Graduate School of Public Health, Ajou University, 164 Worldcup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do 16499, Republic of Korea.
Department of Nursing, Inha University, Incheon, Republic of Korea.
Int J Nurs Stud. 2018 Dec;88:1-8. doi: 10.1016/j.ijnurstu.2018.08.002. Epub 2018 Aug 10.
The prevalence of diabetes is close to reaching an epidemic level, and health literacy has recently emerged as a concept that can influence the health outcomes of patients with diabetes. Health literacy was once defined from the perspective of basic reading and understanding skills, but this has now become more comprehensive to include the abilities and skills to assess, understand, appraise, communicate, and use health information. Nevertheless, there is no instrument reflecting the comprehensive health literacy relevant to diabetes.
The aims of this study were to develop a comprehensive Diabetes Health Literacy Scale and to evaluate its psychometric properties.
An instrument-development study was applied that comprised three steps: conceptualization, item generation and content validity, and field testing of the psychometric properties.
A convenience sample of 462 participants was recruited from December 2016 to September of 2017 at outpatient clinics in 2 Korean university hospitals.
The inclusion criteria for participants were being aged at least 19 years, articulate in the Korean language, and diagnosed with diabetes, while the presence of gestational diabetes was applied as an exclusion criterion. Approximately half of the participants were female (51.1%). The participants were aged 54.5 (SD, 11.0) years, 67.1% of them were taking an oral hypoglycemic agent, and 21.9% of them had well-controlled blood-glucose levels.
The content validity, factorial structure validity, convergent validity, criterion validity, internal consistent reliability, and test-retest reliability of the Diabetes Health Literacy Scale were evaluated. Data were analyzed using exploratory and confirmatory factor analyses, Pearson's correlation, Cronbach's alpha, and the intraclass correlation coefficient.
The content validity was assessed by five experts. Exploratory and confirmatory factor analyses yielded a three-factor solution. Convergent validity was demonstrated using measures of diabetes knowledge and self-efficacy. Criterion validity was demonstrated with generic health-literacy questions. Internal consistency reliability and test-retest reliability were found to be acceptable, as indicated by a Cronbach's alpha of 0.91 and an intraclass correlation coefficient of 0.89, respectively.
The Diabetes Health Literacy Scale is a new instrument that measures comprehensive aspects of informational, numeracy, and communicative health literacy. It is a short instrument, comprising only 14 items scored on a 5-point Likert scale. The instrument exhibits good psychometric properties for four validity metrics (content, structural, convergent, and criterion validity) and two reliability metrics (internal consistency and test-retest reliability). These findings indicate that the instrument can be applied in both research and clinical practice.
糖尿病的患病率已接近流行水平，而健康素养作为一个可以影响糖尿病患者健康结局的概念，最近已经出现。健康素养曾经从基本阅读和理解技能的角度来定义，但现在已经变得更加全面，包括评估、理解、评价、沟通和使用健康信息的能力和技能。然而，目前还没有反映与糖尿病相关的全面健康素养的工具。
本研究旨在开发一个全面的糖尿病健康素养量表，并评估其心理测量学特性。
采用了一个工具开发研究，包括三个步骤：概念化、项目生成和内容效度，以及心理测量学特性的现场测试。
2016 年 12 月至 2017 年 9 月，在韩国两所大学医院的门诊，通过便利抽样招募了 462 名参与者。
参与者的纳入标准为年龄至少 19 岁，能流利地说韩语，并被诊断患有糖尿病，而妊娠糖尿病则作为排除标准。大约一半的参与者为女性（51.1%）。参与者的年龄为 54.5（SD，11.0）岁，67.1%的人服用口服降糖药，21.9%的人血糖控制良好。
评估了糖尿病健康素养量表的内容效度、结构效度、收敛效度、效标效度、内部一致性信度和重测信度。使用探索性和验证性因子分析、皮尔逊相关、克朗巴赫α和组内相关系数进行数据分析。
由五名专家评估内容效度。探索性和验证性因子分析得出了三因素模型。使用糖尿病知识和自我效能的测量来证明收敛效度。使用一般健康素养问题来证明效标效度。内部一致性信度和重测信度可接受，克朗巴赫α为 0.91，组内相关系数为 0.89。
糖尿病健康素养量表是一种新的工具，可测量信息、算术和沟通健康素养的综合方面。它是一个简短的工具，仅包含 14 个项目，采用 5 点 Likert 量表评分。该工具在四项有效性指标（内容、结构、收敛和效标有效性）和两项可靠性指标（内部一致性和重测信度）上表现出良好的心理测量学特性。这些发现表明，该工具可用于研究和临床实践。
