Jia Yitong, Zhuang Xinqi, Zhao Yanzi, Meng Ge, Zhang Jianzhong, Cao Yueying, Zhang Yin-Ping
Faculty of Nursing, Xi'an Jiaotong University Health Science Center, No.76, West Yanta Road, Xi'an, Shaanxi, 710061, P.R. China.
Health Qual Life Outcomes. 2025 Mar 1;23(1):18. doi: 10.1186/s12955-025-02349-z.
Health literacy among family caregivers has been found to be strongly correlated with health exposures and outcomes for their children. Accurate assessment of their health literacy contributes to improving child health outcomes. Given the limited evidence on health literacy measures for family caregivers, the study aimed to develop and validate a novel Health Literacy Scale for Family Caregivers of Preschool Children (HLSFC).
The HLSFC was developed in 4 phases: 1) using Nutbeam's conceptual framework of health literacy as a guide to clarify the content to be measured; 2) generating an item pool; 3) providing feedback on the initial items; 4) psychometric analyses. A cross-sectional survey of 443 family caregivers of preschoolers was conducted in Northwest China. Construct validity was assessed using exploratory factor analysis (n = 213) and confirmatory factor analysis (n = 230). Reliability was assessed using internal consistency, split-half reliability, and test-retest reliability.
Thirty-Three items were included in the final instrument. Principal component analysis yielded a three-factor structure explaining 70.013% of the total variance. All fitting indices met the standard based upon confirmatory factor analysis. The composite reliability values of the factors ranged from 0.928 to 0.944 (> 0.7), and the average variance extracted values ranged from 0.552 to 0.590 (> 0.5), indicating acceptable convergent validity. The Cronbach's alpha value was 0.963. The test-retest reliability was good, with an intraclass correlation coefficient of 0.909. Sociodemographic factors, such as caregiver education, occupation, residence, and monthly household income per person, were significantly associated with health literacy scores.
The HLSFC demonstrated adequate reliability and validity, and can measure a wide range of health literacy skills: from functional to interactive and critical health literacy. It could be potentially applied as an effective tool for the health literacy assessment among family caregivers of preschoolers.
研究发现，家庭照顾者的健康素养与他们孩子的健康暴露情况和健康结果密切相关。准确评估他们的健康素养有助于改善儿童健康结果。鉴于针对家庭照顾者健康素养测量方法的证据有限，本研究旨在开发并验证一种新的《学龄前儿童家庭照顾者健康素养量表》（HLSFC）。
HLSFC分4个阶段开发：1）以Nutbeam的健康素养概念框架为指导，明确要测量的内容；2）生成项目池；3）对初始项目提供反馈；4）进行心理测量分析。在中国西北部对443名学龄前儿童的家庭照顾者进行了横断面调查。使用探索性因子分析（n = 213）和验证性因子分析（n = 230）评估结构效度。使用内部一致性、分半信度和重测信度评估信度。
最终量表包含33个项目。主成分分析产生了一个三因素结构，解释了总方差的70.013%。基于验证性因子分析，所有拟合指数均符合标准。各因素的组合信度值在0.928至0.944之间（> 0.7），平均提取方差值在0.552至0.590之间（> 0.5），表明具有可接受的收敛效度。Cronbach's alpha值为0.963。重测信度良好，组内相关系数为0.909。社会人口学因素，如照顾者的教育程度、职业、居住地和人均家庭月收入，与健康素养得分显著相关。
HLSFC表现出足够的信度和效度，能够测量广泛的健康素养技能：从功能性健康素养到互动性和批判性健康素养。它有可能作为一种有效工具，用于评估学龄前儿童家庭照顾者的健康素养。
