Health Services & Outcomes Research, National Healthcare Group, Annex@National Skin Centre Level 4, 1 Mandalay Road, Singapore, 308205, Singapore.
Community Care Division, Population Health Campus, National Healthcare Group, #03-08 Nexus @ One-north, 3 Fusionopolis Link, Singapore, 138543, Singapore.
BMC Health Serv Res. 2024 Sep 27;24(1):1120. doi: 10.1186/s12913-024-11526-7.
Valid and reliable measures for assessing health activation in school-aged children are currently lacking. This study aimed to develop a scale to measure health activation and evaluate its psychometric properties among English-speaking primary school children in Singapore.
The development of the Health Activation Scale for Children (HAS-C) involved an extensive literature review, expert consultations, cognitive interviews with primary school children, and thorough discussions for dimension and item refinement. A cross-sectional study was conducted with 597 children aged 8 to 12 years, recruited from four mainstream primary schools, comprising 50.1% boys and 64.8% Chinese students. The potential scale, along with other measures, was independently completed by the children. Descriptive statistics were provided for individual scale items. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to assess factorial validity. Convergent validity was examined by correlating the scale scores with scores of health confidence and self-efficacy measures. Hypothesis-testing validity was evaluated by assessing the scale's correlation with self-reported health behaviours, including daily consumption of vegetables and fruits, time spent on sedentary activities and physical activities. Internal consistency reliability was measured using Cronbach's alpha.
EFA suggested a three-factor structure for the 12-item HAS-C, which was subsequently confirmed by CFA with a good model fit. All three HAS-C dimension scores demonstrated moderate correlations (rho = 0.34-0.52) with health confidence and self-efficacy measures, indicating good convergent validity. They were positively correlated with more vegetable and fruit intakes, more time spent on exercises, and negatively correlated with time spent on sedentary activities, supporting hypothesis-testing validity. Internal consistency reliability for individual HAS-C dimensions was generally acceptable, with Cronbach's alpha values of 0.70 or above.
The 12-item multi-dimensional HAS-C exhibited good validity and reliability, making it a valuable tool for assessing health activation in primary school-aged children.
目前缺乏用于评估学龄儿童健康积极性的有效且可靠的测量工具。本研究旨在开发一种量表，以评估新加坡英语为母语的小学生的健康积极性，并评估其心理测量学特性。
健康积极性儿童量表（HAS-C）的开发涉及广泛的文献回顾、专家咨询、与小学生的认知访谈以及对维度和项目的深入讨论。这项横断面研究纳入了来自四所主流小学的 597 名 8 至 12 岁的儿童，其中男生占 50.1%，中国学生占 64.8%。儿童独立完成潜在量表和其他测量工具。提供了各个量表项目的描述性统计数据。进行探索性因子分析（EFA）和验证性因子分析（CFA）以评估因子有效性。通过将量表评分与健康信心和自我效能感测量评分进行相关分析来评估聚合效度。通过评估量表与自我报告的健康行为（包括蔬菜和水果的每日摄入量、久坐活动和体育活动时间）之间的相关性来评估假设检验的有效性。使用 Cronbach's alpha 评估内部一致性信度。
EFA 提出 HAS-C 的 12 项具有三因素结构，随后通过 CFA 得到验证，模型拟合良好。HAS-C 的所有三个维度评分与健康信心和自我效能感测量均呈中度相关（rho=0.34-0.52），表明具有良好的聚合效度。它们与蔬菜和水果摄入量增加、锻炼时间增加呈正相关，与久坐活动时间增加呈负相关，支持假设检验的有效性。个体 HAS-C 维度的内部一致性信度通常可以接受，Cronbach's alpha 值在 0.70 或以上。
具有 12 个项目的多维 HAS-C 具有良好的有效性和可靠性，是评估小学生健康积极性的有用工具。
