Ye Qin, Wang Wei, Zeng Xuan, Kuang Yuxian, Geng Bingbing, Zhou Song, Liu Ning
Department of Basic Teaching and Research in General Medicine, Department of Fundamentals, Department of Nursing of Zunyi Medical University Zhuhai Campus, Zhuhai, China.
Zhuhai People's Hospital, Zhuhai, China.
J Med Internet Res. 2025 Mar 25;27:e64591. doi: 10.2196/64591.
In China, there is limited research on digital health literacy (DHL) among patients with stroke. This is mainly due to the lack of validated tools, which hinders the precision and sustainability of our country's digital transformation.
This study aimed to develop and validate a DHL scale specifically for stroke survivors in China.
We used a sequential, exploratory, mixed methods approach to develop a DHL questionnaire for stroke survivors. This study comprised 418 patients with stroke aged 18 years and older. To evaluate the questionnaire's psychometric qualities, we randomly assigned individuals to 2 groups (subsample 1: n=118, subsample 2: n=300). Construct validity was evaluated through internal consistency analysis, exploratory and confirmatory factor analyses, hypothesis testing for structural validity, measurement invariance assessments using the eHealth Literacy Scale, and Rasch analyses to determine the questionnaire's validity and reliability.
This study underwent 4 stages of systematic development. The initial pool of items contained 25 items, 5 of which were eliminated after content validity testing; 19 items were subsequently retained through cognitive interviews. After an interitem correlation analysis, 2 more items were excluded, leaving 17 items for exploratory factor analysis. Finally, 2 items were excluded by Rasch analysis, resulting in a final version of the questionnaire containing 15 items. The total score range of the scale was 15-75, with higher scores indicating greater DHL competence. Results showed that principal component analysis confirmed the theoretical structure of the questionnaire (69.212% explained variance). The factor model fit was good with χ=1.669; root mean square error of approximation=0.047; Tucker-Lewis Index=0.973; and Comparative Fit Index=0.977. In addition, hypothesis-testing construct validity with the eHealth Literacy Scale revealed a strong correlation (r=0.853). The internal consistency (Cronbach α) coefficient was 0.937. The retest reliability coefficient was 0.941. Rasch analysis demonstrated the item separation index was 3.81 (reliability 0.94) and the individual separation index was 2.91 (reliability 0.89).
The DHL Questionnaire for Stroke Survivors is a reliable and valid measure to assess DHL among stroke survivors in China.
在中国，针对中风患者的数字健康素养（DHL）研究有限。这主要是由于缺乏经过验证的工具，这阻碍了我国数字转型的精准性和可持续性。
本研究旨在开发并验证一款专门针对中国中风幸存者的DHL量表。
我们采用了一种序贯、探索性的混合方法来开发中风幸存者的DHL问卷。本研究纳入了418名18岁及以上的中风患者。为评估问卷的心理测量学质量，我们将个体随机分为两组（子样本1：n = 118，子样本2：n = 300）。通过内部一致性分析、探索性和验证性因素分析、结构效度的假设检验、使用电子健康素养量表进行测量不变性评估以及Rasch分析来确定问卷的有效性和可靠性。
本研究经历了4个系统开发阶段。初始项目池包含25个项目，其中5个在内容效度测试后被剔除；随后通过认知访谈保留了19个项目。经过项目间相关性分析，又排除了2个项目，剩下17个项目用于探索性因素分析。最后，通过Rasch分析又排除了2个项目，形成了最终版本的问卷，包含15个项目。该量表的总分范围为15 - 75分，分数越高表明DHL能力越强。结果显示，主成分分析证实了问卷的理论结构（解释方差为69.212%）。因素模型拟合良好，χ = 1.669；近似均方根误差 = 0.047；塔克 - 刘易斯指数 = 0.973；比较拟合指数 = 0.977。此外，与电子健康素养量表进行的假设检验结构效度显示出强相关性（r = 0.853）。内部一致性（Cronbach α）系数为0.937。重测信度系数为0.941。Rasch分析表明项目区分指数为3.81（信度0.94），个体区分指数为2.91（信度0.89）。
中风幸存者DHL问卷是评估中国中风幸存者DHL的可靠且有效的测量工具。
