Zhuang Xinqi, Jia Yitong, Cui Tianxin, Meng Ge, Zhang Jianzhong, He Linxia, Zhang Yin-Ping
School of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China.
School of Health in Social Science, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK.
BMC Public Health. 2025 Jan 7;25(1):64. doi: 10.1186/s12889-024-21233-x.
The health literacy of staff in preschool childcare institution is an important issue to consider in providing healthcare for children aged 3-6 years, which could contribute to reducing incidence of diseases and accidental injuries as well as maintaining children's good health. Seldom instruments have been designed to measure health literacy across this group. This research aims to develop a health literacy scale for staff in preschool childcare institutions and validate its psychometric properties.
The scale was developed through four phases. In Phase 1, an item pool was developed mainly based on literature review and kindergarten work; In Phase 2, the initial items were reviewed by fifteen experts and content validity analysis was conducted; In Phase 3, a pilot study was conducted involving 30 kindergarten staff, which aimed to further modify the scale; In Phase 4, a psychometric validation study involving 466 kindergarten staff was conducted through a cross-sectional survey in May 2023. Item analysis was performed through critical ration, correlation analysis, and Cronbach's alpha if item deleted. Construct validity was performed through exploratory (n = 190) and confirmatory factor analyses (n = 276). Convergent and discriminant validity were evaluated. Reliability was evaluated through internal consistency, split-half reliability, and test-retest reliability.
The final Health Literacy Scale consisted of 28 items, including dimensions of Basic Health Knowledge (11 items), Functional Health Literacy Skills (3 items), Communicative Health Literacy (5 items), and Critical Health Literacy (9 items). Principal component analysis revealed a four-factor structure that explained 80.092% of the total variance. The goodness-of-fit indices signified an adequate model fit (χ/df = 2.093, RMSEA = 0.063, RMR = 0.031, GFI = 0.852, CFI = 0.958, NFI = 0.923, IFI = 0.958, TLI = 0.953, PCFI = 0.844). Cronbach's alpha showed a good internal consistency reaching a value of 0.921. The split-half reliability was 0.805, and the test-retest reliability was good with an intraclass correlation coefficient of 0.885 (P < 0.001).
The Health Literacy Scale developed in this research focuses on health literacy issues related to children aged 3-6 years. The scale is demonstrated to be valid and reliable for assessing the health literacy of staff in preschool childcare institutions. It could potentially be used as an effective instrument for targeted development of health literacy intervention.
学前儿童保育机构工作人员的健康素养是为3至6岁儿童提供医疗保健时需要考虑的一个重要问题，这有助于降低疾病和意外伤害的发生率，并维持儿童的良好健康状况。很少有工具被设计用于测量这一群体的健康素养。本研究旨在开发一套针对学前儿童保育机构工作人员的健康素养量表，并验证其心理测量特性。
该量表的开发历经四个阶段。在第一阶段，主要基于文献综述和幼儿园工作制定了一个项目池；在第二阶段，由15位专家对初始项目进行评审并进行内容效度分析；在第三阶段，对30名幼儿园工作人员进行了一项试点研究，旨在进一步修改该量表；在第四阶段，于2023年5月通过横断面调查对466名幼儿园工作人员进行了一项心理测量验证研究。通过临界比、相关分析以及删除项目后的克朗巴哈系数进行项目分析。通过探索性分析（n = 190）和验证性因素分析（n = 276）进行结构效度分析。评估收敛效度和区分效度。通过内部一致性、分半信度和重测信度评估信度。
最终的健康素养量表由28个项目组成，包括基础健康知识维度（11个项目）、功能性健康素养技能维度（3个项目）、沟通性健康素养维度（5个项目）和批判性健康素养维度（9个项目）。主成分分析揭示了一个四因素结构，该结构解释了总方差的80.092%。拟合优度指标表明模型拟合良好（χ/df = 2.093，RMSEA = 0.063，RMR = 0.031，GFI = 0.852，CFI = 0.958，NFI = 0.923，IFI = 0.958，TLI = 0.953，PCFI = 0.844）。克朗巴哈系数显示出良好的内部一致性，达到0.921。分半信度为0.805，重测信度良好，组内相关系数为0.885（P < 0.001）。
本研究开发的健康素养量表聚焦于与3至6岁儿童相关的健康素养问题。该量表被证明对于评估学前儿童保育机构工作人员的健康素养是有效且可靠的。它有可能被用作针对性开展健康素养干预的有效工具。
