Miri Mohammad Reza, Moghadam Hakimeh Malaki, Eftekhari Hedieh, Yousefi Azam, Norozi Ensiyeh
Department of Public Health, Faculty of Health, Birjand University of Medical Sciences, Birjand, Iran.
Department of Statistics, Birjand University, Birjand, Iran.
Oman Med J. 2020 Mar 12;35(2):e106. doi: 10.5001/omj.2020.24. eCollection 2020 Mar.
Many scales have been developed to assess health literacy. These scales have been developed extensively in clinical populations in developed countries. Our study describes the process of development and validation of the Health Literacy Questionnaire to measure health literacy in the general Iranian population.
We followed the scale development process outlined by Schwab in 1980. After a comprehensive review of the research published on Nutbeam's definition of health literacy and its measurement, two focus groups were considered to generate a pool of items. We then assessed the face validity and content validity of the items. The final version of the questionnaire was subject to independent exploratory and confirmatory factor analysis. The internal consistency of the questionnaire was evaluated using Cronbach's alpha. Finally, construct validity was assessed using bivariate analysis between the total scores on the scale and theoretically relevant variables.
The results of exploratory factor analysis revealed a three-factor 14-item structure for the scale. Confirmatory factor analysis provided a good statistical and conceptual fit for the data. The analysis of the internal consistency of the scale was satisfactory (α = 0.798). Further, health literacy was significantly associated with participants' age, educational level, self-rated household income, smoking history, self-rated health, and self-rated health literacy.
The results we obtained indicate that this newly constructed health literacy tool is highly valid and reliable. Prospective studies are required to evaluate the predictive validity of the scale with regard to health outcomes.
已开发出多种量表来评估健康素养。这些量表在发达国家的临床人群中已得到广泛开发。我们的研究描述了健康素养问卷的开发和验证过程，以测量伊朗普通人群的健康素养。
我们遵循了施瓦布在1980年概述的量表开发过程。在对关于努特贝姆对健康素养的定义及其测量方法的研究进行全面综述之后，我们组织了两个焦点小组来生成一系列项目。然后，我们评估了这些项目的表面效度和内容效度。问卷的最终版本接受了独立的探索性和验证性因素分析。使用克朗巴赫α系数评估问卷的内部一致性。最后，通过对量表总分与理论相关变量之间进行双变量分析来评估结构效度。
探索性因素分析的结果显示该量表具有一个包含14个项目的三因素结构。验证性因素分析为数据提供了良好的统计和概念拟合。量表内部一致性分析结果令人满意（α = 0.798）。此外，健康素养与参与者的年龄、教育水平、自评家庭收入、吸烟史、自评健康状况和自评健康素养显著相关。
我们获得的结果表明，这个新构建的健康素养工具具有很高的效度和信度。需要进行前瞻性研究来评估该量表在健康结果方面的预测效度。
