Chen Xuewei, Goodson Patricia, Acosta Sandra, Barry Adam E, McKyer Lisako E
Health Lit Res Pract. 2018 May 10;2(2):e94-e106. doi: 10.3928/24748307-20180405-01. eCollection 2018 Apr.
Limited English proficiency compounds the problem of low health literacy, making certain population groups in the United States especially vulnerable to health disparities.
This study clarified the mechanisms underlying low health literacy among people with limited English proficiency using a modified theory-based health literacy assessment survey.
We modified and tested the All Aspects of Health Literacy Scale (AAHLS) with a sample of Chinese speakers who have limited English proficiency in the U.S. The AAHLS is a theory-based health literacy survey assessing functional health literacy, interactive health literacy, information appraisal, and empowerment. We adapted the survey, created dual language scenarios (English and Chinese), translated the questions into Chinese, and conducted cognitive interviews to revise the questions. We examined the health literacy score distributions and performed Confirmatory Factor Analysis (CFA) to evaluate the appropriateness of our modified AAHLS to elicit valid data.
A total of 405 participants completed our AAHLS survey. Compared to the English language scenario, aside from the item assessing if participants would question health care providers, participants had significantly higher health literacy levels when they were immersed in communication using Chinese ( < .001). We also found that more than three-quarters of the participants were not likely to question their doctor's and nurse's advice regardless of language scenarios and most of them had limited empowerment capabilities at the level of community and social engagement. The CFA results showed that the modified Chinese model exhibited good fit (RMSEA [root mean square error of approximation] = 0.06, CFI [the comparative fit index] = 0.98, TLI [Tucker-Lewis index] = 0.97, WRMR [weighted root mean square residual] = 1).
The results showed that our modified AAHLS yielded reliable and valid data among U.S. Chinese speakers. Researchers should consider native languages and cultural differences before conducting health literacy assessments. Public health professionals should incorporate health interventions and policy approaches to improve Chinese immigrants' English proficiency and empowerment capabilities. .
To clarify the mechanisms underlying low health literacy among populations with limited English proficiency (LEP) in the United States, this study aims to tailor a theory-based health literacy survey with dual-language scenarios among Chinese speakers with LEP. The modified survey yielded reliable and valid data. Participants had higher health literacy levels when they were immersed in communication using Chinese rather than English.
英语水平有限加剧了健康素养低下的问题，使美国的某些人群特别容易出现健康差距。
本研究使用经过修改的基于理论的健康素养评估调查，阐明英语水平有限人群健康素养低下的潜在机制。
我们对健康素养量表的各个方面（AAHLS）进行了修改和测试，样本为在美国英语水平有限的讲中文的人。AAHLS是一项基于理论的健康素养调查，评估功能性健康素养、互动性健康素养、信息评估和赋权能力。我们对调查进行了调整，创建了双语场景（英语和中文），将问题翻译成中文，并进行了认知访谈以修改问题。我们检查了健康素养得分分布，并进行了验证性因素分析（CFA），以评估我们修改后的AAHLS获取有效数据的适用性。
共有405名参与者完成了我们的AAHLS调查。与英语场景相比，除了评估参与者是否会质疑医疗服务提供者的项目外，当参与者沉浸在使用中文的交流中时，他们的健康素养水平显著更高（<.001）。我们还发现，超过四分之三的参与者无论在何种语言场景下都不太可能质疑医生和护士的建议，而且他们中的大多数在社区和社会参与层面的赋权能力有限。CFA结果表明，修改后的中文模型显示出良好的拟合度（RMSEA[近似均方根误差]=0.06，CFI[比较拟合指数]=0.98，TLI[塔克-刘易斯指数]=0.97，WRMR[加权均方根残差]=1）。
结果表明，我们修改后的AAHLS在美国讲中文的人群中产生了可靠有效的数据。研究人员在进行健康素养评估之前应考虑母语和文化差异。公共卫生专业人员应采用健康干预措施和政策方法，以提高中国移民的英语水平和赋权能力。
为了阐明美国英语水平有限（LEP）人群健康素养低下的潜在机制，本研究旨在为LEP的讲中文的人群量身定制一项具有双语场景的基于理论的健康素养调查。修改后的调查产生了可靠有效的数据。当参与者沉浸在使用中文而非英语的交流中时，他们的健康素养水平更高。
