Methodology and Validation of Health Literacy Scale Development in Taiwan

This article reports a generic methodology for developing health literacy assessment tools, consisting of 5 steps: (a) semi-structured, in-depth interviews of health care consumers; (b) consultation with health care, education, and psychometrics experts; (c) generation of an item pool; (d) selection of items for inclusion in the Mandarin Health Literacy Scale; and (e) evaluation of readability. To illustrate, the authors applied the methodology in order to develop a health literacy scale for the Mandarin Chinese–speaking population. They field-tested the initial version of the scale with a random sample of 323 Taiwanese adults. In addition, the authors used item response theory and classical test theory to examine the psychometric properties of the scale. Results showed good validity and reliability.     

Development and Validation of the Chinese Health Literacy Scale for Chronic Care

This study aims to develop and test the psychometric properties of the Chinese Health Literacy Scale for Chronic Care (CHLCC). This is a methodological study with a sample of 262 patients 65 years of age and older who had chronic illnesses. Pearson's correlation, independent sample t tests, and analyses of variance were used. The CHLCC showed a significant positive correlation with Chinese literacy levels (r = 0.80; p < .001) but was negatively correlated with age (r =?0.31; p <.001). Respondents who were male (t =4.34; p <.001) and who had reached Grade 12 or higher in school (F = 51.80; p <.001) had higher CHLCC scores than did their counterparts. Individuals with high levels of health literacy had fewer hospitalizations than did their counterparts (β =?0.31; incidence rate ratio = 0.73; p <.05). The CHLCC also displayed good internal reliability (Cronbach'sα =0.91) and good test–retest reliability (intraclass correlation coefficient = 0.77; p <.01). The CHLCC is a valid and reliable measure for assessing health literacy among Chinese patients with chronic illness. The scale could be used by practitioners before implementing health promotion and education.     

Advancing Health Literacy Measurement: A Pathway to Better Health and Health System Performance

The concept of health literacy initially emerged and continues to gain strength as an approach to improving health status and the performance of health systems. Numerous studies clearly link low levels of education, literacy, and health literacy with poor health, poor health care utilization, increased barriers to care, and early death. However, theoretical understandings and methods of measuring the complex social construct of health literacy have experienced a continual evolution that remains incomplete. As a result, the seemingly most-cited definition of health literacy proposed in the now-decade-old Institute of Medicine report on health literacy is long overdue for updating. Such an effort should engage a broad and diverse set of health literacy researchers, practitioners, and members of the public in creating a definition that can earn broad consensus through validation testing in a rigorous scientific approach. That effort also could produce the basis for a new universally applicable measure of health literacy. Funders, health systems, and policymakers should reconsider their timid approach to health literacy. Although the field and corresponding evidence base are not perfect, health literacy—especially when combined with a focus on prevention and integrative health—is one of the most promising approaches to advancing public health.     

母婴健康素养量表编制及考评

目的 编制母婴健康素养量表用以测量孕妇母婴健康素养,并对该量表的信度、效度和可行性进行评价.方法 参考《母婴健康素养——母婴健康素养55条》和相关文献构建量表框架并建立条目库,经条目筛选形成测试版量表,对207名孕妇进行实测后,检验量表信度、效度和可行性.结果 初步建立了包含74个条目的条目库,经条目筛选,最终形成了包含55个条目的母婴健康素养量表,分属基本知识和理念、健康生活方式与行为和基本技能3个维度.总量表和3个维度的Cronbach'sα系数分别为0.890,0.824,0.689和0.536;量表重测相关系数为0.897,分半相关系数为0.802;各条目与其所在的维度/方面相关性均较高;因子分析提取了7个公因子,解释65.99%的方差变异;孕妇大多能在8-15分钟内完成问卷.结论 母婴健康素养量表具有良好的信度、效度和可行性,但对各文化层次人群的适用情况有待于进一步研究.     

Spanish Validation of the Self-Perceived Food Literacy Scale: A Five-Factor Model Proposition

Food literacy is a combination of functional, critical, and relational skills that pave the way for navigating the food system properly, taking personally and contextually available resources into account. The aim was to validate the Spanish version of the self-perceived food literacy scale in university students to explore the factorial structure of it and to correlate food literacy with other variables. The sample was composed of 362 Spanish university students (314 women). The full questionnaire was administered online and also assessed adherence to a Mediterranean diet, impulsivity, and health-related quality of life for convergent validity testing purposes. Confirmatory factor analysis was conducted to determine the factor structure of the food literacy scale. The Spanish version of the scale showed good indices of internal consistency (Cronbach’s α = 0.894). Confirmatory factor analysis revealed a five-factor model that had a better fit index than the seven-factor model of the original scale. External validity was assessed by showing significant correlations with the rest of the variables. Therefore, the Spanish version of the scale is a reliable and valid measure of food literacy. It could be used to promote policies at Spanish universities to improve the food-related behaviors of students.     

Development and Validation of the Assessment of Health Literacy in Breast and Cervical Cancer Screening

For many people limited health literacy is a major barrier to effective preventive health behavior such as cancer screening, yet a comprehensive health literacy measure that is specific to breast and cervical cancer screening is not readily available. The purpose of this article is to describe the development and testing of a new instrument to measure health literacy in the context of breast and cervical cancer screening, the Assessment of Health Literacy in Cancer Screening (AHL-C). The AHL-C is based on Baker's conceptualization of health literacy and modeled from the two most popular health literacy tests, the Rapid Estimate of Adult Literacy in Medicine and the Test of Functional Health Literacy in Adults. The AHL-C consists of four subscales; print literacy, numeracy, comprehension, and familiarity. We used baseline data from 560 Korean American immigrant women who participated in a community-based randomized trial designed to test the effect of a health literacy-focused intervention to promote breast and cervical cancer screening. Rigorous psychometric testing supports that the AHL-C is reliable, valid, and significantly correlated with theoretically selected variables. Future research is needed to test the utility of the AHL-C in predicting cancer screening outcomes.     

Alcohol consumption during pregnancy: A urge to increase prevention and screening

Alcohol consumption was evaluated in 1,027 pregnant women in the Auvergne region of central France. Only 53% declared total abstinence during pregnancy. 33% had 1–4 units on monthly occasion, while 13% drunk more frequently. One percent had 5 or more units per occasion. Despite the consensus recommending total abstinence during pregnancy, prenatal alcohol exposure remains a major public health issue.     

儿童肥胖健康素养量表家长版的编制及评价

目的 编制“儿童肥胖健康素养量表(家长版)”,并评价其信度和效度。方法 依据健康素养内涵,基于世界卫生组织(WHO)提出的终止儿童肥胖相关内容,构建儿童肥胖健康素养量表(家长版)条目池,然后在合肥市小学生家长中进行调查,应用探索性因子分析和验证性因子分析对量表的效度进行检验,应用内部一致性对量表信度进行检验。结果 本次研究共有2 170名小学生家长参与调查,通过敏感性分析、代表性分析、独立性分析及Cronbach′s α系数进行条目筛选,再通过探索性因子分析和验证性因子分析,最终形成29个条目的儿童肥胖健康素养量表(家长版),量表构建成为健康意识、健康知识、健康行为、健康认知及操作技能5个维度。验证性因子分析得到近似误差均方根(root mean square error of approximation,RMSEA)为0.047,残差均方根(root of the mean square residual,RMR)为0.026,拟合优度指数(goodness-of-fit index,GFI)、标准拟合指数(normed fit index,NFI)、相对拟合指数(relative fit index,RFI)和比较拟合指数(comparative fit index,CFI)均接近1,显示模型拟合较好。量表的Cronbach′s α系数为0.833,问卷各维度的Cronbach′s α系数在0.618~0.866之间。结论 所编制的儿童肥胖健康素养量表(家长版)具有较好的信度和效度。     

Development and Validation of the Response to Sexual Difficulties Scale

Leading models of sexual dysfunction, such as those proposed by Masters and Johnson (1970), Barlow (1986), and Janssen, Everaerd, Spiering, and Janssen (2000), emphasize the role of anxiety and self-monitoring in the development and persistence of sexual difficulties. These models have considerable explanatory power, but focus on the intrapersonal factors that yield anxiety and self-monitoring. Accounting for the interpersonal context in which sexual activity occurs is also likely to be important. For example, anxiety and self-monitoring may arise from negative, yet accurate, predictions about how one’s partner will respond to one’s own sexual functioning difficulties. The current studies describe the development and validation of the Response to Sexual Difficulties Scale (RSDS), which was designed to assess how one expects one’s partner to respond to one’s own sexual difficulties (RSDS-Own Difficulties) and how one expects oneself to respond to one’s partner’s sexual difficulties (RSDS-Partner Difficulties). Study 1 established the initial reliability and construct validity of the RSDS-Own Difficulties in a sample of adults in committed relationships (N = 59). Study 2 further examined the construct and discriminant validity of the RSDS Own Difficulties and Partner Difficulties in a sample of heterosexual couples (N = 87). Results indicated that both measures had strong internal consistency and were not redundant with measures of mood or personality. Scores on the RSDS-Own Difficulties and Partner Difficulties were strongly associated, indicating that reports of one’s own response to one’s partner’s difficulty matched the partner’s assessment of the reaction. RSDS scores predicted sexual functioning, relationship satisfaction, sexual satisfaction, and sexual communication. The RSDS may, then, provide a useful means of assessing the role of interpersonal factors in the development and persistence of sexual difficulties.     

The Development and Validation of the Taiwanese Ethnic Identity Scale (TEIS): A “Derived Etic” Approach

The purpose of this study was to design a multidimensional measure of ethnic identity (EI) that would be appropriate for research on acculturating and modernizing cultural groups. Four qualitative approaches were utilized: in-depth interviews, free-listing exercize, card-sorting technique, and cognitive interviews. Qualitative interviews conducted with Taiwanese American subjects identified ten major domains related to EI. Fifty items were generated from the four qualitative approaches and the psychometric properties of the Taiwanese Ethnic Identity Scale (TEIS) were tested with two samples: 305 Taiwanese American (TA) and 354 Taiwanese (T) women. Factor analysis yielded a 26–item TEIS with six factors. The six factors and the percentage of variance accounted for by each factor were: rituals and traditions (22.8%), language (10.3%), family dynamics/good child (7.1%), parental opinion (6.0%), individualism (4.5%), and collectivism (4.5%). Components of content, construct, and known groups validity were assessed, as well as reliability.     

卫生健康类专业报纸在新形势下的发展难题与对策探索

近年来,随着多媒体时代的到来,媒体市场竞争的激烈,卫生健康类专业报纸由于自身体制机制的因素,陷入重重困境。本文结合《上海大众卫生报》近年来的实践经验,分析了卫生健康类报纸目前面临的六大难题,介绍了这类报纸改革体制机制方面的尝试经验,探讨了解决危机的可应对之策,对于卫生健康类报纸的发展具有借鉴意义。     

A Lifecourse Approach to Health Development: Implications for the Maternal and Child Health Research Agenda

Lifecourse-informed models of health fundamentally challenge simple biomedical models, introducing new ways of thinking about how diseases develop. This paper considers the broad implications of lifecourse theory for the maternal and child health (MCH) research agenda. The Lifecourse Health Development model provides an organizing framework for a synthesis of the existing literature on lifecourse health and identification of gaps in knowledge. Priority areas identified for MCH research in order to close these knowledge gaps include: epigenetic mechanisms and their potential mutability; peri-conception as a critical and sensitive period for environmental exposures; maternal health prior to pregnancy; the role of the placenta as an important regulator of the intra-uterine environment; and ways to strengthen early mother–child interactions. Addressing knowledge gaps will require an emphasis on longitudinal rather than cross-sectional studies, long-term (lifetime) rather than short-term perspectives, datasets that include socio-demographic, biologic and genetic data on the same subjects rather than discipline-specific studies, measurement and study of positive health as well as disease states, and study of multi-rather than single generational cohorts. Adoption of a lifecourse-informed MCH research agenda requires a shift in focus from single cause-single disease epidemiologic inquiry to one that addresses multiple causes and outcomes. Investigators need additional training in effective interdisciplinary collaboration, advanced research methodology and higher-level statistical modeling. Advancing a life course health development research agenda in MCH will be foundational to the nation’s long-term health.     

健康素养评估与监测研究进展

通过健康素养评估与监测,可以掌握居民健康素养水平及其动态变化,同时也可衡量健康教育和健康促进工作效果。通过介绍健康素养的概念,分析探索国内外健康素养评估与监测现状及其存在的不足。     

Measuring Early Childhood Health and Health Disparities: A New Approach

Efforts to improve the health of U.S. children and reduce disparities have been hampered by lack of a rigorous way to summarize the multi-dimensional nature of children’s health. This research employed a novel statistical approach to measurement to provide an integrated, comprehensive perspective on early childhood health and disparities. Nationally-representative data (n = 8,800) came from the Early Childhood Longitudinal Study, Birth Cohort. Latent class analysis was used to classify health at 48 months, incorporating health conditions, functioning, and aspects of physical, cognitive, and emotional development. Health disparities by gender, poverty, race/ethnicity, and birthweight were examined. Over half of all children were classified as healthy using multidimensional latent class methodology; others fell into one of seven less optimal health statuses. The analyses highlighted pervasive disparities in health, with poor children at increased risk of being classified into the most disadvantaged health status consisting of chronic conditions and a cluster of developmental problems including low cognitive achievement, poor social skills, and behavior problems. Children with very low birthweight had the highest rate of being in the most disadvantaged health status (25.2 %), but moderately low birthweight children were also at elevated risk (7.9 vs. 3.4 % among non-low birthweight children). Latent class analysis provides a uniquely comprehensive picture of child health and health disparities that identifies clusters of problems experienced by some groups. The findings underscore the importance of continued efforts to reduce preterm birth, and to ameliorate poverty’s effects on children’s health through access to high-quality healthcare and other services.     

Development and Validation of the Young Adult Nutrition Literacy Tool

ObjectiveTo create a tool to measure college students’ functional, interactive, and critical nutrition literacy.Design(1) Focus group: item generation, (2) expert review, (3) exploratory factor structure analysis, (4) item refinement and modification, (5) factor structure validation, and (6) criterion validation.SettingTwo land-grant college campuses.ParticipantsCollege students aged between 18 and 24 years.Main Outcome MeasuresSurvey data was used to assess nutrition literacy.AnalysisExploratory factor analysis, confirmatory factor analysis (CFA), item response theory (IRT) analyses, and correlations.ResultsOne-hundred and twenty-three items were generated and tested in an online survey format. Items were eliminated on the basis of face validity, expert feedback, exploratory factor analysis, and CFA/IRT. The 3 measures (functional, interactive, and critical) were analyzed separately. All 3 measures showed reasonable model fit in the CFA/IRT models. Criterion validity showed small to medium effect sizes between measures and fruit/vegetable intake. Reliability estimates met reasonable standards for each measure.Conclusions and ImplicationsThe Young Adult Nutrition Literacy Tool is a novel instrument that measures all 3 domains of nutrition literacy. Strengths include a rigorous 6-step development process, reasonable psychometric properties, and a large breadth of items.     

Alcohol consumption by parents of Pacific families residing in New Zealand: Findings from the Pacific Islands Families Study

Harmful alcohol consumption amongst Pacific people (those of Polynesian descent) is recognized as a public health priority in New Zealand, yet little epidemiological information exists on this pattern of drinking. Using a large birth cohort study, which includes the mother, father and child triad, this study aims to determine the prevalence and change in any harmful drinking levels prenatally, antenatally and in the postpartum period for mothers and fathers, and to measure the concordance of both partners' reports of that drinking in an ethnically representative sample of Pacific families within New Zealand. Participants were selected from births where at least one parent was identified as being of Pacific ethnicity and a New Zealand permanent resident (1376 mothers and 825 fathers at baseline); many of whom are young to middle aged adults. These participants have been prospectively followed-up multiple times since. The Alcohol Use Disorders Identification Test consumption questions (AUDIT-C) were used over successive measurement waves to define any and harmful drinking levels. Recommended screening thresholds were employed. Longitudinal analyses on complete cases and imputed data, accounting for differential attrition, were undertaken and reported. Clear temporal patterns of alcohol consumption emerged for both mothers and fathers, together with significant and important ethnic differences. Moreover, there was considerable movement in alcohol consumption categories between consecutive measurement waves for both mothers and fathers. Among couples, there was significant asymmetry in drinking patterns and poor statistical agreement. However, 9.1% (14.1% in imputed analyses) of Pacific children aged 2 years had both parents indicated for harmful drinking. The significant important heterogeneity and ethnic differences suggest that both ethnic-specific and pan-Pacific interventions and prevention strategies are likely needed for successful interventions. More emphasis should be placed on targeting and addressing parents' alcohol misuse, particularly in the antenatal or postnatal period.