中国患者健康素养量表修订及改进

Revision and an empirical evaluation of the Chinese Patient Health Literacy Scale

目的 改进和完善《中国患者健康素养量表》,为中国患者健康素养测评提供适宜工具。方法 使用经初步修订的《中国患者健康素养量表》电子问卷,于2021年1—5月抽取中国东、中、西部地区14所医院的2 808例门诊患者进行调查;运用SPSS 23.0软件进行探索性因子分析,对修订后的量表进行进一步改进;运用AMOS23.0进行结构方程模型分析,检验量表结构效度。结果 经初步修订的患者健康素养量表Cronbach′s α系数为0.841,5个维度的α系数分别为0.751、0.787、0.568、0.725、0.412,累积方差贡献率为62.538%。修订后量表探索性因子分析提取3个公因子,提示量表压缩为自我效能、疾病自我管理技能和医学常识3个维度,删除4个题项,量表整体Cronbach′s α系数为0.845,3个维度的α系数分别为0.926、0.831、0.753,累积方差贡献率为67.228%。结构方程模型分析结果显示,改进后量表各条目在所属维度的因子载荷量均> 0.53(0.53~0.90)。残差均方和平方根(RMR)0.083、适配度指标渐进残差均方和平方根(RMSEA)0.086、适配度指数(GFI)0.926、调整后适配度指数(AGFI)0.891、规准适配指数(NFI)0.928、相对适配指数(RFI)0.909、增值拟合指数(IFI)0.931、Tacker-lewis指数(TLI/NNFI)0.913、比较适配指数(CFI)0.931、简约调整适配度指数(PGFI)0.631、简约调整规准适配指数(PNFI)0.737、简约调整比较适配指数(PCFI)0.740、临界样本数(CN)171。结论 改进后的患者健康素养量表具有良好的内部一致性信度和结构效度,更易于在患者中推广应用。

Objective To modify the Chinese Patient Health Literacy Scale(CPHLS) for improving the reliability and validity of the scale.Methods From January to May 2021,the CPHLS was preliminarily revised by expert consultation and the revised electronic scale was employed to measure the health literacy of 2 808 outpatients randomly selected at 14hospitals in eastern,central and western China.SPSS 23.0 was utilized for Cronbach′s α calculation and exploratory factor analysis(EFA) to further improve the revised scale;AMOS 23.0 was applied to build a structural equation model(SEM) to test the validity of the scale.Results The Cronbach′s α coefficient of the preliminarily revised CPHLS was 0.841 and the αcoefficients of the scale′s five dimensions were 0.751 for concept of medical science,0.787 for disease self-management skills,0.568 for medical common sense,0.725 for self-efficacy,and 0.412 for medical information cognition,respectively,with an overall cumulative proportion of variance of 62.538%.Three common factors of the revised scale(e.g.self-efficacy,disease self-management skills and medical common sense) were extracted according to the results of EFA.After deleting four original items,the α coefficient of the revised scale was raised to 0.845,the α coefficients of the three dimensions were0.926,0.831,and 0.753 and the cumulative proportion of variance was 67.228%.The SEM analysis on the revised scale demonstrated that the dimension-specific factor load capability ranged 0.53 – 0.90 and the constructed SEM is of good overall goodness of fit,with the root mean square residual(RMR) of 0.083,root mean square error of approximation(RMSEA) of 0.086,goodness-of-fit index(GFI) of 0.926,adjusted goodness-of-fit index(AGFI) of 0.891,normed fit index(NFI) of 0.928,relative fit index(RFI) of 0.909,incremental fit index(IFI) of 0.931,the Tacker-Lewis index/non-normed fit index(TLI/NNFI) of 0.913,comparative fit index(CFI) of 0.931,parsimony goodness-of-fit index(PGFI) of 0.631,parsimony-adjusted normed fit index(PNFI) of 0.737,parsimony-adjusted comparative fit index(PCFI) of 0.740,and the critical number(CN) of 171,respectively.Conclusion The revised Chinese Patient Health Literacy Scale is of good internal consistency reliability and construct validity,indicating a potential application in the evaluation on patients’ health literacy.