Research Status of Health Literacy Assessment Tools from the Perspective of Active Health and Its Enlightenment to China

doi:10.12114/j.issn.1007-9572.2022.0101

Chinese General Practice ›› 2022, Vol. 25 ›› Issue (31): 3933-3943.DOI: 10.12114/j.issn.1007-9572.2022.0101

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Research Status of Health Literacy Assessment Tools from the Perspective of Active Health and Its Enlightenment to China

1.Department of General Practice, Yangpu Hospital, Tongji University, Shanghai 200090, China
2.Academic Department of General Practice, Tongji University School of Medicine, Shanghai 200090, China
3.Clinical Research Center of General Practice, Tongji University School of Medicine, Shanghai 200090, China
4. Shanghai General Practice and Community Health Development Research Center, Shanghai 200090, China
5.Changning District Center for Disease Control and Prevention, Shanghai 200051, China

Received:2022-03-02 Revised:2022-04-28 Published:2022-11-05 Online:2022-09-20
Contact: YU Dehua
About author:
FU Q Q, JIN H, LI L, et al. Research status of health literacy assessment tools from the perspective of active health and its enlightenment to China [J] . Chinese General Practice, 2022, 25 (31) : 3933-3943.

主动健康视角下健康素养测评工具的研究现状及其对我国的启示

1.200090　上海市，同济大学附属杨浦医院全科医学科
2.200090　上海市，同济大学医学院全科医学系
3.200090　上海市，同济大学医学院全科医学临床研究中心
4.200090　上海市全科医学与社区卫生发展研究中心
5.200051　上海市长宁区疾病预防控制中心

通讯作者: 于德华
作者简介:
付强强，金花，李丽，等.主动健康视角下健康素养测评工具的研究现状及其对我国的启示[J].中国全科医学，2022，25（31）：3933-3943.[www.chinagp.net] 作者贡献：付强强、于德华负责文章的构思与设计；金花、李丽参与文献收集和资料整理；马瑜负责论文的英文修订；付强强负责撰写论文；于德华负责文章的质量控制及审校，并对文章整体负责。
基金资助:
国家自然科学基金资助项目(72104183); 上海市领军人才(YDH-20170627); 上海市医院协会医院管理研究基金课题(X2020168); 上海市医药卫生发展基金会课题(Se1201931); 2021年上海市"医苑新星"青年医学人才培养资助计划; 第十批上海市杨浦区中心医院青年人才"晨光计划"(Ye1202105)

Abstract

Abstract:

Background

The Outline of the "Healthy China 2030" Plan points out improve the health literacy and lifestyle monitoring system covering the whole country, strengthen personal health responsibility, improve residents' self-health management ability and health level, in order to greatly improve the level of national health literacy. Scientific health literacy assessment tools can systematically understand the health literacy level of residents and provide targeted interventions. The health literacy assessment started late in China. The content of existing health literacy assessment tool should been improved, which is called Chinese Citizens' Health Literacy-Trial Implementation of Basic Knowledge and Skills (to try out), because it is definitely important to create an effective and reliable health literacy assessment tool.

Objective

Based on the perspective of active health, this paper reviews the relevant literature on health literacy assessment tools at home and abroad.

Methods

Chinese and foreign databases of PubMed, Web of Science, CNKI, Wanfang and VIP were systematically retrieved using keywords including "Health literacy" "Tool""Evaluation" "Assessment" "Questionnaire" "Scale". The related literature of health literacy assessment tools was obtained with the retrieval time from 1990-01-01 to 2021-06-30, and the current situation and contents of health literacy assessment tools were reviewed.

Results

A total of 47 health literacy assessment tools were screened, including 27 objective assessment tools and 20 subjective assessment tools. The most of research and development (R&D) and application is in the United States (22) , followed by Europe (13) . The number of English tools is the largest (25) , followed by Portuguese (5) , Italian (3) and Spanish (2) . The evaluation time of REALM-SF, SILS is the shortest (1 minute) , and the longest for MHLS (25 minutes) . The least item is in SILS (1 item) , and REALM (125 items) has the most evaluated items. The most widely used evaluation tools are the REALM series scale and TOFHLA series scale in objective evaluation tools, and the HLS-EU-Q series scale in subjective evaluation tools. The evaluation mainly content involves vocabulary recognition, information acquisition, computing ability, reading comprehension, information exchange, information application and so on.

Conclusion

The development and application of health literacy assessment tools are dominated by European and American countries, and the number of objective health literacy assessment tools is in the majority. As the change of the connotation of health literacy from a single personal assessment to a comprehensive assessment of individuals and external environment, the R&D of health literacy assessment tools in China should be based on the establishment of unified standards across the country on the premise of deepening the connotation of health literacy and the concept of active health, the indicators should mainly be quantitative or semi quantitative indicators. A health literacy assessment tool suitable for China's national conditions covering the whole life cycle should be developed to provide scientific and effective support for improving the health literacy level of residents.

Key words: Health literacy, Assessment tools, Active health, Systematic reviews

摘要：

背景

《"健康中国2030"规划纲要》提出：健全覆盖全国的健康素养和生活方式监测体系，强化个人健康责任，提高居民自我健康管理能力和健康水平，提高全民健康素养水平。科学的健康素养测评工具可以系统地了解居民健康素养水平并提供针对性的干预措施。我国的健康素养测评研究起步较晚，现有健康素养测评工具《中国公民健康素养-基本知识与技能（试行）》的评估内容尚存在较大完善空间，因此研发有效、可靠的健康素养评价工具至关重要。

目的

基于主动健康视角，对国内外健康素养评价工具相关文献进行综述。

方法

于2021年7月，以"Health Literacy" "Tool" "Evaluation" "Assessment" "Questionnaire" "Scale" "健康素养" "工具" "测评" "评价" "问卷" "量表"等为中/英文关键词，系统检索PubMed、Web of Science、中国知网、万方数据知识服务平台、维普数据库，以获取健康素养测评工具相关文献，检索时限为1990-01-01至2021-06-30，对健康素养测评工具的现状及内容进行综述。

结果

共筛选出47种健康素养测评工具，包含27个客观测评工具和20个主观测评工具。研发和应用最多的是美国（22个），其次是欧洲地区（13个）。语言方面，英语最多（25个），其次是葡萄牙语（5个）、意大利语（3个）、西班牙语（2个）。测评所需时间方面，成人医学语言阅读能力简化快速测试量表（REALM-SF）、单问题健康素养筛查量表（SILS）用时最短（1 min），汉语健康素养测试量表（MHLS）用时最长（25 min）。测评条目最少的是SILS（1条），最多的是完整版成人医学语言阅读能力测试量表（REALM）（125条）。客观测评工具中被广泛应用的是成人医学语言阅读能力测试量表系列量表（REALM Family）与成人功能性健康素养测试量表系列量表（TOFHLA Family），主观测评工具中被广泛应用的是欧洲健康素养调查问卷（HLS-EU-Q）。测评内容主要涉及阅读理解、计算能力、信息获取、信息应用、信息交流、词汇识别等方面。

结论

在健康素养测评工具的研发和应用中，欧美国家占据主导地位，客观健康素养测评工具数量居多，随着健康素养的内涵从单一的个人评价转变为个人与外部环境的综合评价，我国健康素养测评工具的研发提倡以健康素养内涵深化和主动健康理念为前提，全国建立统一标准，指标以定量或半定量指标为主，开发出涵盖整个生命周期的适合我国国情的健康素养评价工具，从而为提升居民健康素养提供科学、有效的支持。

关键词: 健康素养, 测评工具, 主动健康, 系统评价

FU Qiangqiang,JIN Hua,LI Li, et al. Research Status of Health Literacy Assessment Tools from the Perspective of Active Health and Its Enlightenment to China[J]. Chinese General Practice, 2022, 25(31): 3933-3943. DOI: 10.12114/j.issn.1007-9572.2022.0101.
付强强,金花,李丽等. 主动健康视角下健康素养测评工具的研究现状及其对我国的启示[J]. 中国全科医学, 2022, 25(31): 3933-3943. DOI: 10.12114/j.issn.1007-9572.2022.0101.

Figures/Tables 3

References 63

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Research Status of Health Literacy Assessment Tools from the Perspective of Active Health and Its Enlightenment to China

主动健康视角下健康素养测评工具的研究现状及其对我国的启示

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序号	评估工具名称	作者	发表年份（年）	评估内容	评估对象年龄（岁）	评估形式	条目数量（条）	样本量（例）	评估时间（min）	语言	受试者国家/地区	评定类型	量表家族	信度（Cronbach's α系数）
1	REALM	DAVIS等^[9]	1991	词汇识别、阅读理解	18~64	面谈	125	207	2.5	英语	美国	客观	REALM Family	0.99
2	REALM-S	DAVIS等^[10]	1993	词汇识别	18~64	面谈	66	230	1.5	英语	美国	客观	REALM Family	0.99
3	TOFHLA	PAPKER等^[11]	1995	阅读理解、计算能力、信息获取	18~64	面谈、纸质问卷	67	200	22	西班牙语	美国	客观	TOFHLA Family	0.98
4	S-TOFHLA	BAKER等^[13]	1999	计算能力、阅读理解	18~65	面谈、纸质问卷	40	211	12	英语	美国	客观	TOFHLA Family	计算能力维度为0.68，阅读理解维度为0.97
5	BHLS	CHEW等^[36]	2004	信息获取	18~64	面谈	3	332	1.5	英语	美国	主观	—	—
6	NVS	WEISS等^[15]	2005	计算能力、阅读理解、信息获取	18~64	面谈	6	148	3	英语	美国	客观	TOFHLA Family	—
7	MDIT	SCHWARTZ等^[14]	2005	阅读理解	18~64	邮件调查	18	178	—	英语	美国	客观	—	—
8	REALM-Teen	DAVIS等^[16]	2006	阅读理解	10~17	面谈	66	1 533	2.5	英语	美国	客观	REALM Family	0.94
9	SILS	MORRIS等^[37]	2006	阅读理解、信息应用	18~64	面谈	1	999	1	英语	美国	主观	—	—
10	REALM-SF	AROZULLAH等^[17]	2007	词汇识别	18~64	面谈	7	1 500	1	英语	美国	客观	REALM Family	—
11	HHLT	BARON-EPEL等^[18]	2007	阅读理解、计算能力	18~64	面谈	12	119	—	希伯来语	以色列	客观	TOFHLA Family	0.98
12	SNS	FAGERLIN等^[38]	2007	计算能力	18~64	面谈	8	287	—	英语	美国	主观	—	—
13	DAHL	HANCHATE等^[19]	2008	阅读理解、计算能力、信息获取	>65	面谈	40	9 643	—	英语	美国	客观	TOFHLA Family	—
14	CCHL	ISHIKAWA等^[39]	2008	阅读理解、信息获取、信息传播	18~64	面谈、纸质问卷	5	190	—	日语	日本	主观	—	—
15	SAHLE	LEE等^[20]	2010	词汇识别、计算能力、信息获取	18~64	面谈、纸质问卷	18	403	2.5	英语	美国	客观	—	0.89
16	HLSI	MCCORMACK等^[21]	2010	阅读理解、计算能力、信息获取、信息交流、信息应用	18~64	电子问卷	25	889	12	英语	美国	客观	—	0.86
17	METER	RAWSON等^[22]	2010	词汇识别、阅读理解	18~64	面谈、纸质问卷	40	148	2	英语	美国	客观	REALM Family	—
18	SEHL	SARKAR等^[40]	2011	阅读理解	10~17或18~64	面谈或电话访谈	3	296	—	西班牙语	美国	主观	—	—
19	GLS	GALESIC等^[23]	2011	计算能力、信息获取、阅读理解、信息应用	18~64	电子问卷	13	987	9.5	英语	西班牙、美国、德国	客观	—	—
20	MHLS	TSAI等^[24]	2011	阅读理解、计算能力、信息获取	18~64	纸质问卷	63	323	25	汉语	中国台湾	客观	—	—
21	eHEALS	VAART等^[42]	2011	信息获取、信息交流	18~64	面谈、纸质问卷	8	277	5	荷兰语	荷兰	主观	—	—
22	TAIMI	TAKAHASHI等^[41]	2011	阅读理解、计算能力	18~64	电子问卷	7	6 047	—	日语	日本	主观	—	—
23	BNT-S	COKELY等^[27]	2012	计算能力	18~64	电子问卷、纸质问卷	4	—	3	英语	美国、德国	客观	—	—
24	SAHLPA-18	APOLINARIO等^[25]	2012	词汇识别、阅读理解	18~64	面谈	18	226	1.5	葡萄牙语	巴西	客观	REALM Family	0.90
25	HLSI-10	BANN等^[26]	2012	阅读理解、计算能力、信息获取、信息交流、信息应用	18~64	纸质问卷、面谈	10	889	5	英语	美国、德国	客观	—	—
26	NUMi	SCHAPIRA等^[28]	2012	计算能力	18~64	纸质问卷、面谈	20	1 000	—	英语	美国	客观	—	0.86
27	SAHLPA-50	APOLINARIO等^[25]	2012	词汇识别、阅读理解	18~64	面谈	50	226	4.5	葡萄牙语	巴西	客观	REALM Family	0.93
28	BRIEF	HAUN等^[43]	2012	信息获取	18~64	面谈	4	378	2	英语	美国	主观	—	—
29	C-eHEALS	KOO等^[44]	2012	信息获取、信息交流	10~17	纸质问卷、面谈	8	216	—	汉语	中国台湾	主观	—	0.92
30	STOFHLA	CONNOR等^[29]	2013	阅读理解、计算能力	18~64	面谈、纸质问卷	40	659	12	法语、德语、意大利语	瑞士	客观	TOFHLA Family	—
31	CHLCC	LEUNG等^[30]	2013	阅读理解、信息应用	18~64	面谈	20	262	7	汉语	中国	客观	TOFHLA Family	—
32	AAHLS	CHINN等^[45]	2013	信息应用	18~64	纸质问卷	14	146	7	英语	英国	主观	—	0.74
33	HeLMS	JORDAN等^[55]	2013	阅读理解、信息获取、信息应用	18~64	纸质问卷	29	683	—	英语	澳大利亚	主观	—	—
34	METER-PT	PAIVA等^[31]	2014	词汇识别、阅读理解	18~64或≥65	纸质问卷	70	249	3	葡萄牙语	葡萄牙	客观	REALM Family	0.89
35	HLS-EU-Q47	NAKAYAMA等^[47]	2015	阅读理解、信息获取、信息应用	18~64	电子问卷	47	1 054	—	日语	日本	主观	—	0.97
36	eHEALS	CHUNG等^[46]	2015	信息获取、信息交流、信息应用	18~64	电子问卷	8	866	—	英语	美国	主观	—	0.94
37	HELMA	GHANBARI等^[48]	2016	计算能力、阅读理解、信息应用	10~17	纸质问卷	44	582	—	英语	伊朗	主观	—	—
38	NVS-PT	PAIVA等^[32]	2017	计算能力、阅读理解、信息应用	18~64	面谈	6	249	5	葡萄牙语	葡萄牙	客观	TOFHLA Family	0.85
39	NVS-BR	RODRIGUES等^[33]	2017	计算能力、阅读理解、信息交流	18~64	面谈	6	490	7	葡萄牙语	巴西	客观	TOFHLA Family	0.75
40	HLS-EU-Q16	EFTHYMIOU等^[50]	2017	信息获取、信息应用、信息交流	18~64或≥65	面谈、纸质问卷	16	107	15	希腊语	希腊、塞浦路斯	主观	—	0.77
41	HL-SDHQ	MATSUMOTO等^[51]	2017	阅读理解、信息应用	18~64或≥65	电子问卷	33	831	15	日语	日本	主观	—	0.92
42	SILS-IT	BONACCIRSI等^[49]	2017	阅读理解、信息应用	18~64或≥65	面谈	1	174	1	意大利语	意大利	主观	—	—
43	NVS-HR	BRANGAN等^[34]	2018	计算能力、阅读理解	18~64或≥65	面谈、纸质问卷	6	100	4	克罗地亚语	克罗地亚	客观	TOFHLA Family	—
44	CCHLS	PLEASANT等^[52]	2018	阅读理解，信息获取、信息交流、信息应用	18~64或≥65	面谈、纸质问卷	5	633	—	英语	美国	主观	—	0.80
45	PPSI	AYRE等^[35]	2020	阅读理解、计算能力、信息获取、信息交流、信息应用	18~64	电子问卷	13	1 000	8	英语	澳大利亚	客观	TOFHLA Family	0.70
46	HLS-Child-Q15	BOLLWEG等^[54]	2020	阅读理解、信息交流、信息应用	0~9或10~17	纸质问卷	15	907	10	德语	德国	主观	—	0.79
47	HLVa-IT	BIASIO等^[53]	2020	阅读理解、信息获取、信息交流	18~64或≥65	纸质问卷	14	200	5	意大利语	意大利	主观	—	0.82

序号	测评内容	测评工具数量（个）	百分比（%）
1	阅读理解	34	72.3
2	计算能力	20	42.6
3	信息获取	20	42.6
4	信息应用	17	36.2
5	信息交流	11	23.4
6	词汇识别	8	17.0

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