Amsterdam UMC, University of Amsterdam, Department of Public Health, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands.
Amsterdam UMC, University of Amsterdam, Department of Medical Psychology, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands.
Patient Educ Couns. 2019 Dec;102(12):2335-2343. doi: 10.1016/j.pec.2019.09.016. Epub 2019 Sep 18.
To construct and validate a computer-based and performance-based instrument to assess health literacy skills for informed decision making in colorectal cancer screening among screening invitees.
An instrument was constructed based on a conceptual framework of health literacy skills in colorectal cancer screening and findings from an expert survey. The instrument was field-tested among individuals with low health literacy (n = 28). Its validity and reliability was assessed using classical test theory and item response theory approaches in an online panel of colorectal cancer screening invitees (n = 696).
Confirmatory factor analysis confirmed four separate factors: Comprehension, Application, Numeracy and Communication. A fifth domain (Appraisal) demonstrated poor reliability and validity and was omitted in further analyses. Internal consistency (Cronbach's alpha > 0.6 for the four scales) was acceptable and test-retest reliability was moderate. The four factors were measurement invariant for age, sex and educational level.
The computer-based measures were acceptable for self-administration. The constructed multidimensional health literacy instrument showed acceptable measurement properties.
Our findings imply that the computer-based instrument can be used for the development of interventions to support informed decision making about colorectal cancer screening among individuals with varying health literacy levels. Further research is needed for optimizing performance-based measurement of the Appraisal and Communication domains.
构建并验证一种基于计算机和表现的工具，以评估在结直肠癌筛查中进行知情决策的健康素养技能，对象为筛查邀请者。
该工具基于结直肠癌筛查中健康素养技能的概念框架以及专家调查结果构建。在健康素养较低的个体中进行了现场测试（n=28）。使用经典测试理论和在线结直肠癌筛查邀请者的项目反应理论方法（n=696）评估了其有效性和可靠性。
验证性因子分析证实了四个独立的因素：理解、应用、计算和沟通。第五个领域（评估）表现出较差的可靠性和有效性，因此在进一步分析中被排除。四个尺度的内部一致性（Cronbach's alpha > 0.6）是可以接受的，测试-重测可靠性为中等。四个因素在年龄、性别和教育水平方面具有测量不变性。
基于计算机的测量方法适合自我管理。构建的多维健康素养工具具有可接受的测量特性。
我们的研究结果表明，基于计算机的工具可用于开发干预措施，以支持不同健康素养水平个体对结直肠癌筛查的知情决策。需要进一步研究以优化评估和沟通领域的表现式测量。
