Development of a Short Version of the Health Literacy Scale Based on Classical Test Theory and Item Response Theory

doi:10.12114/j.issn.1007-9572.2023.0072

Chinese General Practice ›› 2024, Vol. 27 ›› Issue (23): 2931-2940.DOI: 10.12114/j.issn.1007-9572.2023.0072

• Research Methodology • Previous Articles

Development of a Short Version of the Health Literacy Scale Based on Classical Test Theory and Item Response Theory

1. Public Health College of Harbin Medical University, Harbin 150081, China
2. School of Philosophy, Anhui University, Hefei 230039, China
3. School of Psychology, Southwest University, Chongqing 400715, China
4. School of Psychology and Cognitive Science, East China Normal University, Shanghai 200062, China
5. State Key Laboratory of Cognition and Learning, Department of Psychology, Beijing Normal University, Beijing 100875, China
6. School of Public Health, Peking University, Beijing 100191, China
7. Department of Social Science and Humanities of Harbin Medical University, Harbin 150081, China

Received:2023-01-21 Revised:2023-06-20 Published:2024-08-15 Online:2024-05-08
Contact: HE Miao, WU Yibo

简版健康素养量表的开发：基于经典测量理论和项目反应理论

1．150081　黑龙江省哈尔滨市，哈尔滨医科大学公共卫生学院
2．230039　安徽省合肥市，安徽大学哲学学院
3．400715　重庆市，西南大学心理学部
4．200062　上海市，华东师范大学心理与认知科学学院
5．100875　北京市，北京师范大学心理学部认知与学习国家重点实验室
6．100191　北京市，北京大学公共卫生学院
7．150081　黑龙江省哈尔滨市，哈尔滨医科大学人文社会科学学院

通讯作者: 贺苗, 吴一波
作者简介:
作者贡献：
孙小楠、陈珂进行文章的构思与设计，撰写论文；孙小楠、陈珂、武运筹、王飞、孙昕霙进行研究的实施与可行性分析；孙小楠、汤靖琪进行数据收集、整理；孙小楠、陈珂、武运筹进行统计学处理，结果的分析与解释；孙小楠、陈珂、汤靖琪进行论文的修订；贺苗、吴一波对文章整体负责，监督管理。
基金资助:
2021年度黑龙江省哲学社会科学研究规划项目(21SHB106); 2023年教育部人文社会科学研究一般项目(23YJA840006)

Abstract

Abstract:

Background

Health literacy is closely associated with health status, most domestic studies tend to use multidimensional and multi-item tools for assessing health literacy, lacking simple and effective assessment methods.

Objective

To simplify health literacy scale and conduct psychometric test within the Chinese population.

Methods

Adults aged 18 years and above were selected from the "China Family Health Index Survey (2021) " for this investigation. Based on inclusion and exclusion criteria, a total of 7 449 participants were selected and randomly divided into two sample sets, including 3 680 cases in sample set 1 and 3 769 cases in sample set 2. The general information questionnaire, Short-form Health Literacy Questionnaire (HLS-SF12), Perception Social Support Scale (PSSS), and Family Health Scale Short-form (FHS-SF) were administered to the respondents. Classical test theory (CTT) and the Mokken model in item response theory (IRT) were used to screen the original items, and validation analyses such as reliability and validity of the simplified scales were also conducted.

Results

A 9-item version (HLS-SF9) and a 4-item version (HLS-SF4) were simplified by using CTT and the Mokken model, respectively. Both the HLS-SF9 and the HLS-SF4 had no ceiling effect or floor effect, and the Cronbach's α coefficients for both were 0.913 and 0.842, with split-half reliabilities of 0.871 and 0.815, respectively. The exploratory factor analysis of HLS-SF4 revealed one common factor, accounting for 67.813% of the cumulative variance, with factor loadings exceeding 0.81 for each item. The confirmatory factor analysis of HLS-SF9 showed that χ²/df was 10.844, goodness of fit index (GFI) was 0.985, adjusted goodness of fit index (AGFI) was 0.971, normative fit index (NFI) was 0.986, comparative fit index (CFI) was 0.987, and root mean squared error of approximation (RMSEA) was 0.051. The correlation analysis demonstrated positive correlation of HLS-SF9 and HLS-SF4 with PSSS (r=0.367, 0.292, P<0.001), as well as FHS-SF (r=0.340, 0.237, P<0.001), respectively. The intraclass correlation coefficients (ICC) (95%CI) for the criterion validity of HLS-SF9 against HLS-SF12 was 0.989 (0.988-0.999), while for HLS-SF4 against HLS-SF12 was 0.892 (0.886-0.899) .

Conclusion

The simplified health literacy scales have good reliability and validity, which are reliable and effective tools for assessing the health literacy of the Chinese population. Researchers can choose the scale according to the needs of research precision (HLS-SF9) or assessment time (HLS-SF4) .

Key words: Health literacy, Item selection, Classical test theory, Mokken model, Short-form health literacy survey questionnaire

摘要：

背景

健康素养与健康状况密切相关，目前国内研究多倾向于运用多维度、多条目的健康素养测评工具，尚缺少简便且有效的健康素养测评工具。

目的

简化健康素养量表并在中国人群中进行心理测量学检验。

方法

从"中国家庭健康指数调查（2021年）"数据中选择18岁及以上人群作为本研究的调查对象，依据纳入与排除标准，最终纳入7 449份数据，并随机分为2个样本集，其中样本集1共3 680份，样本集2共3 769份。对调查对象进行一般资料问卷、12条目健康素养量表（HLS-SF12）、领悟社会支持量表（PSSS）、家庭健康量表（FHS-SF）调查。应用经典测量理论以及项目反应理论中的Mokken模型对HLS-SF12原条目进行筛选，并对精简后的量表进行信效度等验证性分析。

结果

使用经典测量理论和Mokken模型分别简化出1个9条目版本的量表（HLS-SF9）和1个4条目版本的量表（HLS-SF4）。HLS-SF9与HLS-SF4均无天花板效应、地板效应，二者的Cronbach's α系数分别为0.913和0.842，折半信度分别为0.871和0.815。HLS-SF4经探索性因子分析提取出1个公因子，累积方差贡献率为67.813%，各条目的因子载荷量均>0.81。HLS-SF9经验证性因子分析结果显示χ²/df=10.844、拟合优度指数（GFI）=0.985、调整拟合优度指数（AGFI）=0.971、规范拟合指数（NFI）=0.986、比较拟合指数（CFI）=0.987和近似误差均方根（RMSEA）=0.051。相关性分析结果显示，HLS-SF9、HLS-SF4与PSSS呈正相关（r=0.367、0.292，P<0.001），与FHS-SF呈正相关（r=0.340、0.237，P<0.001）。HLS-SF9对HLS-SF12的效标效度的一致性水平（ICC）（95%CI）为0.989（0.988~0.999），HLS-SF4效标效度的ICC（95%CI）为0.892（0.886~0.899）。

结论

简化后的健康素养量表具有良好的信效度，是能够快速测评中国人群健康素养的有效工具，研究者可根据研究精度（HLS-SF9）或测评时间（HLS-SF4）的需求采取针对性选择。

关键词: 健康素养, 条目筛选, 经典测量理论, Mokken模型, 12条目健康素养量表

CLC Number:

R 193

SUN Xiaonan,CHEN Ke,WU Yunchou, et al. Development of a Short Version of the Health Literacy Scale Based on Classical Test Theory and Item Response Theory[J]. Chinese General Practice, 2024, 27(23): 2931-2940. DOI: 10.12114/j.issn.1007-9572.2023.0072.
孙小楠,陈珂,武运筹等. 简版健康素养量表的开发：基于经典测量理论和项目反应理论[J]. 中国全科医学, 2024, 27(23): 2931-2940. DOI: 10.12114/j.issn.1007-9572.2023.0072.

Figures/Tables 6

References 52

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社会人口学信息	数据集1（n=3 680）		数据集2（n=3 769）
社会人口学信息	人数	百分比（%）	人数	百分比（%）
性别
男	1 608	43.7	1 678	44.5
女	2 072	56.3	2 091	55.5
民族
汉族	3 449	93.7	3 544	94.0
少数民族	231	6.3	225	6.0
常住地
城镇	2 700	73.4	2 749	72.9
农村	980	26.6	1 020	27.1
户口性质
非农业	2 156	58.6	2 170	57.6
农业	1 524	41.4	1 599	42.4
是否负债
是	1 514	41.1	1 553	41.2
否	2 166	58.9	2 216	58.8
家庭人均月收入（元）
≤3 000	1 113	30.2	1 118	29.7
>3 000~6 000	1 442	39.2	1 476	39.2
>6 000~9 000	588	16.0	610	16.1
>9 000	537	14.6	565	15.0
年龄（岁）
≤30	1 333	36.2	1 379	36.6
>30~45	1 067	29.0	1 100	29.2
>45~60	873	23.7	866	23.0
>60	407	11.1	424	11.2
最高文化程度
未接受正规学历教育/小学	353	9.6	387	10.3
初中/中专	658	17.9	654	17.4
高中	370	10.1	417	11.1
大专/大学本科	2 058	55.9	2 068	54.9
硕士研究生/博士研究生	241	6.5	243	6.3
婚姻状况
未婚	1 200	32.6	1 239	32.9
已婚	2 329	63.3	2 330	61.8
离异	56	1.5	95	2.5
丧偶	95	2.6	105	2.8
职业状态
学生	812	22.1	864	22.9
在职	1 776	48.3	1 781	47.3
退休	318	8.6	333	8.8
无固定职业	774	21.0	791	21.0

社会人口学信息	数据集1（n=3 680）		数据集2（n=3 769）
社会人口学信息	人数	百分比（%）	人数	百分比（%）
性别
男	1 608	43.7	1 678	44.5
女	2 072	56.3	2 091	55.5
民族
汉族	3 449	93.7	3 544	94.0
少数民族	231	6.3	225	6.0
常住地
城镇	2 700	73.4	2 749	72.9
农村	980	26.6	1 020	27.1
户口性质
非农业	2 156	58.6	2 170	57.6
农业	1 524	41.4	1 599	42.4
是否负债
是	1 514	41.1	1 553	41.2
否	2 166	58.9	2 216	58.8
家庭人均月收入（元）
≤3 000	1 113	30.2	1 118	29.7
>3 000~6 000	1 442	39.2	1 476	39.2
>6 000~9 000	588	16.0	610	16.1
>9 000	537	14.6	565	15.0
年龄（岁）
≤30	1 333	36.2	1 379	36.6
>30~45	1 067	29.0	1 100	29.2
>45~60	873	23.7	866	23.0
>60	407	11.1	424	11.2
最高文化程度
未接受正规学历教育/小学	353	9.6	387	10.3
初中/中专	658	17.9	654	17.4
高中	370	10.1	417	11.1
大专/大学本科	2 058	55.9	2 068	54.9
硕士研究生/博士研究生	241	6.5	243	6.3
婚姻状况
未婚	1 200	32.6	1 239	32.9
已婚	2 329	63.3	2 330	61.8
离异	56	1.5	95	2.5
丧偶	95	2.6	105	2.8
职业状态
学生	812	22.1	864	22.9
在职	1 776	48.3	1 781	47.3
退休	318	8.6	333	8.8
无固定职业	774	21.0	791	21.0

条目	项目间残差相关法	相关系数	CITC	极端值法（P值）	被入选次数	删除条目
HLS1	215.869	0.730	0.928	<0.001	4
HLS2	129.501	0.791	0.925	<0.001	4
HLS3	517.124	0.745	0.927	<0.001	3	√
HLS4	230.189	0.725	0.927	<0.001	4
HLS5	361.478	0.737	0.927	<0.001	3	√
HLS6	210.054	0.760	0.926	<0.001	4
HLS7	18.808	0.785	0.925	<0.001	4
HLS8	123.271	0.785	0.925	<0.001	4
HLS9	8.414	0.770	0.925	<0.001	4
HLS10	5.270	0.797	0.924	<0.001	4
HLS11	41.051	0.762	0.926	<0.001	3	√
HLS12	5.978	0.716	0.928	<0.001	4

条目	项目间残差相关法	相关系数	CITC	极端值法（P值）	被入选次数	删除条目
HLS1	215.869	0.730	0.928	<0.001	4
HLS2	129.501	0.791	0.925	<0.001	4
HLS3	517.124	0.745	0.927	<0.001	3	√
HLS4	230.189	0.725	0.927	<0.001	4
HLS5	361.478	0.737	0.927	<0.001	3	√
HLS6	210.054	0.760	0.926	<0.001	4
HLS7	18.808	0.785	0.925	<0.001	4
HLS8	123.271	0.785	0.925	<0.001	4
HLS9	8.414	0.770	0.925	<0.001	4
HLS10	5.270	0.797	0.924	<0.001	4
HLS11	41.051	0.762	0.926	<0.001	3	√
HLS12	5.978	0.716	0.928	<0.001	4

条目	H_i（SE）	#vi/#ac	#zsig	Crit
HLS1	0.571（0.012）	0	0	0
HLS2	0.622（0.011）
HLS3	0.630（0.012）	0.02	1	13
HLS4	0.593（0.013）
HLS5	0.611（0.012）	0.02	1	19
HLS6	0.605（0.012）
HLS7	0.618（0.011）	0	0	0
HLS8	0.635（0.012）
HLS9	0.610（0.012）
HLS10	0.629（0.011）
HLS11	0.633（0.013）
HLS12	0.558（0.013）

Development of a Short Version of the Health Literacy Scale Based on Classical Test Theory and Item Response Theory

简版健康素养量表的开发：基于经典测量理论和项目反应理论

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References 52

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量表	最小值（分）	最大值（分）	得分（分）	地板效应（%）	天花板效应（%）
HLS-SF9	0	50	35.08±7.96	0.2%	9.2%
HLS-SF4	0	50	33.05±9.05	0.5%	10.2%

量表	最小值（分）	最大值（分）	得分（分）	地板效应（%）	天花板效应（%）
HLS-SF9	0	50	35.08±7.96	0.2%	9.2%
HLS-SF4	0	50	33.05±9.05	0.5%	10.2%