/df=0.525,RMSEA=0.000,GFI=0.988,AGFI=0.961)。总量表、医疗服务、疾病预防、健康促进的Cronbach'sα系数分别为0.823、0.661、0.717、0.641,分半信度分别为0.834、0.677、0.729、0.642;重测信度分别为0.726、0.696、0.718、0.666。结论 4~6岁儿童家长健康素养量表具有良好的信度和效度,可用于筛查4~6岁儿童家长的健康素养水平。

Objective To develop a scale for assessing health literacy among parents of the children aged 4-6 years and to evaluate the reliability and validity of the scale. Methods We recruited the parents with 4-6 years old in Shanghai city. Based on the integrated theoretical model of health literacy proposed by Regional Office for Europe of World Health Organization in 2013, we developed a scale through systematic literature reviews, interviews with experts, and Delphi expert consultations. Then we revised the scale after a pretest and the reliability and validity of the revised scale were evaluated. Critical ratio, correlation coefficient of an item score and total score of the scale, and Cronbach＇s alpha coefficient were adopted in item selection. Results The developed 35-item scale consists of 3 subscales for health care, disease prevention, and health promotion and each of the 3 subscales is composed of 4 domains including acquisition, comprehension, evaluation, and application. The results of confirmatory factor analysis demonstrated that the fitting is good for each of the theoretical framework model of the 3 subscales （for health care subscale：χ2/df=1.138, root mean square error of approximation[RMSEA]=0.036, goodness of fit index[GFI]=0.919, adjusted goodness of fit index[AGFI]=0.870; for disease prevention：χ2/df=1.136, RMSEA=0.036, GFI=0.892, AGFI=0.845; and for health promotion：χ2/df=0.525, RMSEA=0.000, GFI=0.988, AGFI=0.961）. The Cronbach＇s alpha coefficient was 0.823 for the whole scale and 0.661, 0.717, and 0.641 for the 3 subscales; the split-half reliability was 0.834 for the whole scale and 0.677, 0.729, and 0.642 for the 3 subscales; and the test-retest reliability was 0.726 for the whole scale and 0.696, 0.718, and 0.666 for the 3 subscales, respectively. Conclusion The developed health literacy scale for parents of 4-6 years old children is of good reliability and validity and the scale could be used as an instrument for assessing health literacy of the parents.