Matsumoto Masayoshi, Nakayama Kazuhiro
Universal Business Solutions, 3-1-1 Kyoubashi TOKYO SQUARE GARDEN, Chuo-ku, Tokyo, 104-0031, Japan.
Department of Nursing Informatics, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan.
BMC Public Health. 2017 Jan 6;17(1):30. doi: 10.1186/s12889-016-3971-3.
Health inequities are increasing worldwide, with mounting evidence showing that the greatest cause of which are social determinants of health. To reduce inequities, a lot of citizens need to be able to access, understand, appraise, and apply information on the social determinants; that is, they need to improve health literacy on social determinants of health. However, only a limited number of scales focus on these considerations; hence, we developed the Health Literacy on Social Determinants of Health Questionnaire (HL-SDHQ) and examined its psychometric properties.
We extracted domains of the social determinants of health from "the solid facts" and related articles, operationalizing the following ten domains: "the social gradient," "early life," "social exclusion," "work," "unemployment," "social support," "social capital," "addiction," "food," and "transport," Next, we developed the scale items in the ten extracted domains based on the literature and included four aspects of health literacy (ability to access, understand, appraise, and apply social determinants of health-related information) in the items. We also evaluated the ease of response and content validity. The self-administered questionnaire consisted of 33 items. The reliability and construct validity were verified among 831 Japanese adults in an internet survey.
The scale items had high reliability with a Cronbach's alpha of 0.92, and also adequate results were obtained for the internal consistency of the information-processing dimensions (Cronbach's alpha values were 0.82, 0.91, 0.84, and 0.92 for accessing, understanding, appraising, and applying, respectively). The goodness of fit by confirmatory factor analysis based on the four dimensions was an acceptable value (comparative fit index = 0.901; root mean square error of approximation = 0.058). Furthermore, the bivariate relationship between HL-SDHQ and the frequency of participation in citizen's activities was similar to the theoretical results.
HL-SDHQ clarifies the relationship between the ten domains of the social determinants of health and health in each domain and is able to measure whether it is possible to access, understand, appraise, and apply related information. The reliability and validity of the scale were adequate.
全球范围内健康不平等现象日益加剧，越来越多的证据表明，其最大原因在于健康的社会决定因素。为了减少不平等现象，许多公民需要能够获取、理解、评估并应用关于社会决定因素的信息；也就是说，他们需要提高对健康社会决定因素的健康素养。然而，仅有少数量表关注这些因素；因此，我们开发了《健康社会决定因素健康素养问卷》（HL-SDHQ）并检验了其心理测量特性。
我们从《确凿事实》及相关文章中提取了健康社会决定因素的领域，将以下十个领域进行了操作化：“社会梯度”“早年生活”“社会排斥”“工作”“失业”“社会支持”“社会资本”“成瘾”“食物”和“交通”。接下来，我们根据文献在提取的十个领域中制定了量表项目，并在项目中纳入了健康素养的四个方面（获取、理解、评估和应用与健康社会决定因素相关信息的能力）。我们还评估了回答的简易程度和内容效度。自填式问卷由33个项目组成。在一项针对831名日本成年人的网络调查中验证了其信度和结构效度。
量表项目具有较高的信度，克朗巴哈系数为0.92，信息处理维度的内部一致性也获得了较好结果（获取、理解、评估和应用的克朗巴哈系数分别为0.82、0.91、0.84和0.92）。基于四个维度的验证性因素分析的拟合优度为可接受值（比较拟合指数 = 0.901；近似均方根误差 = 0.058）。此外，HL-SDHQ与公民活动参与频率之间的双变量关系与理论结果相似。
HL-SDHQ阐明了健康社会决定因素的十个领域与各领域健康之间的关系，并且能够测量是否有可能获取、理解、评估和应用相关信息。该量表的信度和效度是足够的。
