Windsor Liliane Cambraia, Jemal Alexis, Goffnett Jacob, Smith Douglas Cary, Sarol Jesus
The University of Illinois at Urbana-Champaign, School of Social Work, USA.
Silberman School of Social Work at Hunter College of City University of New York, USA.
SSM Popul Health. 2022 Jan 27;17:101034. doi: 10.1016/j.ssmph.2022.101034. eCollection 2022 Mar.
Critical consciousness (CC) theory has been proposed as a framework to inform health interventions targeting a wide variety of health conditions. Unfortunately, methodological limitations have made it difficult to test CC as a mediator of health outcomes. Specifically, standardized and widely accepted measures of health-related CC are needed. The goal of this study was to develop and test a measure of critical reflection on social determinants of health (SDH). This measure focused on critical reflection, an essential dimension of CC.
Community-based participatory research principles and a mixed methods design were used with three samples: (1) experts in SDH and CC, (2) 502 individuals completing online surveys, and (3) 602 men with histories of substance use disorder and incarceration. All participants were over 18 years of age. Analysis included descriptive frequencies, exploratory factor analyses (EFA), confirmatory factor analysis (CFA), generalized linear regression models, correlations, and Cronbach's alpha calculations.
The Critical Reflection about SDH scale (CR_SDH) is a short, unidimensional, and reliable scale (α = 0.914). Construct validity was supported and known-groups validity showed that the scale discriminated different levels of CR_SDH based on political views, educational level, knowledge of health inequities, and gender.
The CR_SDH is a standardized measure that can assess critical reflection about the impact of SDH on health among providers and consumers of health care. The CR_SDH can be used to identify critical reflection related training needs and inform decisions about development and testing of critical reflection related health interventions and health care policy.
批判性意识（CC）理论已被提出作为一个框架，为针对各种健康状况的健康干预提供指导。不幸的是，方法学上的局限性使得难以将CC作为健康结果的中介进行检验。具体而言，需要标准化且被广泛接受的与健康相关的CC测量方法。本研究的目的是开发并测试一种关于健康社会决定因素（SDH）的批判性反思测量方法。该测量方法聚焦于批判性反思，这是CC的一个基本维度。
采用基于社区的参与性研究原则和混合方法设计，研究对象包括三个样本：（1）SDH和CC领域的专家；（2）502名完成在线调查的个体；（3）602名有物质使用障碍和监禁史的男性。所有参与者年龄均超过18岁。分析包括描述性频率、探索性因素分析（EFA）、验证性因素分析（CFA）、广义线性回归模型、相关性分析以及Cronbach's alpha计算。
关于SDH的批判性反思量表（CR_SDH）是一个简短、单维度且可靠的量表（α = 0.914）。结构效度得到支持，已知群体效度表明该量表能根据政治观点、教育水平、健康不平等知识和性别区分不同水平的CR_SDH。
CR_SDH是一种标准化测量方法，可评估医疗服务提供者和消费者对SDH对健康影响的批判性反思。CR_SDH可用于识别与批判性反思相关的培训需求，并为有关批判性反思相关的健康干预措施和医疗保健政策的制定与测试提供决策依据。
